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CARDIOLOGY TECHNOLOGY
NATIONAL OCCUPATIONAL
COMPETENCY PROFILE
Canadian Society of
Cardiology Technologists
February 2005
CARDIOLOGY TECHNOLOGY
An
OCCUPATIONAL ANALYSIS
Prepared for
The Canadian Society of Cardiology Technologists
Revised February 2005
Background
This document was prepared by the Canadian Society of Cardiology Technologists
(CSCT) as part of a process to meet the requirements for accreditation by the Canadian
Medical Association’s Committee on Conjoint Accreditation (CMACCA).
The CSCT had previously undertaken an occupational analysis study and a national
survey of cardiology technologists to identify the complete range of tasks,
responsibilities, and related knowledge and skills of a Cardiology Technologist’s job role.
The outcomes of this process enabled the CSCT to define the scope of practice for this
job role and to validate cardiology technology as a distinct specialty within the national
family of medical technologies. The comprehensive Task Analysis Report, detailing the
findings of the occupational analysis study and the national survey, was the subject of
subsequent examination by professional bodies, key personnel from the medical
community and other technical associations and interested parties. The report was
submitted for consideration to the Canadian Medical Association’s Committee on
Conjoint Accreditation.
After a thorough review of this report, including comments from the field, the CMACCA
accepted the application of Cardiology Technology in the conjoint accreditation process
subject to submission by the CSCT of a validated entry-level competency profile. It was
the CSCT’s belief, based upon feedback it received, that the original occupational
analysis, which identified both basic and advanced level competencies, had addressed the
entry-level consideration.
To meet CMACCA requirements for accreditation, the Canadian Society of Cardiology
Technologists, with the support of Human Resources Development Canada, has updated
the foundation Occupational Analysis document and differentiated between entry-level to
practice knowledge and skills and those which require a specialty certificate.
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Canadian Society of Cardiology Technologists
Cardiology Technology Occupational Profile
February 2005
Entry Level and Specialty Competencies
The essential purpose of the original occupational study was to identify all of the tasks
carried out by those in cardiology technology positions in order to define National
practice competencies. A considerable range of responsibilities performed by
technologists was evident from the national study, the results of which was confirmed by
the provincial validation sessions and was supported by the job analysis study. In
recording the outcomes it was agreed that some specialty areas should be included within
the foundation document.
It is now appropriate to discriminate between those competencies that legitimately belong
to the entry level and those which can be considered as specialty areas of practice and
responsibility. Accordingly, this document defines the competencies that belong at entry
level and specialty level respectively.
For competencies at the specialty level, there is a declaration of the foundation in both the
knowledge and practical skills. It is expected that, although the fundamental knowledge
and skills may be reviewed in teaching specialty level competencies, the underlying
competencies will already have been acquired. Where additional knowledge particular to
the advanced entry level, some competency in question is required and has not been
addressed in entry level training, this knowledge has been defined and must be addressed
in the education or training designed to teach this competency or set of competencies.
While this document intends to capture and categorize all competencies within the
cardiology technology scope of practice it is recognized that, due to differences in the
jurisdictions and in the various employment settings, an individual technologist may not
perform all the competencies. This is a medical technology that is heavily impacted by
technology and evolutions in practice. It is important to ensure that the declared
fundamental knowledge and skills have been firmly established at the entry level.
From the educational or training perspective, it is also evident that advanced entry and
specialty level knowledge and practice competencies may be met in a number of ways
according to the level of knowledge and skill required, as well as with respect to the level
of supervision provided. These may range from one-day seminar sessions provided
through recognized in-service training events through to a fully dedicated and extensive
training program.
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Methodology
The initial work of reviewing, editing and categorizing the competencies was carried out
by a project task group. The group was comprised of CSCT executive members,
cardiology department managers, cardiology technologists, and a facilitator who guided
the process. This work was validated at a national meeting of cardiology technologists,
where necessary changes were suggested to ensure that the competencies are current and
accurately reflect the responsibilities at the entry and specialty levels in the various
jurisdictions. As a final step in the validation process, a comparison was made of the
competencies against a sample of typical current job descriptions obtained from each
province. Following this comprehensive review, the Project Task Committee made all
necessary changes to the document.
Structure and Format
This document, an Occupational Profile for the CSCT has been formatted to provide
clarity and ease of understanding the comparisons between the entry and specialty levels
of practice. Entry level competencies, defined in terms of the required knowledge and
skills, are presented first and specialty competencies are presented separately and require
a higher level of education. Where no additional knowledge is specified, the knowledge
base has been satisfied at the entry level.
Product
This product is a current, complete, accurate and valid Occupational Profile of cardiology
technology at the entry and specialty levels. This document has been prepared to meet the
requirements of the Canadian Medical Association’s Conjoint Accreditation Committee.
It will be the foundation for reviewing the existing educational training programs at the
entry level, and for planning courses offered in specialty areas. It provides the frame of
reference for revising the curriculum and instructional delivery methods that may be
required to adequately prepare graduates to meet employment expectations as well as to
successfully complete the national certification examinations set by the CSCT. The
CSCT is in the process of reviewing and redesigning, as necessary, the National
examination with respect to the competencies as defined in the revised Occupational
Profile.
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Canadian Society of Cardiology Technologists
Cardiology Technology Occupational Profile
February 2005
Nature of this Document
It is recognized that the competencies contained in this profile represent the current state
of practice. It is the intent of the CSCT to ensure that the National Occupational Profile
becomes a “living” document. As with most medical technical occupations, the area of
cardiology technology continues to evolve as a field of practice. It is impacted by
changes in technology, delegation of additional responsibilities, increasing work demands
and changes in health care delivery. The Canadian Society of Cardiology Technologists
is committed to the process of annually reviewing this document and making necessary
changes to ensure the maintenance of a current and accurate Occupational Profile.
The addition of the Essential Skills Component commissioned by Human Resources
Development Canada makes a valuable contribution to this profile as it brings a
comparative aspect that permits the essential knowledge, skills and judgements to be
viewed with respect to a much broader range of occupations and to be valued
accordingly.
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CSCT OCCUPATIONAL
COMPETENCY PROFILE
Outline
Main Profile A – H and sub-areas listed below. There are additional subjects under each of the
sub-areas; refer to document.
A. Non-Invasive Cardiology
1. Apply the basic theory and principles that form the foundation for non-invasive
cardiology.
