A new Lifelong Learning Statement from the ACC and the Heart Rhythm Society (HRS) defines the lifelong learning requirements for all clinical cardiac electrophysiology (CCEP) specialists. The statement – the first specific to a subspecialty of cardiovascular medicine – complements both the 2016 ACC Lifelong Learning Competencies for General Cardiologists as well as the 2015 ACC/AHA/HRS Advanced Training Statement for Clinical Cardiac Electrophysiology.

"This Lifelong Learning Statement complements the Advanced Training Statement on CCEP by focusing on the competencies expected of practicing cardiac electrophysiologists throughout their careers," the authors write. "It also recognizes those competencies that exceed standard expectations and may be achieved and maintained by some cardiac electrophysiologists based on their specific training and practice focus."

The lifelong learning competencies for CCEPs are organized using the six domains promulgated by the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties and endorsed by the American Board of Internal Medicine (ABIM). These domains focus on Medical Knowledge; Patient Care and Procedural Skill; Systems-Based Practice; Practice-Based Learning and Improvement; Interpersonal and Communication Skills; and Professionalism. The competencies falling under Medical Knowledge and Patient Care and Procedural Skill domains are broken down into categories, including basic electrophysiology, diagnostic tests, nondevice therapies, implantable devices, and arrhythmia types and syndromes. While in many cases the competencies apply to all CCEP specialists, practice-focused competencies pertaining to things like lead management, left atrial appendage management, and catheter ablation are also included, particularly in the Practice Skills section.

"Importantly, there is a growing subspecialization career focus within CCEP, in which some highly skilled practitioners limit the scope of their clinical activity to pacemaker and defibrillator implantation and follow-up, whereas others focus their efforts on complex ablation and device-related procedures," the authors note. "Thus, although maintenance of some CCEP competencies is an expectation for all [CCEP specialists], the maintenance of select CCEP competencies and the evaluation tools to assess them can be career focused."

In addition to clinical competencies, nonclinical skills such as involving patients in shared-decision making, demonstrating high ethical standards, and identifying knowledge and performance gaps and committing to performance improvement are defined within the other domains. The document also highlights numerous ways CCEP specialists can maintain competency and expand lifelong learning. Along with demonstrating successful completion of a dedicated CCEP training program and obtaining ABIM certification, the statement recommends participation in ongoing Continuing Medical Education programs, leveraging of quality data collected in hospital databases and registries like ACC's NCDR, and staying on top of new technologies and procedures. Additionally,  "experts in particular aspects of CCEP (e.g., device implantation or atrial fibrillation ablation) should perform an adequate annual volume to maintain skills and, where possible, provide their results for open scrutiny in the appropriate national databases," the authors write.

Keywords: Accessory Atrioventricular Bundle, Action Potentials, Arrhythmias, Cardiac, Heart Conduction System, Cardiac Electrophysiology, Ion Channels, Cardiomyopathies, Electrocardiography

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