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1. Certification - General
2. Logbook - Who can sign it off?
3. Logbook - Evidence
4. Logbook - Implant Case Studies
5. Logbook - Miscellaneous
Certification - General
1. Is there a fee for BHRS Certification?
Yes, there is only one fee, which is for the written paper exam.
• If you have previously failed the written paper overall (both sections), you will need to re-register and pay in full.
• If you partially failed (passed one section and failed the other) the written paper last year, you can re-register for free as a re-sit candidate. However if you have partially failed more than once, you will need to re-register and pay in full.
2. When and where does the exam take place?
The exam usually takes place on the 3rd Friday in March, unless it clashes with Easter. The exam centres are: Belfast, Leeds and London. You are unable to sit the exam remotely.
3. How do I register for the exam and logbook?
Registration for the exam is online via the BHRS website and opens early December. You will need to notify BHRS you wish to commence your logbook via email.
4. How long do I have to complete the exam and logbook?
You have 2 years from the date you receive confirmation from BHRS that your registration to commence your logbook has been accepted.
5. Can I notify BHRS I wish to commence my logbook after I have sat the exam?
No. You will need to notify BHRS you wish to commence your logbook before exam registration closes. If you don't, your logbook start date will default to the exam registration closing date. For example, for 2015 exam candidates, exam registration closed on Friday 20 February. Therefore all 2015 exam candidates need to have informed BHRS they wish to start their logbook before Friday 20 February. Notifications after this date will not be accepted and your logbook start date will default to Friday 20 February.
6. Does it matter at what point I sit the exam during the 2 year logbook period?
Yes. You may sit the exam in the 1st or 2nd year however if you sit the exam in the 2nd year and fail you will not have enough time to re-sit and will need to re-register for your logbook again. It is therefore strongly recommended that all candidates sit the exam at the 1st available sitting after they have notified BHRS in writing that they wish to commence their logbook. You should start collecting evidence for your logbook as soon as you’ve received confirmation of your logbook registration and NOT after you have passed the written exam.
7. The exam paper consists of four sections: Core, Devices, EP and Clinical? Can I just complete one section?
All candidates have to complete the Core questions plus one of the specialist sections – Devices, EP or Clincial. However if you passed both sections in 2013 and subsequent years, you are eligible to register for the exam to sit the remaining specialist section. If you passed both sections before 2013, you will have to register for the full exam – Core plus the remaining specialist section.
8. If I sit the Devices, EP or Clincial specialist section as a standalone exam, am I also required to complete a new logbook to gain BHRS Certification?
Yes. If you are sitting a standalone specialist section you need to then complete the relative logbook to gain your certification.
9. Do BHRS run a course for the exam?
A course covering the Core part of the exam is held during Heart Rhythm Congress, usually on the Sunday and costs £70 to attend. Other sections of the exam are incorporated into the scientific sessions of the congress.
10. When can I start collecting cases for my logbook?
You can start collecting cases from the date you receive confirmation from BHRS that your logbook registration request has been accepted. All candidates must notify BHRS in writing they wish to commence their logbook. Any work carried out before this date is invalid.
11. How long does it take for my logbook to be marked and when can I expect to receive the results?
Allow for a minimum of 12 weeks; the duration depends on the individual marker’s workload.
If you are concerned over the timescale and/or wish to enquire about the marking progress, please get in contact firstname.lastname@example.org and the marker can be contacted on your behalf for an update.
12. Is it possible to receive an extension for my logbook and who should I contact?
Requests for logbook extensions must be submitted in writing to email@example.com giving full reasons why an extension is being sought. Please note: only one extension request will be awarded and extension requests require clear mitigating circumstances (e.g. ill-health, pregnancy) and not simply failure to achieve cases. Requests are considered on a case by case basis by the Certification Committee.
All logbook extension requests need to be received prior to the logbook submission deadline.
13. I work within the device industry can I get BHRS Certification?
Yes, we run industry certification. You can get an EP or Devices (industry) certification by passing the exam however you not need to complete the logbook component.
14. What do I need to do in order to ensure I keep up my BHRS Certification? i.e. how many courses; how many CPD points etc.
BHRS Certification currently lasts 10 years then the written exam needs to be re-sat. The logbook does not need to be completed. You must also remain a member of the British Heart Rhythm Society.
In the meantime, if there are any relevant courses out there you feel that you ought to attend, you should attend them when possible for your own personal and professional development and keep up to date with the latest information/technologies etc.
15. I’ve noted that in order to remain certified, you need to remain a member of BHRS; I have not maintained my annual BHRS membership - can I renew my subscription to BHRS?
Yes, you can renew your subscription by submitting an updated membership form. You cannot re-certify if you are not a member.
