The New, Single-Part RCIS Exam
Todd Ginapp, EMT-P, RCIS, FSICP, Cardiology Manager, Memorial Hermann Southeast,
Houston, Texas, talks with Christopher Nelson, RN, RCIS, FSICP, President, Cardiovascular
Credentialing International; Director, Cardiac Education & Technology,
Sentara College of Health Sciences, Chesapeake, Virginia.
Cardiovascular Credentialing International (CCI)
announced that starting July 1, 2010, the registered cardiovascular invasive specialist (RCIS) credentialing
processes will move to a single examination format (the
previous 2-part format included both a cardiovascular
science exam, and the Invasive Registry level exam).
Chris Nelson
Todd Ginapp, author of CLD’s “Ask the Clinical
Instructor” column, and CCI President Chris Nelson
explore reasons for the change.
Todd: As I participate in RCIS review
courses, the RCIS review class I facilitate online, Facebook, and so on, I hear
many questions about the changes to
the RCIS exam. Chris, I appreciate your
taking the time to discuss the new
exam. I hope we can alleviate some of
the fears people may have.
Let’s first take a step back and look at
where the RCIS exam originates. What
is important for us to know about Cardiovascular Credentialing International
(CCI)?
Chris: In a nutshell, CCI develops
and administers credentialing exams
for the professions they credential.
We are an organization responsible
for credentialing only. It’s important
to note that CCI is not a professional
membership organization. After taking
the RCIS registry and paying dues, you
are considered a registrant.
Our vision is to be recognized as the
credentialing organization for cardiovascular technology and emerging
medical professions as they relate to
cardiac care. We began within cardiovascular, but are quickly becoming
both cardiac and vascular. CCI is
anticipating other credentialing opportunities as the fields of practice dictate.
Todd: Why the change to a single-part
RCIS examination?
Chris: In professional licensing, it is
a requirement for all candidates to
demonstrate the same fundamental
knowledge, skill set and aptitude. So,
philosophically we believe it is important that everyone who earns the RCIS
credential is measured using the same
assessment tool (i.e. the examination
process).
The basic concepts of cardiovascular
science remain important contextually
Todd Ginapp
in the registry examination. Across the
industry of test development, especially
as it pertains to computer-based testing
formats, item (meaning, test question)
development has improved, affording
credentialing bodies the ability to
measure fundamental knowledge of
multiple subjects in one item. CCI took
the opportunity to employ these
advanced item-writing techniques to
streamline the examination process.
Prior to the transition, CCI had an
exemption for individuals who had
demonstrated fundamental knowledge
in cardiovascular science either by
graduating from an educational program whose curriculum has been
accredited or who had successfully
passed a credentialing or licensure
examination (an examination that tested the fundamental knowledge
assessed on CCI’s cardiovascular science exam). The candidates who were
Article reprinted with permission from CAth LAb Digest June 2010, Vol. 18, No. 6
©
2010 hMP Communications
granted exemption from taking the
Cardiovascular Science exam were presumed to have demonstrated knowledge by virtue of their existing or current credential or license. There will be
no opportunity for exam exemption
with the new process.
Now, having said all that, I would be
curious to know your thoughts, Todd.
Todd: I think it is a very good idea. I
entered the system as one who took
the cardiovascular science exam before
I took the Invasive Registry exam. I
actually thought the cardiovascular science exam was more difficult than the
Invasive Registry examination, because
it was covering things I hadn’t touched
in 20 years. I had to do some things in
advance of the cardiovascular science
exam, like taking an algebra class. I
knew I needed it. Whether you are an
RT, a nurse, a CVT, etc., you are
right, the job requires nearly the same
knowledge base, regardless of your
position, and everyone should be evaluated the same way.
Chris: CCI has received a number
of inquiries regarding the change.
