1.3 Examination Matrix & Study Plan

1.3 Examination Matrix & Study Plan

Quick Answer: CCI's current RCIS examination matrix weights are Pre-Procedural 8%, Diagnostic 40%, Interventional 34%, Emergency 13%, and Post-Procedural 5%. Build study time in proportion to those weights—roughly three of every four hours on Diagnostic + Interventional topics. Source: CCI RCIS Examination Matrix and Task List.

Passing RCIS is not about reading one textbook cover to cover. It is about task-weighted competence—the same distribution CCI uses to build the 150 scored items. This section converts the official matrix into a 200-hour sample plan (adjust up or down based on your baseline), connects each domain to high-yield tasks, and shows how to iterate with practice exams.

The Five Domains (Current CCI Weights)

Visual Weight Distribution

Diagnostic     ████████████████████████████████████████  40%
Interventional ██████████████████████████████████          34%
Emergency      █████████████                             13%
Pre-Procedural ████████                                   8%
Post-Procedural █████                                     5%

Teaching point: Pre-procedure (8%) and post-procedure (5%) feel like "small" domains, but items often integrate knowledge from larger domains—Universal Protocol, ACT targets, and closure devices bridge pre, intra, and post. Do not skip them; just right-size time.

Map Tasks to Study Modules

A. Pre-Procedural (8%) — ~16 hours in a 200-hour plan

Tasks include preparing procedure/control rooms (equipment, radiation, sterile technique, QC/QA), preparing patients and personnel, and validating records (H&P, labs, consent, time-out, patient status).

Study focus:

• Sterile table setup, cap/mask/gown rules, contrast warmer checks.
• Universal Protocol elements and timeout documentation.
• Pre-procedure labs (Cr/eGFR, INR, platelets, potassium) affecting contrast and access.
• Radiation equipment QC basics tied to ALARA prep.

B. Diagnostic (40%) — ~80 hours

This is the backbone of RCIS. Tasks span monitoring vitals and waveforms, left/right heart cath, 12-lead ECG interpretation, intracardiac and intravascular imaging, FFR/iFR, radiation safety during acquisition, angiographic setup/interpretation, pharmacologic anticipation, and vascular access (femoral, radial, brachial, jugular, ultrasound-guided).

Study focus:

• Waveforms: RA, RV, PA, PCWP, LV; tamponade, constriction, valve disease patterns.
• Calculations: Fick and thermodilution CO, valve areas (Gorlin), shunt runs, SVR/PAWP interpretation.
• Coronary anatomy and standard projections (LAO/RAO cranial/caudal uses).
• Radiation: time-distance-shielding, collimation, dose metrics, staff monitoring.
• Pharmacology: heparin/ACT, antiplatelets, vasopressors, reversal agents, contrast reactions.

C. Interventional (34%) — ~68 hours

Tasks include device implants (pacemaker/ICD/CRT/loop recorders), coronary and complex PCI (CTO, atherectomy), peripherals and carotid/critical limb cases, mechanical circulatory support, temporary pacing, pericardiocentesis, thrombectomy, distal protection, structural therapies (ASD/PFO/LAA), and valve interventions (valvuloplasty, TAVR, leak closure).

Study focus:

• Stent/balloon selection basics, deployment troubleshooting, no-reflow and perforation recognition.
• Structural: TAVR access routes, pre/post imaging checkpoints; LAA closure devices.
• MCS: IABP timing, Impella/ECMO cannulation support roles.
• Large-bore access and closure device families (suture, plug, compression).

D. Emergency (13%) — ~26 hours

Tasks cover emergency presentations (STEMI, cardiogenic shock, pulmonary edema, stroke) and intraprocedural complications (coronary perforation/no-reflow; peripheral/structural dissection, embolism, device migration), plus maintaining emergency equipment (defibrillator, crash cart, suction, airway tools).

Study focus:

• ACLS algorithms adapted to cath lab (air embolism, contrast anaphylaxis, tamponade).
• Complication kits: covered stents, coils, fat embolism protocols, stroke activation.
• When to call for surgery versus continue percutaneous management.

E. Post-Procedural (5%) — ~10 hours

Tasks: arterial/venous hemostasis, access-site complication management, patient education, reporting, transfer of care.

Study focus:

• Radial vs femoral hemostasis (TR band, DSTAT, manual hold, closure devices).
• Recognition of retroperitoneal bleed, pseudoaneurysm, AV fistula, compartment syndrome.
• Discharge instructions, hydration, contrast-induced nephropathy counseling, activity restrictions.

Proportional Study-Time Calculator

Use this formula: Domain hours = Total plan hours × Domain %.

Most successful candidates land 120–200 hours over 12–20 weeks while working full time—front-load Diagnostic, overlap Interventional labs with PCI chapters, and schedule timed 170-item sets in the final month.

16-Week Sample Schedule (200 Hours)

Within each week, split time 60% reading/video, 40% questions—RCIS rewards applied recognition (waveforms, cine loops, drug scenarios) over passive highlighting.

Cross-Cutting Knowledge List

CCI publishes a Knowledge List that spans domains: mathematics (shunts, valve orifice area), medical terminology, anatomy/pathophysiology, regulatory standards, patient assessment, lab values, ECG, pharmacology, hemodynamic waveforms, imaging (angiography, IVUS, ICE, radiation equipment), sterile technique, procedural indications/contraindications/complications, hemostasis, and emergency equipment. Expect calculation and pharmacology items in Diagnostic even when the stem describes an interventional case.

Practice Validation Loop

1. Baseline: CCI Self-Assessment Exam (paid)—matrix-weighted performance profile by content area.
2. Weekly: Untimed domain quizzes from this study guide; log missed tasks, not just facts.
3. Monthly: Timed mixed sets (~50 items) with 2:50 pacing discipline.
4. Final two weeks: Two full 170-item, 2-hour-50-minute simulations; review every incorrect and "lucky guess" item.
5. Red flag: If Self-Assessment or practice sets show Diagnostic or Interventional areas below ~65% correct, delay scheduling—even if Pre/Post feel easy.

Study Resources (CCI-Aligned)

CCI suggests texts such as Grossman and Baim's Cardiac Catheterization, The Cardiac Catheterization Handbook (Kern), Hemodynamic Monitoring (Darovic), and Invasive Cardiology: A Manual for Cath Lab Personnel (Watson/Gorski). No single book covers the full matrix; use Diagnostic + Interventional chapters as the spine.

Execution Principles

• Weight your calendar like CCI weights the exam—do not spend week three on post-procedure bandaging while waveforms remain shaky.
• Integrate tasks—a question on radial hemostasis may test Post domain knowledge with Pre-procedure patient selection context.
• Simulate innovation item types—practice labeling coronary segments on still frames and multi-select pharmacology questions.
• Track hours by domain in a simple spreadsheet; rebalance every two weeks.

When exam day arrives, the matrix becomes muscle memory: you will have spent ~74% of prep where CCI spends ~74% of scored items—Diagnostic and Interventional cath lab practice, supported by emergency readiness and bookended pre/post procedure safety.