16. Is BHRS Certification recognised at Masters' level?
Yes, the School of Health and Social Care at Teesside University has agreed to recognise the British Heart Rhythm Society (BHRS) Certification. Candidates who successfully complete the BHRS Certificate will be able to gain exemption from the module ‘Arrhythmia Management’ (AHH4002-N) at Teesside University (30 credits at Masters Level) and thus transfer these credits into the following programmes:
- MSc Advanced Clinical Practice
- MSc Nursing
- PG Dip Surgical Care Practitioner
This exemption applies to all candidates who have successfully received BHRS Certification since 2008 (candidates must have passed both the exam and logbook). This also only applies to candidates who have received Certification for the first time, not candidates who have Re-certified.
Applications for Recognition of Prior Learning (RPL) for other postgraduate programmes at Teesside University will be considered where appropriate. Other universities may consider these academic credits for RPL experience purposes upon application.
To apply, please contact the programme lead for the MSc Advanced Clinical Practice or MSc Nursing via the School of Health Switch board on 01642 384 100.
17. Does obtaining BHRS Certification allow me to included post-nominal letters following my name?
Post-nominal letters, also called post-nominal initials or post-nominal titles, are letters placed after the name of a person to indicate that the individual holds a position, educational degree, accreditation, office, or honour.
Following successful completion of BHRS accreditation no post nominal is awarded (although the committee is aware that numerous individuals use unofficial post nominal letters).
Logbook - Who can sign it off?
1. Who is suitable to sign paperwork as a supervisor? What requirements are necessary for a colleague to sign, act as supervisor?
You must obtain verification of the information and completion of the assessment sections from your supervisor, who must be experienced in device management and ideally hold BHRS certification (previously Heart Rhythm UK certificate of certification) or the IBHRE qualification (pacing and devices) or the EHRA CP/AP qualifications. Medical device company representatives will not be accepted as supervisors.
2. I have a query about the person signing off my cases in my logbook. For all my pacemaker cases this is not a problem as we have someone with IBHRE here at [X hospital]. However, for my ICD and CRT cases I am going to other hospitals. At [X] they have no-one with either BHRS or IBHRE. I have now completed my ICD/CRT Follow ups at [X], and currently [X colleague] has initialled them for me. They have a great deal of device experience. Is this satisfactory, or do you want their consultant to countersign it, they were also present during the checks?
Essentially, the countersigning person should be experienced and competent enough to form an accurate and fair assessment on you. If they have BHRS or IBHRE Certification even better, but we appreciate that not everyone will have this. If it is not too much of a problem, get the consultant to counter initial as well. When you finally submit your logbook, at the start, enclose a cover letter and mention who the supervisors were; this is where you could mention [X consultant] also countersigned my logbook.
3. My logbook has been signed in part by a supervisor who has recently left the job and so I now have a few sections that need signing and I am unable to get hold of them to sign it off. Therefore is it acceptable for two supervisors to sign off my logbook?
This is acceptable as long as both supervisors are BHRS or IBHRE accredited/a senior member of staff who has the necessary experience. When you return your logbook, it would be worthwhile mentioning in a short covering letter that you’ve had to use two supervisors.
4. Is it admissible for a consultant cardiologist who takes the lead in devices to sign the log books? We have no one in the department with IBHRE or BHRS certification.
Yes, a consultant cardiologist can sign your logbook.
7. I am doing some of the implant work at [X] as I work at [X hospital] and we do not do ICD and CRT implants yet - can my logbook be signed off by more than one supervisor depending on who was assessing me at the time?
Yes, more than one supervisor can sign your logbook.
8. Does it matter what date order the work is done in? For example, do I have to complete the initial implant logs before doing the case studies or does it not matter?
It does not matter what date order the work is done in.
Logbook - Evidence
1. The printouts which need attaching to the individual case studies - can these be photocopies or do I have to use the original patient printouts?
The printouts can be photocopies but please ensure that the copy quality is clear enough to read, otherwise use the originals.
Please note: the names of the patients must always be anonymised. If patients’ names and addresses are visible this is a breach of confidentiality - use patient hospital ID number instead.
2. With regards to the devices logbook and the section on pacemaker follow-up can you clarify what evidence is required in this section. Do you require countersigned evidence other than a signature on the logbook page that the follow-ups are done by the logbook holder? If so, what format? Does all evidence for this and other sections need to be the original printouts?
Yes, original printouts are required where it asks for them. For section two of the device logbook you only require a countersignature from your supervisor.
3. Do I need to include EGMs for the implant section for both Brady and tachy devices? And do I need to include a physician’s report with each implant for both the Brady and tachy implants?
The only section you need to supply additional info is the case studies section. Printouts from the analysers are sufficient for case studies. You do not need physician reports etc.
Logbook - Implant Case Studies
1. Can you verify whether the case studies and implants have to be different patients or whether they can be the same?
The patients need to be different.