Most of the reactions to the transition
have been positive. The majority of the
comments have been centered on the
fact that a change has occurred. Let’s
face it, change is not always welcome
— what is important is for people to
be open to the need to change and take
the time to appreciate the rationale
behind the decision to change. The
impetus for making this change (transitioning to a single exam format) was
to be in keeping with current advancements in testing and to continually
improve upon the process by which
individuals are credentialed. Additionally, we know that the federal government and some states are considering
developing licensure examinations for
“medical imaging personnel.” CCI is
committed to maintaining the highest
standards for credentialing; standards
that regulatory agencies consider when
determining credentialing, and in some
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cases, licensure requirements for their
constituents.
Todd: Will the new, single-part exam
take questions that used to be on the
cardiovascular science exam and move
them to the Invasive Registry exam?
Chris: In some cases, yes. Each item
is categorized by the subject content to
which it belongs. The subject content
area tested on the examination is
determined by the job task analysis
(JTA) performed by CCI every three to
four years. It is from this JTA that the
exam blueprint/ matrix is developed.
As the exam blueprint/matrix has been
organized into a one-part process, the
current examination questions are recategorized to fit into this new matrix.
Please remember, though, that this
new matrix covers the same content as
the former two-part credentialing
process. It should also be noted that
each year item writers and examination committee members submit hundreds of new items for review and statistical analysis. New items are written
based on the examination blueprint
and are being added to the credentialing examinations constantly.
Todd: If somebody is taking the exam
after July 1st, they don’t have to worry
about what’s on the cardiovascular science matrix as it is published today,
because that exam will now disappear.
As long as they study and understand
the Invasive Registry matrix, that is
what applicants are accountable for on
the exam, correct?
Chris: Great question Todd, but it’s
not quite that simple.
As of June 1, if you are brand new
to the application process, you will
only be permitted to apply for the 1part Invasive Registry exam, and
therefore, should only use the updated
Invasive Registry exam matrix to prepare for this exam. This DOES NOT
mean that the content that was formerly on the Cardiovascular Science
Examination won’t be seen on the new
Invasive Registry Examination. In fact,
you can count on the fact that there be
the same subject matter in the new
Invasive Registry Examination as there
was in the Cardiovascular Science
Examination. It will just be that the
items will combine fundamental
knowledge found on the Cardiovascular Science Examination (such as cardiovascular anatomy and physiology,
general concepts, patient care, etc.) as
well as job-specific knowledge such as
interventional procedures, diagnostic
techniques and pharmacology, among
other topics.
Todd: How many active RCIS registrants are there?
Chris: At this time, we have 4,400
active RCIS registrants. We have seen
the greatest increase in the number of
registrants over the past 5 years. Currently, we have roughly 13,100 active
registrants (all credentials included)
with CCI. We estimate that within the
next 24 months, that number will hit
15,000. To be clear, I am speaking of
active registrants, not the total number
of individuals who have taken a CCI
exam.
Todd: I personally see a mandate for
credentialed staff coming from CMS in
the future, because we are seeing it
with echo and vascular.
Chris: I believe cath lab accreditation is in our future. Credentialing of
staff is an important component of lab
accreditation and is considered as part
of the reimbursement process for the
federal government and other thirdparty payers. It’s interesting to note
that six states are now working on
licensing imaging specialists (Oregon,
New Mexico, New Jersey, West Virginia, Pennsylvania, and California).
Todd: How many RCIS exams were
administered in the U.S. in 2009?
Article reprinted with permission from CAth LAb Digest June 2010, Vol. 18, No. 6
©
2010 hMP Communications
Chris: Over 630.
Todd: How many on the international
level (RCIS)?
Chris: Active registrants, over 50,
but the number of individuals who
earn the RCIS credential outside of the
U.S. who keep their credential active is
below 10%.
Todd: I’ve taken the exam twice. I’m
due for re-cert again this year, so I’m
going to take it in August.
Chris: I took the new form two
weeks ago to review the examination
in its entirety. As a member of the
invasive examination writing committee, I have contributed some of the
questions in the item bank, but only a
small percentage, so for me it was very
informative to see the examination in
its final version.
