The following are 10 points to remember about the fourth revision of the American College of Cardiology Core Cardiovascular Training Statement (COCATS 4):

1. The aggregated competencies described in COCATS 4 form the basis for the overarching Entrustable Professional Activities (EPAs) of the cardiology profession; namely, those activities that patients and the public expect all competent clinical cardiologists can perform.
2. Training and requirements in cardiovascular disease address the six general competencies promulgated by the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties (ABMS) and endorsed by the American Board of Internal Medicine (ABIM). These competency domains include: Medical Knowledge, Patient Care and Procedural Skills, Practice-Based Learning and Improvement, Systems-Based Practice, Interpersonal and Communication Skills, and Professionalism.
3. This iteration of COCATS contains a number of structural changes in the cardiovascular curriculum since the recommendations issued in 2008. There is a substantially stronger focus on ambulatory, consultative, and longitudinal care, reflecting a commitment to patient-centric education in clinical cardiology.
4. Experience in ambulatory, consultative, and longitudinal care should incorporate three general approaches: 1) acquisition of key skills through practical exposure and clinical practice, 2) participation in consultative cardiology, and 3) a formal curriculum that emphasizes the pathophysiological mechanisms and core knowledge of cardiovascular diseases.
5. Noninvasive imaging techniques are key components of the evaluation of patients with cardiovascular disease, and every cardiovascular trainee should gain a basic understanding of how to utilize them properly in patient care. In line with this, every cardiovascular trainee should learn the principles underlying echocardiographic, nuclear, cardiovascular computed tomography (CCT), and cardiac magnetic resonance (CMR) imaging modalities, including their respective advantages, limitations, and potential risks.
6. Nuclear cardiology provides important diagnostic and prognostic information that is an essential part of the knowledge base required of the well-trained cardiologist for optimal management of the cardiovascular patient.
7. Every cardiovascular fellow should develop familiarity with the technical performance, interpretation, strengths, and limitations of and its multiple clinical applications.
8. It is essential that all cardiologists understand the appropriate application of invasive and interventional cardiology and for those planning to practice these disciplines to achieve the knowledge and skills needed for advanced training. The ultimate goal of a cardiac catheterization training program is to teach the requisite cognitive and technical knowledge of invasive cardiology. This includes indications and contraindications for the procedures, procedural skills, pre- and post-procedure care, management of complications, and analysis and interpretation of the hemodynamic and angiographic data.
9. The diagnosis and management of cardiac arrhythmias and conduction disorders are common and important components of the practice of clinical cardiology, and thus part of the core competency training of a clinical cardiologist.
10. The essentials of critical care cardiology should be taught to all fellows. Critical care training should be integrated into the fellowship program and include the evaluation and management of patients with acute, life-threatening cardiovascular illnesses, exposure to noninvasive and invasive diagnostic modalities commonly used in the evaluation of such patients, familiarity with both temporary and long-term mechanical circulatory support devices, and understanding of the management of the critically ill patient.

Keywords: Accreditation, Curriculum, Education, Medical, Graduate, Fellowships and Scholarships, Angiography, Arrhythmias, Cardiac, Cardiac Catheterization, Cognition, Critical Care, Heart Conduction System, Hemodynamics, Knowledge Bases, Magnetic Resonance Spectroscopy, Patient Care, Tomography

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