I’m struggling with the ICD evidence collection for my logbook; I have collected a considerable amount of CRT-D devices but not many ICDs. I am still outstanding on my case studies. Would it be possible to use CRT-D for ICD case studies at all?
Yes, it is acceptable to use CRT-D in place of ICDs. It is a general rule that more complex devices outdo simpler devices, in the order CRT – ICD – pacemaker. Therefore you can use CRT-D as any ICD, you can use CRT-D box changes for ICD box changes, and CRTs/ICDs for pacemakers. The only rule is you can’t go the other way, so an ICD does not count as a CRT-D.
Can I include box changes and upgrades in the implants?
No, you cannot include box changes in the implants. If you upgrade a pacemaker to CRT, this can be included if needed.
Do the 30 pacemaker follow up checks have to come from the 30 implants or can they come from any patients from my follow up clinics?
No, the 30 follow up checks can be different patients and do not have to come from the 30 implants.
Under the section called amplitude is it the P and R wave size that you enter or is it the output amplitude? e.g. 1.5v etc.
It is the size of P and R waves, not output.
I’m a SpR and perform pacemaker implants and there are several people completing logbooks where I work therefore if I implant a pacemaker and count this as an implant, can someone else (e.g. clinical physiologist) involved in programming also use this as an implant? Similarly if I am using this as a case study can someone else count it as an implant? Also with the follow-up patients - can they be used by more than one person if we are both involved in their pacemaker check and programming at follow-up?
No, the logbook is clear that implants refer to the role of the physiologist. If a SpR is performing an implant this should be as a physiologist and they should be using the analyser/PSA to perform lead measurements; this is not possible if the operator is scrubbed.
The problem arises in terms of knowing who does what; it would be easy for one person to do all the work and then two people use different parts of the same case for different purposes. Therefore only one person can use any individual patient for a case.
Does each case study include data from the 1st follow up post discharge or is all data collected for pre-discharge period?
All data is from pre-discharge.
It mentions all case studies require a 12-lead ECG post procedure. As per our hospital protocol we do not routinely perform 12-lead ECGs post procedure, so this part of my case study will be incomplete. How can I satisfy the requirements of the logbook without this detail?
If this is a case study then you should be seeing the patient the day after the procedure or pre discharge (if day case) to do the necessary checks and as such should be able to get a 12 lead ECG.
In the case studies, the post implant check, should it be just after the implant or does it need to be a 6/52?
Post implant check would be same or next day.
With regards to the logbook ICD implants, must they all involve induction. We have 2 operators, one of which never seems to induce. Could my logbook represent this, or would you like all to have induction?
If the operator does not undertake DFT testing then the implant can still be used but they must document the reason why a DFT test was not done e.g. SIMPLE trial.
There are sections for three CRT case studies, do all three have to be CRT-D or could one be a CRT pacemaker only, as it isn’t stipulated in the logbook. There are several sections for ICD information so I was unsure whether they all had to be CRT patients.
The case studies can be CRT-P or -D but ideally at least one should be an ICD.
For the case studies section in the devices logbook where copies of previous investigations are required (for example Echo), do you need the actual printouts and images or can I include the written report as evidence?
A written report will be accepted.
If a patient has got a brady device in situ and is due to have an upgrade to CRT-P, is that acceptable to use for a case study if all the relevant checks for all leads are completed i.e. threshold?
Logbook - Miscellaneous
1. How large should my logbook be?
It is recommended that your logbook should not exceed one A4 lever-arch folder in size.
2. In the SpR device logbook, in the initial section labelled Pacemaker Implants, I presume this is implants in which you have acted in a physiologist/technician role rather than as a surgical operator?
Yes, the implants in which you have acted in a “physiologist” role rather than a surgical operator. The logbook clearly states “For doctors / allied health professionals completing the log you need to take on the role as a cardiac physiologist for ALL sections of the logbook”.
3. The hospital I’m attending to complete my logbook has asked if it is necessary for the implants and follow-ups to be spread out? Or whether it matters if they are all carried out in one day?
It does not matter if the implants and follow ups are carried out in one day or spread out, providing you do the work and are appropriately overseen and signed off by your supervisor.
4. Where it says implant aetiology code in the devices logbook, is there a standardised list as I can't see one at my hospital?
There is a standard list that can found on the pacemaker ID card / national device database.
5. I'm in the process of completing the physiologist logbook for devices and I have a query about the CRT checks. Our St Jude Medical CRTs are programmed to RV bipolar sense only at implant therefore we do not measure the LV R wave when doing checks. Is this a problem where our logbooks are concerned?
6. With regards to my logbook where it asks for the printout with implant measurements, does this mean the saved printout stating threshold, impedance, R & P wave and slew rate? Or am I required to include the EGM showing the threshold check?
The saved printout stating threshold, impedance, R & P wave and slew rate.