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Miami Valley Hospital – Cardiology DCC
Ceferino Cata, MD 1126 South Main Street
John Duckak III, MD Dayton, OH 45409
Irshad Hussain, MD 223-3053
Mujtaba Khan, MD
Raymond Pratt, MD
Sukirtharan Sinnathamby, MD
General Description of Rotation:
This is an optional ½ or 1 month rotation at the PGY 2 or 3 level. One month of credit for meaningful patient
responsibility will be granted for each month on the service. Time in ambulatory setting will be approximately 80%
exclusive of primary care clinics.
This rotation is considered a general cardiology experience with a focus on pathophysiology of common disorders
(ischemic heart disease, CHF, valvular heart disease, arrhythmias). The resident should develop excellent skills in
obtaining a cardiac history. The resident will improve skills in physical diagnosis, especially cardiac auscultation
and the examination of the arterial and venous vascular systems. The resident will also develop therapeutic plan for
patients in ambulatory and inpatient settings.
The strengths of the rotation are the variety of cardiac disorders seen in varying stages of disease and the quality and
availability of the attending physicians, all of whom are Board Certified in Cardiology
Educational Purpose and Goals:
Improve skills in history-taking related to cardiac illness
Improve skills in cardiac examination, with special attention to cardiac auscultation
Review pathophysiology and management of congestive heart failure, including diagnosis and management of
Define the spectrum of ischemic cardiac disease and select proper testing and treatment of varying stages of illness
Discuss evidence for primary and secondary prevention of coronary artery disease and review guidelines for patient
Diagnose and initiate treatment for common and complex arrhythmias, recognizing indications for
Review diseases of the pericardium, understanding principles of treatment and recognizing indications for
pericardiocentesis or surgical intervention
Discuss cardiac causes of syncope and become familiar with applications of Holter monitoring, cardiac event
monitoring, and tilt testing
Describe indications for cardiac transplantation
Recognize congenital cardiac defects present in adult patients and review indications for surgical intervention
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Observe at least one cardiac catheterization procedure involving interventional treatment for coronary occlusion
Interpret basic findings of echocardiography and recognize indications for specific types of echocardiographic
Recognize the role of diet and exercise in prevention and treatment of cardiac diseases
Gain experience in counseling of patients concerning lifestyle modifications related to cardiac disease
Establish habits for lifelong learning related to new developments in cardiology
Residents should be actively involved in the care of patients on the service. To the extent possible, they should be
fully integrated into the management team, working under the supervision of the attending physician but having the
opportunity for independent analysis of data and proposal of treatment plans. The resident should assume
progressively more responsibility as he/she advances through each year of training.
The goal of resident involvement patient management is to provide a basis for practice as a general internist. It is not
expected that residents shall spend excessive amounts of time in the cardiac catheterization laboratory, nor shall they
participate directly in management of complex support systems such as intra-aortic balloon pumps, advanced
pacemaker systems, etc.
Principal Teaching Methods:
Early in the rotation discuss impressions and plans with the attending before writing in the chart or consult sheet.
The attending will let the resident know when he/she may begin documenting impressions and plans independently.
For progress notes, address only the cardiac problems; notes should be focused and concise.
The resident will be expected to see and manage a reasonable patient load, and if time permits to view or participate
in procedures. It is the resident’s responsibility to check the endoscopy schedule for any procedures he/she would
like to observe.
The rotation is not tightly structured and the resident will need to read on his/her own and initiate discussion of
topics with faculty. The resident should present an informal topic to the attending or GI Fellow at least once per
week on a preselected topic. The resident will need to coordinate times to round with faculty for new consults;
rounds may be conducted after 5:00 P.M. in which case attendance is optional.
Types of Clinical Encounters:
Average 1-2 new hospital consults per day, and total inpatient service of 5-10 patients.
Average 10-12 patients per session in the office.
EKG Interpretation: Residents should practice a systematic approach to reading EKG’s. Resident will be expected to
identify ischemic changes, interpret common arrhythmias, recognize paced rhythms, identify chamber enlargement,
and assess the effects of drugs and electrolyte abnormalities.
Echocardiogram Interpretation: Resident should participate in reading of echocardiograms with the attending
physician and should become familiar with indications for the study and best techniques for specific disorders.
Cardiac catheterization: Resident should observe at least one cardiac catheterization procedure. It is not the intent of
this rotation to spend significant amounts of time observing interventional procedures.
Chest X-ray interpretation: Resident should develop skills in chest x-ray interpretation, particularly related to
assessment of cardiac size, chamber enlargement, and signs of pulmonary edema.
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The attending physician will have responsibility for all patient care provided. Residents will be supervised by an
attending for each patient, although attending physicians need not be physically present during each encounter.
Residents will be granted some independent decision-making according to their ability and level of training.
Patient Characteristics and Services:
Patients encountered during this rotation will reflect the general population of Dayton, including a wide variety of
socioeconomic groups, ethnic diversity, and balanced gender and age groups.