2. Demonstrate ability to effectively record and analyze electrocardiograms.
3. Apply ambulatory ECG monitor/recorder.
4. Analyze ECG ambulatory monitor recordings.
5. Perform exercise tolerance testing (ETT) to assess cardiovascular response.
6. Assist with tilt table testing to determine vaso-vagal response.
7. Perform trans-telephone monitoring procedures for analysis of arrhythmias and basic
pacemaker function.
8. Assess pacemaker function.
9. Assess cardiac structure and function using cardiac ultrasound.
B. Invasive Cardiology
1.
2.
3.
4.
5.
6.
7.
8.
Participate in hemodynamic procedures.
Perform hemodynamic measurement procedures.
Assist with esophageal ECG lead procedure.
Assist with esophageal cardiac ultrasound studies.
Assist with pericardiocentesis procedure by echocardiography.
Assist with pericardiocentesis procedure by ECG.
Assist with implant of pacemakers by establishing lead integrity.
Assist with internal mapping of the cardiac conduction system and accessory pathways
to locate sites of arrhythmias.
9. Assist with insertion of temporary pacemakers.
C. Equipment, Instruments and Supplies
1.
2.
3.
4.
Demonstrate proficiency in using equipment.
Assist in the evaluation of new equipment and accessories.
Assist with managing inventory and supplies.
Maintain and stock resuscitation cart as required.
D. Professional Standards
1.
2.
3.
4.
5.
6.
Demonstrate legal and ethical behavior.
Participate in continuing education.
Follow policy and procedure.
Practice with respect to cultural, ethnic and religious beliefs.
Follow occupational health, safety guidelines and practices.
Actively participate in continuous quality improvement programs.
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CSCT OCCUPATION COMPETENCY PROFILE
Outline (continued)
E. Practice Skills and Techniques
1. Demonstrate problem solving skills.
2. Have an understanding of cardiac auscultation.
3. Demonstrate proper lifting, moving, positioning and transferring techniques to ensure
safety of patients, self and equipment.
4. Demonstrate special electrocardiographic techniques.
5. Demonstrate ability to perform and or assist in research project.
6. Demonstrate aseptic techniques.
7. Demonstrate basic computer skills.
8. Demonstrate proficiency in emergency life support.
9. Demonstrate proficiency in venipuncture.
F. Patient Care
1.
2.
3.
4.
5.
Demonstrate a professional bed-side manner.
Take an accurate and concise verbal and/or written patient history.
Assess patient status.
Demonstrate appropriate skin preparation to ensure high quality recordings.
Demonstrate the ability to perform requested procedures on patients requiring special
care.
6. Triage to set priorities and make decisions.
7. Provide information and educate the patient.
G. Knowledge
1. Demonstrate fluency in use of and understanding of medical terminology required to
communicate effectively.
2. Demonstrate a general level of knowledge of human anatomy and physiology.
3. Demonstrate a thorough and detailed knowledge of cardiovascular anatomy and
physiology in the normal heart, and when the heart is affected by pathological
conditions.
4. Demonstrate basic knowledge of pharmacological agents.
5. Demonstrate a fundamental knowledge of statistics applied in health science.
6. Demonstrate an applied knowledge of electrical circuits.
7. Demonstrate a general knowledge of other cardiac procedures.
H. Communication
1.
2.
3.
4.
5.
Demonstrate oral communication skills.
Demonstrate effective written communication skills.
Demonstrate effective non-verbal communication skills.
Demonstrate effective interpersonal skills.
Provide in-service training and education for students and other members of the health
care team.
6. Effectively operate within a complex organizational structure.
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A Non-Invasive Cardiology
MAIN AREA
1. Apply the basic theory and principles that form the foundation for
non-invasive cardiology.
SUB-AREAS
a. Describe the cellular transmembrane action potential of the heart and
the process by which it produces electrical activity to be measured
on a surface ECG.
b. Define principles of operation of various instruments that are used in
non-invasive cardiology such as electrodes, electrocardiograph,
treadmills, ambulatory monitor analyzers, and computers.
c. Identify the conduction system of the heart and correlate with
electrocardiography.
d. Explain lead theory and describe appropriate lead placement for all
cardiology related tests.
e. Recognize the sensitivity and specificity of all cardiology related
tests.
f.
Understand the concepts of basic cardiac pacing, including
sensitivity, capture, polarity, NBG code, and timing cycles.
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A Non-Invasive Cardiology
MAIN AREA
2. Demonstrate ability to effectively record and analyze
electrocardiograms.
SUB-AREAS
a. Ensure patient identification, where applicable enter patient
demographics, time and date, and review indication for procedure.
b. Explain the purpose and clarify requirements of the patient during
the test procedure.
c. Select proper sensor (electrode) placements.
d. Prepare skin sites appropriately.
e. Activate equipment and record cardiac waveforms (tracings).
f. Identify ECG waveforms checking for technical accuracy, ensure
artefact free tracing and correct lead placement.
g. Record rhythm strips and speciality leads to enhance interpretation
(where applicable).
h. Identify normal sinus rhythm. Review measurements of rates,
intervals and axis. Analyze ECG criteria associated with various
abnormalities including arrhythmias arising from the sinus node,
atria, AV node or ventricles. Identify infarcts, ischemia, injury
patterns, atrial enlargement, ventricular hypertrophy, basic
pacemaker function, and other ECG abnormalities associated with
chemical imbalances or pharmaceutical overdose, etc.
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A Non-Invasive Cardiology
MAIN AREA
2. Demonstrate ability to effectively record and analyze
electrocardiograms (continued).
i. Compare current tracing to previous tracings where applicable.
j. Determine appropriate response required as a result of the tracing
analysis.
k. Make arrangements for appropriate transfer of patient according to
results.
l.
Remove leads and sensors (electrodes), clean sensor sites and
provide any assistance required in dressing, etc.
m. Prepare tracing for interpretation by physician per institution
protocol.
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A Non-Invasive Cardiology
MAIN AREA
3. Apply ambulatory ECG monitor/recorder.
SUB-AREAS
a. Ensure patient identification and review indications for procedure.
