General description and goals:

The resident will achieve patient care and medical knowledge competencies in the care of patients with common and emergent cardiologic problems. The resident will be responsible for the evaluation and daily follow-up of a subgroup of patients on the medical and non-medical service including the ICU, cardiac catheterization lab., cardiac stress lab., CVR and telemetry floor under supervision of the cardiology attending. Each resident   will receive additional exposure to cardiology subspecialty outpatient care in a practice setting with one of the cardiology attendings. The resident will be exposed to various forms of cardiac stress testing (EKG exercise stress test, exercise thallium, adenosine thallium, exercise echocardiography, dobutamine stress echocardiography), trans-thoracic and trans-esophageal echocardiography and coronary angiography with and without intervention.

Educational Objectives:

1. Improve bedside clinical skills and demonstrate proficiency in cardiac history taking and physical examination.  

2. Interpret electrocardiograms and laboratory studies related to cardiology.

3. Employ risk stratification on patients with various presentations of coronary artery disease. Identify risk factors for cardiac risk in patients scheduled for cardiac and non-cardiac surgery and institute effective risk-stratification measures and management plans in the pre-operative, peri-operative and post-operative period.

4. Distinguish high risk from low risk findings on invasive and non-invasive tests.

5. Understand the indications, contraindications, methods and interpretations of various invasive and non-invasive cardiac tests. Implement a cost-effective approach to medical care without compromising quality.

6. Prepare and present cases efficiently on rounds and in conferences.

7. Implement evidence-based patient management plans based on effective clinical decision-making. Develop sound discharge planning skills based on a multi-disciplinary approach involving the primary care physician, cardiology consultants, general internal medicine/ hospitalist services, dietary and nutrition, cardiac rehabilitation, case management and social services.

8. Teach medical students effectively who are rotating on the service.

9. Communicate effectively with referring physicians, health care personnel, patients and families.

10. Maintain detailed, accurate, and legible medical records.

11. Develop a sound knowledge base in cardiovascular pharmacology and anticoagulation therapy.

12. Understand and implement effective preventive care strategies, monitoring, life-style modifications, diet and nutritional interventions and counseling both in the inpatient and outpatient setting.

13. Demonstrate practice-based learning and improvement, interpersonal skills, professionalism, and systems-based practice through the care of patients and their families on the consult service and through interactions with other members of the health care team.  To understand better the role of the cardiac consultant and the considerations involved in the inpatient and outpatient follow-up of patients with complex cardiac disease.   To distinguish cardiac conditions that can be managed by an internist and those that require subspecialty consultation.

 14. Understand the basic mechanisms, relevant patho-physiology, clinical and laboratory manifestations and evidence-based therapy of common cardiac conditions including, but not limited to the following: 

 

• Acute Myocardial Infarction (STEMI and NSTEMI).
• Acute Coronary Syndromes and other presentations of atherosclerotic cardiovascular disease and coronary artery disease. Knowledge of coronary anatomy.
• Heart Failure.
• Myocardial diseases including myocarditis and cardiomyopathies.
• Hypertensive heart disease and peripheral vascular disease.
• Hyperlipidemia and metabolic syndromes.
• Syncopal disorders.
• Diagnosis and management of congenital and valvular heart disease including endocarditis.
• Pericardial diseases.
• Common atrial and ventricular arrhythmias, criteria for ablation and pacemaker therapy.
• Cardiac disorders in pregnancy.
• Pulmonary hypertension and heart disease. Understanding of right heart hemodynamics and interpretation of PA and Swan-Ganz catheterization data.
• Thrombo-embolic and neoplastic diseases of the heart.
• Cardiac involvement in systemic diseases.
• Acute cardiovascular emergencies including but not limited to hemodynamic instability, cardiac tamponade, cardiogenic shock, acute arterial dissections, aneurismal rupture, hypertensive urgency and emergency, cardiopulmonary arrest and sudden cardiac death.
• Indications for pacemaker therapy, intra-aortic balloon pump, implanted cardiac defibrillator and resynchronization therapies.

 

Learning Venues:

1. The attending will provide an orientation at the beginning of the rotation, discuss each new case in detail and each old case with new developments, and observe and verify both the historical and physical examination findings elicited.  The venues for learning will be as described in the general description and goals in this curriculum.

2. The attending will develop a list of topics for discussion on rounds including an overview of various diagnostic modalities with the pros and cons of each.  The attending should discuss the findings of various tests with respective negative and positive predictive values.  

3.  The attending will review the notes written by the resident for clarity and completeness and discuss any deficiencies.  

4.  The resident will participate in EKG rounds held by Dr. Whiting and all other didactic sessions including noon conferences, M&Ms, death review, journal club, research meetings and grand rounds.

5. The resident will maintain a log of all procedures performed during the rotation.

Required Reading:

Regular reading assignments including review and journal articles will be given by the cardiology attending. Residents are encouraged to incorporate the ACP’s MKSAP series and current ACP, ACC/AHA guidelines in their practice. Harrison’s Principles of Internal Medicine, Cecil Textbook of Medicine, Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine and Marriott’s Practical Electrocardiography are available in the medical library for reference.

Competency Evaluation: 

An end-of-rotation web-based global evaluation form will be completed by the attending and reviewed face-to-face with the resident to assess all six competencies.   This is a good opportunity for feedback.   The resident will also be required to evaluate the rotation and provide feedback on the attending’s teaching skills and other attributes. The resident will be required to take a written examination prepared by the program director and the course director at the end of the rotation.

Outcomes Assessment: 

The national in-service examination will be used to provide both the individual resident and the cardiology division with feedback on the rotation.  A score of 50^th percentile or better in the cardiology section for each resident is a reasonable goal.