International Journal of Medical Education.

2012;3:141-150
ISSN: 2042-6372
DOI: 10.5116/ijme.4fee.d2ea

Entry-level role task performance criteria for the

cardiovascular technology domain

Daniel P. Herbst

King Abdulaziz Cardiac Center, Department of Cardiac Sciences, King Saud bin Abdulaziz University for Health
Sciences, Kingdom of Saudi Arabia

Correspondence: Daniel P. Herbst, Department of Cardiac Sciences, Mail Code -1413, King Fahad National Guard
Hospital, PO Box – 22490, Riyadh, 11426, Kingdom of Saudi Arabia. Email: [email protected]

Accepted: June 30, 2012

Abstract
Objectives: This study aims to identify entry-level role task 17 of the 35 centers targeted. Respondents included 59
performance criteria for the development of competencies Saudi nationals, 29 Filipinos, three South Africans, two
in the cardiovascular technology domain. Jordanians one American and one missing data entry for
Methods: A task analysis survey instrument was aligned nationality. In total, 88 entry-level performance criteria
with the CanMEDS 2005 physician competency framework were identified and two areas of deficiency in current
along with other competency documents from the cardio-
cardiovascular technology training and scope of practice
vascular technology domain to collect data on performance
were highlighted.
criteria using recognized areas of competence for health
Conclusions: Aligned with the purpose of outcomes-based
professionals and to ensure a broad coverage of relevant
role task definitions. The research targeted practitioners education, this study offers an initial step toward further
from 35 tertiary care centers across Saudi Arabia where development of competencies for the cardiovascular tech-
cardiovascular technology services are utilized. Entry-level nology domain using a well established competency frame-
performance criteria identified in the survey were then used work, and highlights the need to increase emphasis on
as inputs for a proposed competency profile for the cardio- training and development of clinical expertise and attitudes
vascular technology field. toward more patient-centered care.
Results: A total of 182 email invitations were sent with a Keywords: Competency-based education, performance
response rate of 52% (n=95), generating participants from criteria, CanMEDS, cardiovascular technology

Introduction
The field of cardiovascular technology (CVT) has advanced sional influences that shape health policies of the geograph-
rapidly over the last several decades, increasing demands on ical region or institution where work is carried out. For
the knowledge, skills and attitudes required to effectively example, the VIR technologist who in one setting is respon-
work in the broad spectrum of patient care areas it serves.1, 2 sible for maintaining a sterile field and communicating
Traditionally separated into subspecialties to support directly with the patient while monitoring progress of the
invasive or noninvasive procedures, CVT specialists play an procedure may have a reduced role in another setting where
important role in patient care during cardiac catheteriza- a nurse specialist performs some or all of these tasks.
tions, vascular interventions, echocardiography studies, Within the invasive subspecialties, the cathlab technolo-
holter/stress monitoring and electrocardiogram (ECG) gist, cathlab radiology technologist and electrophysiology
recording and analysis. Based primarily on either North technologist work closely together to assist the physician
American or European training standards, scope and during complex diagnostic and therapeutic interventions in
practice of the subspecialties within the CVT domain varies the cardiac catheterization laboratory and are often cross-
depending on the level of training, can overlap with one trained to perform multiple roles, while the vascular inter-
another and is greatly impacted by the political and profes- ventional radiology technologist is highly trained to assist in
141
© 2012 Daniel P. Herbst. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work
provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0
Herbst  Role task performance criteria

