As cardiovascular workforce shortages continue to intensify, health systems are increasingly relying on advanced practice providers (APPs) to expand access, improve efficiency and support team-based care delivery. However, the successful integration of APPs requires more than staffing solutions. According to Nicole Lohr, MD, PhD, FACC, and Lisa Findley, DNP, ACNP-BC, CCK, FACC, both from UAB Medicine in Birmingham, AL, intentional education and competency development are also critical.

Speaking at MedAxiom's CV Transforum in Ponte Vedra Beach, FL, earlier this year, Lohr and Findley noted that while APPs are increasingly recognized as key members of team-based care models, educational pathways for APPs remain highly variable. As a result, APPs entering cardiovascular practice face a knowledge and skills gap that must be addressed through structured postgraduate education, mentorship and competency frameworks.

Lohr and Findley propose a four-part pathway centered around learning, assessment, validation and continued development that would provide a framework for moving APPs from early confidence-building to measurable competency and ongoing professional growth.

Learn

Structured onboarding and mentoring are the focus of the first phase centered around learning. Using MedAxiom's CV Essentials for APPs course as a roadmap during an APP's first year of cardiovascular practice (or first year of practice within a new program) helps APPs build foundational cardiovascular knowledge while giving organizations a standardized, streamlined onboarding experience.

Designed specifically for APPs newly entering cardiology practice, CV Essentials offers up to 50 CME credits and develops competency in cardiovascular diagnosis, clinical decision-making and guideline-directed management. Building these competencies can reduce onboarding variability, accelerate the transition to confident practice, ease the burden on physician mentors and preceptors, and improve consistency across care teams, say Findley and Lohr.

Assess

ACC's ACCSAP is key to the next step involving assessment – helping APPs expand competencies, reinforce broad cardiovascular knowledge, identify gaps and simulate board-style testing experiences before pursuing certification.

Offering up to 185 CME and 185 AAPA credits, the curriculum design can help APPs stay current, enhance their expertise and develop in the areas outlined in ACC's Clinical Competencies for NPs and PAs. Offering in-depth content and board-style questions with rationale and references, ACCSAP's exams are similar with the questions in ACC's Certified Cardiovascular Knowledge Examination (CCKE).

Validate

The final step in the pathway is validation using the ACC's CCKE and ultimately earning the CCK designation. "More than a series of letters behind your name. Passing the exam and earning the CCK is a signal of commitment to a defined standard of care," says Findley.

For individual APPs, the exam validates broad cardiovascular knowledge, demonstrates commitment to evidence-based care and may support leadership opportunities and career advancement. Importantly, passing the exam qualifies individuals seeking to become an AACC and helps with progression toward FACC status. For health systems, hospitals and other organizations, the CCKE provides an objective benchmark to help standardize competency expectations across APP teams.

Based on their experiences at UAB, Lohr and Findley emphasize the importance of program directors clearly communicating both the professional value of the CCKE and its role in strengthening team-wide competency. They also highlight the need for institutions to provide APPs with the support necessary to prepare for the exam, including funding the learning and assessment portions of the pathway.

"If you're going to use the CCKE as a benchmark, you have to provide the runway and the resources," says Findley. "When APPs feel supported, educated and empowered to practice at the top of their license, everyone benefits."

Keywords: Cardiology Magazine, ACC Publications, CM-Sep-2026, Education, Certification, Patient Care Team