I also would like to mention the
subject of the passing score, as the CCI
National Office gets frequent questions on how the passing score is
determined. Passing scores are calculated based on subject matter expert
performance, along with those experts’
evaluations of how likely it would be
for a fundamentally knowledgeable
candidate to answer the questions correctly. It is an intense process to calculate the minimum passing score. Subject matter experts take the exam and
then are scored on their performance,
resulting in a raw score. As the expert
takes the exam, he or she must also
rate each item as to how likely they
believe a fundamentally knowledgeable allied professional would be to get
that same item or question correct
(25% – 95% likely). When it is accomplished with a group of subject matter
experts, that’s called a passing score
analysis, and it is then followed by a
validation study.
How we get the passing score has
not changed, but how we publish the
score has changed. Two years ago, we
did a passing score study. Remember,
this is not a raw score, i.e. from 100%.
It was tough to make people understand, because for the longest time, if
you got a 70 on the examination
required for the RCIS credential, you
passed, and people equated that with a
70%, a “C.” However, that perception was incorrect; you weren’t being
tested on only 100 questions — the 70
was actually a calculated score. After
the passing score study, the calculated
score went up to 72. We then had a
very upset group of individuals
because CCI had changed the rules,
affecting their credentialing. What we
ended up doing was going to “scaled
scoring,” like with the SATs, a wellaccepted method.
Todd: Are some questions weighted
more heavily than others?
Chris: No, the questions are all
scored the same. If I came to your hospital today and tested 100 people on
any topic, generally you have three
groups: an upper 27%, a lower 27%,
and a group in the middle. When you
look at the examinations required for
the RCIS credential, we definitely are
able to determine the group generating
a higher score. We use this information when we look at each item’s performance. We actually can see, well,
all the high performers got this correct,
all the low performers did not get this
correct, and that helps us to say that
the item is a good one — meaning it
discriminates between an individual
who has the fundamental knowledge
in that subject category and one who
does not. Versus (and this happens
sometimes) a large percentage of the
high performers get the item wrong
and a significant percentage of the low
performers answer the question correctly. Well, that item is not discriminating between those who have the
knowledge and those who do not.
From that point, there is analysis of
the question to figure out if these items
should be thrown out or if they can be
re-worked, such as changing the distracters or the phraseology. Remember
that every item on our examinations
go through a pilot phase where the
question is not scored, so that this type
of analysis can be performed before
that item becomes a scored question.
Todd: I get comments from people
who say, “Gosh, I worked in the lab
for 15 years. I’m just going to go take
the exam; I don’t need to study for it.”
Chris: If they would stop and
review the matrix, they would know
very quickly whether or not they have
had any formal education in hemodynamics, which is usually a challenging
area for those individuals who have
not had either formal education at
work as part of a committed orientation/professional development program, or are coming from a college. It
is very important to read the exam
matrix and look at the sample questions.
Todd: I noticed the matrix includes
intracardiac echo (ICE). ICE is not
something that is generally done in the
cath lab during cath or interventional
procedures, but is done during electrophysiology studies. If the exam concept is job description-based, why is
ICE on the Invasive Registry exam?
Chris: It’s true that our exams are
developed based on a job task analysis. We create a survey, designed by
our subject matter expert, that is
then sent out to the field. In that survey, we ask what we believe to be
relevant questions. Based on the
responses to those surveys, we determine what is going on in the field
and use this information to design
the exam blueprint. The reason ICE
is on the exam is because when we
completed our most recent job task
analysis, the feedback from individuals practicing in the field is that people were doing it, and the job task
analysis measures not just the performance of the skill, but also the frequency of the performance of that
skill. Topics we are testing are based
purely on whether or not field survey
Article reprinted with permission from CAth LAb Digest June 2010, Vol. 18, No. 6
©
2010 hMP Communications
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results indicate it is something that
needs to be evaluated.
good regional representation in the job
task analyses.
Todd: Was the job task analysis for
the Invasive Registry (for the RCIS credential) completed before or after the
job task analysis for the EP Registry
(for the RCES credential)? If you were
to go to cath labs today that have EP
services, I would almost guarantee that
they would say ICE is used in EP, not
in the cath lab.
