BASIC STANDARDS FOR
RESIDENCY TRAINING IN
CARDIOLOGY
American Osteopathic Association and the
Specific Requirements
For Osteopathic Subspecialty Training
In Cardiology
This is part of the Basic Standards for Fellowship Training in Internal Medicine
Subspecialties, which govern and define training in the subspecialties. The Basic Standards are incorporated into this document by reference.
I. Education Program - The residency training program in cardiology shall be three (3) years in duration and shall provide supervised clinical experience and didactic programs to enable the resident to develop sufficient skills and knowledge in the performance and interpretation of cardiovascular diagnostic modalities, and in the care of patients with cardiovascular diagnoses.
II. Facilities and Resources
A. Inpatient and outpatient facilities with an appropriate number of patients of a wide age range and a broad variety of cardiovascular disorders;
B. Laboratories for cardiac catheterization, electrocardiography, exercise and pharmacologic stress testing, Doppler transthoracic and transesophageal echocardiography and ambulatory ECG monitoring;
C. Facilities for nuclear cardiology, including ventricular function assessment, myocardial perfusion imaging and the study of myocardial viability;
D. Facilities for management of patients with arrhythmias, including
electrophysiologic testing, arrhythmia ablation, signal averaged ECGT and tilt table testing as well as the evaluation of patients for pacemakers and
implantation of pacemakers and automatic defibrillators; E. Faculty and resources for clinical research;
F. Modern intensive care facilities;
G. Surgical program for all cardiac procedures and surgical intensive care services;
H. Facilities for assessment of peripheral vascular disease, pulmonary function and cardiovascular radiology;
I. Faculty and program for diagnosis and follow-up care of patients with congenital heart disease;
J. Faculty and facilities involved in the instruction of preventive cardiology, risk factor modification, management of lipid disorders and cardiac rehabilitation; K. Access to comprehensive library facilities;
L. Ambulatory clinic facilities where the trainee will follow an independent panel of patients for a minimum of one-half day per week on a continuity basis for the entire 36 month program.
III. Specific Program Content
B. A core curriculum in the basic medical sciences of cardiovascular medicine, to include physiology, anatomy, histology and pharmacology;
C. A clinical sciences curriculum that shall include formal, regularly scheduled lectures, cardiac catheterization conference, mortality and morbidity review and literature review. Teaching rounds must be conducted in a regular and organized fashion;
D. There shall be Training in the principles of operation and function, indication, limitation, risk vs. benefit ratio and cost effectiveness of the various technical procedures used in the diagnosis, therapy and management of cardiovascular disorders;
E. Procedural Training
Procedural training shall adhere to the guidelines established by the Core Cardiology Training Symposium (COCATS) as approved by the American College of Cardiology:
Level 1: Basic level of training required of all trainees to be competent as consulting cardiologists;
Level 2: Additional training in one or more specialized areas enabling a cardiologist to perform or interpret specific procedures at an intermediate skill level;
Level 3: Advanced training in a specialized area enabling a cardiologist to perform, interpret and train others to perform and interpret specific procedures at a high skill level.
1. Level 1 training shall be achieved in all areas by all trainees;
2. Level 2 training shall be required of all trainees intending to achieve primary operator status in the areas of cardiac catheterization, echocardiography and nuclear cardiology;
3. Level 3 training shall be offered based on faculty and facilities for any or all of the above areas of expertise;
4. Training and attainment of competency in electrophysiology and
interventional cardiology may not be accomplished during the 36 month cardiology fellowship. This may be accomplished by separate programs requiring 12 months of additional training in the area of interest;
5. Rotational requirements include a minimum of:
Eight (8) months clinical non-laboratory practice activity with a minimum of three (3) months in the CCU/ICU;
Four (4) months of echocardiography;
Two (2) months in electrophysiology and pacemaker service;
Four (4) months of ECG, Stress Testing, Holter interpretation and various stress modalities;
The remaining 12 months shall include exposure to pediatric cardiology, transplant cardiology and other areas of interest as determined by the Program Director.
