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  • 1. FELLOWSHIP IN INTERVENTIONAL CARDIOLOGY (FIIC) I. GOALS: Although all postgraduates in DM Cardiology have extensive knowledge of cardiology yet their exposure to cardiac Interventions will be limited. Majority of graduates will not have hands on training. All DM in Cardiology graduates are capable of doing diagnostic procedures. But they are not in a possession to do therapeutic interventions. This course will help DM graduates to have adequate training in the field of Interventional Cardiology and start practicing independently. II. OBJECTIVES: The following objectives are laid out to achieve the goals of the course. These objectives are to be achieved by the time the candidate completes the course. The objectives may be considered under the subheadings. 1. Knowledge 2. Skills 3. Human values, ethical practice and communication abilities. 1. Knowledge: The course provides an intense structured training programme for Post DM/DNB in Cardiology candidates to enhance their knowledge in all aspects of Interventional Cardiology. 2. Skills: After successful completion of Fellowship in Interventional Cardiology course the Candidate. a) Will be able to do all diagnostic procedures in the Cath Lab. b) Will be able to do all therapeutic interventions in CAD, CHD and RHD. c) Will be able to run the Cath Lab independently . d) Will be able to guide others in the field of interventional Cardiology. 1
  • 2. 3. Human values, Ethical practice and Communication abilities  Adopt ethical principles in all aspects of his/her practice, professional honesty and integrity are to be fostered. Care is to be delivered irrespective of the social status, caste, creed or religion of the patient.  Develop communication skills, in particular the skill to explain various options available in management and to obtain a true informed consent from the patient.  Provide leadership and get the best out of his team in a congenial working atmosphere.  Apply high moral and ethical standard while carrying out human or animal research.  Be humble and accept the limitations in his knowledge and skill and to ask for help from colleagues when needed,  Respect patient’s right and privileges including patient’s right to information and right to seek a second opinion. III. DURATION OF THE COURSE One Year IV. ELIGIBILITY a). Candidates must have passed DM in cardiology or DNB in Cardiology b). Selection will be done on all India Basis 2
  • 3. V. COURSE CONTENTS: 1. Basics of Interventional Cardiology: a) Historical Aspects b) Applied Anatomy c) Applied Physiology d) Drugs used in Interventional Cardiology 2. Patient Evaluation: a) History and clinical Examination b) Electrocardiogram c) Echocardiogram d) Chest Roentgenogram e) Stress Test f) Holter Monitoring g) Nuclear Cardiology h) CT Angio 3. Basics of Cath Lab a) Cardiac Catheterization b) Oxymetry analysis c) Pressure measurements d) Coronary Angiogram e) Peripheral Angiogram f) Other Angiograms g) Drugs used in Cath Lab h) Radiographic Contrast media 4. Instruments in Cath Lab: a) Cath Lab Machine b) Pressure Recorder c) Intra Cardiac Balloon Pump d) Intra vascular ultrasound e) Defibrillator f) Pacemakers g) Catheters, Guide wires etc used in Cardiac interventions h) Radiation Safety measures. 3
  • 4. 5. PTCA A) Selection of cases a) Procedure b) Post PTCA Management c) New devices and strategies i) Atherectomy ii) Cutting Balloon iii) Thrombectomy iv) Distal Protection device v) Ratablator vi) Other new devices 6. Stents: i) Metalic stents ii) Drug eluting stents 7. Mechanical Interventions in Acute MI i) Primary Angioplasty ii) Glycoprotein II b/III a inhibitars iii) Facilitated PCI 8. Rheumatic Heart Disease: i)Balloon Mitral Valvoplasty ii)Balloon Tricuspid Valvoplasty iii)Balloon Aortic Valvoplasty iv)Percutaneous Valve Replacement 9. Congenital Heart Diseases: i)Balloon Dilatation for Pulmonary stenosis, aortic stenosis, Coarctation of aorta ii)Device closure of ASD, VSD and PDA iii) Coil closure of PDA, AV Fistula 4
  • 5. 10) Rhythm and conduction disorders i) Pacemakers ii) Techniques of electro physiologic evaluation iii) Catheter ablative techniques iv) AICD 11) Interventions in other arteries a) Carotid arteries b) Renal arteries c) Peripheral Angioplasty d) Aortic Interventions. 12) Other Special Techniques: i) Transeptal Catheterization ii) Endo myocardial Biopsy iii) Pericardiocentesis iv) Septal ablation 13) Other Interventions: a) Stem cell therapy b) Recent advances in Interventional Cardiology 5
