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(BETHESDA,
MD)—Training is one of the most important
factors in preparing the next generation of cardiologists
for the challenges that lie ahead in health care.
To help ensure overall uniform training standards
for cardiology fellowship training programs, the
American College of Cardiology Foundation (ACCF)
has revised a document that has been, and will
continue to be, an indispensable resource for
fellows, chiefs of cardiology, and training directors.
Still
known by the unusual name "COCATS,"
the document was originally the product of a conference
held in 1994 at Heart House and titled, "The
COre CArdiology Training Symposium." No such
conference was held this time around and the document
has a new name—"The Revised Guidelines
for Training in Adult Cardiovascular Medicine
Core Cardiology Training II"—but the
nickname has stuck. And COCATS II is expected
to be every bit as useful as its predecessor,
said ACC Immediate Past President George A. Beller,
MD, who co-chaired the steering committee along
with Robert O. Bonow, MD, and Valentin Fuster,
MD, PhD. Working with them were approximately
50 experts comprising 12 task forces organized
to reflect the document's major training categories.
The task forces included representatives from
the various subspecialty societies as well as
from the American Board of Internal Medicine and
the Accreditation Council for Graduate Medical
Education.
"We
used a very broad process for obtaining input
and, more important, we had a large number of
peer reviewers, including members of ACCF committees
that related to the various training disciplines,
the Board of Governors, the American Heart Association,
subspecialty societies, and training directors
who are on the front lines training fellows,"
said Dr. Beller.
The
entire COCATS document has been revised significantly
to reflect the rapidly changing field of cardiovascular
care. Perhaps most evident is the addition of
two new task forcesÑone on vascular medicine and
peripheral catheter-based interventions and the
other on cardiovascular magnetic resonance.
"These
new areas were not mature enough back in 1995,
when the first COCATs document was published,"
said Dr. Beller. "The knowledge base in these
areas is now sufficient that the updated document
describes a career track for each."
Despite these additions and major expansion of
various sections—such as to the discussion
of specialized electrophysiology, cardiac pacing,
and arrhythmia management—some things have
not changed.
"We
have maintained the clinical core of 24 months.
It has not been increased, although additional
years of training are recommended for trainees
who want to develop advanced expertise in specialized
areas, who are seeking dedicated time for research,
or both," said Dr. Beller. "And there
is still a minimum of nine months in nonprocedural
activities. To be a well-trained cardiologist,
you can't just focus on procedures—either
noninvasive or invasive. We are continuing to
recommend nonprocedural rotations in areas such
as the coronary care unit, heart failure service,
and a general cardiology consult service."
Also
familiar to those who used the first installment
of COCATS will be three levels of training recommended
for associated degrees of expertise. They range
from level 1, the basic training required of all
fellows to be competent, consultant cardiologists
(see diagram); through level 2, corresponding
with intermediate skill in a specialized area;
and level 3, wherein the fellow receives advanced
training and develops a high skill level.
For
each training level, the task force addresses
(often with helpful charts) the duration of training
and how evaluations should be conducted as well
as experiences in which fellows should participate
during training. Where appropriate, the latter
includes how many procedures are recommended for
each level of training, often reflecting new ACCF
clinical competence statements.
"This
information will be particularly helpful to fellows,"
said Dr. Beller. "If, for example, a fellow
wants to be trained in electrophysiology, he or
she can look in COCATS to see how many procedures
are recommended. That way, as the fellow maintains
a procedures log, he or she will know when the
volume requirements have been fulfilled."
As
valuable as COCATS II will be for fellows, Dr.
Beller expects that it will be most valuable for
training directors and chiefs of cardiology, who
can use the recommendations "to make sure
that their program provides the training experience
that is thought by the experts to be optimal for
training."
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