EP Education

Order and Disorder EP Training Program: Twenty Years and Counting

Linda Moulton, RN, MS
Owner, Critical Care ED and C.C.E. Consulting
Faculty, Order and Disorder Electrophysiology Training Program
New Berlin, Illinois

Linda Moulton, RN, MS
Owner, Critical Care ED and C.C.E. Consulting
Faculty, Order and Disorder Electrophysiology Training Program
New Berlin, Illinois

For the last 20 years, we have enjoyed presenting educational content to thousands of EP professionals. Our hope is that we’re making a positive contribution to the specialty. Here is the story of the Order and Disorder EP Training Program, past and present.


The 1990s brought a new specialty into large city hospitals and many community hospitals: cardiac electrophysiology. As fellowship programs sent new electrophysiologists out into the world, hospitals had to step up to the plate and provide equipment and trained staff. Staff in the hospitals found that they needed a whole new group of skills and a different type of knowledge. The creation of the Order and Disorder EP Training Program was an attempt to meet that need.

In 1991, Dr. Kriegh Moulton started an EP practice with Prairie Cardiovascular Consultants in Springfield, Illinois. Dr. Moulton had completed a cardiac electrophysiology fellowship at the University of Oklahoma Health Sciences Center, and had vast experience in the realms of research, writing, and teaching.

I became a cardiac educator at a Springfield hospital in 1993. My background had included that of critical care manager, educator, clinical specialist, and clinical instructor. I had taught staff members in various hospitals about cardiac arrhythmias since the 1970s. I had also started an independent education business in 1991 called Critical Care ED/C.C.E. Consulting, and held educational conferences covering arrhythmias, 12-lead EKGs, pacemakers, and overviews of cardiac electrophysiology. 

In 1993, we began to offer a series of educational programs that incorporated all of these topics to our hospital staff. We advertised our course to EP programs statewide and soon had a following. The need was great, as hospital EP programs were expanding and new programs were being developed, and there was only a paucity of offerings for EP professionals at the time. In 1996, we decided to begin teaching nationally. We developed a national hospital mailing list and began marketing our program. Our first course was in northern Indiana, and the next was in Los Angeles.

Importance and Philosophy of Education

We have always felt that education of hospital staff was crucial and that it benefited all parties. The process of learning involves laying down some ground level concepts and then building on those. It is not just a quick inservice and back to work — we repeat and expand, and hopefully the material is reinforced with the student at their workplace. I always tell attendees that in our program we try to teach, not just tell, and fill in theory gaps that exist in the clinical setting.

Staff education has been a passion for most of my career. I have worked in various critical care staff development positions, and have observed that for most staff members, there was a positive correlation between the education provided and retention. Employees who know more tend to stay longer, which results in less frequent employee turnover. More education can also lead to greater efficiency, better patient care, and quicker case turnaround time in the lab — all of which makes financial sense to hospitals.

We attend many medical meetings and take note of the agendas of major programs being offered across the country. However, the majority of programs are aimed specifically at a physician audience. We often hear about newer staff being sent to these programs and finding the experience to be overwhelming. Therefore, one of our goals is to help prepare staff with the knowledge they need to be able to attend and understand the content of such meetings, to feel that they have gotten the most out of the experience. 

Where Do We Teach?

Our programs have been presented in most major cities and are often located in airline hubs, to make it easier and less costly for attendees. In addition, we try to pick hotels for the programs that are located close to the airport and that have airport shuttles, in order to eliminate the need for cab fares.

We have presented our programs at many individual hospitals and have partnered with them to market the program to others in the area, helping to decrease cost overhead. In addition, we have presented programs for industry employees as prep courses for exams and as new employee training.

The programs are offered 3-4 times per year in different regions of the country. We present material at different levels, aiming to attract different groups based on knowledge and experience. For example, we have presented programs to cardiac and EP fellows. We introduced heart dissection into our programs early on. We have also presented device-only courses.

Current Classes

Current offerings include a Basics course and Beyond the Basics course. Our Basics class is two days in length, and designed for those who are brand new to EP or have been in EP for less than six months. (However, more experienced staff interested in a review can also attend this course.) The first day includes an introduction to EP-related anatomy and physiology, the basics of electrophysiology, an overview of arrhythmias, introduction to the 12-lead EKG, axis and bundle branch block, and wide and narrow QRS tachycardias. This material provides a preparation for the more complex concepts introduced on day 2. The second day is taught by Dr. Moulton, who talks in greater depth about anatomy, physiology, and EP principles. He also discusses fluoroscopy, reviews the components of an EP study, covers syncope, and goes over practice tracings.

Beyond the Basics is a three-day program ideal for those with at least six months of experience. This advanced-level course builds on the material covered in the Basics program. On the first day, I review mechanisms of arrhythmias, antiarrhythmic drugs and ablation concepts, bradycardias and device indications, and supraventricular tachycardias. The focus is on defining the problem, assessing rhythm strips and 12-lead EKGs, and reviewing treatment options. Dr. Moulton teaches day 2 beginning with an in-depth review of anatomy, followed by a dissection lab. The anatomy theme is then carried on to fluoroscopic anatomic and electroanatomic mapping. A review of the basic EP study is then presented, and the day finishes with various types of EP cases and tips.

Day 3 begins with my teaching an overview of ventricular arrhythmia disorders, their differentiation, assessment, treatment options, and device guidelines. Dr. Moulton completes the course with more clinical cases.

Beyond the Basics is ever-changing. We try to incorporate all the new theories and techniques, distilling current EP trends, practice guidelines, and journal material so they are more digestible for the EP professional. We have had many nurse practitioners attend this course. This course will be offered again in February.

Why Do People Attend?

Our attendees come for a variety of reasons. For example, they may be from startup labs or new lab employees, preparing for exams, wanting a refresher or continuing education credits, or new hires in industry. One of my favorite things is that we often see people who attended 10 years ago or more, and are back for a review. It is always wonderful to see them. 

Our programs provide excellent networking opportunities. We teach in a small, classroom-type setting and participants have the opportunity to get to know each other and have lunch together. Often this is the first time they have met anyone from an EP program other than the one at their hospital. We all share what’s going on in different areas of the country and learn from one another.

Our programs are approved for nursing contact hours and ASRT contact hours. Many of the electrophysiology programs that Dr. Moulton and I attend do not offer credits to nurses and radiology techs. We believe it is important that EP professionals have access to approved programs to meet the requirements for their specialty certifications and licensure renewals.

New Self-Study Development

Through the years we have spoken to people who want to attend our programs but do not have the money or time, the hospital cannot send, or the location is too far away. In order to respond to this, we are in the process of converting the material from the Basics to a self-study format. This program can be used to help train new hospital employees, and can be a more cost-effective and flexible way to train. Individuals with no medical background or who are new to industry may also find this beneficial.

The first part of the self-study material is newly available as of September 2016 and will include day 1 of the Basics program. It will initially be approved for RN contact hours, but will also be submitted to the American Society for Radiologic Technology (ASRT) for radiology technologist credits. Day 2 of the Basics program will follow later this fall. Our goal is to convert the entire program and then periodically provide updated self-study courses for credits.

For more information, please visit www.orderanddisorder.com for current course availability and information about our course books.