Label tape or digital card with patient demographics.
b. Explain purpose of the procedure and clarify requirements of the
patient, including diary entries, notation of symptoms, activities, and
monitor/recorder care.
c. Prepare skin sites appropriately prior to electrode application.
d. Apply sensors (electrodes) and secure. Connect lead wires to
monitor/recorder.
e. Record rhythm strip and/or 12-lead tracing (where applicable) to
ensure correct calibration, lead placement (sufficient amplitude of
the R wave) and good connections (electrodes, leads and battery).
f. Ensure proper working order such as tape movement.
g. Secure recorder, assisting patients to dress if required, and provide
patient with instructions for return of monitor/recorder.
h. Upon patient return, disconnect monitor/recorder and clean patient
skin and equipment. Assess skin integrity post application.
i. Query patient for any significant symptoms and review diary prior to
the patient’s release.
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A Non-Invasive Cardiology
MAIN AREA
3. Apply ambulatory ECG monitor/recorder.
j. Inspect equipment to ensure proper working order and take any
actions as required.
k. Prepare recording for analysis.
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A Non-Invasive Cardiology
MAIN AREA
4. Analyze ambulatory ECG monitor recordings.
SUB-AREAS
a. Ensure that patient information or requisition is applicable to the tape
label or digital card including patient diary and 12 lead ECG.
b. Review indication of test, ECG and test strips (where applicable) and
determine history of conditions such as known or suspected cardiac
abnormalities, arrhythmias, pacemaker function, medical disorders
(i.e. sleep apnea, diabetes, etc.) and pharmacological implications.
c. Review and enter data into computer analyzer including age, name,
medications, date and time of recording, indication for test,
symptoms obtained from diary, referral source.
d. Initiate recording for analysis using facility protocols.
e. Identify and save appropriate strips for reports of cardiac
arrhythmias, pacemaker and implantable cardiac defibrillator
activity.
f. Using standard terminology, prepare the patient report, which is a
representative document of underlying rhythms and any ECG
abnormalities. Take timed strips and examples of the abnormalities
etc., their morphology, frequency and compile for interpretation.
g. Take responsibility for analysis and report to ensure a
comprehensive and accurate overview of the ECG data has been
acquired.
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A Non-Invasive Cardiology
MAIN AREA
4. Analyze ambulatory ECG monitor recordings.
h. Enter comments on quality of the recording and any additional
pertinent observations. Differentiate between arrhythmias and
artefact.
i. Make any necessary amendments to data; e.g. change labels of
strips or beats if the analyzer has mislabelled them.
j. Identify and report any ominous arrhythmias, making a
comprehensive report to physician and/or cardiologist.
Communicate effectively and answer any questions or concerns
regarding the report.
k. Troubleshoot for recorder malfunctions, broken patient lead
wires, timing artefact such as tape stretch, etc., electrical
interference and software problems, etc.
l. Participate in research projects and be able to follow specific
analyzer protocols and procedures.
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A Non-Invasive Cardiology
MAIN AREA
5. Perform exercise tolerance testing (ETT) to assess cardiovascular
response.
SUB-AREAS
a. Ensure patient identification and review indication for procedure.
b. Take pertinent patient history including cardiac risk factors and
medications.
c. Explain purpose and procedure to the patient and clarify
requirements of them for the test.
d. Obtain written consent (where applicable).
e. Use appropriate skin preparation, prepare sensor sites and apply
sensors. Identify any modified lead placements.
f. Set up and calibrate the equipment according to specific procedures.
g. Attach required equipment to record blood pressure, oxygen
saturation, etc. as per facility protocol.
h. Enter required patient demographics and data into equipment,
including pre-test blood pressure measurements.
i. For patient safety, instruct and demonstrate the use of the equipment
to the patient.
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A Non-Invasive Cardiology
MAIN AREA
5. Perform exercise tolerance testing (ETT) to assess cardiovascular
response (continued).
j. Recognize patient risk factors associated with exercise tolerance
testing such as cardiovascular, skeletal/muscular limitations,
psychological response and anticipate potential problems.
k. Start test, continually observing the patient’s condition and reactions,
monitoring ECG and taking required measurements and recordings,
at intervals appropriate to patient’s symptoms and/or test protocol.
l. Follow required procedures for testing using a variety of exercise
testing protocols. Identify associated workload measurements such
as METs and aerobic impairment etc.
m. Instruct, monitor, assess and reassure patient. Take appropriate
actions as required by patient’s symptoms or test findings.
n. Analyze for normal and abnormal ECG findings, BP measurements
and symptoms, prior to the test, during test and in recovery.
o. Follow established absolute indicators to cancel or discontinue the
test.
p. Recognize positive, negative, false positive and false negative
results.
q. Follow test procedures and protocols for Exercise Testing including
the use of injectable radionuclide and pharmacological agents such
as dipyridamole (persantine), dobutamine and other medications.
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A Non-Invasive Cardiology
MAIN AREA
5. Perform exercise tolerance testing (ETT) to assess cardiovascular
response (continued).
r. Participate in research projects and follow protocols, procedures and
record and enter data where applicable.
s. Remove leads and sensors (electrodes), clean sensor sites and
provide any assistance required in dressing.
t. Prepare test report for physician’s interpretation.
u. Correlate results of the test with possible prognosis, treatments and
additional procedures that may be required.
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A Non-Invasive Cardiology
MAIN AREA
6. Assist with tilt table testing to determine vaso-vagal response.
SUB-AREAS
a. Ensure patient identification; explain purpose of the test and
procedure to the patient. State the common symptoms the patient
may encounter.
b. Assess patient to determine physical condition and review
medication prior to testing.
c. Obtain written consent where applicable.
d. Attach required equipment to record ECG and blood pressure.
e. Set high/low alarms on monitors.
f. Prepare intravenous infusion pump, set up supplies to start IV and
set rate for infusion of specific medication (where applicable).
g. To ensure patient safety, position and secure the patient
appropriately on table.
h. Record a resting 12 lead ECG and/or monitor strips.
i. Follow procedure for selected protocol.
j. Observe patient and monitor measurements, e.g. blood pressure,
ECG, signs and symptoms.
k. Observe for appropriate duration (according to protocol) and any
normal or abnormal responses.
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A Non-Invasive Cardiology
MAIN AREA
6. Assist with tilt table testing to determine vaso-vagal response
(continued).
l. If adverse reaction occurs, return table to a recovery position and,
assist physician, continue monitoring until patient is conscious and
has returned to pre-test conditions or has received appropriate
treatment.
m. End test, remove sensors, clean sites and assist with dressing as
required.
n. Assess patient’s recovery and ensure he or she is safe to leave.
o. Prepare test results for interpretation.
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A Non-Invasive Cardiology
MAIN AREA
7. Perform trans-telephonic monitoring procedures for analysis of
arrhythmias and basic pacemaker function.
