A paper published June 21 in the Journal of the American College of Cardiology details a new alternative training pathway in cardiovascular disease and clinical cardiac electrophysiology (CCEP) that focuses on achievement of competency as opposed to time-based experiences alone.

The alternative training pathway, which has been approved as a pilot program by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine, was designed in response to the recent expansion of CCEP training from one to two years, allowing for competency-based early career focus in CCEP during the third year of cardiovascular disease training.

Lisa A. Mendes, MD, chair of ACC’s Competency Management Committee, et al., write that competency-based training models aim to enhance efficiency, promote educational innovations, and enable fellows to focus on educational activities based on their respective career goals during general cardiovascular disease and subspecialty fellowship. They add that this approach also offers benefits such as reduced financial strains on trainees and fellowship programs, decreased length of training, and the potential to minimize barriers to diversity within cardiology.

In this alternative training pathway, the first two years of fellowship focus on achieving clinical competencies in cardiovascular disease. The third year focuses primarily on CCEP, although fellows are encouraged to take on educational experiences that are relevant to both general cardiology and CCEP (such as multidisciplinary conferences, imaging and research). The third year counts for both cardiovascular disease and CCEP board certification eligibility, with oversight provided by both cardiovascular disease and CCEP program directors. The final year of training focuses solely on CCEP clinical experiences. Alternate pathway trainees are eligible to take certification examinations for cardiovascular disease and CCEP after the third and fourth training years, respectively.

Twenty programs will be selected by lottery to participate in the program, with the first trainees expected to start the combined cardiovascular disease-CCEP fellowship year in July 2023. The pilot phase of this program will be completed in five years, at which time the ACGME will determine if this training model should be continued as is, modified, or recognized as an official option for select cardiovascular disease trainees. Success of the pilot will be defined by graduation of fellows that are competent to practice cardiovascular disease and CCEP independently after four years of training and pass both the cardiovascular disease and CCEP certification examinations.

“This pilot, if it proves to be successful, could move us one step forward toward the goal of true competency-based medical education in fellowship training,” Mendes writes.

Keywords: Accreditation, Certification, Education, Medical, Graduate, Pilot Projects, Electrophysiologic Techniques, Cardiac, Clinical Competence

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