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Ask the Clinical
Instructor
A Q&A column for those
new to the cath lab
Questions are answered by:
Todd Ginapp, EMT-P, RCIS, FSICP
Todd is the Cardiology Manager for
Memorial Hermann Southeast in Houston, Texas. He also
teaches an online RCIS Review course for Spokane Community
College, in Spokane, Washington, and regularly presents with
RCIS Review Courses.
“My hospital has told us that we have to obtain our RCIS credential within a year. Why do you think I have to do this and
where do I start?”
— Anonymous email to tginapp@rcisreview.com
“Our hospital does not perform many right heart caths, yet 15%
of the exam covers hemodynamics. Where do I possibly start?”
— RCIS Online Review student
T
he Registered Cardiovascular Invasive Specialist (RCIS) credential is
increasingly becoming a standard in cath labs. As governmental agencies
and healthcare insurance companies look for a “standard of care” or
“minimal credentialing,” the RCIS is the most relevant and most specific credential provided for the cath lab today.
The RCIS examination is administered
through
Cardiovascular
Credentialing International (www.
cci-online.org). The current information booklet, as well as exam applications and details, are available
through their website. If you do not
have a copy of the booklet, you
should download it for review.
Your hospital either decided that
a credentialing standard is desired,
or has seen that credentialing of staff
may someday be required and they
are getting an early start. For the
record, I commend your hospital for
taking this jump. I personally believe
that it should be required for all cath
lab staff who participate in diagnostic and/or interventional procedures
in the lab. It ensures a basic knowledge base through the administration of the exam. However, the exam
does miss a clinical component, so it
Table 1. Content Category and Approximate
Percentage of RCIS Exam
Cardiovascular A&P
Cardiovascular Disease/Pathophysiology
Diagnostic Techniques
Intervention
Hemodynamic Data
Pharmacology
Equipment and Instrumentation
Patient Care/Patient Assessment
TOTAL
5%
8%
20%
16%
15%
7%
11%
18%
100%
does not assure competency in the
job performed. We have all seen
those individuals who are text-book
smart, but something happens when
that knowledge must be applied in
the real world.
“Where do I start?”
First, I will share processes that I
have seen work. I understand that
every learner has a different need and
a different method of learning. What
works well for one person does not
necessarily work well for another.
You have to decide what your learning style is, and this just gives a basic
foundation for that learning.
First, you should understand
what you will be tested on. Table 1
shows the topics and what percentage
covering this topic you will likely see
on the exam.
Now that you know what you will
be tested on, you need to develop a
plan to review materials. This can’t
be understated. Even if you have
worked in a cath lab for 15 years, this
still doesn’t mean you are prepared
for the exam. I speak with a lot of
individuals in my classes who are
experienced cath lab staff, but did not
properly prepare for the examination
and failed their first attempt.
There are still items on the examination that aren’t used by most labs
on a day-to-day basis (shunt calculations, myocardial biopsies, manual
calculations of cardiac outputs and
valve areas are some examples).
Even if you have worked in a cath lab for
15 years, this still doesn’t mean you are
prepared for the exam. I speak with a lot
of individuals in my classes who are
experienced cath lab staff, but did not
properly prepare for the examination.
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Where Do I Start with a
Hemodynamics Review?
The information provided in the beginning of this article
can also be applied to preparing yourself for the hemodynamics questions on the exam. There are many
books that can be recommended, but without “seeing”
the information and working with it in an interactive
manner, it can be hard to pick it up, especially if you are
not performing these procedures every day in the lab.
One example of a recently published useful resource is
the hemodynamics article series written by Jon Jenkins
RN, RCIS, in various 2007 issues of Cath Lab Digest:
Hemodynamics is a 12-Letter Word! An intro to the
basics.
Part I: Basics with Wiggers (March 2007):
http://cathlabdigest.com/article/6928
Part II: Normal Values/Waveforms and Attention-getters (May 2007): http://cathlabdigest.com/article/7232
Part III: Stenosis and regurgitation (July 2007):
http://cathlabdigest.com/article/7511
These are simple, basic and to the point. Each article
highlights what you need to know not only to perform
your job, but also to prepare for the examination.
I strongly believe that the very first step in familiarizing
yourself with hemodynamics is to have a solid grasp of
anatomy. You should challenge yourself to know the flow
of blood through the body, including the chambers of the
heart and valves that the blood flows through. You should
be able to recite this flow starting from anywhere in the
body until you return back to where you started. Until you
are able to do this, you will likely always struggle with
waveform identification and pathology of abnormalities.
A useful tool for this study is available at:
www.blaufuss.org/tutorial/#.
The internet is a very useful place to find educational
information on nearly any topic you desire. There are
some sites that provide specific education and interactive
Undoubtedly, the most popular
RCIS exam-preparedness materials
are the products sold by Wes Todd
(www.westodd.com). Whether your
method of study is active interaction
or book learning, his materials have
been proven effective for many
years. As I was changing careers
from a paramedic to a cath lab professional, I found these invaluable.