SUB-AREAS
a. Ensure patient identification and record symptoms where applicable.
b. Test transmitter to ensure proper function.
c. Provide patient instruction as to recording procedure and use of
equipment.
d. Ensure that data is properly received and documented, e.g.
pacemaker transmission non-magnet and magnet application.
e. Analyze transmitted data, compile report and prepare for
interpretation.
f. Identify abnormalities such as pacemaker elective replacement
indicators and life-threatening arrhythmias. Take appropriate action
and alert physician where applicable.
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A Non-Invasive Cardiology
MAIN AREA
8. Assess pacemaker function.
SUB-AREAS
a. Ensure patient identification and explain procedure to the patient and
its relevance.
b. Take pertinent history including exercise capacity, symptoms, and
past and present medications. Identify pulse generator (PG), leads
and previous implant history and hardware.
c. Inspect incision site to determine if infection and/or erosion is
present and take appropriate action.
d. Take blood pressure and perform auscultation (where applicable) for
clinical assessment of respiratory and cardiac function.
e. Perform initial 12 lead ECG (where applicable) and attach monitor to
assess pacemaker function.
f. Take magnet rate and interrogate pacemaker using applicable
programmer.
g. Interpret diagnostic information and telemetry.
h. Establish underlying rhythm by reducing pacemaker rate (where
applicable).
i. Assess sensing and capture thresholds.
j. Assess for myopotential inhibition.
k. Assess cross talk and VA conduction.
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A Non-Invasive Cardiology
MAIN AREA
8. Assess pacemaker function (continued).
l. Demonstrate a thorough knowledge and understanding of all
definitions, timing cycles and normal and abnormal measurements
related to pacing.
m. Determine correct mode, parameters and rate response using various
protocols to obtain the optimal hemodynamic output according to the
patient’s requirements.
n. If atrial paced, determine the Wenkebach block point per institution
protocol.
o. Analyze results to determine for normal and abnormal findings.
p. Observe patient for clinical signs and symptoms of distress during
procedure and take appropriate action(s).
q. Select final parameters; interrogate and generate printout, make
copies where applicable and chart findings.
r. Provide instructions and ongoing education to patient; set follow-up
schedule, and arrange for exercise tolerance test, ambulatory
monitoring and other related tests where necessary.
s. Assess implanted cardiac defibrillators. Provide follow up for
routine and post event anti-tachy pacing and shocks.
t. Make recommendations regarding selection of pacing system for
initial and replacement of pulse generator and leads (where
applicable)
u. Identify and respond to recalls or alerts on pulse generator and/or
leads and adjust follow-up accordingly.
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A Non-Invasive Cardiology
DECLARATION:
This specialty requires
certification in Cardiac
Ultrasound.
MAIN AREA
9. Assess cardiac structure and function using
cardiac ultrasound.
SUB-AREAS
a. Ensure patient identification and explain procedure to the patient.
b. Record patient’s data and history.
c. Activate machine, calibrating if required.
d. Attach ECG sensors using modified lead II and position patient.
e. Apply transducer gel to designated test sites.
f. Utilize various transducer positions to maintain optimum views of
the structures and functioning of the heart, using such methods as
2D, M-mode, Doppler analysis, to meet the expected standards for
the clinical indications or protocols.
g. Perform stress echo and contrast studies.
h. Report measurement findings using required forms and formats.
i. If clinically indicated, take appropriate actions.
j. Detach equipment and clean test areas. Assist with dressing if
required.
k. Prepare for interpretation and ensure quality control in reviewing
final report following interpretation by physician.
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B Invasive Cardiology
DECLARATION:
MAIN AREA
1. Participate in hemodynamic procedures.
This specialty requires
certification in Invasive
Cardiovascular Technology.
SUB-AREAS
a. Set-up, calibrate and operate physiological data monitoring
equipment such as pressure recording devices, oximetry, infusion
pumps, ECG and computerized catheterization laboratory database
system.
b. Assemble, operate, maintain and clean monitoring and support
equipment for invasive procedures as per protocol.
c. Assist with insertion of catheter by observing and providing
feedback to physician.
d. Alert the physician of abnormal signs or measurements during
catheterization such as arrhythmias, abnormal gradients and
pressures.
e. Complete collection, calculation and analysis of physiological data.
f. Record results and prepares reports.
g. Perform flow studies for cardiac procedures and other procedures
such as coronary artery intervention as per protocol.
h. Prepare and assemble cine film after catheterization to record flow,
volume and injection fractions.
i. Provide intra-operative and follow-up for procedures employing
heparin and protamine.
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B Invasive Cardiology
MAIN AREA
1. Participate in hemodynamic procedures (continued).
j. Complete patient record as required.
k. Assemble, operate and maintain the thermal dilution cardiac output
computer and dye dilution.
l. Assist with imaging procedures as required.
m. Assist with procedures performed within a sterile field.
o. Prepare patient for return to ward or recovery room.
p. Be able to perform job duties related to scrub and circulate positions.
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B Invasive Cardiology
MAIN AREA
2. Perform hemodynamic measurement
procedures.
DECLARATION:
This specialty requires
certification in Invasive
Cardiovascular Technology.
SUB-AREAS
a. Review patient’s chart and history.
b. Ensure proper identification of patient and that the consent is signed,
where applicable, and pre-medication is given.
c. Obtain patient data and complete worksheets for hemodynamic
measurements such as heart rate, rhythm and pressures.
d. Enter pertinent data to computerized cardiac catheterization
laboratory database system.
e. Assist with placing patient on x-ray table.
f. Apply sensors to patient and connect to monitor.
g. Assist with setting up of sterile tray.
h. Once patient has been draped, connect flush solution, contrast media
and transducer to manifold – check transducer.
i. Take rhythm strip and record calibration.
j. Calibrate and operate physiological data monitoring equipment
throughout procedure.
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B Invasive Cardiology
MAIN AREA
2. Perform hemodynamic measurement procedures (continued).
k. Monitor patient and ECG for syncope while sheath and catheter
are inserted and provide feedback to physician.
l. Monitor hemodynamic status and advise physician of abnormal
signs or measurements during catheterization such as
arrhythmias, abnormal gradients and pressures.
m. Assist in emergency rescue and defibrillate according to
institution’s protocol (where applicable).
n. Record and interpret calculations of hemodynamic procedures.
o. Prepare and assemble cine film after catheterization to record
flow, volume and ejection fractions as per protocol.
p. Assist with imaging procedures as required.
q. Prepare reports.
r. Be able to calculate hemodynamic measurements manually left
and right chamber pressure measurements, valve areas, cardiac
output, cardiac index, SVR and PVR, flow ratio of ASD/VSD
shunts, etc.
s. Assemble, operate and maintain the thermodilution cardiac output
computer and dye dilution.
t. Provide follow-up analysis for procedures employing heparin and
protamine.
u. Complete patient record as required.
