Review Looks at Training Pathways, Competencies For Critical Care Cardiology

As interest in training for critical care cardiology (CCC) continues to rise, a recent study found there is significant heterogeneity in current standardized CCC training paradigms for meeting training competencies and board certifications, reinforcing the unmet need to define competencies in the field, according to a study published Feb. 12 in JACC: Advances.

Saraschandra Vallabhajosyula MD, MSc, et al., conducted a scoping review of literature to help inform the standardization of competencies in CCC. The study included 20 articles from 2000 to 2022 that focused on the contemporary landscape of training for cardiovascular medicine, CCC, and CCC and hybrid training. The articles were mostly opinion/editorial articles along with two surveys, and discussed training paradigms, scope of practice and training, duration, sequence and milestones.

The authors divided the training pathways into two groups: 1) specialty training in both cardiovascular medicine (three years) and CCC (one to two years) leading to dual American Board of Internal Medicine (ABIM) board certification; or 2) base specialty training in cardiovascular medicine with competencies in interventional cardiology, heart failure or CCC leading to a non-ABIM certificate. Results showed that the duration of the total fellowship varied between four and seven years after completing a three-year residency in internal medicine.

“While multiple articles commented on the ability to integrate the fellowship training pathways into a holistic and seamless training curriculum, few have highlighted how this may be achieved to meet competencies and standards,” the authors note.

“CCC remains a rapidly evolving field in [cardiovascular] medicine and represents a unique opportunity for customized training, collaborative and high-quality patient care, and academic development,” write the authors. They note the need for innovative approaches to training, such as flexible training pathways, potentially tailored to the patient population being served based on the levels of CICU complexity, to balance the need to provide optimal training and address the “persistent deficit of these physicians to staff acute care units.”

In a related editorial comment, Brandon M. Wiley, MD, FACC,  and Emily K. Zern, MD, FACC, note, “Defining the standard for CCC training is crucial for the future of CCC practice within the landscape of critical care. CCC trainees not only need to develop the clinical expertise to manage critically ill cardiac patients, but they also need to be recognized by the critical care community as critical care physicians. [Cardiovascular] fellows need a clear definition of the CCC training process and reassurance that their efforts will yield marketable skills and a clinical position post-fellowship.”

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Certification, Critical Care, Curriculum, Fellowships and Scholarships, Internship and Residency

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