  • 6. VI. TEACHING AND LEARNING ACTIVITIES A) Theoretical Teaching: 1. Lectures: Lectures are to be kept to a minimum. Certain selected topics can be taken as lectures. Lectures may be didactic or integrated. 2. Journal Club: Recommended to be held once a week. All the PG students are expected to attend and actively participate in discussion and enter in the Log Book the relevant details. The presentations would be evaluated using check lists and would carry weightage for internal assessment. A time table with names of the students and the moderator should be announced in advance. 3. Subject Seminar: Recommended to be held once a week. All the PG students are expected to attend actively participate in discussion and enter in the Log Book relevant details. The presentations would be evaluated using check lists and would carry weightage for internal assessment. A time table for the subject with names of the students and the moderator should be announced in advance. 4. Case Discussion: Recommended to be held once a week. All the PG students are expected to attend and actively participate in discussion and enter in the Log Book relevant details. The presentations would be evaluated using check lists and would carry weightage for internal assessment. A time table for the case presentation with names of the students should be announced in advance. 5. Ward Rounds: Ward rounds may be service or teaching rounds. a) Service Rounds: Postgraduate students should do service rounds every day for the care of the patients. Newly admitted patients should be worked up by the post graduate student and presented to the faculty members the following day. b) Teaching Rounds: Every unit should have ‘grand rounds’ for teaching purpose at the bed side. A diary should be maintained for day-to day activities by the post graduate students. Entries of (a) and (b) should be made in the Log Book. 6. Clinico-Pathological Conference: Recommended once a month for all post graduate students. Presentation to be done by rotation. Presentations will assessed using checklist. If cases are not available due to lack of clinical postmortems, it could be supplemented by published CPCs. 6
  • 7. 7. Inter Departmental Meetings: Strongly recommended particularly with departments of Cardiac Surgery, Pathology and Radio-Diagnosis at least once a month. These meetings should be attended by post-graduate students and relevant entries must be made in the Log Book. Pathology: Interesting cases shall be chosen and presented by the post-graduate students and discussed by them as well as the senior staff of Pathology department. The staff of pathology department would then show the slides and present final diagnosis. In these sessions the advanced immunohisto-chemical techniques, the bugeoning markers, other recent developments can be discussed. Radio-Diagnosis: Interesting cases and the imaging modalities should be discussed. Emphasis should be given for the radiological differential diagnosis. Cardiac Surgery: Interesting cases and important topics related to the field should be discussed . 8. Mortality Meeting: The mortality meeting should be conducted in the department every month. The post graduate students should prepare the details regarding the cause of death after going through the case records in detail, and should present during the mortality meeting. The death records will discussed in detail during this meeting. 9. Teaching Skills: Post graduate students must teach under graduate students (eg. Medical Nursing) by taking demonstrations, bedside clinics, tutorials, lectures etc. Assessment is made using a checklist by medical faculty as well as by the students. Record of their participation is to be kept in Log Book. Training of postgraduate students in Educations Science and Technology is recommended. 10. Continuing Medical Education Programmes (CME) : Recommended that at least 1 state level CME programmes should be attended by each student during the course. 11. Conferences: Attending conference is compulsory. Post graduate student should attend at least one national and one state level conference during the course. Research Activities: The candidate shall furnish proof of having undertaken the original research work of higher order. The research work shall be performed by the student during his/her study period under the supervision of the postgraduate teacher. This work shall be submitted to the university six months prior to the date of final examination as a proof of this research work. OR The candidates shall publish at least one research paper in a national indexed journal. OR 7