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B Invasive Cardiology
MAIN AREA
2. Perform hemodynamic measurement procedures (continued).
v. Participate with research projects, following set up protocols and
procedures as required.
w. Disconnect patient from transducer and monitor, assist with
returning patient to designated area.
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B Invasive Cardiology
MAIN AREA
3. Assist with esophageal ECG lead procedure.
SUB-AREAS
a. Ensure patient identification and obtain patient’s consent.
b. Review indication and explain the procedure and requirements of
patient.
c. Set up for procedure.
d. Follow established protocols for recording atrial activity using a
transesophageal pacing lead.
e. Assist with insertion of lead such as head stabilization and
positioning.
f. Analyze recordings in different positions in the eosphagus for
optimal identification of atrial activity and document placement in
centimeters.
g. Remove lead and sensors (electrode), clean sites and provide any
assistance required in dressing.
h. Disinfect transesophageal leads. Place in a plastic bag and send for
sterilization.
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B Invasive Cardiology
DECLARATION:
MAIN AREA
4. Assist with transesophageal cardiac
ultrasound studies.
This specialty requires
certification in Cardiac
Ultrasound.
SUB-AREAS
a. Set up as for standard cardiac ultrasound study.
b. Assemble tray for procedure, including intravenous setup, and draw
up medication as required.
c. Assist physician (where applicable) with insertion of transducer.
d. Perform procedure as per protocol and obtain required data.
e. Assist in bubble study if required by drawing up saline.
f. Clean patient and sterilize equipment.
g. Assess patient recovery by monitoring BP, ECG, and O2 levels.
h. Prepare report.
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B Invasive Cardiology
MAIN AREA
DECLARATION:
5. Assist with pericardiocentesis procedure by
echocardiography.
This specialty requires
certification in Cardiac
Ultrasound.
SUB-AREAS
a. Ensure patient identification and obtain patient’s consent (where
applicable).
b. Explain the indication for the test and the procedure to the patient.
c. Set up pericardiocentesis tray.
d. Follow protocol for reverse isolation/sterile procedure.
e. Assist physician with sterile gown and gloves.
f. Using 2-D echo, locate the optimal echocardiographic window for
needle insertion.
g. Record the amount of fluid aspirated from the pericardial sac and
send for testing as required. Document appropriately.
h. Assist physician, ensuring entry site is sterilized and covered.
i. Clean and sterilize equipment
30
B Invasive Cardiology
MAIN AREA
6. Assist with pericardiocentesis procedure by ECG.
SUB-AREAS
a. Ensure patient identification and obtain patient’s consent (where
applicable).
b. Explain the indication for the test and the procedure to the patient.
c. Follow protocols for procedure.
d. Attach patient to electrocardiograph and continuously monitor.
e. Alert physician of any significant ST-T wave changes and or
arrhythmias.
f. Record the amount of fluid aspirated, label appropriately and send
for testing as required. Document appropriately.
g. Assist ensuring entry site is sterilized and covered.
h. Remove leads and sensor (electrode), clean electrode sites and
provide any assistance required in dressing.
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B Invasive Cardiology
MAIN AREA
7. Assist with implant of pacemakers by establishing lead integrity.
SUB-AREAS
a. Ensure patient identification, review patient history with appropriate
personnel to determine type of lead to be used.
b. Follow all required aseptic and protective procedures.
c. Set up monitoring area and analyzers used to record values and
receive cables from sterile field hook-up.
d. Establish intrinsic rate and set paced rate, assisting with temporary
pacing procedures when required.
e. Measures capture threshold, lead impedance, current drain, and
sensitivity.
f. Repeat process “e” if second lead is required.
g. Assess diaphragmatic stimulation and micro lead dislodgement as
per protocol.
h. Constantly monitor record data and advise accordingly.
i. After connection of generator, observe for appropriate function of
device.
j. Complete documentation, including registration of leads and
generator as well as required reports for the chart.
32
B Invasive Cardiology
MAIN AREA
7. Assist with implant of pacemakers by establishing lead integrity
(continued).
k. In the event of a tachyarrhythmia, be prepared to re-establish rhythm
by following institute protocols.
l. Assist with lead ex-plants as per facility protocol.
33
B Invasive Cardiology
MAIN AREA
DECLARATION:
8. Assist with internal mapping of the cardiac
conduction system and accessory pathways
to locate sites of arrhythmias.
This specialty requires
certification in Invasive
Cardiovascular Technology.
SUB-AREAS
a. Confirm identity of patient.
b. Explain procedure and have patient sign consent form as required.
c. Prepare table and assist in patient transfer.
d. Prepare skin sites.
e. Set-up as for modified ECG or 12 Lead ECG.
f. Record and calibrate ECG and label tracing.
g. Connect patient to oxygen consumption monitor.
h. Place and connect defibrillator pads.
i. Prepare patients by sterilizing subclavian and then shave and sterilize
groin.
j. Prepare required equipment such as catheters, syringes, and scalpels,
draping materials.
34
B Invasive Cardiology
MAIN AREA
8. Assist with internal mapping of the cardiac conduction system and
accessory pathways to locate sites of arrhythmias (continued).
k. Acquire pertinent data from chart and establish record.
l. Calibrate equipment and enter required data into computer.
m. Upon physician’s insertion of cardiac catheters, connect external
catheter ends to electrophysiology machine for monitoring, adjusting
signals according to voltage and physician’s instructions.
n. Record and monitor blood pressure.
o. Assist physician with pacing by monitoring, and recording at various
paper speeds, patient ECG, charting catheter position, mapping sites,
non-capture and pacing spikes, monitor for blocks, atrial and/or
ventricular activity, rate of pacing as set or instructed by a physician.
p. Chart measured cycle lengths.
q. Record pacing rate identifying refractory period.
r. Record 12 Lead at appropriate paper speed while patient is in SVT or
VT for comparison.
s. Record all ablations and mark time length and watts or degrees
applied.
t. Monitor arrhythmias, which may be a consequence of medications
administered.
u. Monitor patient’s vital signs and record all arrhythmias during the
procedure.