Todd: Can you address the on-the-job
training (OJT) pathway?
Chris: The EP Registry job task
analysis was done in 2007; the RCES
exam wasn’t completed and launched
until 2008. The most recent invasive
registry (RCIS) JTA was completed in
2008.
Here’s where it gets interesting,
because this is where it becomes jobdependent. What I’m sure you appreciate is that there are some labs where
each staff member can perform every
technical component of the lab. So the
staff that does the interventional procedures may also be participating in
EP procedures. If you take a look at
the RCES matrix, you can actually see
that there are probably more individuals that I would respectfully suggest
function in an interventional role as a
technologist to support EP rather than
in a primary role of EP, at least based
on the feedback that we received in
our original job task analysis. Frankly,
some of this crossover is related to the
significant reduction in cath volume
that labs have experienced for the past
two years. As you know, in some
cases, it’s been as high as 25%. At the
same time, there has been a dramatic
increase in endovascular and EP procedures, and so we have much more
cross-training of staff that includes
other areas in addition to interventional/cath. When we send out these job
task analyses, if you happen to be one
of those people that perform all tasks
in a lab, you are going to respond as
though you do everything, versus a
high-volume center where the cath
team only does caths and nothing else.
It’s our job to make sure that we have
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Chris: Let me ask you a question
that may help you appreciate the direction we are heading. Do you know of
any other professional license where
you don’t have to demonstrate that
you have completed formal education
before you can sit for the exam?
Todd: No, not offhand.
Chris: We do realize that there are
credible people who deserve an opportunity to sit for the registry exam
under the OJT pathway because we
believe in the strength of the credentialing examination and its ability to
measure that individual’s fundamental
knowledge and skill, whether they
have been educated in a formal capacity or not.
What is changing are the minimum
education requirements as dictated by
the professional societies, as well as
both state and federal regulatory bodies. I anticipate at some time in the
future, it is likely that the pathways to
sit for the exam will require formal education in some capacity and the OJT
pathway will be retired. It is critical that
we (CCI) are prepared to come in line
with the greater accepted minimum
education expectations espoused by the
state and federal regulatory agencies
that will be dictating regulations in our
field yet to come.
Todd: Why do you think the RCIS is
the best choice for professionals working in the cath lab versus other registry
examinations, such as the one for radiologic technologists?
Chris: The RCIS is the only credential that truly encompasses the specialty of interventional cardiology. That is
my personal opinion. I have not sat for
the current version of ARRT’s (American Registry of Radiologic Technolo-
gists) CI (Cardiac-Interventional)
exam, so I can’t address that exam.
What I can speak to is that since 1996,
I have been doing everything I can to
promote the profession that I was
raised in — interventional cardiology.
The educational programs which
have been accredited by CAAHEP
(Commission on Accreditation of Allied
Health Programs) are evaluated and
accredited through a process where program directors, people who are actively
teaching and running programs in the
field, evaluate their peers to determine
accreditation status. There is a tremendous sense of appreciation and comfort
in knowing that the curricula developed
for those programs is strong. It is not
only the program operations that are
accredited, but also the curriculum,
Likewise, I am appreciative of hospitals
that invest in their staff through OJT
training and continuing education to the
point that their staff is capable and comfortable enough to sit for the registry.
Individuals like Wes Todd, who
have committed their time and energy
to creating study materials to assist
allied health professionals in preparing
for the RCIS exam, also speak to the
value of this particular credential.
I would respectfully say that I believe
that every interventional cardiology
procedure should have at least one
individual in that room credentialed as
an RCIS.
Todd: Chris, thank you for a great discussion. Any final thoughts?
Chris: If anything, I would want to
offer my thanks to you and CLD for
giving us the opportunity to help people understand what is happening and
why. I would invite readers to visit
CCI’s website (www.cci-online.org),
where they can find links to the board
of trustees as well as more information
about the RCIS credential. n
Article reprinted with permission from CAth LAb Digest June 2010, Vol. 18, No. 6
©
2010 hMP Communications