Division of Cardiology Fellowship Training Program by liaoqinmei


									                             Division of Cardiology, Fellowship Training Program
                         Maryland General Hospital Rotation – Consultative Cardiology
                                              Goals & Objectives

Educational Purpose:
To provide an opportunity for the fellow to learn the art and practice of consultative cardiology in a community based
hospital setting. The problems encountered in this setting will likely encompass a broad aspect of routine clinical
cardiology, and will allow the trainee to understand what hospital based cardiology practice is like outside of the
tertiary care center.

Specific Objectives
            A. To improve basic clinical skills as applied to a diverse array of cardiac
            B. To learn key guidelines and evidence based medical approaches to work-up
                  and treatment for an array of clinical cardiac problems.
            C. To improve skills in communicating with consulting physicians and with
                  patients as well as staff in a wide array of hospital settings.
            D. To experience community based hospital cardiac care, and develop an understanding of when
                 patients should be transferred for tertiary care and how local systems operate to facilitate this care,
                 as well as what systems are available for community based practice.

Teaching Methods:
Fellows will learn through a combination of teaching during rounds with an attending cardiologist, and through self-
study. Daily rounds will cover all patients in need of initial or follow-up evaluation. The patients will be seen and
examined by the attending in the company of the cardiology fellow as well as students and residents. All needed
cardiac studies and key lab reports will be reviewed in detail. Written reports will be prepared and will reflect the
careful assessment by the team. By demonstrating the “art” of writing an effective report, the attending will serve as
a model for the fellow trainee, illustrating how proper consideration of differential diagnosis and various treatment
options makes the consultation most effective. Global assessment, state of the art practice and appropriate
overview of numerous psychosocial factors as well as preventive aspects of cardiac care will be highlighted.

         Focused areas for Study
       a) Peri-operative Cardiac Assessment: prior to major non-cardiac surgery
       b) Chest pain evaluation
       c) Stress testing
       d) Interpretation of complex ECG’s and arrhythmias
       e) Approach to ventricular ectopy
       f) Approach to evaluation and treatment of atrial fibrillation and atrial flutter
       g) Valvular heart disease and focus on analyzing murmurs and infective endocarditis
       h) Coronary risk factor analysis and preventive cardiology (focus on diabetes)
       i) Clinical heart failure: evaluation and management
       j) Titration of anti-hypertensive medications in refractory hypertension
       k) C-V assessment in patients with stroke
       l) Pericardial diseases – less common but important
       m) Physical examination with recognition and differential diagnostic approach to common murmurs and
           extra heart sounds
Mixes of Disease:
Fellows will be exposed to patients with cardiovascular problems in the setting of non-cardiac disease. These
patients will have a wide range of different types of illnesses, which will include:
                Coronary artery disease
                Congestive heart failure
                Valvular heart disease
                Simple and complex arrhythmias
                Congenital heart disease
                Pericardial disease

Patient Characteristics:
Fellows will be exposed to adult and geriatric patients of both genders and a wide variety of socioeconomic and
racial backgrounds.

                Types of Encounters:
                         All encounters during this rotation will be inpatient. The cardiology fellow will attain
                         familiarity with both acute and chronic issues that necessitate cardiology input. The
                         fellow may, at the discretion of the attending, be involved in procedures including
                         catheterization, transesophageal and transthoracic echocardiography, stress testing and

Reading List / Edcuational Material:
             ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery –
                 Executive Summary. (2002) JACC 39:543-553.
                 (Note full text available online at ACC site {Cardiosource} as well as American Heart Association
             Eagle and Guyton et al. ACC/AHA Guidelines for CABG Surgery. JACC (1999) 34:1262-347.

                Fuster et al., ACC/AHA/ESC Guidelines for the Management of Patients with Atrial Fibrillation
                 (2001) JACC 38:1231-1265.

                Bonow et al., ACC/AHA Task Force Report. ACC/AHA Guidelines for the Management of Patients
                 with Valvular Heart Disease JACC (1998) 32:1486-1588.

                Cheitlin et al., ACC/AHA Task Force Report. ACC/AHA Guidelines for the Clinical Application of
                 Echocardiography. JACC (1997) 29:862-79.

Level of Supervision:
The fellow will be directly supervised during rounds by an attending cardiologist (Dr. Randy Whipps / Dr. Reyez
Evaluation and feedback
The supervising attending physician will provide direct and written feedback to the fellow based upon direct
        observation and according to the following six competencies:

                  Patient Care:
                       1) Gathers essential and accurate information about the patient through interviews, examination, and
                           complete history and by appropriately accessing adjunctive sources of information to this obtained
                           from the patient and/or family members.
                       2) Makes informed diagnostic and therapeutic decisions based on patient information, current
                           scientific evidence, clinical judgment, and patient preference
                       3) Carries out patient management plans based on age, diagnosis and psychosocial issues, including,
                           but not limited to, management of patients with ischemic heart disease, congestive heart failure,
                           valvular heart disease, and disorders of cardiac rhythm.

                  Medical Knowledge:
                      1) Understands and employs current guidelines for peri-operative cardiac consultation
                      2) Understands post-operative care of the cardiac patient
                      3) Understands concepts regarding stratification of patients with chest pain syndromes
                      4) Understands concepts regarding heart disease, pregnancy and pharmacotherapy
                      5) Understands indications for current medical and surgical treatment of endocarditis
                  Practice-Based Learning and Improvement:
                      1) Uses feedback to identify areas for improvement.
                      2) Seeks opportunities to strengthen deficits in knowledge/skills.
                      3) Demonstrates initiative in researching current scientific evidence and applying it to problems
                           encountered during daily practice

                  Interpersonal and Communication Skills:
                       1) Communicate effectively with other members of a multi-disciplinary team, working effectively with
                           others as a leader of the health care team, member or consultant.
                       2) Maintains comprehensive, timely and legible medical record demonstration and correspondence
                           related to patient care activities.
                       3) Provides accurate and timely feedback to referring physician.
                       4) Actively listens and elicits appropriate information from the patient and/or family members and

                      1) Recognizes ethical dilemmas and utilizes / seeks out appropriate consultation where needed.
                      2) Obtains informed consent from patient and/or family member/legal guardian.
                      3) Adheres to the laws and rules governing the confidentiality of patient information.
                      4) Engages in ethical business practices and adheres to the institution’s Code of Conduct.

                  Systems Based Practice:
                      1) Understands, accesses, utilizes and evaluates effectiveness of resource providers, and systems to
                          provide optimal cardiac therapy.
                      2) Understands different medical practice models and delivery systems and how to best utilize them
                          to care for the individual patient.
                      3) Practices quality, cost-effective health care.
                      4) Advocates and facilitates patient advancement through the health care system

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