35
B Invasive Cardiology
MAIN AREA
8. Assist with internal mapping of the cardiac conduction system and
accessory pathways to locate sites of arrhythmias. (continued)
v. Perform advanced cardiac life support (ACLS), where necessary,
according to institution’s protocol.
w. Following the procedure, assist physician with removal of catheters
by monitoring vital signs, applying pressure to catheter sites, and
checking for bleeding and hematomas.
x. Remove sensors and clean lab.
y. Assist with patient care and transfer to stretcher and relocation.
z. Compile data and prepare necessary report.
36
B Invasive Cardiology
MAIN AREA
9. Assist with insertion of temporary pacemakers.
SUB-AREAS
a. Ensure patient identification and obtain consent.
b. Set up sterile tray and equipment required.
c. Connect patient to monitor and/or defibrillator monitor.
d. Prep insertion site (groin or neck) and drape patient with sterile
sheets.
e. Connect cable to pacemaker once pacing lead wire is positioned.
f. Under the direction of the physician, establish a sensing threshold
and capture threshold.
g. Set milliampere output, sensing and heart rate according to findings.
h. Observe monitor and provide feedback to physicians as required.
i. Complete required reports.
j. Assist with dismantling of sterile field and clean equipment.
k. Transport patient to designated area while on defibrillator monitor.
37
C Equipment, Instruments and Supplies
MAIN AREA
1. Demonstrate proficiency in using equipment.
SUB-AREAS
a. Select, set up, calibrate, operate, maintain and troubleshoot a range of
commonly used equipment such as:
- calipers
- computers/keyboards/databases
- single-channel and three channel
electrocardiographs
- ambulatory ECG recorder/monitor
- ambulatory ECG analysis systems
- oscilloscopes
- treadmills and stress system
recording devices
- ergometer and bicycle
- digital, mercury, aneroid
sphygmomanometers
- oxygen saturation devices
- external pacemakers
- external defibrillators
- external pacing systems
- ECG management systems
- ECG/BP computer systems
- simulators
- intravenous pumps
- tilt table
- stethoscope
- resuscitation cart
- transtelephonic recorders
- oxygen regulators
- suction devices
- ambulatory blood pressure recorders
/monitors
38
-
pacing leads
esophageal pacing leads
temporary pacemakers
pacemaker minclinic
pacemaker magnet
all types of electrodes
pacemaker system analyzers
- pacemaker programmers
- EPS – Electrophysiology
systems
- implantable cardioverter
defibrillators (ICD)
- implantable loop recorders
- AEDs
C Equipment, Instruments and Supplies
MAIN AREA
2. Assist in the evaluation of new equipment and accessories.
SUB-AREAS
a. Identify new equipment and accessories that are needed.
b. Review technical specifications.
c. Compare cost/benefits of equipment to assist in purchasing
recommendations.
39
C Equipment, Instruments and Supplies
MAIN AREA
3. Assist with the managing of inventory and supplies.
SUB-AREAS
a. Ensure adequate supplies and appropriate function of equipment.
b. Anticipate future supply requirements.
c. Assist with purchasing of equipment and supplies.
40
C Equipment, Instruments and Supplies
MAIN AREA
4. Maintain and stock resuscitation cart.
SUB-AREAS
a. Ensure equipment is maintained and functional.
b. Ensure supplies and medications are appropriately stocked and
supplies and drugs are not outdated.
c. Ensure proper care and security of any controlled drugs such as
morphine.
d. Test defibrillator as per protocol.
41
D Professional Standards
MAIN AREA
1. Demonstrate legal and ethical behaviour.
SUB-AREAS
a. Be familiar with and abide by the profession’s Code of Ethics,
Standards of Practice and policies and procedures as set out by the
employer.
b. Report and document all incidents of harassment, malpractice or
negligence through appropriate channels.
c. Discuss and describe the legal implications of practice.
d. Describe role and function of the professional association.
42
D Professional Standards
MAIN AREA
2. Participate in continuing education.
SUB-AREAS
a. Provide excellence in patient care by maintaining competency in the
theory and practice of cardiology technology.
b. Participate in ongoing education and training opportunities provided
by the CSCT, your employer, allied professions, and institutions, etc.
c. Interpret literature and research to stay current with advancements in
treatments and technology related to the profession.
d. Maintain required membership in your Canadian Society and
Provincial Association.
e. Participate in a continuing education program and maintain
appropriate number of continuing education units (CEUs) required
by CSCT and your provincial association.
43
D Professional Standards
MAIN AREA
3. Follow policy and procedure.
SUB-AREAS
a. Be familiar with institution, association and profession’s Code of
Ethics and Standards of Practice.
b. Participate in review and development of policy and procedures
related to your profession.
c. Provide orientation and instruction for students and new employees
regarding policy, procedures and practice.
d. Perform roles and responsibilities as designated by Delegated
Medical Acts or Transfer of Function.
44
D Professional Standards
MAIN AREA
4. Practice with respect to cultural, ethnic and religious beliefs.
SUB-AREAS
a. Describe the cultural, ethnic and religious issues that may be
encountered in practice.
b. Describe appropriate responses in dealing with issues in respect to
culture, ethnic and religious beliefs.
c. Practice without prejudice towards those with cultural, religious,
sexual preference, racial and physical differences.
45
D Professional Standards
MAIN AREA
5. Follow occupational health, safety guidelines and practices.
SUB-AREAS
a. Describe legal requirements for health and safety.
b. Describe high-risk health and safety factors in the job environment.
c. Identify programs and services available to assist in safety such as
infection control, back injury prevention, and WHMIS, etc.
d. Participate in programs designed to ensure employee health and
safety.
46
D Professional Standards
MAIN AREA
6. Actively participate in continuous quality improvement programs.
SUB-AREAS
a. Describe the quality service requirements.
b. Act consistently with respect to guidelines.
c. Identify key success indicators of quality service or lack thereof.
d. Contribute to the highest standards and quality of service by
consistently practicing at the highest level and exercising proper
judgement.
47
E Practice Skills and Techniques
MAIN AREA
1. Demonstrate problem-solving skills.
SUB-AREAS
a. Exercise and be able to justify professional judgement by identifying
problems and selecting the most effective method of response.
b. Establish confidence and competence in procedures by applying
knowledge and using professional judgement.
c. Demonstrate high level of self-examination.
d. Recognize situations outside level of competence or expertise and
seek consultation when required.
e. Render reliable, valid decisions and be able to explain rationale.
f. Apply logical and realistic thought to problems.
