Electrophysiologist Outlines Extended Training Program Changes
Since its inception as an Accreditation Council for Graduate Medical Education (ACGME)-approved sub-subspecialty training program in 1992, clinical cardiac electrophysiology (CCEP) has continued to evolve in both scope and complexity. At present, electrophysiology trainees complete a one-year specialty program, in addition to the requisite three years of general cardiology. However, as CCEP and the cardiovascular field have continued to evolve, this one-year program has seemed increasingly short.
Many cardiovascular programs now use all of their elective time to provide CCEP training for those interested. This extra time ensures their trainees are prepared to enter the specialty, making electrophysiology a de facto two-year program. On the other hand, other programs continue to follow the standard format and only provide electrophysiologists-in-training with the required one year extra CCEP fellowship, leaving their trainees with only modest experience before entering practice.
Now changes are on the horizon. The majority of experienced CCEP practitioners feel that young professionals entering the field are in a much better position to give care if they were involved with a “two-year” program, and that all trainees should have this practice. Because of this, there is a move among the community to require a two-year CCEP program in addition to the three years of cardiovascular fellowship.
And professional societies are stepping up to help. The ACC, in conjunction with the American Heart Association and the Heart Rhythm Society have come together to produce an advanced training statement. This statement outlines which fundamental CCEP training changes are needed and the specific knowledge and skill requirements which must be updated.
The statement is structured to be compatible with the six general competency domains promulgated by the ACGME and the American Board of Medical Specialties and the ACGME’s concept of “milestones” to measure progress during the fellowship. Thus the statement tabulates in detail the goals and objectives of a CCEP training period, and indicates which of these may have been mastered during a general cardiovascular fellowship, and during each year of a two-year CCEP fellowship. The statement recognizes that teaching certain skills – such as lead extraction – may not be available in all CCEP training programs and that in such cases additional training should be sought for those wishing to perform these procedures.
The first step to implement this new training structure was to get the American Board of Internal Medicine – the organization responsible for codifying what is required to take Board exams – to agree that those wishing to take the test must complete the proposed two-year training starting July 2017, and this has been done. Next, ACGME, the organization responsible for classifying how training programs must implement and document the actual training, is expected to rely heavily on the statement as the basis for new program requirements.
Many ask whether training has become too extended between the three years of medicine, three years of cardiology and two years electrophysiology. The answers are not yet in. The changes in CCEP, however, are a first step that may trigger further discussion of the duration of training. Regardless, one thing remains clear: electrophysiologists will emerge from training with more uniform and enhanced capabilities.
This article was authored by John D. Fisher, MD, FACC, chair-elect of the Electrophysiology Section.
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