Fast-track training of nonelectrophysiologists to implant defibrillators: is it needed?

Standard training pathways in cardiac electrophysiology are being short-circuited for a "fast-track" approach to train nonelectrophysiologists (not necessarily cardiologists) to implant defibrillators in patients. This approach has been undertaken by a professional society (The Heart Rhythm Society), a society that cannot police, or properly credential. They have support from the American College of Cardiology and, perhaps, even the Combined Medicare and Medicaid Services. This issue is particularly disturbing as there are no data to support the approach taken with regard to the safety and benefit for patients. This process disrupts the standard training pathways and will have long-term implications for the field of clinical cardiac electrophysiology and for the availability of highly trained individuals qualified to implant defibrillators. This issue has broad implications with regard to medical training pathways. We discuss these issues in detail and provide the results of two surveys, including a survey from members of the Heart Rhythm Society, most of whom disagree with the "fast-track" approach. A survey of cardiologist faculty members of the American College of Cardiology yielded similar results. We are particularly concerned about the disruption of training pathways in medicine and how this can affect patient care and can influence established training pathways in medicine.