Mix of diseases:
Topics: A Expect to see patients with and to have teaching about
B May or may not be seen but must be read about
C Rarely seen on service but should be read about
D Optional for this rotation
A Expect to see patients with and to have teaching about
• Evaluation of chest pain
• Evaluation of dyspnea
• Evaluation and management of peripheral edema
• Physical examination of the heart
• Cardiac catheterization
• Coronary artery disease including evaluation of angina and indications for CABG, PTCA, and
• Systolic and diastolic congestive heart failure
• Supraventricular arrhythmias
• Valvular heart disease
• Cardiac evaluation prior to noncardiac surgery
B May or may not be seen but must be read about
• Sudden cardiac death
• Acute myocardial infarction
• Ventricular arrhythmias
• Pacemakers and indications for pacing
• Cardiopulmonary resuscitation
• Hemodynamic monitoring and use of vasoactive medications
• Thrombolytic therapy
• Use of glycoprotein IIa/IIIb inhibitors
C Rarely seen on service but should be read about
• Pericardial disease
• Cardiac amyloidosis
• Myocardial contusion
• Cardiac disease in pregnancy
• High cardiac output states (high output heart failure)
• Cocaine effects on the heart
D Optional for this rotation
• Congenital heart disease
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• Cardiac tumors
• Cardiac transplantation, evaluation of potential recipients and management of post-transplant
Reading List and Ancillary Educational Materials:
Selected chapters of Braunwald’s The Heart.
Cardiology, MKSAP 13, 2004.
Specific articles recommended by attending physicians will be discussed based upon cases seen during the rotation.
Rotation Specific Competency Objectives:
a. Patient Care
PGY-2 residents will regularly integrate medical facts and clinical data while weighing alternatives and keeping in
mind patient preference. They will regularly incorporate consideration of risks and benefits when considering testing
and therapies. They will present up-to-date scientific evidence to support their hypotheses. They will consistently
monitor and follow-up patients appropriately.
PGY-3 residents will demonstrate the above and in addition, will demonstrate appropriate reasoning in ambiguous
situations, while continuing to seek clarity. Residents at this level of training will not overly rely on tests and
procedures. PGY-3 residents will continuously revise assessments in the face of new data.
b. Medical Knowledge.
PGY-2 residents will demonstrate a progression in knowledge and analytical thinking in order to develop well-
formulated differential diagnoses for multi-problem patients.
PGY-3 residents in addition to the above will demonstrate appropriate habits to stay current with new medical
knowledge, and will exhibit knowledge of effective teaching methods.
c. Interpersonal and Communication Skills.
PGY-2 residents will develop and refine their individual style when communicating with patients. They will strive to
create ethically sounds relationships with patients, the physician team and supporting hospital personnel.
They will create effective written communications through accurate, complete, and legible notes. They will exhibit
listening skills appropriate to patient-centered interviewing and communication. Residents will recognize verbal and
nonverbal cues from patients. PGY-2 residents will be able to communicate with patients concerning end-of-life
PGY-3 residents should additionally be able to successfully negotiate nearly all “difficult” patient encounters with
PGY-2 and PGY-3 residents will serve as role models, demonstrating integrity, accountability, respect, compassion,
patient advocacy, and dedication to patient care that in all encounters. Residents will demonstrate a commitment to
ethical principles pertaining to provision or withholding of clinical care, confidentially of patient
information, and informed consent.
PGY-3 residents will be especially sensitive and responsive to patients’ culture, age, gender and disabilities.
e. Practice Based Learning and Improvement
PGY-2 residents will consistently seek out and analyze data on practice experience, identify areas for improvement
in knowledge or patient care performance and make appropriate adjustments.
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3. PGY-3 residents will additionally model independent learning and development. They will regularly demonstrate
knowledge of the impact of study design on validity or applicability to individual practice.
f. Systems Based Practice.
PGY-2 residents will be sensitive to health care costs while striving to provide quality care. They will effectively
coordinate care with other health care professionals as required for patient needs. They will consistently understand
and adopt available clinical practice guidelines and recognize the limitations of these guidelines. They will work
with patient care managers, discharge coordinators and social workers to coordinate and improve patient care and
PGY3 residents, in addition, will enlist social and other out-of-hospital resources to assist patients with therapeutic
plans. PGY-3 residents are expected to model cost-effective therapy.
Resident Performance Evaluations:
Written evaluation will be completed by the attending physician at the end of the rotation. The resident should seek
verbal formative feedback continuously during the rotation.
Weekdays: Mornings and afternoons will be spent in the physicians’ office or making hospital rounds at Miami
Valley Hospital. The resident will attend the MVH Cardiology Clinic on the 1st and 3rd Thursday mornings of each
Weekends: Residents will have at least one day off each weekend which will be negotiated with the faculty
member. The resident may be asked to round on inpatients one day each weekend.
Primary Care Clinics supercede the above schedule.
Cardiology Ambulatory, DCC, MVH
Sun Mon Tues Wed Thurs Fri Sat
7:00 AM 7:30 7:30 7:30 7:30 7:30
4:00 PM 4:30 4:30 4:30 5:00 4:30
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Where to Report the First Day:
1126 South Main Street
Dayton, OH 45409
Contact the office at the number listed above prior to the start of the rotation for further instructions on whom to
work with on the first day of the rotation. The office is across the street from the entrance to the Montgomery
Conferences to be Attended While on Rotation:
Senior check-out and morning report 7:30-8:30 weekdays
Internal Medicine Resident Forum - 1:00-4:30 1st, 3rd, 4th, and 5th Tuesdays
GSH, MVH, or WPMC clinic meeting – 2nd Tuesday 12:00-1:30
OR Med/Peds Business Meeting – 3rd Friday 12:00-3:00
Noon Conferences - 12:00-1:00 most weekdays, except Tuesday
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