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IM VA Cardiology Consult Curriculum.doc

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  • 1. Internal Medicine CARDIOLOGY CONSULTATION ROTATION Kansas City VA Hospital Revised 12/2006 Educational Purpose for Rotation: The cardiology consultative rotation is offered as an elective to residents and is strongly encouraged because of the important experience it offers in preparation for the ABIM examination and for development of the strong foundation in cardiovascular medicine which is prerequisite to the practice of general medicine as well as many subspecialties. Residents are given the opportunity to initially evaluate patients for preoperative cardiac risk assessment, as well as congestive heart failure, cardiac arrhythmias, and acute coronary syndromes. In addition to the patient care and medical knowledge skills acquired through the clinical experience, residents also gain important professional development and communication skills through acting as a consultant to both medical and surgical care teams. Teaching Methods: 1. Each patient the resident evaluates is discussed in detail with the attending. Direct feedback is given on accuracy and completeness of patient histories. The attending directly observes the resident’s cardiac physical examination skills, and reviews and critiques the resident’s independent interpretation of diagnostic studies and assessment and plans. 2. The attending makes daily patient management rounds with the house staff and fellow. 3. Diagnostic, invasive and non-invasive tests and procedures are reviewed daily with the attending. 4. Hemodynamic data from cardiac catheterization and echocardiography is reviewed with the attending. 5. Residents will have the opportunity to be present during non-invasive and invasive testing that their patients will undergo. These include cardiac catheterization, non- invasive testing such as echocardiograms and nuclear cardiology with exercise and pharmacologic stress tests. 6. A non-invasive imaging conference occurs Wednesdays at noon and is televised to the Kansas City VAMC. 7. Housestaff are required to attend DOIM morning report, Wednesday morning Internal Medicine Grand Rounds, and noon conferences. 8. Residents are strongly encouraged to pursue self-guided study using the included learning objectives and references. Upper-level residents are also required to
  • 2. complete the Internet-based board review module assigned to them for the rotation. Clinical Experience and Level of Resident Supervision: Residents on the consult service work closely with the cardiology attending in evaluation and care of patients. The consult resident will evaluate the consultations received from all in- patient services and provide pre-operative cardiac evaluation “clearance” for patients who are undergoing surgical procedures at the Kansas City VA Hospital. They may be requested to see patients in the emergency room for consultations on a variety of cardiovascular problems. Residents may also assist in supervision and education of 4th year medical students who are taking cardiology electives and rotating through the consult service. Competency-Based Educational Goals and Objectives by Level of Training and Evaluation Methods: Medical Knowledge: PGY-1: • Expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of patients with cardiac disease, including risk factors and risk stratification for coronary artery disease and assessment and management of patients with heart failure • Access and critically evaluate current medical information and scientific evidence relevant to acute cardiac care • Understand indications for aggressive anticoagulant and antiplatelet therapy as well as the mechanisms of action of the various agents • Understand the physiologic and pathophysiologic principals of invasive hemodynamic monitoring including indications PGY-2: All of the above, and: • Be aware of indications, contraindications and risks of commonly used cardiac medications and procedures • Demonstrate knowledge of epidemiologic and social-behavioral sciences. • Apply the basic, clinical, epidemiologic and social behavioral science knowledge to the care of the patient • Successfully complete required Internet-based training modules. • Show progress in board preparation indicative of successfully passing the board exam. PGY-3: All of the above, and: • Demonstrate an investigatory and analytic approach to clinical situations Evaluation Methods: Attending evaluation, Internet-based training module, chart-stimulated recall Patient Care: PGY-1: • Effectively evaluate and manage patients with cardiac illness • Effectively evaluate and manage patients who have undergone interventional procedures
  • 3. • Effectively manage patients with undiagnosed chest pain, including the appropriate use of diagnostic testing • Recognize limits in clinical experience and know when to ask for help. • Complete a cardiovascular history and elicit common findings on physical examination. • Recognize deterioration in clinical condition and take appropriate initial diagnostic and therapeutic steps. • Be able to perform ECG interpretation consistent with level of training, as well as interpretation of treadmill stress tests and Holter monitors. • Be able to formulate pre-operative risk assessment and management of patients undergoing non-cardiac procedures. • Learn details of risk management and basis of primary prevention of atherosclerosis. PGY-2: All of the above, and: • Elicit subtle findings on physical examination • Obtain a precise, logical and efficient history • Interpret results of procedures properly • Be able to manage multiple problems at once • Make informed decisions about diagnosis and therapy after analyzing clinical data. • Develop and carry out management plans. • Consider patient preferences when making medical decisions. • Be able to correlate physical examination with other cardiology laboratory diagnostic techniques, such as echocardiography and stress imaging procedures such as stress echo and stress nuclear procedures and cardiac catheterization. PGY-3: All of the above, and: • Reasons well in ambiguous situations • Spends time appropriate to the complexity of the problem Evaluation Methods: Attending evaluation, mini-CEX Professionalism: PGY-1: • Establish trust with patients and staff • Be honest, reliable, cooperative and accept responsibility • Show regard for opinions and skills of colleagues • Demonstrate respect, compassion and integrity. • Demonstrate sensitivity to patient culture, gender, age, preferences and disabilities. • Acknowledge errors and work to minimize them. PGY-2: All of the above, and: • Display initiative and leadership • Be able to delegate responsibility to others • Demonstrate commitment to ethical principles pertaining to the provision or withholding of care, patient confidentiality, informed consent and business practices. PGY-3: All of the above, and: • Demonstrate commitment to on-going professional development.
