Authors: Zaky AF et al.
Cureus. 17(11): e98104, November 29, 2025. DOI: 10.7759/cureus.98104
Summary:
This study describes the expert validation of a structured curriculum and curricular map on cardiac implantable electronic devices (CIEDs) for cardiac anesthesia (CA) trainees. Despite rapidly increasing numbers of patients with pacemakers, ICDs, CRT devices, and leadless systems, there has been no formally validated, anesthesiology-focused CIED curriculum with clearly defined goals and learning objectives.
The authors designed a comprehensive curriculum aimed at CA fellows and anesthesiology residents rotating on cardiothoracic anesthesia. Initial development involved identifying broad content goals (15 core domains) based on textbooks and expert input, then generating specific learning objectives for each goal. Objectives covered electrophysiology fundamentals, CIED indications and modes, device components, hemodynamic effects of pacing, perioperative management and interrogation, and interactions with other technologies (electrocautery, LVADs, ECMO, etc.).
For validation, a national panel of 17 subject matter experts (SMEs) in CIEDs—electrophysiologists, general cardiologists, device representatives, and one anesthesiologist—completed a Qualtrics survey. They rated each objective on: importance (not important / important / essential), fit with its learning goal (does not fit / aligns), and clarity (unclear / clear). From these ratings, content validity ratios (CVR) for each objective and content validity indices (CVI) for each goal were calculated. “Stringent” CVRs counted only “essential” ratings; “modest” CVRs counted “important or essential.” CVIs >0.78 were considered evidence of good validity for a goal.
All 77 objectives were judged “important or essential” by at least 80% of raters, and over 80% of experts felt the objectives fit their stated goals. However, relatively few objectives met the strict “essential” threshold from ≥75% of experts. Some goals (e.g., understanding unique features and proprietary algorithms of specific vendors) had low stringent CVRs because SMEs felt these details were less critical for anesthesiologists given rapid device evolution and the availability of vendor reps at the point of care. In contrast, goals about core concepts—basic electrophysiology, pacemaker timing cycles, pacing modes, pacer malfunction/pseudomalfunction, and shared features across vendors—achieved stronger validity metrics.
Experts also flagged several objectives as unclear or too advanced for CA trainees (e.g., detailed vendor-specific upper rate behaviors, advanced mode-switching algorithms, and controversial topics like pacing for hypertrophic obstructive cardiomyopathy). Based on this feedback, the authors refined the curriculum: rewording or removing unclear objectives, downgrading advanced/vendor-specific content into an “advanced” curriculum track, and retaining the broad core goals that achieved high agreement as important or essential.
The study demonstrates that the proposed CIED curriculum is broadly acceptable and relevant to experts, while highlighting the need to distinguish between core, essential objectives and advanced or vendor-specific material. The authors are now piloting the refined curriculum through an app-based platform and plan further validation linking objectives to actual teaching materials, assessments, and learner outcomes.
What You Should Know
• There is a growing need for structured CIED education for cardiac anesthesia trainees, but until now no validated curriculum existed.
• A national panel of multidisciplinary CIED experts reviewed 15 goals and 77 objectives for importance, fit, and clarity.
• All objectives were rated “important or essential” by at least 80% of raters, but relatively few reached the strict “essential” threshold.
• Core topics (electrophysiology fundamentals, pacing modes, hemodynamic effects, malfunction recognition) received the strongest validation.
• Vendor-specific details (e.g., individual company algorithms, upper rate behaviors) were considered less essential for anesthesiologists and better suited to advanced or specialty-level training.
• Expert feedback led to refinement of objectives, removal of unclear or controversial items, and creation of an advanced track for more detailed content.
• Further work will test how well the curriculum improves trainee knowledge, usability, and alignment of content, teaching, and assessment.
Key Points
• This is the first formal content validation study of a dedicated CIED curriculum for cardiac anesthesia trainees.
• Expert review supports the curriculum’s overall relevance but differentiates truly essential objectives from merely important or advanced ones.
• Content validity ratios and indices (CVR/CVI) provide a structured framework for deciding which objectives stay in a core anesthesiology curriculum.
• Detailed, vendor-specific programming knowledge is generally not viewed as essential for CA trainees, whereas foundational pacing and perioperative management concepts are.
• The validated curriculum has been refined and is being piloted via an app, with future work focusing on learner outcomes and further iteration.
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