UPDATE ON CREDENTIALING of VASCULAR LABORATORY PERSONNEL

UPDATE ON CREDENTIALING of VASCULAR LABORATORY PERSONNEL R. Eugene Zierler, M.D. The D. E. Strandness, Jr. Vascular Laboratory University of Washington Medical Center Division of Vascular Surgery University of Washington, School of Medicine

DISCLOSURE INFORMATION R. Eugene Zierler, M.D. No relevant financial or commercial relationships Previously: RVT Exam Committee RPVI Exam Committee ARDMS Board of Directors Inteleos Board of Directors Past-President ICAVL

CREDENTIALING ORGANIZATIONS Vascular Laboratory Personnel American Registry for Diagnostic Medical Sonography (ARDMS) - RVT Alliance for Physician Certification and Advancement (APCA) RPVI* Cardiovascular Credentialing International (CCI) RVS, RPhS (peripheral venous testing only) American Registry of Radiologic Technologists (ARRT) - RT (VS) American Society of Neuroimaging (ASN) - Neurosonology (IC/EC cerebrovascular testing only) *Formerly under ARDMS

ARDMS American Registry for Diagnostic Medical Sonography Founded in 1975 to provide certification examinations in medical ultrasound A Peripheral Vascular Doppler examination was given from 1975-1982 Registered Vascular Technologist (RVT) examination first given in 1983 ARDMS has now certified over 35,000 vascular technologists

THE ARDMS RVT CREDENTIAL 4000 All RVTs 1983 2017 (October) 3500 3000 2500 2000 1500 1000 500 0 Total RVTs = 35,674

Sonographer RDMS RDCS RVT RMSKS Physician ARDMS Credentials Offered in 2013 Abdomen, Breast, Fetal Echo, Ob-Gyn, Pediatric Adult Echo, Pediatric Echo, Fetal Echo Vascular Technology Musculoskeletal Sonographer RPVI* Physicians Vascular Interpretation RMSK Musculoskeletal Sonography (RPVI China and others being developed) *First physician only ARDMS credential (2006)

Physician (MD) RVTs 1983 2017 (October) 140 THE ARDMS RVT CREDENTIAL 120 100 80 60 40 RPVI Exam? 20 0 Total MD-RVTs = 1,870

ARDMS RESTRUCTURE PROJECT 2013-2016 Perception of ARDMS as a sonographer credentialing organization was a barrier to continued expansion especially for physician credentials New Board and Council structure implemented in 2016 Main goals: Maintain the ARDMS brand for sonographers Create a new home for physicians credentialing Allow flexibility for credentialing other healthcare providers (nurses, PAs, nurse-midwives)

INTELEOS BOARD AND COUNCILS Parent organization for the ARDMS and APCA Councils Volunteer Board of Directors Provide governance and infrastructure for the Councils Psychometric services Strategic direction Fiduciary responsibilities Development of new assessment programs

INTELEOS A non-profit certification organization that delivers rigorous assessments and cultivates a global community of professionals dedicated to the highest standards in healthcare and patient safety. Introduced in January 2016 Parent company for the ARDMS and APCA Councils Volunteer Board of Directors Provide governance and infrastructure for the Councils Psychometric services Strategic direction Fiduciary responsibilities Development of new assessment programs

THE ARDMS COUNCIL Continues the 40-year ARDMS mission of certifying ultrasound professionals Focuses on sonographers as the core constituency Currently has 90,000 sonographer registrants Volunteer-led management of the sonographer credentials RDMS RDCS RVT RMSKS Assessment Oversight Teams (AOTs) and Working Groups

THE APCA COUNCIL Introduced in January 2016 Focuses on physicians as the core constituency Currently has 20,000 physician registrants Volunteer-led management of the physician credentials RPVI RMSK RPVI China Sonography Certifications Council for Certification in Cardiovascular Imaging (CCCVI) - CBNC, CBCCT Point of Care Ultrasound (POCUS Academy) Latin American US Certificate Program

THE APCA RPVI CREDENTIAL RPVI Registrants 2005 2017 (October) 800 700 726 600 524 602 500 400 300 200 Exam Released Jan 2006 Pilot Exam 142 144 154 190 223 283 323 468 407 100 49 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Total RPVIs = 4,235