  • 4. • Appreciate the spiritual and social context of wellness and disease. Evaluation Methods: Attending evaluation Systems-Based Practice: PGY-1: • Understand the complexities of cardiovascular disease patients and utilize the multidisciplinary resources needed to care for them. • Develop effective communication with referring physician, other members of the health care team, patients and their families regarding purpose and findings of the consult. • Consideration of cost effectiveness and outcome measurements of tests and interventions associated with consult. PGY-2: All of the above, and: • Apply knowledge of how to partner with health care providers to assess, coordinate and improve patient care • Use systematic approaches to reduce errors. • Participate in developing ways to improve systems of practice and health management. • Demonstrate ability to adapt to change PGY-3: All of the above, and: • Understand how individual practices affect other health care professionals, organizations and society. • Demonstrate knowledge of types of medical practice and delivery systems. • Use evidence-based, cost-conscious strategies in the care of patients with chest pain and other acute cardiac disease Evaluation Methods: Attending evaluation Practice-Based Learning and Improvement: PGY-1: • Identify and acknowledge gaps in personal knowledge and skills in the care of acute cardiac patients • Develop real-time strategies for filling knowledge gaps that will benefit patients PGY-2: All of the above, and: • Understand limitations of knowledge • Show willingness to learn from mistakes • Be self motivated to acquire knowledge • Be able to access and apply multiple sources of information to practice evidence-based care of the cardiac patient • Accept feedback and develop self-improvement plans. PGY-3: All of the above, and: • Undertake self-evaluation with insight and initiative. • Facilitate the learning of students and other health care professionals. Evaluation Methods: Attending evaluation
  • 5. Interpersonal and Communication Skills: PGY-1: • Write pertinent and organized notes • Use effective listening, narrative and non-verbal skills to elicit and provide information. • Create and sustain therapeutic and ethically sound relationships with patients and families. • Communicate effectively the consult findings to physician, colleagues and other members of the health care team in a timely manner. • Inform patient and families of consult findings and recommendation in a professional manner. • Educate and provide methods for risk reduction. PGY-2: All of the above, and: • Provide education and counseling to patients, families and colleagues. PGY-3: All of the above, and: • Work effectively as a leader of the health care team. • Evaluation Methods: Attending evaluation, mini-CEX with observation and feedback on how the resident interacts with patient families and other medical personnel. References 1. Braunwald, E. Heart Disease, 6th Edition. Philadelphia, W.B.Saunders Company. 2002 2. Murphy JG. Mayo Clinic Cardiology Review, 2nd Edition. Philadelphia, Lippincott, Williams and Wilkins. 2000. 3. Baim DS, Grossman W. Grossman's Cardiac Catheterization, Angiography, and Intervention, 6th Edition. Philadelphia, Lippincott, Williams and Wilkins. 2000. 4. Topol EJ. Textbook of Interventional Cardiology, Third Edition. Philadelphia, W.B. Saunders Company. 1999. 5. Zipes DP, Jalife J. Clinical Electrophysiology: From the Cell to the Bedside. Philadelphia, WB Saunders Company. 1995. 6. Feigenbaum H. Echocardiography, Lea and Febiger, Malvern PA. 7. Marriot HJ. Practical Electrocardiography. Williams & Wilkins, Baltimore MD. 8. Cho TC. Third Edition, WB Saunders Company 1991 9. Wayman AE. Second Edition. Lea and Febiger, Malvern PA 1992 10. www.uptodate.com
  • 6. 11. ACC/AHA guidelines for preoperative cardiac evaluation 12. Annals of Internal Medicine article on management of atrial fibrillation.
  • 7. Review of Goals and Objectives with Resident Block ______ Rotation_________________________________ Resident statement: The above goals and objectives were reviewed with me at the beginning of my rotation, and I understand the expectations for the rotation and how I will be evaluated. Resident Signature: ______________________________________________________ Printed Name: ______________________________________________________ Date: ______________________________________________________ Staff Signature: ______________________________________________________ I have discussed with my staff my need for a Mini-CEX during this block. 