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Introduction
Joseph
S. Alpert, MD, FACC - Chairman
William J. Arnold, MD, FACP
Bernard R. Chaitman, MD, FACC
C. Richard Conti, MD, FACC
Gordon A. Ewy, MD, FACC
Eric L. Michelson, MD, FACC
Robert J. Myerburg, MD, FACC
Continuing advances in the diagnosis and treatment of
patients with cardiovascular disease necessitate an
update of the training guidelines for physicians to
be consultants in cardiovascular disease. This has occurred
as the result of a remarkable increase in knowledge
of the basic science and clinical areas of cardiovascular
disease along with the development of new drugs and,
importantly, complex new diagnostic and therapeutic
techniques and devices. At the same time, the population
is aging, and there are increasing numbers of patients
with severe and complicated cardiovascular disease,
including those with surgically repaired or replaced
heart valves, corrected congenital heart disease, pacemakers
or who have undergone coronary artery bypass surgery.
The cardiologist must make more and more complex decisions,
frequently in the role of consultant. There is an increased
requirement to learn the specificity, sensitivity, risk/benefit
and cost/benefit of newer diagnostic techniques as well
as indications and expected outcomes for the newer therapeutic
options. The appropriate utilization of these new diagnostic
methods and therapeutic modalities requires a thorough
knowledge of a large body of published data.
The increasing volume of information to be acquired
and the increased clinical experience necessary to make
proper clinical decisions in cardiology have necessitated
an increase in the training requirements for physicians
who wish to become practitioners of cardiology. Furthermore,
the sophisticated diagnostic and therapeutic procedures
that enhance patient care require procedural and interpretative
skills and the judgment to use them properly in patient
management.
The American Board of Internal Medicine (ABIM) Subspecialty
Board on Cardiovascular Disease requires 3 years of
training. An additional year of training is required
by the ABIM to sit for the certification examination
for added qualifications in clinical cardiac electrophysiology.
A full year or more of training is recommended as a
minimum for trainees who want advanced expertise in
specialized areas, such as transplantation medicine;
interventional cardiac catheterization involving interventional
procedures, such as percutaneous transluminal coronary
angioplasty, atherectomy and balloon valvuloplasty;
congenital heart disease in the adult; or dedicated
research to establish a foundation for an academic career.
In this document, fellow and trainee are used interchangeably,
as is cardiovascular medicine and cardiology. Furthermore,
it is important that the quantity of a particular traineeÕs
experience not be confused with quality. Thus, the performance
of a specified number of procedures is not synonymous
with excellence in the carrying out of these procedures.
Careful supervision and critique of procedures by faculty
members is far more important than merely performing
the required number of procedures.
Throughout this document, training is suggested at three
levels:
- Level
1: Basic training required of all trainees to be a
competent, consulting cardiologist.
- Level
2: Additional training in one or more specialized
areas enabling a cardiologist to perform or interpret,
or both, specific procedures at an intermediate skill
level.
- Level
3: Advanced training in a specialized area enabling
a cardiologist to perform, interpret and train others
to perform and interpret specific procedures at a
high skill level.
In
this document, full-time training periods are defined
as a time period in which the trainee has no primary responsibilities
other than the specified rotation. This document contains
recommendations for the training of cardiovascular medicine
fellows. It does not set training requirements for graduate
fellows wishing to return for additional training. The
guidelines recommended in this document differ from those
suggested by the Accreditation Council for Graduate Medical
Education (ACGME). In every instance, the present guidelines
require a greater number of procedures than the suggestions
of the ACGME.
Copyright © 1995 American College
of Cardiology
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