1. Internal Medicine Curriculum
Contact Person: Dr. Steven Monroe
The cardiology rotation is designed to familiarize the resident with the management of
patients with cardiovascular problems typically encountered by internists. The resident
will gain experience in the diagnosis and treatment of patients with cardiac conditions
and appropriate selection of cardiac diagnostic testing. The cardiology rotation includes
both inpatient and outpatient experiences designed to maximize the learning opportunities
for general internists.
Educational Purpose and Goals
The primary goal of the rotation is to enhance the resident’s ability to diagnose, provide
cost-effective treatment for, and understand the pathophysiology of cardiovascular
disease processes. Other goals of the rotation include:
A. Improving cardiac physical examination techniques.
B. Learning basic EKG and arrhythmia interpretation.
C. Improving diagnostic and management skills of patients with common cardiac
D. Demonstrating an understanding of the clinical interpretation and complications of
noninvasive and invasive cardiac tests.
E. Developing an understanding of diagnostic evaluation for syncope.
F. Diagnosing and initiating management of patients presenting with acute coronary
Multiple teaching methods are utilized on the cardiology rotation including:
A. Self-study of assigned readings.
B. Self-study with faculty review of EKG interpretation.
C. Faculty supervision of resident performed cardiac procedures such as stress testing.
D. Supervised cardiology consultations with critique and feedback.
E. Presenting information about assigned cardiology topics.
A. Arteriosclerotic cardiovascular disease and its manifestations including management
of myocardial infarction and acute coronary syndromes, chronic angina pectoris, and
peripheral vascular disease.
B. Congestive heart failure, both diastolic and systolic dysfunction.
C. Cardiac arrhythmias including: 1) common atrial and ventricular arrhythmias, 2)
normal and abnormal pacemaker function, and 3) cardiac conduction abnormalities.
D. Evaluation of patients with syncope.
E. Evaluation and management of patients with congenital and acquired valvular heart
2. F. Preventive cardiology including: 1) identification of patients at risk for cardiovascular
events and 2) following current guidelines for risk reduction.
Patient Characteristics and Clinical Encounters
The rotation has been designed to include significant outpatient and inpatient exposures
important for general internists, including participating in noninvasive cardiac diagnostic
testing. Patients encountered by the resident will represent a wide diversity in age,
lifestyles and cardiovascular disease.
Patients on this rotation include: 1) inpatients with urgent or emergent cardiac conditions,
2) inpatients for whom cardiac consultation has been requested, and 3) outpatients with
cardiac conditions being evaluated and managed in clinical practices of cardiology
faculty and the University Medical Associates clinic.
Procedures and Services
A. EKG and rhythm strip interpretations.
B. Stress test performance and interpretations.
C. Nuclear and pharmacologic stress testing.
D. Introduction to echocardiographic techniques including transthoracic and
E. Introduction to cardiovascular CT imaging.
A. Required reading includes:
1. Cardiology Section from the MKSAP 14 Series.
2. Braunwald Heart Disease 7th Edition 2005 (or most current)
a. Chapter 10, pp. 153-185, Exercise Stress Testing
b. Chapter 13, pp. 300-306, Assessment of Myocardial Blood Flow by
c. Chapter 13, pp. 311-319, Disease Detection, Risk Stratification and
3. EKG instructional modules and self-assessment quizzes from University of Utah
B. Supplemental reading includes:
1. Current guidelines from the American College of Cardiology: congestive heart
failure, acute coronary syndromes, atrial fibrillation, syncope.
2. The AFFIRM Trial. A comparison of rate control and rhythm control in patients
with atrial fibrillation (AFFIRM). NEJM. 2003;347:1825-1832.
3. Review of Congenital Heart Disease in Adults NEJM 2000;342:256-263,334-342.
4. Valsartan, captopril or both in MI complicated by heart failure, LV dysfunction or
both. (The VALIANT TRIAL) NEJM 2003;349:893-906.
5. CHARM Trials. Effects of candesartan in patients with chronic heart failure and
preserved left ventricular ejection fraction: the CHARM-Preserved Trial. Lancet
3. 6. Structured didactic EKG teaching using EKG teaching files.
7. Current Literature as assigned by the faculty supervisor.
When possible, residents will be encouraged to participate in clinical procedures to
correlate the anatomy and physiology of the disorder being evaluated.
Evaluation of Resident Performance
The resident on the cardiology rotation is evaluated continuously by the faculty
cardiologist as residents evaluate and present to the attending physician. Residents
receive a verbal mid-month evaluation by the attending cardiologist. In addition,
residents receive a written end of month evaluation which is forwarded to their residency
During the cardiology rotation, residents are constantly encouraged to promote healthy
lifestyles in their patients, particularly through changing modifiable risk factors. The risks
for cardiovascular diseases imposed by behavioral choices are constantly highlighted.
Through presentation of patients to the attending cardiologist, interviewing,
communication and interpersonal skills are constantly on display and critiqued in order to
encourage thorough and accurate history taking and physical exams.
The cardiology attending will provide immediate supervision to the resident when
performing procedures, such as stress tests, and will review all patient recommendations
with the resident.
The attending cardiologist conducts patient rounds daily. Residents accompany the
attending cardiologist on patient rounds most days. The resident and cardiology attending
supervise all medical students participating in the cardiology rotation. Residents are
expected to participate in teaching of those junior to them in the residency program as
well as medical students present on the rotation.