48
E Practice Skills and Techniques
MAIN AREA
2. Have an understanding of cardiac auscultation.
SUB-AREAS
a. Describe normal and abnormal heart sounds, i.e. S1, S2, S3 and S4.
b. Define normal and abnormal sounds of respiration, i.e. Rales.
49
E Practice Skills and Techniques
MAIN AREA
3. Demonstrate proper lifting, moving, positioning and transferring
techniques to ensure safety of patients, self and equipment.
SUB-AREAS
a. Demonstrate lifts, carries and transfers.
b. Position patient for optimum test results.
c. Make effective adjustments required on patients with Parkinson’s
disease, burns, seizures/collapse, orthopedics surgeries, etc.
d. Demonstrate proper lifting and movement techniques for various
types of equipment.
50
E Practice Skills and Techniques
MAIN AREA
4. Demonstrate special electrocardiographic techniques.
SUB-AREAS
a. Identify the objective for these procedures and state the techniques
used.
b. Understand the basic principles of vagal manoeuvres, such as
valsalva, diving reflex and Trendelenburg position.
c. Perform procedure for deep inspiration and expiration to differentiate
between diaphragmatic septal Q waves and significant Q waves in
the inferior leads and/or T waves.
d. Record additional leads (where applicable), right chest leads,
posterior leads, Lewis lead, Frank x, y, and z, etc.
e. Describe the basic principles and procedure of signal averaging.
f. Describe the basic principles of vector loops.
51
E Practice Skills and Techniques
MAIN AREA
5. Demonstrate ability to perform and/or assist in research project.
SUB-AREAS
a. Follow protocols and choose equipment required to gather and measure
data.
b. Describe ethics for working with human subjects.
c. Act as a knowledgeable resource person to provide information requested by colle
to other medical personnel.
d. Describe the basic fundamentals of applied research and some
common designs.
e. Read, analyze and interpret a research papers and reports.
f. Compile and interpret data using data collection and statistical
techniques.
52
E Practice Skills and Techniques
MAIN AREA
6. Demonstrate aseptic techniques.
SUB-AREAS
a. Demonstrate universal precautions, isolation and reverse isolation
techniques.
b. Demonstrate specific equipment protocols prior to entering isolation
or reverse isolation.
c. Demonstrate appropriate techniques and protocols when working in
areas such as isolation, neonatal, and burn units, etc.
d. Follow required sterile field and operating room protocols.
e. Demonstrate decontamination procedure and cleaning of affected
equipment and self. Be able to recognize general situations where
decontamination of equipment may be necessary without prior
knowledge of contamination i.e. body fluid, skin lesions, etc.
53
E Practice Skills and Techniques
MAIN AREA
7. Demonstrate basic computer skills.
SUB-AREAS
a. Demonstrate basic keyboard skills and enter data correctly and
completely.
b. Interface with the network and databases to review previous results,
information search, and change or verify data (where applicable),
etc.
c. Describe basic functions of hardware and software in a computer
system.
54
E Practice Skills and Techniques
MAIN AREA
8. Demonstrate proficiency in emergency life support.
SUB-AREAS
a. Describe common cardiac and/or respiratory arrest (code) policy and
procedures.
b. Assume your role in the response depending on your level of training
(BCLS/ACLS).
c. Identify hazards and complications to ensure safe procedure.
d. Assist in maintaining an airway, as directed, in an emergency situation.
e. Successfully complete training and provide documentation of annual
certification at BCLS level and, if required, at the ACLS level.
f. Understand the principles and techniques regarding defibrillation.
55
E Practice Skills and Techniques
MAIN AREA
9. Demonstrate proficiency in venipuncture.
SUB-AREAS
a. Ensure proper patient identification.
b. Explain procedure and requirements of the patient.
c. Practice universal precautions.
d. Select the correct vacutainer(s) and draw in the correct order.
e. Perform venipuncture as per institutional standards (where applicable).
f. Label samples.
56
F Patient Care
MAIN AREA
1. Demonstrate a professional bed-side manner.
SUB-AREAS
a. Introduce self and clearly explain procedure(s).
b. Provide reassurance and psychological support.
c. Answer questions and give appropriate response within realm of
expertise and professional limitations.
d. Establish a professional working relationship with patient and
patients family.
57
F Patient Care
MAIN AREA
2. Take an accurate and concise verbal and/or written patient history.
SUB-AREAS
a. Ensure patient identification and indication for the procedure or test.
b. Obtain patient’s cardiac history, such as history of arrhythmia,
myocardial infarction, identify cardiac risk factors, i.e. smoker,
family history, hyperlipidemia, etc.
c. Attain history of symptoms such as dyspnea, dizziness, chest pain,
edema, and follow up with questions as required for further
clarification.
d. Identify nature and type of chest pain to determine class of angina
(depending upon procedure requested).
e. Note recent changes in symptoms.
f. Obtain a list of medications currently taken and/or any recent
changes in medications or dosage.
g. Take general patient history, relevant medical history, such as
diabetes, asthma, hypertension and relevant past surgical procedures
i.e. coronary artery bypass graft (CABG), valve replacement, AV
node ablation, etc.
h. Assess relevant patient information with respect to the ordered
procedure and take appropriate action.
58
F Patient Care
MAIN AREA
3. Assess patient status.
SUB-AREAS
a. Observe and identify physical signs and symptoms to determine status,
such as edema, heart failure, skin colour and texture, mental alertness,
nail bed colouration and jugular venous pressure.
b. Perform blood pressure measurement (automatic and/or manual).
c. Weigh patient.
d. Auscultation of heart and breath sounds associated with various
conditions (where applicable).
e. Chart all findings accurately.
f. Notify physician if necessary.
g. Consult physician if patient fails to meet procedure testing criteria.
59
F Patient Care
MAIN AREA
4. Demonstrate appropriate skin preparation to ensure high quality
recording.
SUB-AREAS
a. Shave chest hair where necessary if not prohibited by ethnic or
religious beliefs.
b. Ensure skin is clean and dry.
c. Abrade if required.
d. Swab skin with alcohol (where applicable).
e. Apply sensors (using conduction gel where applicable).
f. Attach leads ensuring lead integrity.
60
F Patient Care
MAIN AREA
5. Demonstrate the ability to perform requested procedures on
patients requiring special care.