a wide range of procedures dedicated to the treatment of performance criteria as inputs for the development of entry-
vascular pathologies. level competency requirements. As a framework for the
For the noninvasive subspecialties, the echocardiog- development of outcomes-based education, CanMEDS8 has
raphy technologist receives extensive training in hands-on reached widespread use as a standard for medical education
bedside performance and interpretation of echocardiog- in healthcare communities throughout the world. Derived
raphy studies as well as the identification of anatomical from extensive research efforts directed by the Royal
landmarks and features, while the holter/stress lab technol- College of Physicians and Surgeons of Canada, the
ogist and electrocardiogram technologist share a common CanMEDS framework is now being successfully embedded
background being highly skilled at interpreting ECG results within accreditation, evaluation, assessment and continuing
and recognizing signs of physiological stress during electro- professional development programs aimed at assisting
cardiogram recording. This diverse and rapidly advancing educators, trainees, healthcare professionals, public officials
workplace environment requires CVT practitioners to rely and patients alike.8 Focused on addressing what health
heavily on training experiences if they are to continue professionals need to be able to do to practice effectively,
developing as self-directed learners capable of maintaining CanMEDS describes essential abilities of a competent
competence in the procedural skills necessary to handle physician which it embodies in core competencies or roles
increasingly complex diagnostic instruments and other that include a central role of Medical Expert with integrated
specialized equipment, stay current with advances in overlapping roles of Communicator, Collaborator, Manag-
technology and be able to apply theory in practice while er, Health Advocate, Scholar and Professional.8 Although
fostering qualities of professional conduct and ethical originally implemented to describe core areas of compe-
behavior in patient care. tence for physicians, roles defined in the CanMEDS are also
To help graduates of health professions better prepare well suited for other health professions9 and can be used to
for the real world challenges they will face, the Ministry of help guide health professionals attain competence as experts
Higher Education (MOHE) in Saudi Arabia is currently in their field capable of managing resources and effectively
aligning post-graduate medical education and other allied communicating and collaborating with others while advo-
health disciplines with competency-based education.3 In a cating the promotion of health, pursuing personal devel-
drive to improve its educational structure, the MOHE has opment through on going scholarly work and developing
joined worldviews on innovations in curriculum reform high standards of professional and ethical conduct.
that shift away from a central core of educational processes,
emphasizing instead the evaluation of competencies and the Methods
importance of learning outcomes. Carraccio et al. define
competency as a set of demonstrable behaviors derived Study design
from the learner’s knowledge, skills and attitudes that An on-line cross-sectional survey was used to provide
portray the individual’s personal ability in a given task.4 quantitative descriptions of demographics and identify
Gonczi asserts that competency-based education improves entry-level performance criteria for the CVT domain. The
the link between practice and theory, promotes knowledge research targeted 35 tertiary healthcare centers within the
application over knowledge acquisition, advances a more Kingdom of Saudi Arabia (KSA) where cardiovascular
self-directed learning style, offers the potential to improve technologists are employed. To aid identification of perfor-
validity of vocational assessment methods and provides an mance criteria within the CVT domain, the survey included
integrated approach and sound basis for the educational a task analysis with questions corresponding to the CVT
reform needed to ensure accountability to public interests.5 roles of cath lab (CL) technologist, cath lab radiology (CLR)
The use of a task analysis to identify components of per- technologist, electrophysiology (EP) technologist, interven-
formance criteria either through direct observation of tional vascular radiology (VIR) technologist, echocardiog-
experts in action, or by having skilled practitioners verbalize raphy (ECHO) technologist, holter/stress (H/S) lab tech-
behaviors during role performance has been well docu- nologist and electrocardiogram (ECG) technologist.
mented.6-7 Once identified, performance criteria can then be
used as a starting point for an outcomes-based curriculum Study population
and the required competencies targeted by the educational Permission was sought from the leadership of relevant
program.7 departments to access contact lists of the targeted popula-
For the purpose of developing a competency-based edu- tion and facilitates communication with prospective partic-
cation curricula, Carraccio et al. propose the following four ipants. Support from key members within the CVT field
steps as a guide: competency identification, determination was also solicited to heighten awareness of the research and
of performance levels, competency assessment and valida- drive motivation to participate. Study subjects comprised all
tion of the education program.4 In addressing the first step male and female participants currently residing in KSA as