As a testimony, I would not have
been able to pass the exam on my
first try without utilizing these
materials.
The CD is structured in such a
way that you are given a question to
think through, and asked to choose
what you think the answer is.
Whether you choose the right or
wrong answer, you are provided a
“mini-education”
session
that
explains the rationale behind why
certain answers are wrong, and why
certain answers are right. With
graphics and interaction between the
learner and the CD, an enhancement
to learning is provided for the user.
For those people who prefer reading and studying a textbook, Wes
Todd’s series of books are, essentially,
the CD put on paper. While there isn’t
the level of interactivity, the same
materials, questions and answers, and
explanations are provided.
Many people also prefer to study
from a variety of invasive cardiology
textbooks. Some of the more common books are The Cardiac
Catheterization Handbook by Kern
(ISBN
0-323-02247-2)
and
Grossmans’ Cardiac Catheterization
by Baim (ISBN 0-683-30741-x).
While not specifically directed
towards the preparation of the RCIS
exam, these books would contain
the information needed to be ready
for the exam. Of course, there are
many more books on the market that
can be reviewed, and I only mention
a couple with which I have personal
experience.
What do you do if you review
these materials, but feel that you are
still not prepared for the exam? The
Society for Invasive Cardiovascular
Professionals (SICP) provides RCIS
Review Courses on a regular basis.
Some are provided at national conferences, and some are provided
independently for facilities that are
requiring their staff obtain the credential in the near future. These are
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tutorials concerning hemodynamics. A few are listed
below, in no particular order. If you have one that you find
to be useful, please send me an email so that I can distribute it to others in need:
www.manbit.com/PAC/Chapters/PAC.cfm
www.pacep.org (requires registration)
http://medi-smart.com/card-pac.htm
www.anesoft.com/demo/hemo/hemo.html (Note: this is
a demo of their product)
www6.medical.philips.com/cmsmedia/hemo_1/
www.medicine.utas.edu.au/teaching/year2/chg210/hem
odynamics/cvphome.html
The RCIS online review class also offers the opportunity for interactive learning with the use of an online video.
Wes Todd and Darren Powell, RCIS, FSICP, Program
Director, Invasive Cardiovascular Technology at
Spokane Community College, present a video presentation and explanation while you are able to view graphics
and actual waveforms on the screen.
If you utilize the materials and resources I mentioned,
you should be fairly well prepared for your examination
and hemodynamics questions. While these resources
can help you, it is still up to you to prepare yourself and
express the motivation and dedication necessary for
learning the material.
Learners post their progress on assignments and interact with
other learners through the discussion boards.
If you have any questions or need additional direction,
please email me at tginapp@rcisreview.com.
usually 1 or 2-day courses that cover
a majority of the content on the
exam. These courses are intended to
provide a review of materials, but
also helps direct the learner to the
areas where they need to concentrate
their studies.
If you come away from the review
session thinking you are still not
ready or you are the type of person
who needs a structured direction for
studying over a period of time, you
could also participate in an online
RCIS Review program, such as the
one I facilitate through Spokane
Community College. This continuing
education program requires the use of
the Wes Todd CD. There are required
weekly assignments, as well as weekly
interactive discussions through a discussion board. There are also weekly
“Virtual Classes” that allow real-time
interaction with the instructor and
other students. These classes are broken down into two parts (able to be
taken in either order) and are offered
in concurrent 11-week quarters to
make one semester.
Some of you may have to take a basic
science examination as a precursor to
obtaining your RCIS credential.
Most individuals with a nursing
degree or who have graduated from
an accredited CVT program will be
exempt from this requirement. You
will have to work with CCI to determine your eligibility of exemption. If
you must take the basic science
exam, remember that most people find
it to be more difficult because it covers
basic items that you may have not had
to deal with since high school. The
matrix for that examination is also
available in the CCI booklet.
The information for the basic science review is also available through
the Wes Todd materials, and there are
some organizations who provide
review sessions a few times a year to
help learners prepare for the exam.
One of those organizations is Pegasus
Lectures (www.pegasuslectures.com).
Their main function is to provide
echo and vascular learners a review
session for those specific registry
examinations. They provide a oneday class that covers most all of the
topics covered on the basic science
exam, including the dreaded math
and statistics materials.
A “snippet” from a recent Virtual Class session.
More information about this class can be obtained at
http://www.rcisreview.com/SCConlineRCISreview.html, or by
emailing tginapp@rcisreview.com.
If you still need help with study
materials and advice, please do not
hesitate to email me. I have many
more resources that can help direct
you in your studies to prepare you for
your successfully completion of the
RCIS examination. If you work in a
cath lab, you CAN pass the exam.
Sometimes you might just need to be
pointed in the right direction. n
Next month, we will address
a reader question concerning beta blockers.
“The only foolish question
is one left unasked.”
New Staff: Your suggested topics
and questions are needed!
(You are welcome to remain anonymous.)
Email us at: tginapp@rcisreview.com