THE APCA RPVI CREDENTIAL Specialties of 4,240 Successful Applicants Through October 2017 Specialty Number Cardiology 1,597* Vascular Surgery 1538 Not Available 405 Radiology 244 Other 207 Vascular Medicine 128* Internal Medicine 40 Int Radiology 52 Family Practice 16 Cardiac Surgery 13 *Total = 1,725

THE APCA RPVI CREDENTIAL No longer voluntary for vascular surgery trainees Starting in 2014 the RPVI credential is required by the Vascular Surgery Board of the American Board of Surgery for all applicants prior to taking the Vascular Surgery Certifying Exam This makes the RPVI a prerequisite for certification in Vascular Surgery

RPVI CHINA Vascular Ultrasound in China The Chinese RPVI Ultrasound in China is a medical specialty that includes diagnostic studies and ultrasound-guided procedures The Chinese Ultrasound Doctors Association (CUDA) was interested in the ARDMS RPVI credential since it was designed specifically for physicians The RPVI examination was given in Beijing in 2008 and 2012 as a pilot to assess interest (in English)

RPVI CHINA Vascular Ultrasound in China The Chinese RPVI Nov 2008 First pilot the ARDMS RPVI credential Educational conference

RPVI CHINA Vascular Ultrasound in China The Chinese RPVI Visited the Peking Army Hospital #301 >4000 beds 1200 ultrasound exams/day 200 vascular duplex exams/day

MEDICAL SONOGRAPHY Vascular Ultrasound in China The Chinese RPVI May 2012 Second pilot the ARDMS RPVI credential Another Educational conference

RPVI CHINA Vascular Ultrasound in China The Chinese RPVI 57 Chinese ultrasound doctors took the RPVI pilot exam Pass rate 51% (>90% in US) They had particular difficulty with arterial physiologic testing because they don t do it

Vascular Ultrasound in China The Chinese RPVI CUDA respects ARDMS credentials but wanted a Chinese version of the RPVI that reflects their language and unique scope of practice RPVI CHINA This resulted in a joint venture between CUDA, ARDMS, and Pearson-Vue testing centers to develop a Chinese RPVI exam Item-Writing in China

RPVI CHINA Vascular Ultrasound in China The Chinese RPVI Exam given starting in 2014 Year Total Exams Passed (%) Failed 2014 60 39 (65%) 21 2015 20 16 (80%) 4 2016 341 233 (68%) 108 2017 102 Not available

NEW CREDENTIALS (CERTIFICATES) APCA POCUS Academy (Launched May 1, 2017) First 10 Certificates

NEW CREDENTIALS (CERTIFICATES) APCA POCUS Academy (Launched May 1, 2017) 1069 Total enrollments 752 Clinical certificate enrollments 236 EM certificate enrollments 81 Fundamentals enrollments 540 Total certificates issued

NEW CREDENTIALS (CERTIFICATES) APCA POCUS Academy (Launched May 1, 2017) 140 120 100 80 60 40 20 0 In Progress Certificates Issued No Certificate Awarded

NEW CREDENTIALS (CERTIFICATES) Coming Soon and Under Development Midwife Sonography Certificate Cardiovascular Magnetic Resonance (CMR) New POCUS Academy certificates Needle Guidance (US-guided procedures) MSK (soft tissue, upper extremity, lower extremity Pediatrics (basic, neonatal procedural) Eligibility for POCUS Academy will be extended to advanced practice providers (NP, PA)

UPDATE ON CREDENTIALING What Does All This Mean To You? Sonographer (RVT) ARDMS will continue to be your certification organization No change (website, phone numbers) Physician (RPVI) APCA is now your certification organization All functions will transition from ARDMS to APCA Other Providers and Assessments POCUS Academy, Midwife Sonography, etc.

MEDICAL SONOGRAPHY Vascular Ultrasound in China The Chinese RPVI Educational conference Talks on Renal Duplex and Physiologic Testing (?)

MEDICAL SONOGRAPHY Vascular Ultrasound in China The Chinese RPVI Another Educational conference Duplex Follow-up of EVAR

MEDICAL SONOGRAPHY Vascular Ultrasound in China The Chinese RPVI A Lesson in International vs. Global Certification Taking the English version of the ARDMS RPVI to China makes it International Making a true Chinese RPVI that reflects their language and unique scope of practice makes it Global On track for roll-out in 2015