competency identification, a task analysis of the cardiovas- either CVT students, practicing technologists, supervisory
cular technology domain was undertaken to identify role staff and CVT department managers of both national and
142
international origin. Convenience sampling was used to a starting point, general definitions relevant to the CVT
maximize enrollment and ensure representation of all field and scope of practice were first formed to identify with
stakeholders. Enrollment in the study was voluntary and all the seven CanMEDS roles; medical expert, communicator,
candidates received via email an overview of the studies collaborator, manager, scholar, health advocate and profes-
purpose with a link to the surveys through survey- sional.8 Following the creation of role definitions, tasks
monkey.com. All non-respondents received two reminders from the proposed list of performance criteria were then
one week apart following the initial invitation to participate. matched by consensus with a corresponding role to form
No exclusion criteria were defined. either core competencies that could be used across the
entire CVT domain, or key competencies relevant to one or
Survey instrument development
more of its seven sub-specialties. The role-task groupings
A paper-based pilot survey instrument was first developed were then compared to well-established competency pro-
to explore domain demographics and entry-level perfor- files from the Canadian Society for Cardiovascular Tech-
mance criteria using several information sources. CVT job nology (CSCT) and the Canadian Association of Registered
descriptions and task lists were taken from employer Diagnostic Ultrasound Professionals (CARDUP)10,11 to
websites within KSA along with relevant information from assess the task analysis for completeness and ensure a broad
well-established international professional CVT bodies to coverage of applicable role task definitions.
form the basis of a first draft document and initial discus-
sion points. The draft document was further refined Data analysis
through interviews and focus group meetings with cardiol- Completed surveys were collected through survey-
ogy staff and CVT technicians from the King Abdulaziz monkey.com and the generated quantitative data was
Cardiac Center (KACC) in Riyadh. Finally, two cardiology entered into PASW Statistics v.18 to tabulate descriptive
physicians and two technologists from the KACC piloted statistics of all research variables (SPSS Inc., 2009, Chicago,
the survey instrument for validation purposes prior to data IL). Data is presented as frequencies and percentages where
collection. appropriate. No personal identification was requested and
To improve quality of the survey and minimize its all information obtained in the study remained anonymous
length, question response sequences were customized using to ensure participant confidentiality.
the skip-logic feature incorporated in the website
Ethical approval
www.Surveymonkey.com so that respondents from the
various CVT subspecialties were required to answer only Grant approval for this research was obtained from the
those questions relevant to their domain of practice. The institutional review board (IRB) of the King Abdullah
minimum and maximum number of survey questions International Medical Research Center (KAIMRC).
required for the task analysis ranged between 29 and 43.
Results
Study procedures
To identify entry-level role task performance criteria, Study demographics
participants were asked to review a list of job-related duties A total of 182 email invitations were sent out with a re-
relevant to their area of expertise and indicate the frequency sponse rate of 52% (n=95). Respondents from 17 tertiary
of performance as either ‘Routinely’ if the task is part of care centers across Saudi Arabia participated in the survey,
regular practice, ‘Frequently’ if it is not part of regular including nine respondents in supervisory roles, 17 cathlab
practice but done often, ‘Rarely’ if it is not part of regular technologists, five electrophysiology technologists, five cath
practice but done occasionally, or ‘Never’ if it is not per- lab radiology technologists, 11 vascular interventional
formed or non-applicable as an entry-level task. To deter- radiology technologists, 17 echocardiography technologists,
mine a cutoff point, results were aggregated into two groups five holter/stress technologists, 11 electrocardiogram
combining responses for ‘Routinely/Frequently’ and ‘Rare- technologists, seven students enrolled in a post-bachelor
ly/Never’. Each task was considered relevant if the cumula- diploma program in cardiovascular technology at the King
tive percent of responses for ‘Routinely/Frequently’ was Saud bin Abdulaziz University for Health Sciences and eight
greater than responses for ‘Rarely/Never’. When responses missing data entries for occupation. From the total number
were equal, a decision to retain the task was reached by of respondents, 89% (n=85) completed the survey while
consensus using the criteria “entry-level task”. Survey 11% (n=10) were excluded due to insufficient data. From
outcomes were then analyzed and used to form a proposed the completed surveys, 13% (n=11) contained some missing
list of entry-level role performance criteria for the CVT data. From the total number of valid responses, 47% (n=40)
domain. were female, 53% (n=45) were male, while Saudi nationals
The CanMEDS Framework was utilized as a model formed 60% (n=51) of this study population. Most have
template to align proposed CVT performance criteria with completed a bachelor’s degree (59%, n=50) and have less
recognized areas of competence for health professionals.8 As than ten years of work experience (69%, n=59) (Table 1).

