A Start to Finish Guide for Success in Hiring, Orienting and Precepting in the Cardiac Cath Lab – (2 of 3)

Tips & Tricks
October 25, 2022 by Douglas Langager

Five Methods for Great Teaching Strategies

This series of articles is published with permission from Douglas Langager.  Doug graduated from the Navy’s cardiopulmonary program in Bethesda, Maryland, in 1975. From 1983-1988, the cardiac catheterization program at Brooke Army Medical Center, Fort Sam Houston, Texas, was under his care. After retiring from the Army, he worked as both a supervisor and staff educator at Providence Hospital in Portland, Oregon, and University Hospital in Augusta, Georgia. Mr. Langager then worked at Berkeley Medical Center in Martinsburg, West Virginia, and recently retired from patient care.  He continues an active relationship with the cardiovascular community through education and thought leadership.

This article is the second in a series of three articles by Doug that will discuss cardiac cath lab hiring, orientation, and precepting from start to finish.  Originally published in Cath Lab Digest in 2006 and 2019.

Five Methods for Great Teaching Strategies

  1. Chunking: organizing information in meaningful units
  2. Rote rehearsal: repeating information or skill many times
  3. Elaborative rehearsal: immersing information in meaning or highlighting its relevance
  4. Pattern recognition: identifying familiar patterns
  5. Emotional involvement: embedding information with feelings or emotions.1

Training Methods

The following concepts are taken from Strategies for Great Teaching, by Mark Reardon and Seth Derner, which discusses several valuable approaches to teaching. The Hole-in-One Moment couples mental imaging with a few practice swings to increase success. Learners mentally prepare to perform a new skill. First, they visualize the step or process. Next, they take a few practice swings. Finally, they take a shot (i.e., perform the step or process). Another helpful method is called The Fred Astaire. Mr. Astaire worked out, rehearsed, and put together his dance routine increment by increment. The secret to creating his routines was fitting together the step sequences, initially broken down into manageable parts. Individual tasks must be learned in pieces. Once learned, each of the steps, now strung together, becomes magic on the screen. In the cardiac cath lab, individuals learn tasks that support the cardiac catheterization procedure. We organize a learning pathway, setting a course that typically takes three months to complete.

Example Learning Situations

Sterile Technique. When I scrub, I first become aware of the steps and standards of surgical scrub. Donning a gown and gloves, and draping the patient both pose a high risk of an inadvertent break in sterile technique. I exaggerate my actions, keeping my distance from potential sources of contamination. I frequently challenge new employees on this process. I will tell them they contaminated themselves. If the new employee was focused on what he or she was doing, they will know their technique was flawless. If they have doubt or hesitation, they will head back to the sink and start over. Once they become confident in their processes and procedures, they will look me in the eye and know with confidence that I am pulling their proverbial chain.

Seldinger Technique. New trainees also focus on learning the Seldinger technique. I have them write the sequence of the steps many times.

  1.  Obtain arterial or venous access 
  2. Physician protocol: Introducing a JL4 catheter. Take pictures. 
  3. Catheter exchange to a JR4, more pictures. 
  4. Catheter exchange for a pigtail catheter.

This process is universal. These simple activities by the scrub tech and physician provide unique markers in time during a procedure. The circulator and the monitoring person can anticipate and queue their tasks off these steps.

Organizing for Speed. Setting up the procedure table has its own training demands. The preparation sequence focus moves from table organization to developing on-call speed. Emergency cases place a demand on safety and efficiency. If all the steps are done correctly, there is no wasted motion. Prioritization is crucial as you work against time to open a closed artery. Important tasks include immediate draping of the patient, drawing up of lidocaine, and having the 18-gauge thin-walled needle with flush available for the physician. Then, flushing the guide wire, place up on the field do the same to the introducer set. As you are watching through the eyes in the back of your head, the manifold and transducer are flushed. Maybe the physician has gotten arterial access, and your assistance must be directed back to those Seldinger steps.

When you are there, it is like watching a well-rehearsed dance. Three important things to remember:

  1. A good team has a script and everyone is on the same page. New employees focus on each element of the procedure, but with their preceptor, should take it from the beginning and perfect the steps so that eventually each step can be performed at on-call speed. After a procedure, ask trainees to critique themselves and answer any questions that they may have. Reassure them of the process. Get them back into another procedure; they will improve.
  2. It is very common that when training new employees in other areas of the job, their focus is on the newest task and they lose much that was learned earlier. Very little falling off of trained skill and information occurs.
  3. As a team, ALL our activity is supported. Anticipating the next move keeps the team focused on patient care. Just remember, as a preceptor, you need to help others get to this same point. Keep focused on the priorities. Let’s break the sink-or-swim orientation trend. As a physician at our facility once said, If you don’t fix the problem, you still have a problem.

Create a Fair Playing Field

The new team member’s first impressions set the stage for success; even the fundamentals need a proper setup. The entire orientation process is about safety, efficiency, and effectiveness. Whether you are operating as a preceptor or a new employee in the process of developing skills, orientation has numerous requirements that need to be appropriately prioritized. Training of the new hire typically falls third on the list of priorities in the lab. The list goes as follows:

  1. Patient needs
  2. Physician needs
  3. Needs of the trainee

The patient may be very sick and require the full attention of the staff. This makes it even more important to have expectations for new hires set from the start. Prioritization of tasks needs to be discussed so the new team member does not feel slighted, snubbed, or inadequate. Ensure that all the players understand the rules, level the field, and ensure comfort for all parties. As with any new experience, transition leaves new employees, preceptors, and physicians with mixed feelings. Lack of comfort can leave the new hire feeling totally overwhelmed. Often feelings of ineptitude follow a stressful case. These issues typically occur when expectations have not been set in such a fast-paced work environment. We are continually working with new people, learning procedures, and dealing with the idiosyncrasies of physicians and coworkers, all of which makes it even more critical for preceptors to be clear and concise on prioritization. These issues should be discussed up-front with the physicians, trainees, and coworkers to ensure comfort for all parties. This will create a team atmosphere that will help the trainee feel more accepted and comfortable.


Next in a series of “A Start to Finish Guide for Success in Hiring, Orienting and Precepting in the Cardiac Cath Lab”

Personal Attributes and Personalities that make up every Cath Lab