SUB-AREAS
a. Determine conditions and factors that may affect the ability to take
recordings such as burns, amputees, neonates, mastectomy and
autistic patients.
b. Select alternate electrode sites and use appropriate methods to obtain
recordings.
c. Chart alternate placement sites used (where necessary).
d. Be sensitive to patients’ needs and maintain professionalism to
ensure patient’s dignity.
e. Describe special requirements and procedures with respect to
patients with dressings, chest tubes, respirators, post-operative
conditions, contagious infection, etc.
f. Identify and follow professional guidelines and facility policy and
procedures regarding patient care including DNR (do not resuscitate)
and compassionate care only.
61
F Patient Care
MAIN AREA
6. Triage to set priorities and make decisions.
SUB-AREAS
a. Accurately assess patient’s condition noting level of distress.
b. Make decisions regarding which patients to treat or perform testing
on in relation to patient’s condition and/or information received from
other medical staff.
c. Take appropriate action and/or assist in situations which require
immediate response.
d. Accompany patient during transfer if required.
62
F Patient Care
MAIN AREA
7. Provide information and educate the patient.
SUB-AREAS
a. Ensure patient identification and establish a professional relationship.
b. Provide instruction and information regarding procedures and long-term
follow-up required.
c. State risks and benefits where applicable.
d. Educate patients’ so they can assess their condition and know when to
seek assistance.
e. Review important points and evaluate patient’s ability to comprehend
and comply with expectations.
63
G Knowledge
MAIN AREA
1. Demonstrate fluency in use and understanding of the medical
terminology required to communicate effectively.
SUB-AREAS
a. Interpret a full range of general medical terminology, abbreviations
and notations.
b. Effectively use a full range of medical terminology unique to the
cardiac specialty.
64
G Knowledge
MAIN AREA
2. Demonstrate a general level of knowledge of human anatomy and
physiology.
SUB-AREAS
a. Identify the different systems of the body.
b. Describe structures and functions of all major body systems with
particular emphasis on applications to cardiology.
65
G Knowledge
MAIN AREA
3. Demonstrate a thorough and detailed knowledge of cardiovascular
anatomy and physiology in the normal heart, and when the heart is
affected by pathological conditions.
SUB-AREAS
a. Identify and describe the structure and functions of heart and
circulatory system for adults, children and neonates.
b. Describe structures and functions of heart in embryology including
basic congenital heart defects.
c. Identify and describe commonly encountered cardiac structural
abnormalities and defects, including hemodynamics.
d. Describe the electrophysiology and hemodynamics of stimulation
and conduction.
e. Describe cellular function of myocardial and specialized cardiac
cells.
66
G Knowledge
MAIN AREA
4. Demonstrate basic knowledge of pharmacological agents.
SUB-AREAS
a. Describe the purpose of cardiovascular pharmacological agents.
b. List the classes of cardiovascular agents and some common drugs
within each class.
c. Describe the basic mechanisms of drugs and their effect(s) on the
action potential.
d. Identify drugs commonly used in treatment of cardiac emergencies
and describe their immediate effects.
e. Describe the most common side effects and major contraindications
of commonly used cardiovascular drugs.
f. Demonstrate the use of the Compendium of Pharmaceuticals and
Specialities (CPS).
67
G Knowledge
MAIN AREA
5. Demonstrate a fundamental knowledge of statistics applied in
health science.
SUB-AREAS
a. Follow appropriate statistical methods for various applications in
cardiology technology.
b. Accurately perform statistical calculations for required measurements
(i.e. BMI, nomograms, etc.)
c. Read and interpret commonly encountered statistics in cardiology.
68
G Knowledge
MAIN AREA
6. Demonstrate an applied knowledge of electrical circuits.
SUB-AREAS
a. Describe basic principles of electricity and simple circuits including
Ohm’s Law, strength duration curves, etc.
b. State the purpose and general guidelines for electrical safety.
c. Describe basic lead theory as it relates to electrocardiography.
d. Correlate lead theory to pacemaker lead position and function.
e. Have a general knowledge of the current theory and design of
pacemakers, ICD, loop recorders, etc.
69
G Knowledge
MAIN AREA
7. Demonstrate a general knowledge of other cardiac procedures.
SUB-AREAS
a. Identify other cardiac procedures not discussed previously in this
document. Include radiography, surgical procedures, MRI, nuclear
medicine, radiofrequency ablation, angioplasty, stents, pacemaker
lead extraction, etc. as they relate to cardiovascular assessment and
disease.
b. List the indications for each procedure.
c. Briefly describe each procedure and recognize the most common
benefits and complications.
70
H Communication
MAIN AREA
1. Demonstrate oral communication skills.
SUB-AREAS
a. Communicate clearly and effectively with patients, physicians, and
other health care personnel.
b. Use terms and language appropriate to the purpose and targeted
audience.
c. Identify possible communication problems and select methods to
improve and/or avoid any miscommunication.
71
H Communication
MAIN AREA
2.
Demonstrate effective written communication skills.
SUB-AREAS
a. Write clearly, effectively, concisely.
b. Use appropriate language and terminology.
c. Select the proper forms and formats for task such as requisitions and
consent forms.
d. Ensure charting is complete, accurate and concise.
e. Discuss and describe legal implications of written orders and
documents.
72
H Communication
MAIN AREA
3.
Demonstrate effective non-verbal communication skills.
SUB-AREAS
a. Use and interpret non-verbal forms of communication appropriately.
b. Describe the effects of non-verbal communication.
73
H Communication
MAIN AREA
4.
Demonstrate effective interpersonal skills.
SUB-AREAS
a. Appropriately use empathy to establish a professional relationship
and understanding with patients.
b. Show respect and ensure dignity of patients.
c. Show tolerance and patience when interacting with patients
experiencing stress and other emotions.
d. Demonstrate team work skills.
e. Recognize interpersonal conflict and assist in resolving.
f. Demonstrate cultural and gender sensitivity.
74
H Communication
MAIN AREA
5.
Provide in-service training and education for students and other
members of the health care team.
SUB-AREAS
a. Clarify learning objectives.
b. Select the best methods to use when instructing adult learners to
achieve learning outcomes.
c. Evaluate effectiveness of instruction.
75
H Communication
MAIN AREA
6.
Effectively operate within a complex organizational structure.
SUB-AREAS
a. Describe the structure and function of the organization and its
components.
b. Describe the roles and relationships of those involved in the health
care organization and delivery.
c. Identify and follow established lines of communication and
authority.
76