Cardiac Stress Testing: Application to Interpret (Non-Cardiologists)

Please review the additional notes below:

1. Medical Director Eligibility

To be eligible to become the Medical Director of a CST facility, you need to be qualified and approved by the CPSA to supervise and interpret cardiac stress testing.

2. Training Framework

This timeframe and minimum number of supervised interpretation and test performance is to allow for fulsome quality training and review. The intention is not for how quickly the studies can be completed, rather sufficient time for quality training, feedback, diagnostic review and interpretation has occurred.

ECG Interpretation Competency **

1. Write and successfully pass an ECG interpretation competency examination before arranging for private CEST lab stress testing training/supervision.
2. Two providers acceptable to the CPSA are:
   • American Board of Cardiovascular Medicine – Advanced ECG Board Certification Examination,
   • College of Physicians and Surgeons of Saskatchewan.

Private Lab Environment

1. You will be required to seek out training in the private cardiac stress testing (CST) lab accredited to perform both non-pharmacological and pharmacological stress testing.

Preceptor for Direct Supervision

1. You will need to seek out a preceptor to provide direct supervision of your training.
2. The preceptor must be with recent experience in the out-of-hospital cardiac stress testing lab:
   • faculty affiliated internal medicine physician with CPSA cardiac stress testing approval is satisfactory for non-pharmacologic cardiac stress testing supervision/interpretation training, or
   • faculty affiliated cardiologist for both non-pharmacologic and pharmacological cardiac stress testing supervision/interpretation training.
3. Preceptor participation agreement providing:
   • Evidence of faculty affiliation,
   • Indicating their experience and competency in the private CST lab specific to:
     • Internal Medicine Physician providing non-pharmacologic cardiac stress testing supervision/interpretation training and a copy of their CPSA interpretation approval letter, or
     • Cardiologist for both non-pharmacologic and pharmacologic cardiac stress testing supervision/interpretation training,

• • Available to directly supervise the hands’ on training portion,
  • Has reviewed and evaluated the didactic and hand’s on training framework as adequate,
  • Agreement to provide to the CPSA Private CST Accreditation Program a formal (dated & signed) written evaluation of competency at completion of training to the CPSA Private CST Accreditation Program.

Training Elements

1. Specification of a predetermined timeframe in which this training will be completed by.
2. Description of didactic training, the concepts covered, list of the references for the materials and the hours required.
3. Hands-on Training:
   • Non-pharmacological CSTs
     • Minimum of 2 weeks and maximum of 3 months full-time participation with direct involvement in a minimum of 200 studies or number of studies required to include at least 50 abnormal studies,

• • Pharmacological CSTs
    • Minimum of 100 studies within same time period outlined above
      • The training requires a combination of vasodilators and inotropes,

• • Full-time participation with under direct supervision
    • Equates to 8hrs/day or 44hrs/week (as per Alberta Labor Laws).

Training Log

1. A detailed training log must be kept to evidence of competence and compliance with CPSA CST lab accreditation standards for the performed tests:
   • Selecting appropriate non-pharmacologic and pharmacological CST patients,
   • Conducting testing and data review,
   • Interpreting tests and preparing recommendations.
2. Log design to include preceptor feedback for each of the tests.
3. Medical emergency preparedness training specific to the out of hospital environment:
   • Prior to the hands-on training, the preceptor will ensure the applicant/trainee has:
     • Current Health Care Provider CPR &AED use (Heart & Stroke provider)
     • Current ACLs (Heart & Stroke)
   • Thereafter the medical emergency preparedness training will comprise of:
     • Defibrillator/Cardiac Monitor Settings/Use
     • Resuscitation cart equipment familiarity
     • Mock drill of the management of common non-pharmacologic and pharmacological CST patient complications and cardiac arrest.

If testing includes pharmacological stress testing, an additional two weeks of full-time participation with direct involvement in 100 studies under the supervision of a faculty appointed specialist in cardiology or a specialist in internal medicine is required.

If testing includes the pediatric population, evidence of training and/or experience with that technique is also required. An additional two weeks of full-time participation with direct involvement in 100 studies under the supervision of a faculty appointed specialist in cardiology or a specialist in internal medicine is required.

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