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Department of Internal Medicine
 

Department of Internal Medicine

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    Department of Internal Medicine Department of Internal Medicine Document Transcript

    • Department of Internal Medicine Texas Tech University Health Sciences Center Odessa, Texas Cardiology Curriculum 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 cardiac catheterization. 4. Didactic Lectures: Residents are expected to attend the following: I. Cardiac Catheterization Conference in which angiograms and hemodynamic data are discussed. II. Cardiology Emergency Lectures III. Scheduled Cardiology Lectures IV. Cardiovascular Research Conference (Third Thurs of the month at 6PM) 1
    • 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 IX. Hyperlipidemia 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, 2
    • and appropriate interaction with Cardiology attending for follow- up of the patient care plan: 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 attending physician. 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 feedback. 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. 3
    • 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 heart failure. 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 pathophysiology. 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- management. 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. 5. Professionalism 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. 4