  • 8. The candidate shall present at least one research paper in a national or International conference. Candidate will have to actively participate in the following programme. Subject Seminar 12 Journal Clubs 12 B. Clinical /Practical Training: Candidate will have to perform all interventions independently under supervision. Minimum numbers expected is PTCA 20 PTMC, ABV, PBV etc 20 Device Closure 05 Pacemakers 05 Exact number will be decided by HOD depending upon the needs of the candidate. The candidate will be posted to the following areas during the course. 1) Cardiac Catheterization Lab 8 months 2) Cardiac Electrophysiology 1 month 3) Pediatric Cardiology 1 month 4) Cardiac Surgery 1 month 5) ICCU ward 1 month Exact posting will be done by HOD depending upon the needs of the candidate. The candidate will work in Cath Lab during his course. 8
  • 9. VII OTHER CRITERIA TO BE FULFILLED FOR THE FELLOWSHIP COURSE 1. Internal Evaluation: During the course of one year, the department will conduct one test at the end of six months. The test may include the written papers, practicals/ clinicals and viva-voce. Records and marks obtained in such tests will be maintained by the head of the department and will be sent to the University when called for. Results of all evaluations should be entered into P.G.’s diary and departmental file for documentation purpose. Main purpose of periodic examination is to ensure clinical expertise of students with practical and communication skills and balance broader concept of diagnostic and therapeutic challenges. 2. Maintenance of Log Book: Every candidate shall maintain a Log book/work diary and record his/her participation in the training programme conducted by the department such as Journal review, seminars, etc. Special laboratory procedures, if any, conducted by the candidate, all the procedures performed by the post graduate students should be entered in the Log Book. All the daily activities including the ward round and the routine procedures preformed on day to day basis should be entered in the Log book and it should be verifed and signed by the faculty member. The Log book shall be scrutinized and certified by the Head of Department and Head of Institution, and presented in the University practical/clinical examination. 9
  • 10. VIII. SCHEME OF EXAMINATION Final examination will be held at the end of one year. Candidates will be allowed to appear for examination only if attendance (Minimum 80%) and internal assessment are satisfactory and research and publication work is satisfactory. A. Theory: 300 marks The theory examination shall consist of three papers of three hours duration. Each paper shall carry 100 marks and the total marks would be 300. The format of each paper will a below . Type of Questions No of questions Marks for each Total Marks question Long Essay 02 20 40 Short Essay 06 10 60 Grand Total 100 1. Paper I Ischemic Heart Disease 2. Paper II Congenital Heart Disease 3. Paper III RHD , Pacemakers and other topics of Interventional cardiology Note: The distribution of topics shown against the papers are suggestive only and may overlap or change. B. Clinical Examination: 200 marks One Long case, 125 marks, One Hour One short case, 75 marks, 30 minutes C. Viva Voce Examination: 100 marks i) Spotters Ten 30 minutes 30marks ii) Oral Examination 30 minutes 70 marks 10
  • 11. All examiners will conduct viva-voce conjointly on candidate’s comprehension, analytical approach, expression and interpretation of data. It includes all components of course contents. Student’s knowledge on use of instruments and drugs will also be evaluated during viva-voce examination. D Maximum Marks: Theory Clinical Examination Viva Voce Grand Total 300 200 100 600 IX. RECOMMENDED BOOKS (LATEST EDITION) Sl. Name of the Book/Title Author Publisher No. Name & Place of publication 1 Text book of interventional Eri. J. Topal Harcourt Asia Limited, cardiology Singapore 2 The Heart Hurst Mc.GrowHill Company USA 3 Heart Disease Braunwarld W.B. Saunders Company zipes, Libby Philadelphia, USA 4 Grossman’s Book on Cardiac Donald S. Lippincot Williams and Catheterization , Angiography and Baim Wilkins . USA Interventions X. RECOMMENDED JOURNALS (LATEST EDITION) Sl. Name of the Journal No. 1 Indian Heart Journal 2 Journal of American college of Cardiology 3 Journal of Indian college of Cardiology 4 Journal of Interventional Cardiology 11