Teaching Rounds and Conferences
A. Daily morning resident conferences
B. Resident Noon Conference daily
C. Regular EKG teaching conference
D. Daily attending teaching rounds (see monthly schedule)
Requirements of Cardiology Rotation Completion
The following components are required for successful completion of the cardiology
A. Attendance at all scheduled inpatient and outpatient sessions.
B. Obtaining a passing score on the EKG examination.
C. Completion of 25 supervised exercise treadmill tests.
D. Successful completion of the required readings based on resident attestation and
faculty testing of resident knowledge.
4. E. Demonstration of appropriate skills in eliciting accurate cardiac history and physical
F. Obtain satisfactory end-of-rotation evaluation.
G. Complete assigned case report, abstracts and/or posters if assigned by the supervising
H. Complete CDs on heart sounds and cardiac murmurs.
Accreditation Council on Graduate Medical Education
“Every competency can be taught with every patient.” B. Joyce, 2006
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health. Residents are
communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients and their families
gather essential and accurate information about their patients
make informed decisions about diagnostic and therapeutic interventions based on
patient information and preferences, up-to-date scientific evidence, and clinical
develop and carry out patient management plans
counsel and educate patients and their families
use information technology to support patient care decisions and patient education
perform competently all medical and invasive procedures considered essential for
the area of practice
provide health care services aimed at preventing health problems or maintaining
work with health care professionals, including those from other disciplines, to
provide patient-focused care
Residents must demonstrate knowledge about established and evolving biomedical,
clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the
application of this knowledge to patient care. Residents are expected to:
demonstrate an investigatory and analytic thinking approach to clinical situations
know and apply the basic and clinically supportive sciences which are appropriate
to their discipline
5. PRACTICE-BASED LEARNING AND IMPROVEMENT
Residents must be able to investigate and evaluate their patient care practices, appraise
and assimilate scientific evidence, and improve their patient care practices. Residents are
analyze practice experience and perform practice-based improvement activities
using a systematic methodology
locate, appraise, and assimilate evidence from scientific studies related to their
patients’ health problems
obtain and use information about their own population of patients and the larger
population from which their patients are drawn
apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness
use information technology to manage information, access on-line medical
information; and support their own education
facilitate the learning of students and other health care professionals
INTERPERSONAL AND COMMUNICATION SKILLS
Residents must be able to demonstrate interpersonal and communication skills that result
in effective information exchange and teaming with patients, their patients families, and
professional associates. Residents are expected to:
create and sustain a therapeutic and ethically sound relationship with patients
use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
work effectively with others as a member or leader of a health care team or other
Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents
are expected to:
demonstrate respect, compassion, and integrity; a responsiveness to the needs of
patients and society that supercedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices
demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
6. SYSTEMS-BASED PRACTICE
Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide
care that is of optimal value. Residents are expected to:
understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and the larger society and
how these elements of the system affect their own practice
know how types of medical practice and delivery systems differ from one another,
including methods of controlling health care costs and allocating resources
practice cost-effective health care and resource allocation that does not
compromise quality of care
advocate for quality patient care and assist patients in dealing with system
know how to partner with health care managers and health care providers to
assess, coordinate, and improve health care and know how these activities can
affect system performance
7. Cardiology Rotation Checklist
Intern/Resident ______________________ PGY 2 or 3
Supervising Faculty___________________ Month_________________________
Rotation Check List Yes No Comments
Reviewed the goals and objectives at the beginning of the rotation
Evaluation and feedback mid month
Evaluation and feedback at the end of rotation
Attended all scheduled clinical sessions
Completed required case reports/abstracts/posters if assigned
Reviewed and met the core competencies as outlined. Please give at least
one additional example.
A. Patient Care
• Consistently obtains a complete history focused on the
identification of specific symptoms representing cardiovascular
• Consistently performs a thorough physical examination focused on
findings that represent underlying cardiovascular disorders
B. Medical Knowledge
• Completed the required reading list (see curriculum)
• Demonstrated competency in diagnostic evaluation and
management of common cardiovascular disorders
• Completed minimum 25 supervised exercise treadmill tests
• Completed EKG self instruction modules and quizzes
C. Practice Based Learning
• Recognizes when to access cardiology resources to develop
diagnostic and treatment plans
• Accesses information sources appropriately to construct treatment
D. Interpersonal and Communication Skills
• Communicates diagnosis, treatment plan and follow up care to
patients and referring physicians
• Communicates with staff, and physician extenders appropriately
• Recognizes the importance of patient preferences when
recommending diagnostic and therapeutic options.
• Appropriately participated and discussed consent for procedures
8. F. Systems-Based Practice
• Able to develop, implement and evaluate treatment plans for patients
that include available resources
• Utilizes national guidelines from the American College of Cardiology
to plan and evaluate care
Please check at which PGY level the resident functioned.
PGY 1 Residents are responsible:
-for gathering relevant patient data
-performing and interpreting physical examination findings
-perform basic procedures and interpret data
-interpret laboratory tests
-interpret basic radiographic studies
PGY 2 Residents will have improved competence and demonstrate:
-improved data gathering and physical examination skills
-improved decision making
-enhanced ability to counseling
PGY 3 Residents will approach proficiency and demonstrate the ability to
Function as a consultant
Resident Signature__________________________ Date__________
Supervising Faculty _________________________ Date _________