Int J Med Educ. 2011;3:141-150 143

Herbst  Role task performance criteria

Table 1. Demographic data for CVT technologists (N=85) in that participant self-awareness and attitude toward the role
Saudi Arabia (2011)
of health advocate may be related to the level of patient
Saudi Non-Saudi Total interaction during role performance.
Variable ( n=51) (n=34) (n=85)
Following information gathering and role alignment
n (%) n (%) n (%)
with established CVT competency profiles during survey
Gender
instrument development, performance criteria for the
Female 15 (29) 25 (74) 40 (47)
Male 36 (71) 9 (27) 45 (53)
health advocate role were missing while only one perfor-
Age
mance criterion related to participation in continuing
20-30 years 31 (61) 6 (18) 37 (44) education activities had been established for the scholar
31-40 years 16 (31) 16 (47) 32 (38) role, indicating a deficiency in current CVT training and
41-50 years 4 (8) 7 (21) 11 (13) scope of practice. The additional performance criteria for
>50 years - - 5 (15) 5 (6) these roles had to first be adapted from the CanMEDS
Highest level of education achieved framework to be included in the survey. Compounding this
Diploma 24 (47) 2 (6) 26 (31) finding is the fact that three out of seven groups (43%)
Bachelor degree 19 (37) 31 (91) 50 (59) rejected one of the adapted health advocate performance
Master degree 7 (14) 1 (3) 8 (9)
criteria while five out of seven (71%) rejected the added
Missing 1 (2) - - 1 (1)
scholar role, suggesting that these performance criteria are
Work experience
not well recognized at entry-level. As part of the CanMEDS
0-5 years 21 (41) 10 (29) 31 (37)
6-10 years 17 (33) 11 (32) 28 (33)
framework, these roles have been established as important
11-15 years 7 (14) 5 (15) 12 (14)
entry-level areas of competence for health professions
>15 years 6 (12) 8 (24) 14 (17) where advancing current knowledge, promoting best
practice and developing more patient-centered care are
Task analysis outcome concerns. These outcomes point to needed improvements
In total, 23 core and 65 key role performance criteria were in CVT educational curricula aimed at developing gradu-
identified (Appendix A). Three core performance criteria ates from this domain into more reflective, lifelong learners
related to the communicator role required a consensus capable of using methods of inquiry to advance practice
decision to retain due to equal response rates, 18 other while keeping the health needs and best interests of the
performance criteria were rejected out-right and one communities they serve as a central focus.
additional criterion was identified as missing from the Another aspect revealed in this research is the unex-
original task analysis through an ECHO group respondent’s pected, but possible relationship between attitudes toward
comments to the open-ended survey question “Please use health advocacy and level of patient interaction during role
the space provided to list additional tasks and their performance. While differentiating the CVT domain into
frequency”. groups according to similarities in practice, it can be appre-
Of the seven CVT subspecialties surveyed, participants ciated that the CL, CLR, EP and VIR groups assist during
from VIR were the only group to retain all core and key invasive procedures in surgical suits or sterile environ-
performance criteria without the need for a consensus ments, while the ECHO, H/S and ECG groups perform the
decision. All groups except for VIR and CL scored low in actual noninvasive studies themselves at the patient bedside
the scholar role resulting in one of two performance criteria in unsterile surroundings. For the CL, CLR, EP and VIR
being rejected, while the CL, EP and CLR groups all scored groups roll task performance is centered on assisting with
low on health advocacy resulting in the same. The CLR implantation and monitoring of delicate instruments placed
group also rejected one-performance criteria from its core in the patient’s heart or intravascular space. For the ECHO,
manager role, while the H/S group rejected one of its core H/S and ECG groups roll task performance is defined by the
communicator roles. All groups except for CL, EP and application and use of sophisticated external probes and
ECHO retained 100% of their key expert role performance recording devices needed to perform the desired study.
criteria. The CL group rejected six of 11 (55%) key expert Practitioners from the CL, CLR, EP and VIR groups act as
performance criteria, while the EP and ECHO groups team members within a larger group structure, while CVT
rejected 10% (n=1), and 8% (n=1) respectively. specialists from the ECHO, H/S and ECG groups usually
perform their role tasks one-on-one with the patient and
Discussion with more autonomy.
As its principal aim, this research utilized a task analysis While other similarities exist between these groups of
aligned with the CanMEDS framework to explore roll task like practice, a relationship that connects the groups in a
performance criteria of seven subspecialties within the CVT different way was also revealed. With the exception of VIR,
domain. Results from this study identified the roles of the CL, CLR and EP invasive subspecialties in this survey
health advocate and scholar as not being well supported in defined roles that are more technically oriented and per-
current CVT training and scope of practice, and revealed formed at arms length from the patient bedside. In contrast,
144
the VIR group described more patient centered roles, being educational curricula aimed at improving learning out-
in direct contact and having frequent communication with comes using recognized standards of competence.
the client during role performance. This information was
Study limitations
obtained earlier in the interviews and focus group meetings
during survey development, but can also be further appreci- In addition to the small number of respondents and the
ated in survey outcomes as the CL and EP groups both limitations this imposes on interpreting results, another
rejected performance criteria related to maintaining a sterile weakness may be the lack of an international consensus on
field while the CL group rejected all key performance competency development for this domain, which impacts
criteria related to assisting at the patient bedside. The CLR generalizability of the research findings. One method to
group had no comparable performance criteria assigned to overcome this could include use of the Delphi technique
it during survey development. These findings differentiate within an international forum to help incorporate a broader
roll performance between the invasive subspecialties in a view. This study does however include an international
way that links aspects of VIR group practice to similarities presence in its target population as well as material taken
in the non-invasive subspecialty areas. from international professional bodies that may help
balance the effect of this weakness. Another shortcoming
The salient feature of most interest here is the relation-
related to study design is the scope of work the research
ship between the level of patient interaction during role
attempted to undertake. This overambitious work could
performance and how the different groups scored the roll of
have more easily been completed if it were carried out as
health advocate and other aspects of patient interaction.
two separate projects for the invasive and noninvasive
While the VIR, ECHO, H/S and ECG groups scored high in
subspecialties alone if not one dedicated for each of the
the health advocate role retaining both performance crite-
seven CVT technologies. The huge area of focus made it
ria, they also scored high in core communicator roles
difficult to manage time and give fair treatment to all seven
related to introducing self, explaining procedure to patient
groups. As a result, this oversight in study design allowed
and responding to patient concerns. In contrast, the CL,
whole areas of the task analysis for the ECHO and ECG
CLR and EP groups all scored low in the health advocate
subspecialties to be missed. In a rush to meet research
roll rejecting one of two performance criteria. Moreover,
deadlines, it was realized too late that important role
these groups also scored lower in the patient oriented
performance criteria related to the identification of various
communicator rolls with the CLR group requiring a con-
anatomical features using ultrasound and the electrocardio-
sensus decision to retain the performance criteria related to
graphic detection of specific cardiac arrhythmias were
self-introduction and procedural explanation. The CVT
conspicuously missing.
subspecialties from this research that identified with a high
level of patient interaction during role performance scored Acknowledgement
higher in health advocacy and roles requiring communica- I would like to thank Mr. Mohammed Aljuwayyan and Mr.
tions with patients then those who identified with a lower Akram Alajmi for their help and support without which this
level of patient interaction during role performance. Does research would not have been possible, and to all those who
the level of patient interaction during role performance supported this project in numerous ways or participated in
influence individual self-awareness and attitude toward the the survey to help make it a success. I would also like to
role of health advocate? While it may be argued that health thank the institutional review board of the King Abdullah
advocacy is or should be an important characteristic of all International Medical Research Center for their encour-
health professionals, this research proposes an interesting agement and financial support of this project. Finally, I
insight into elements that may help shape this facet of would like to thank the MHPE faculty of Maastricht Uni-
behavior in healthcare delivery. More research is needed to versity for their labors and support with special thanks to
further explore the importance of these relationships and to Professor Van der Vleuten.
what degree if any they may help the development and
participation in health advocacy roles for better patient care. Conflict of Interest
While efforts to define competency standards for this broad The author declares that he has no conflict of interest.
domain of practice will no doubt continue to progress, this
study attempts to advance CVT curriculum reform initia-
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Appendix

Proposed competency profile for the Cardiovascular Technology field (2011)