F. Specific Rotation Requirements 1. Clinical Cardiology
Clinical cardiology must encompass a broad range of cardiac disease states. The trainees must spend a minimum of eight months in clinical cardiology. This experience must include daily inpatient management of cardiovascular diseases and cardiology consultation. At least three of these months must be spent by the trainee in the coronary care unit or the intensive care unit during the trainee’s 36-month program. If the trainee has extensive coronary care unit experience from his/her internal medicine residency, then this requirement can be met by ongoing patient interaction in the CCU supervising medical residents over the three-year period. Either alternative must enable the trainee to gain exposure to
hemodynamic monitoring, postoperative patient care, as well as other aspects of critical/acute care cardiology; i.e.: myocardial infarction, congestive heart failure, postoperative coronary artery bypass grafting and transplant.
2. Cardiac Catheterization and Interventional Cardiology
A minimum of four months in cardiac catheterization must be spent by the trainee, or exposure to a minimum of 100 cases. During this time, the trainee must gain exposure to valvular hemodynamics, right and left cardiac catheterization and limited exposure to interventional cardiology. The trainee must participate in a minimum of 300 left heart
catheterizations as primary operator to achieve Level II proficiency. The trainee must also maintain a procedure log for accurate documentation. Level II trainees must also perform at least 10 intraaortic balloon pumps during the 36-month training period.
3. Non-Invasive Testing
rotations, such as heart station or noninvasive. This is to expose the trainee to all types of exercise testing. The trainee at the end of his/her time, By completion of the fellowship, the trainee must be capable of performing and interpreting the electrocardiographic portion of the treadmill and pharmacological testing. The trainee must also be competent in the test protocols and the appropriateness of ordering tests. A minimum interpretation of 150 exercise tests should be
performed. Dobutamine and stress echocardiography requirements are in addition to this. Interpretation of standard 12-lead
electrocardiograms should be incorporated in the entire 36-month training period. In order for the trainee to become proficient in interpretation and gain exposure to a wide variety of ECG
abnormalities, it is recommended that a minimum of 3,500 studies be reviewed.
4. Echocardiography
a. The trainee must spend a minimum of four months in the
echocardiography lab. As an alternative, this maybe incorporated in other rotations such as heart station or noninvasive. During this time, the trainee will gain exposure in performing and interpreting 2 D and M Mode echocardiography and cardiac Doppler. A minimum of 300 studies must be interpreted to obtain Level II proficiency in
echocardiography. These studies must include a wide variety of cardiac abnormalities, such as valvular heart disease, endocarditis, prosthetic valve evaluation, myocardial ischemia, primary and
secondary diseases of the heart, pericardial disease and diseases of the great vessels.
b. The trainee must have attained proficiency in standard 2 D and M Mode echocardiography and cardiac Doppler prior to or parallel with obtaining expertise in transesophageal echocardiography. A minimum of 25 intubations supervised by an experience transesophageal
echocardiographer, as well as performing 50 transesophageal echocardiographs are necessary to achieve proficiency in this area. c. The trainee must obtain proficiency in standard echocardiography
prior to or parallel with obtaining proficiency in stress
echocardiography and dobutamine echocardiography. A minimum of 100 stress/dobutamine echocardiographic studies are recommended for proficiency in this area.
5. Nuclear Medicine
set specific guidelines for licensure in this field. Trainees interesting in obtaining licensure must adhere to these guidelines.
6. Electrophysiology
The trainee must have a minimum of two months of electrophysiological exposure. During this time, the trainee must gain exposure to the
appropriateness of electrophysiological studies, interpretation of basic electrophysiological studies, technique involved, indication for
pharmacological and non pharmacological management of arrhythmias and indications for temporary and permanent pacemakers.
A minimum of 10 temporary transvenous pacemakers should be inserted during the 36-month training period, as well as a minimum of eight elective cardioversions in the 36-month training period.
Exposure to permanent pacemaker insertion must be available to cardiovascular trainees. A minimum of 50 permanent pacemaker implantations must be performed.
The ability for the trainee to participate in pacemaker follow-up is mandatory for those performing pacemaker implantation. One hundred (100) pacemaker follow-up visits must be performed. The pacemaker clinic must allow the trainee to gain experience in a variety of pacemaker programmers, as well as pacemaker follow-up and management.
7. A model rotation schedule for the three year general cardiology fellowship is posted on the ACOI website (www.acoi.org).
G. Ambulatory Clinical Experience
Ongoing outpatient clinical experience is mandatory for all cardiovascular trainees. At least one-half day per week in an outpatient setting with appropriate supervision throughout the 36-month period must be provided. This will allow the cardiovascular trainee to gain experience and exposure in the management of cardiovascular problems in the outpatient setting.
H. Elective Time
