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Seymour Furman was
the first to recognize the usefulness of pacing the heart endocardially, which
ultimately led to the development of an entirely new discipline of clinical
cardiac electrophysiology.
After serving as a
naval surgeon in the early 1960s, he embarked on a clinical career at Montefiore
Medical Center where he directed the pacemaker program until 1994. He also
became a Professor of Medicine and Surgery at the Albert Einstein College of
Medicine. A pioneer in cardiac rhythm management, much of his work was supported
by the National Institutes of Health leading to the development of clinical
cardiac electrophysiology.
Among his
contributions were the founding of some of the earliest pacemaker clinics, the
demonstration that mercury-zinc cells destroy pacemaker circuitry, and the
establishment of a database and statistical analysis of patient and hardware
survival. The awards for his work are numerous, including: the Distinguished
Service Award from Intersociety Commission for Heart Disease Resources; the
Pioneer in Pacing Award; and the Distinguished Scientist Award from the ACC,
among many others.
His work in medicine
was rivaled by his service in countless organizations. In 1977, he co-founded,
along with J. Warren Harthorne, Dryden Morse, and Victor Parsonnet, the North
American Society of Pacing and Electrophysiology (NASPE), eventually
becoming its president in 1981. In 1984, he established an affiliate of NASPE,
NASPExAM® (now the International Board of Heart Rhythm Examiners),
an organization devoted to the examination process for recognizing physicians
and allied professionals for competency in cardiac pacing and implantable
defibrillation and to certify allied professionals in clinical cardiac
electrophysiology. He acted as chair of NASPExAM® through 1998.
Dr. Furman was also a
prolific academic writer. He published over 400 manuscripts and book chapters,
over 100 editorials in PACE, and over 800 abstracts. He also gave over 1000 oral
presentations. He coauthored the first American book on cardiac pacing, titled
“A Practice of Cardiac Pacing”, being published in three successive editions.
Not only was he an
excellent scientist, Dr. Furman also had a loving family. A father of three, he
was married for more than 45 years. Dr. Furman remained an active physician
until his death on February 20, 2006. The cause of death was due to
complications of cardiovascular disease.
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1984
NASPExAM, now the International Board of Heart Rhythm Examiners (IBHRE), is
founded by its first President, Dr. Seymour Furman. As an independent affiliate
organization to the Heart Rhythm Society (HRS), it is devoted to the examination
and certification of physicians and allied professionals for competency in
cardiac pacing, cardioversion defibrillation and clinical cardiac
electrophysiology. The National Board of Medical Examiners is approved to
administer exam.
1985
NASPExAM is established in a Boston, Massachusetts office
Cardiac Pacing Test Writing Committee is founded
1986
First examinations of Special Competency in Cardiac Pacing and Cardioversion
Defibrillation for the physician are administered in Los Angeles, Chicago, New
York and London
1989
First Examinations for Special Competency in Cardiac Pacing and Cardioversion
Defibrillation for the allied professional are administered in Los Angeles,
Chicago, New York and London
1995
NASPExAM moves to a Washington, DC office
1996
Extensive role delineation study conducted to update the list of essential
competencies for heart rhythm professionals
Cardiac Electrophysiology Test Writing Committee is founded
1997
First Examinations for Special Competency in Cardiac Electrophysiology for the
allied professional are administered in New Orleans and New York
1998
Dr. David Steinhouse becomes second President of NASPExAM
2005
Dr. Charles J. Love becomes third President of NASPExAM
Physician exam is recognized as a competency requirement for
completion of the Heart Rhythm Society’s alternate training pathway for non-electrophysiologists
NASPExAM adopts new by-laws, a new strategic plan, and expands
the Board of Directors to include international members from Japan, London and
Canada
2006
NASPExAM becomes the International Board of Heart Rhythm Examiners
New IBHRE website is launched and first web-based registration
system is introduced
Job task analyses conducted to initiate change from competency
to certification, to identify core tasks in the heart rhythm practice and to
standardize global knowledge-base of heart rhythm professionals
Comprehensive market research and promotional strategy conducted
around the value of IBHRE certification
2007
Examinations re-named and structured to align with new certification program:
Certification Examination for Competency in Cardiac Rhythm Device Therapy for
the Physician Certification Examination for Competency in Cardiac Rhythm Device
Therapy for the Allied Professional, Certification Examination for Competency in
Cardiac Electrophysiology for the Allied Professional
New certification credentials announced:
Certified Cardiac Device Specialist (Physician)
Certified Cardiac Device Specialist (Allied Professional)
Certified EP Specialist (Allied Professional)
Strategic partnership formed with the Japanese Heart Rhythm
Society and establishment of first IBHRE Japanese Test Translation Committee
Establishment of new organizational structure, policies and
procedures to support the administration of the new IBHRE program and prepare
for certification personnel accreditation from the American National Standards
Institute (ANSI)
2008
First introduction of computer-based testing and world-wide administration of
certification examinations
First tailored foreign-language certification exam is
administered in Japan to 644 cardiac pacing allied professionals
IBHRE establishes registered trademarks for the IBHRE name and
mark
2009
IBHRE submits an application to ANSI for accreditation under ISO Standard 17024
for Personnel Certification Programs
Physician Electrophysiology Test Writing Committee is founded to
develop international-based adult and pediatric EP exams for physicians
First IBHRE Certification Orientation is held at the Boston
Convention and Exhibition Center
New Recertification Policy is established to require
professional development maintenance every 5 years and recertification every 10
years
First IBHRE Review and Appeals Committee is established
2010
IBHRE receives American National Standard Institute Accreditation
2011
IBHRE officially announces the Examination for Special Competency in Cardiac
Electrophysiology for the Physician
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In 1985, the Executive Committee of NASPE (now Heart Rhythm Society)
created a wholly owned subsidiary, NASPExAM®, to develop and administer
an “Examination of Special Competency in Cardiac Pacing and Cardioversion
Defibrillation” for the Physician. The examination was first offered in 1986 and
the outcome of this initial examination has previously been reported.1
The examination was initially to be offered annually but in 1989 was changed to
every other year administration. The actual years of administration were 1986,
1987, 1988, 1989, 1991, 1993, 1995, 1997, 1999, 2001, and 2003. Beginning in
2001, the Physician examination was administered during the Annual Scientific
Sessions and biennially thereafter in odd years. All examinations have been open
to licensed physicians, board certified or board eligible in internal medicine,
cardiology, pediatric cardiology, general surgery, thoracic and cardiovascular
surgery, pediatric surgery, emergency medicine, and anesthesiology.