Response rate
Role
No CL Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Set up sterile trays in preparation for procedures reject 7(6/1) 13(8/5)
2 Select appropriate equipment for procedure (e.g. catheter, Stent, Balloon ect) expert (Key) 13(9/4) 7(5/2)
3 Perform or coordinate equipment calibration and troubleshooting. manager (Core) 18(12/6) 2(1/1)
4 Verify equipment safety checks manager (Core) 18(14/4) 2(1/1)
5 Introduce self & explain procedure to patient communicator (Core) 11(4/7) 9(5/4)
6 Appropriately respond to patient’s questions or concerns communicator (Core) 11(4/7) 9(5/4)
7 Assist physician at table during angioplasty reject 7(5/2) 13(3/10)
8 Assist physician at table during valvuloplasty reject 7(5/2) 13(3/10)
9 Assist physician at table during coronary angiogram reject 7(5/2) 13(3/10)
10 Assist physician at table during pediatric device placement reject 5(4/1) 15(4/11)
11 Assist physician at table during pacemaker/AICD insertion reject 7(6/1) 13(4/9)
12 Assist with intravascular ultrasound (IVUS) procedure expert (Key) 15(11/4) 5(4/1)
13 Assist with pressure wire measurement (flow fraction rate) expert (Key) 16(12/4) 4(4/0)
14 Perform quantitative coronary analysis (QCA) to determine vessel length, caliber and lesion area expert (Key) 13(7/6) 7(6/1)
15 Measure valve area using hemodynamic studies expert (Key) 16(11/5) 4(2/2)
16 Monitor and record patient physiological parameters during procedures communicator (Core) 19(19/0) 1(1/0)
17 Communicate patient parameters and abnormal events to appropriate staff communicator (Core) 19(19/0) 1(1/0)
18 Communicate within your department to relay important information collaborator (Core) 19(16/3) 1(0/1)
19 Communicate with other Departments to relay important information collaborator (Core) 15(7/8) 5(4/1)
20 Document and archive relevant patient information communicator (Core) 20(19/1) 0(0/0)
21 Use appropriate medical terminology in written and verbal communication communicator (Core) 20(19/1) 0(0/0)
22 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 11(2/9) 9(7/2)
23 Take affirmative action to promote health needs that are in the patient’s best interest reject 7(1/6) 13(11/2)
24 Review Department policies & procedures professional (Core) 18(10/8) 2(2/0)
25 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 15(14/1) 5(5/0)
26 Demonstrate professional conduct in appearance, communication and action professional (Core) 20(19/1) 0(0/0)
27 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 20(19/1) 0(0/0)
28 Maintain patient privacy and confidentiality professional (Core) 20(19/1) 0(0/0)
29 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 20(19/1) 0(0/0)
30 Apply aseptic technique and infection control policy and procedures expert (Core) 16(8/8) 4(4/0)
31 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes appro- scholar (Core) 13(3/10) 7(6/1)
priate for practice
32 Understand research methodology and how to apply it scholar (Core) 11(3/8) 9(8/1)
33 Order consumable supplies and use resources efficiently to promote optimal department function manager (Core) 19(13/6) 1(1/0)
34 Maintain certification in Basic Life Support (BLS) expert (Core) 20(20/0) 0(0/0)

Response rate
Role
No EP Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Set up sterile trays in preparation for procedures reject 1(0/1) 4(1/3)
2 Select appropriate equipment for procedure (e.g. ablation catheter, mapping catheter) expert (Key) 5(3/2) 0(0/0)
3 Perform or coordinate equipment calibration and troubleshooting manager (Core) 5(3/2) 0(0/0)
4 Verify equipment safety checks manager (Core) 5(3/2) 0(0/0)
5 Introduce self & explain procedure to patient communicator (Core) 3(2/1) 2(2/0)
6 Appropriately respond to patient’s questions or concerns communicator (Core) 3(2/1) 2(2/0)
7 Assist physician during EP mapping expert (Key) 5(4/1) 0(0/0)
8 Assist physician during catheter ablation expert (Key) 5(4/1) 0(0/0)
9 Assist physician during tilt table test expert (Key) 5(4/1) 0(0/0)

146
10 Assist physician during pacemaker insertion expert (Key) 5(3/2) 0(0/0)
11 Assist physician during Automated Implantable Cardiac Defibrillator (AICD/ ICD) insertion expert (Key) 5(3/2) 0(0/0)
12 Assist Physician during pacemaker clinic expert (Key) 5(4/1) 0(0/0)
13 Perform non-contact 3D EP mapping (endocardial solution) expert (Key) 4(3/1) 1(0/1)
14 Perform electro-anatomical mapping expert (Key) 4(3/1) 1(0/1)
15 Monitor and record patient physiological parameters during procedures communicator (Core) 5(4/1) 0(0/0)
16 Communicate patient parameters and abnormal events to appropriate staff communicator (Core) 5(5/0) 0(0/0)
17 Communicate within your department to relay important information collaborator (Core) 5(5/0) 0(0/0)
18 Communicate with other Departments to relay important information collaborator (Core) 2(2/0) 2(2/0)
19 Document and archive relevant patient information communicator (Core) 5(5/0) 0(0/0)
20 Use appropriate medical terminology in written and verbal communication communicator (Core) 5(5/0) 0(0/0)
21 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 3(3/0) 2(2/0)
22 Take affirmative action to promote health needs that are in the patient’s best interest reject 1(0/1) 4(4/0)
23 Review Department policies & procedures professional (Core) 5(3/2) 0(0/0)
24 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 4(3/1) 1(1/0)
25 Demonstrate professional conduct in appearance, communication and action professional (Core) 5(5/0) 0(0/0)
26 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 5(5/0) 0(0/0)
27 Maintain patient privacy and confidentiality professional (Core) 5(5/0) 0(0/0)
28 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 5(5/0) 0(0/0)
29 Apply aseptic technique and infection control policy and procedures expert (Core) 5(3/2) 0(0/0)
30 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes appro- scholar (Core) 4(1/3) 1(0/1)
priate for practice
31 Understand research methodology and how to apply it reject 1(0/1) 4(2/2)
32 Order consumable supplies and use resources efficiently to promote optimal department function manager (Core) 4(3/1) 1(1/0)
33 Maintain certification in Basic Life Support (BLS) expert (Core) 5(5/0) 0(0/0)

