Department of Internal MedicineDocument Transcript
Department of Internal Medicine
Texas Tech University Health Sciences Center
Revision Date: July 10, 2006
Approved by the Curriculum Meeting June 30, 2006
I. Educational Purpose and Goals: Cardiovascular diseases are not only the leading cause
of death in the United States but also represent a significant proportion of the admitting
diagnoses to the internal medicine in-patient service. Accordingly, understanding of the
principles of diagnosis and management of the most common cardiovascular diseases is an
essential part of the training of the general internist. The mission of the cardiology rotation is
to give the internal medicine residents the opportunity to develop advanced skills in clinical
interviewing, physical exam and differential diagnosis of patients with cardiovascular disease
symptoms, strengthen their medical knowledge in the basic and clinical science of
cardiovascular disease, and apply this knowledge to the care of patients. The critical
evaluation of current medical information and scientific evidence is crucial to the
understanding and appropriate use of diagnostic strategies and treatments in cardiology and
will be emphasized.
II. Principal Teaching Methods:
1. Supervised Direct Patient Care Activities: Residents evaluate and manage cardiology
patients at Medical Center Hospital (MCH) and Midland Memorial Hospital (MMH)
attended by physicians on clinical faculty at both institutions, including patients admitted
to these cardiologists and patients referred to these physicians for cardiology
consultation. In addition, residents will participate in patient evaluation and care in the
outpatient cardiology clinics of supervising clinical faculty. In the inpatient setting, each
patient evaluated by the internal medicine resident will be seen with the cardiology
attending during daily management rounds. All patients evaluated by the resident in the
clinic will be subsequently evaluated with the cardiology faculty. Thorough assessment
will be performed and a management plan will be formulated by the resident and
discussed with the cardiology attending. In the hospital setting, the rounding team will
consist of the attending and the rotating Texas Tech resident(s).
2. Required Presentations: Residents present cases at teaching rounds and are expected
to research and present a case-based presentation during one of the weekly
Cardiology Grand Rounds conferences.
3. During one half-day per week the resident will be assigned to a diagnostic testing
activity including exercise and pharmacological stress testing (including echo and
nuclear modalities) echocardiography, upright tilt testing, electrophysiology testing, and
4. Didactic Lectures: Residents are expected to attend the following:
I. Cardiac Catheterization Conference in which angiograms and hemodynamic data
II. Cardiology Emergency Lectures
III. Scheduled Cardiology Lectures
IV. Cardiovascular Research Conference (Third Thurs of the month at 6PM)
III. Educational Content
1. Patient characteristics: Patients are admitted from Ector and Midland county area, as
well as surrounding West Texas counties. Patients encountered reflect the diverse
nature of pathology present in the area with equal exposure to men and women of
multiple ethnicities and socioeconomic backgrounds. Similar population sources are
reflected in the outpatient cardiology clinics.
2. Disease Mix: Diverse acute and chronic cardiac conditions are encountered both as
admissions and as consults. Possible clinical conditions include:
I. Coronary Artery Disease; Acute Coronary syndromes and their complications
II. Congestive Heart Failure
III. Endo, Myo and Pericarditis
IV. Valvular Heart Disease
V. Brady and Tachy Arrhythmias
VI. Cardiac Conduction Abnormalities
VII. Cardiac Pacemakers and ICDs
VIII. Peripheral Vascular Disease
X. Ischemic and Non ischemic Cardiomyopathy
XI. Preoperative cardiac evaluation for cardiac and non-cardiac surgery under both
elective and emergency procedures
3. Learning venues, type of clinical encounters, procedures and services: The inpatient
component of the cardiology rotations is based at Medical Center Hospital in Odessa
and Midland Memorial Hospital, both serving as major referral centers for West Texas
residents. Residents work with staff cardiologists on clinical faculty at both facilities.
Residents perform rounds in the hospital, where they admit patients and see new
consults. Residents gain valuable insight into the indications, contraindications, and
performance of commonly ordered cardiac tests. Cost-effective health issues are
regularly addressed in this setting. Residents may also observe diagnostic and
therapeutic cardiac catheterizations in the four Sparrow Hospital cardiac catheterization
suites. The evaluation and care of patients with cardiovascular problems in the
outpatient setting is performed through resident’s participation in the outpatient clinics
of the supervising clinical cardiology faculty.
4. Structure of rotation:
I. Cardiology is an elective 4-week training rotation.
II. Residents start work on the floors at a time designated by the attending physician.
They also perform patient care duties on two weekend days when they are on call
but must have one day off per week. Resident training may extend before 7:30
AM or after 5 PM at the discretion of the cardiology attending when necessary for
patient care reasons, but overall resident work hours may not exceed 80
hours/week and must abide by ACGME duty limits.
III. Residents continue to attend mandatory Medicine didactic sessions and their
mandatory afternoon continuity primary care clinics for which they are excused
from cardiology patient care duties.