At the request of non-physician Allied Professionals, i.e., engineers,
technicians, physician assistants, and nurses employed by hospitals, in academe
or by industry, an “Examination of Special Competency in Cardiac Pacing and Cardioversion Defibrillation” for the Allied Professional, NASPExAM®
AP/Pacing, was developed and initially administered in 1989 after being
administered on a trial basis to a select group of examinees in 1988. This
examination was administered in 1989, 1990, 1992, 1994, 1996, 1998, 2000, 2001,
and 2003 and is now offered biennially during the Annual Scientific Sessions.
An “Examination of Special Competency in Cardiac Electrophysiology” for the
Allied Professional, NASPExAM® AP/EP, was administered during 1997
and was administered in 1999, 2001, 2002, 2004, and biennially thereafter during
the Annual Scientific Sessions.
References
1. Furman S, Bilitch M. NASPExAM®. PACE 1987;
10:278-280
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From the Editor . . .
Certification of Special Competence in Cardiac Pacing
It is reliably estimated that 100,000 new pacemaker implants are performed in
the United States annually and that about one-half million people are alive with
implanted pacemakers. The procedure is performed in university hospitals, major
teaching affiliates, community hospitals, and in those of very small bed
capacity. The implanting physicians and surgeons include thoracic and
cardiovascular surgeons, cardiologists who undertake a variety of invasive
procedures, those whose only invasive efforts are pacemaker implantations, and
general surgeons who implant pacemakers as their only cardiovascular procedure.
These pacemakers are implanted by teams including surgeons and cardiologists, by
surgeons, cardiologists, or internists alone. Implantations are done in an
operating or radiology room, cardiac catheterization laboratory, or special
procedure room with fixed or “portable” fluoroscopy. Those involved in pacemaker
implantation may be only hospital and medical staff or may include, on a routine
basis, a manufacturer’s sales representative or engineer. Follow-up,
programming, and troubleshooting are commonly accomplished by commercial
services and by manufacturer’s representatives as well as by physicians and
their office and hospital staffs. The conclusion sometimes reached by observers
of pacemaker implant and follow-up is that there is a wide diversity of medical
knowledge and competence concerning indications for implantation, operative
techniques, electrocardiographic interpretation, and follow-up procedures
involved in cardiac pacing.
The North American Society of Pacing and Electrophysiology (NASPE) was
founded to raise the level of professionalism in the practice of cardiac pacing.
It has included the organization of tutorial and policy conferences and the
annual convention. The next step is an attempt to raise the level of knowledge
of those who practice cardiac pacing. There is little doubt that the time to
begin increasing that knowledge is during residency training. The only
systematic indication of what has been taught and learned during the residency
is by testing those who have completed training. It is thus routine for
physicians and surgeons who have completed a residency training program to seek
the imprimatur of a specialty board to attest to their proficiency and
knowledge. The existing boards cover many fields of endeavor within their
specialties. New fields within a specialty can grow, become major therapeutic
endeavors, and still receive little attention in the examination of the broader
specialty. Successful completion of the broader exam then does not signify
useful knowledge or competence in the narrower field. Members of NASPE commonly
receive requests from chairs of hospital departments and of credential
committees to guide in the determination of who should be given approval to
implant or otherwise be involved in pacemaker work. So far there has been
virtually no answer. Now, if the process of provision of a “Certificate of
Special Competence” is successful, an applicant approaching such a person or
committee will be able to indicate that (s)he has indeed taken the time and made
the effort to learn about cardiac pacing. Cardiac pacing is now a mature
therapy; training and education can no longer be left to a casual and
potentially less effective approach.
Formulation of an examination as an instrument for certification is not an
attempt to restrict who it is that can implant pacemakers; indeed, a written
examination cannot evaluate a person’s surgical skills. Each institution will
still make its own decisions. There will be no effort to affect the credentials
of those who now practice cardiac pacing in all of its ramifications. But the
public does deserve that the profession make efforts to maximize the skill and
professionalism of the practice of cardiac pacing. Furtherance of education and
skills is a worthy endeavor and NASPE is the logical organization to initiate
the effort. If, as with other competency examinations, it increases the
incentive to improve education (in cardiac pacing), that is all to the good. The
first examination will be held during the fall of 1986.
Reprinted from PACE journal, Vol. 9, No. 1 (January–February, 1986), p 1.
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Photos courtesy of the Heart Rhythm Society History Project
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