Response rate
Role
No CLR Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Verify equipment safety checks manager (Core) 5(5/0) 0(0/0)
2 Perform or coordinate equipment calibration and troubleshooting manager (Core) 5(3/2) 0(0/0)
3 Coordinate periodical x-ray emissions calibration manager (Key) 5(3/2) 0(0/0)
4 Use and maintain x-ray safety equipment (thyroid shield & lead apron) during procedures manager (Key) 5(5/0) 0(0/0)
5 Monitor & record radiation exposure and ensure proper use of radiation badges manager (Key) 5(5/0) 0(0/0)
6 Set up injector and load contrast prior to procedure expert (Key) 5(2/3) 0(0/0)
7 Introduce self & explain procedure to patient communicator (Core) 2(1/1) 2(2/0)
8 Appropriately respond to patient’s questions or concerns communicator (Core) 3(1/2) 2(2/0)
9 Operate Bi-Plane or Single-Plane X-ray equipment expert (Key) 4(3/1) 1(1/0)
10 Adjust X-ray table during contrast injection expert (Key) 4(3/1) 1(0/1)
11 Communicate within your department to relay important information collaborator (Core) 5(3/2) 0(0/0)
12 Communicate with other Departments to relay important information collaborator (Core) 2(1/1) 2(2/0)
13 Document and archive relevant patient information communicator (Core) 5(4/1) 0(0/0)
14 Use appropriate medical terminology in written and verbal communication communicator (Core) 5(5/0) 0(0/0)
15 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 3(2/1) 2(2/0)
16 Take affirmative action to promote health needs that are in the patient’s best interest reject 1(0/1) 4(3/1)
17 Review Department policies & procedures professional (Core) 5(3/2) 0(0/0)
18 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 5(4/1) 0(0/0)
19 Demonstrate professional conduct in appearance, communication and action professional (Core) 5(5/0) 0(0/0)
20 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 5(4/1) 0(0/0)
21 Maintain patient privacy and confidentiality professional (Core) 5(5/0) 0(0/0)
22 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 5(5/0) 0(0/0)
23 Apply aseptic technique and infection control policy and procedures expert (Core) 4(3/1) 1(1/0)
24 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes appro- scholar (Core) 4(3/1) 1(1/0)
priate for practice
25 Understand research methodology and how to apply it reject 1(1/0) 4(2/2)
26 Order consumable supplies and use resources efficiently to promote optimal department function reject 1(1/0) 4(3/1)
27 Maintain certification in Basic Life Support (BLS) expert (Core) 5(5/0) 0(0/0)

Response rate
Role
No VIR Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Set up sterile trays in preparation for procedures expert (Key) 12(6/6) 1(1/0)
2 Set up embolization material expert (Key) 12(5/7) 1(0/1)
3 Select and prepare appropriate equipment for procedure (e.g. catheter, balloon, sheath) expert (Key) 11(5/6) 2(2/0)
4 Perform or coordinate equipment calibration and troubleshooting manager (Core) 13(10/3) 0(0/0)
5 Verify equipment safety checks manager (Core) 13(9/4) 0(0/0)
6 Inform Biomedical Engineering of any equipment failures manager (Key) 13(11/2) 0(0/0)
7 Coordinate periodical x-ray emissions calibration manager (Key) 12(8/4) 1(0/1)
8 Introduce self & explain procedure to patient communicator (Core) 13(12/1) 0(0/0)

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Herbst  Role task performance criteria

9 Appropriately respond to patient’s questions or concerns communicator (Core) 13(12/1) 0(0/0)

10 Prepare patient for procedure expert (Key) 13(11/2) 0(0/0)
11 Use and maintain x-ray safety equipment (thyroid shield & lead apron) during procedures manager (Key) 13(13/0) 0(0/0)
12 Monitor & record radiation exposure and ensure proper use of radiation badges manager (Key) 13(13/0) 0(0/0)
13 Operate Bi-Plane or Single-Plane X-ray equipment expert (Key) 13(7/6) 0(0/0)
14 Operate digital subtraction angiography equipment expert (Key) 13(12/1) 0(0/0)
15 Operate contrast power injectors expert (Key) 13(13/0) 0(0/0)
16 Operate vessel measurement equipment expert (Key) 13(12/1) 0(0/0)
17 Assist physician at table during angiography/angioplasty expert (Key) 13(12/1) 0(0/0)
18 Assist physician at table during Embolization expert (Key) 13(12/1) 0(0/0)
19 Assist physician at table during Radio-frequency Ablation (RFA) expert (Key) 12(12/0) 1(1/0)
20 Assist physician at table during tissue biopsy expert (Key) 12(12/0) 1(1/0)
21 Assist physician at table during sclerotherapy expert (Key) 12(12/0) 1(1/0)
22 Assist physician at table with fluid drainage procedures (abscess, pleural effusion) expert (Key) 12(12/0) 1(1/0)
23 Monitor and record patient physiological parameters during procedures communicator (Core) 10(10/0) 3(3/0)
24 Communicate patient parameters and abnormal events to appropriate staff communicator (Core) 10(8/2) 3(3/0)
25 Communicate within your department to relay important information collaborator (Core) 11(11/0) 2(2/0)
26 Communicate with other Departments to relay important information collaborator (Core) 11(5/6) 2(2/0)
27 Document and archive relevant patient information communicator (Core) 12(11/1) 1(1/0)
28 Use appropriate medical terminology in written and verbal communication communicator (Core) 13(12/1) 0(0/0)
29 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 11(10/1) 2(2/0)
30 Take affirmative action to promote health needs that are in the patient’s best interest health advocate (Core) 10(7/3) 3(2/1)
31 Review Department policies & procedures professional (Core) 12(10/2) 1(1/0)
32 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 13(12/1) 0(0/0)
33 Demonstrate professional conduct in appearance, communication and action professional (Core) 13(13/0) 0(0/0)
34 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 13(13/0) 0(0/0)
35 Maintain patient privacy and confidentiality professional (Core) 13(13/0) 0(0/0)
36 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 13(12/1) 0(0/0)
37 Apply aseptic technique and infection control policy and procedures expert (Core) 13(13/0) 0(0/0)
38 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes appropri- scholar (Core) 13(10/3) 0(0/0)
ate for practice
39 Understand research methodology and how to apply it scholar (Core) 10(2/8) 3(3/0)
40 Order consumable supplies and use resources efficiently to promote optimal department function manager (Core) 13(8/5) 0(0/0)
41 Maintain certification in Basic Life Support (BLS) expert (Core) 13(13/0) 0(0/0)