IV. Minimum duty expectations account for expected time for resident H&P, review of
clinical data including EKGs, labs and radiology/echo data, supervision of the
patient encounter by the cardiology attending, reading/research, documentation,
and appropriate interaction with Cardiology attending for follow- up of the patient
a. Residents are expected to evaluate a minimum of two new consults or
admissions during the weekday. Inpatient consultations performed by
residents will not be placed on the patient chart until reviewed by the
b. Days which combine inpatient and outpatient duties should appropriately
balance resident workload.
V. Residents will experience educational interactions with the supervising attending
physician, beyond the functional time required for usual patient care. This teaching
interaction may be integrated into the daily work schedule but must total a
minimum of 4.5 hours weekly.
IV. Principal Ancillary Educational Materials
a. At the beginning of the rotation, each resident receives a copy of the Cardiology
curriculum’s Goals and Learning Objectives.
b. Braunwald’s Textbook of Cardiology, 7th edition, 2004
c. Online access to standard cardiology texts and journals through TTUHSC library
V. Methods of Evaluation
1. Resident Performance: Cardiology clinical faculty complete written resident evaluation
forms provided by the Internal Medicine Residency coordinators. The evaluation is
competency-based, and uses a detailed assessment of resident’s effort, progress and
achievement on each core competency component. Faculty reviews the written
evaluation in person with each resident and provides detailed feedback on resident’s
performance. In addition, the following sources and methods of evaluation are
included in assessing residents’ performance: a) mini-CEX and CEX. b) all other
(verbal, written) evaluation comments provided to the Program Director/Associate
Program Director by faculty and community physicians interacting with the resident
during cardiology rotation are documented in writing. f) performance on the periodic
Cardiology exam administered as part of the monthly subspecialty exams. All
evaluations are available for resident review (excluding direct review of evaluations
completed by resident colleagues). All evaluations are part of the resident file and
are incorporated into the semiannual performance review for directed resident
2. Procedures: Residents submit documentation of any procedures performed during
the rotation, on a hard-copy form, completed by supervising faculty. Procedure forms
include supervisors’ evaluation of resident’s performance.
VI. Rotation Specific Competency Objectives
1. Patient Care
I. By the conclusion of the rotation, PGY-1 rotating residents will demonstrate ability
to perform an appropriate cardiac history and physical exam, documenting their
findings in an appropriate consultative summary, with appropriate generation of a
differential diagnosis list.
II. By the conclusion of the rotation, PGY-2 and PGY-3 residents will perform the
above skills, and will also demonstrate appropriate ability to independently
generate an appropriate management plan.
III. While on the cardiology rotation, the resident will be able to demonstrate
proficiency in the physical exam features of valvular heart disease and congestive
IV. During the cardiology rotation, the resident will enhance his or her skills in
obtaining and presenting a hypothesis-driven history and problem-based
assessment and plan of common cardiovascular presentation including acute
chest pain syndromes, CHF exacerbations and syncope.
2. Medical Knowledge
I. All residents will be evaluated by the supervising faculty for demonstration of
appropriate analytic approach to cardiac conditions, and residents will be
evaluated for satisfactory basic and clinical knowledge of cardiac function and
II. The resident on the cardiology rotation will demonstrate knowledge expansion on
current evidence-based practices in primary and secondary prevention of
cardiovascular disease especially atherosclerotic disease.
III. The resident will gain and demonstrate understanding of the pathophysiology and
prognosis of common cardiovascular diseases and their medical and non-
3. Practice Based Learning and Improvement
I. Residents will demonstrate self-initiative in the use of information technology to
access and retrieve materials for self-education regarding cardiac cases and
demonstrate skills of critically appraising medical literature, and apply evidence to
the care of patients.
II. Residents will be expected to show progressive learning throughout the rotation,
with emphasis on learning from any cognitive or procedural errors. They are also
expected to facilitate any quality improvement initiatives in place.
4. Interpersonal and Communication Skills
I. Residents are expected to demonstrate professional communication skills
throughout their interactions with cardiology patients and their families, Cardiology
attending and other clinicians and non clinical staff involved in patients’ care.
Residents are expected to act as a constructive and proactive member of the
cardiology rounding team.
I. Throughout the rotation, residents are expected to exhibit reliability in their clinical
duties, as well as integrity and respect in their interactions with patients, their
family members, colleagues, and all other members of the healthcare team.
II. Residents will be able to demonstrate appropriate consultative principles of
communication and responsiveness to professional consultative requests.
6. Systems Based Practice
I. Residents are expected to interact with the MCH and MMH care systems, as well
as gain insight and experience with systems of care of outpatient clinical setting,
and appropriately access different facets of the health care system necessary for
the care of their patients. This includes but not limited to PT/OT services and
discharge planning services in the inpatient setting, and proper and effective
engagement of system resources in the outpatient care environment.