Response rate
Role
No ECHO Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Review patient chart and confirm physician orders collaborator (Key) 19(17/2) 6(0/6)
2 Set up ECHO equipment and select appropriate probes expert (Key) 24(22/2) 1(1/0)
3 Perform or coordinate equipment calibration and troubleshooting manager (Core) 17(13/4) 8(3/5)
4 Verify equipment safety checks manager (Core) 20(15/5) 5(2/3)
5 Introduce self & explain procedure to patient communicator (Core) 21(17/4) 4(3/1)
6 Appropriately respond to patient’s questions or concerns communicator (Core) 21(17/4) 4(3/1)
7 Prepare patient for procedure expert (Key) 23(22/1) 2(1/1)
8 Use correct orientation of transducer expert (Key) 25(24/1) 0(0/0)
9 Perform ECHO procedure using M-Mode expert (Key) 25(24/1) 0(0/0)
10 Perform ECHO procedure using 2D ECHO expert (Key) 25(25/0) 0(0/0)
11 Perform ECHO procedure using 3D ECHO reject 8(4/4) 17(11/6)
12 Perform ECHO procedure using pulse and continuous wave doppler expert (Key) 25(24/1) 0(0/0)
13 Perform ECHO using tissue doppler expert (Key) 24(22/2) 1(1/0)
14 Assist physician with Trans-Esophageal ECHO (TEE) expert (Key) 18(14/4) 7(1/6)
15 Assist physician during exercise stress ECHO (treadmill) expert (Key) 14(12/2) 11(2/9)
16 Assist physician during pharmacological stress ECHO (thallium & dobutamine) expert (Key) 17(13/4) 8(2/6)
17 Perform TEE probe disinfection and cleaning. Identified as missing from task analysis manager (Key) ----- -----
18 Perform calculations manually and while using software packages expert (Key) 20(15/5) 5(2/3)
19 Correlate results with findings from other medical investigations expert (Key) 17(13/4) 8(3/5)
20 Perform interpretation of ECHO findings communicator (Key) 16(10/6) 9(4/5)
21 Communicate patient parameters and abnormal events to appropriate staff communicator (Core) 25(24/1) 0(0/0)
22 Communicate within your department to relay important information collaborator (Core) 18(13/5) 7(1/6)
23 Communicate with other Departments to relay important information collaborator (Core) 16(6/10) 9(3/6)
24 Document and archive relevant patient information communicator (Core) 20(18/2) 5(1/4)
25 Use appropriate medical terminology in written and verbal communication communicator (Core) 25(25/0) 0(0/0)
26 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 14(12/2) 11(2/9)
27 Take affirmative action to promote health needs that are in the patient’s best interest health advocate (Core) 13(11/2) 12(3/9)
28 Review Department policies & procedures professional (Core) 16(8/8) 9(6/3)
29 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 20(18/2) 5(1/4)
30 Demonstrate professional conduct in appearance, communication and action professional (Core) 25(25/0) 0(0/0)
31 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 25(24/1) 0(0/0)

148
32 Maintain patient privacy and confidentiality Core (professional) 25(25/0) 0(0/0)
33 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 25(25/0) 0(0/0)

34 Apply aseptic technique and infection control policy and procedures expert (Core) 25(24/1) 0(0/0)
35 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes scholar (Core) 16(6/10) 9(5/4)
appropriate for practice
36 Understand research methodology and how to apply it reject 8(1/7) 17(10/7)
37 Order consumable supplies and use resources efficiently to promote optimal department function manager (Core) 13(5/8) 12(4/8)
38 Maintain certification in Basic Life Support (BLS) expert (Core) 25(24/1) 0(0/0)

Response rate
Role
No H/S Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Review patient chart and confirm physician orders collaborator (Key) 5(5/0) 0(0/0)
2 Set up and program Holter / Stress equipment expert (Key) 5(3/2) 0(0/0)
3 Perform or coordinate equipment calibration and troubleshooting manager (Core) 5(0/5) 0(0/0)
4 Verify equipment safety checks manager (Core) 5(2/3) 0(0/0)
5 Introduce self & explain procedure to patient communicator (Core) 5(4/1) 0(0/0)
6 Appropriately respond to patient’s questions or concerns communicator (Core) 5(4/1) 0(0/0)
7 Provide patient with Holter device training communicator (Key) 5(4/1) 0(0/0)
8 Retrieve and download Holter study data communicator (Key) 5(5/0) 0(0/0)
9 Perform basic Interpretation of Holter study (arrhythmia type & duration) expert (Key) 5(4/1) 0(0/0)
10 Recognize recording errors /artifacts expert (Key) 5(4/1) 0(0/0)
11 Prepare patient for stress test expert (Key) 5(5/0) 0(0/0)
12 Monitor and record patient physiological parameters during procedures communicator (Core) 5(5/0) 0(0/0)
13 Communicate patient parameters and abnormal events to appropriate staff communicator (Core) 5(5/0) 0(0/0)
14 Communicate within your department to relay important information collaborator (Core) 5(4/1) 0(0/0)
15 Communicate with other Departments to relay important information reject 2(1/1) 3(3/0)
16 Document and archive relevant patient information communicator (Core) 5(4/1) 0(0/0)
17 Use appropriate medical terminology in written and verbal communication communicator (Core) 5(5/0) 0(0/0)
18 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 5(4/1) 0(0/0)
19 Take affirmative action to promote health needs that are in the patient’s best interest health advocate (Core) 3(1/2) 2(2/0)
20 Review Department policies & procedures professional (Core) 5(3/2) 0(0/0)
21 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 5(4/1) 0(0/0)
22 Demonstrate professional conduct in appearance, communication and action professional (Core) 5(5/0) 0(0/0)
23 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 5(5/0) 0(0/0)
24 Maintain patient privacy and confidentiality professional (Core) 5(5/0) 0(0/0)
25 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 5(5/0) 0(0/0)
26 Apply aseptic technique and infection control policy and procedures Expert (Core) 5(5/0) 0(0/0)
27 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes appro- scholar (Core) 5(4/1) 0(0/0)
priate for practice
28 Understand research methodology and how to apply it reject 0(0/0) 5(5/0)
29 Order consumable supplies and use resources efficiently to promote optimal department function manager (Core) 4(4/0) 1(0/1)
30 Maintain certification in Basic Life Support (BLS) expert (Core) 5(5/0) 0(0/0)

Response rate
Role
No ECG Competency Profile - Roll performance criteria routinely/ rarely/
retain/reject
frequently never
1 Review patient chart and confirm physician orders collaborator (Key) 7(3/4) 5(4/1)
2 Set up ECG equipment and select appropriate leads expert (Key) 12(12/0) 0(0/0)
3 Perform or coordinate equipment calibration and troubleshooting manager (Core) 8(3/5) 4(4/0)
4 Verify equipment safety checks manager (Core) 8(4/4) 4(4/0)
5 Introduce self & explain procedure to patient communicator (Core) 11(10/1) 1(1/0)
6 Appropriately respond to patient’s questions or concerns communicator (Core) 12(10/2) 0(0/0)
7 Prepare patient for procedure expert (Key) 12(12/0) 0(0/0)
8 Perform standard 12-Lead ECG expert (Key) 12(11/1) 0(0/0)
9 Perform 15-Lead pediatric ECG (0 to 8 years) expert (Key) 10(10/0) 2(1/1)
10 Perform basic interpretation of ECG study (arrhythmia type & duration) expert (Core) 7(3/4) 5(5/0)
11 Recognize recording errors /artifacts expert (Key) 12(11/1) 0(0/0)
12 Communicate patient parameters and abnormal events to appropriate staff communicator (Core) 12(11/1) 0(0/0)
13 Communicate within your department to relay important information collaborator (Core) 12(9/3) 0(0/0)
14 Communicate with other Departments to relay important information collaborator (Core) 8(2/6) 4(3/1)
15 Document and archive relevant patient information communicator (Core) 12(10/2) 0(0/0)
16 Use appropriate medical terminology in written and verbal communication communicator (Core) 12(12/0) 0(0/0)
17 Provide information willingly to educate and promote the patient’s health and well-being health advocate (Core) 8(2/6) 4(3/1)
18 Take affirmative action to promote health needs that are in the patient’s best interest health advocate (Core) 7(3/4) 5(5/0)
19 Review Department policies & procedures professional (Core) 11(8/3) 1(1/0)
20 Use professional judgment to identify contraindications to procedure and take appropriate action professional (Core) 7(3/4) 5(5/0)
21 Demonstrate professional conduct in appearance, communication and action professional (Core) 12(12/0) 0(0/0)

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Herbst  Role task performance criteria

22 Demonstrate reliability, flexibility and adaptability in clinical practice professional (Core) 12(10/2) 0(0/0)
23 Maintain patient privacy and confidentiality professional (Core) 12(12/0) 0(0/0)
24 Demonstrate awareness and sensitivity to patient’s cultural and gender-specific needs professional (Core) 12(12/0) (0/0)
25 Apply aseptic technique and infection control policy and procedures Expert (Core) (10/2) 0(0/0)
26 Participate in continuing education activities to maintain clinical knowledge, skills and attitudes appropri- scholar (Core) 9(3/6) 3(3/0)
ate for practice
27 Understand research methodology and how to apply it reject 5(1/4) 7(2/5)
28 Order consumable supplies and use resources efficiently to promote optimal department function manager (Core) 11(6/5) 1(1/0)
29 Maintain certification in Basic Life Support (BLS) expert (Core) 12(12/0) 0(0/0)

150