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Q: Cardiology procedures denoting proficiency ( Answered 5 out of 5 stars,   1 Comment )
Subject: Cardiology procedures denoting proficiency
Category: Miscellaneous
Asked by: toyanukenut-ga
List Price: $100.00
Posted: 13 Aug 2006 05:22 PDT
Expires: 12 Sep 2006 05:22 PDT
Question ID: 755501
I would like to know how many cardiology studies denote proficiency in:
Cardiac Catheterization
Nuclear Cardiac Imaging
Regular Treadmill
Routine ECG (EKG)
ICG (Impedance Cardiography
2 D Echocardiogram
Venous Doppler
Arterial Doppler
Carotid Ultrasound
Tilt Table Testing
EECP(Enhanced External Counterpulsation)
Pacemaker Clinic (Biventricular  and Dual)
AICD (AutomaticInternal Cardiac Defibrillator)
Arteriogram (Abdomenal Runoff)
Lower Extremity Iliac STENTS
Carotid Arteriogram
T-Wave Alternans (Advanced Arrhythmia Risk Analysis)

Request for Question Clarification by crabcakes-ga on 13 Aug 2006 06:51 PDT
Hello Toyanukenut,

   Just to clarify-do you mean to become proficient as in "certified"
to perfom each procedure? Are you asking the procedures to become
certified in each area?

   Regards, Crabcakes

Clarification of Question by toyanukenut-ga on 13 Aug 2006 09:20 PDT
I am looking for what a cardiology school of medicine or a
professional cardiological society would consider enough studies
performed to be considered
as proficient at performing these procedures.
Thank you for asking.
Subject: Re: Cardiology procedures denoting proficiency
Answered By: crabcakes-ga on 13 Aug 2006 16:18 PDT
Rated:5 out of 5 stars
Hello Toya,

     Thank you for your clarification. It?s not as easy as it would
seem from your question. Medical schools follow established guidelines
for teaching and evaluating cardiology fellows. The topics you
mentioned are included in a cardiac fellowship,that lasts 2-3 years,
followed by several additional years of research and study. Different
schools may follow their own order of study, but all accredited
schools follow the ACGME guidelines. The student goes through the
fellowship, then takes the board exams to be considered competent as a
board certified cardiologist. Fellows are closely observed and
evaluated for each sub-specialty.

    ?Sub-specialty resident performance is provided following each
rotation. This evaluation form is provided to all sub- specialty
residents either at the program office or on the program web page. The
evaluation includes critical assessment of the core objectives and
goals for that particular rotation. These evaluations are reviewed and
discussed with the sub-specialty resident following completion by the
evaluator. The document is signed by each and included in the
sub-specialty resident file for review by the program director at the
time of the semi-annual review.

Faculty and rotational evaluations are completed by the sub-specialty
residents also following each rotation. These evaluations are
completed and returned to the program office for inclusion in the
computer database and then the paper forms are destroyed. This allows
for anonymous critical review of both faculty and the
program/rotations. These are reviewed by the program director and if
necessary by the Teaching and Evaluation Committee at least annually.?

   ?A cardiologist has special training and skill in finding,
treating, and preventing diseases of the heart and blood vessels in
A pediatric cardiologist has special training and skill in finding,
treating, and preventing heart and blood vessel disease in infants,
children, and teenagers. In some cases, the pediatric cardiologist
begins diagnosis and treatment in the fetus and continues into

A cardiac surgeon has special training and skills to perform delicate
operations on the heart, blood vessels, and lungs.
?After four years of medical school, these highly-trained doctors
spend from six to eight more years in specialized training. A
cardiologist receives three years of training in internal medicine and
three or more years in specialized cardiology training. A pediatric
cardiologist receives three years of training in pediatrics, and three
or more years in specialized pediatric cardiology training. A cardiac
surgeon must complete five years of training in general surgery before
starting a two-or three-year cardiothoracic training program. Some
cardiac surgeons have additional training to perform pediatric or
transplant surgery.?
Please see this site for complete information.

     Since most sites ?lump? all cardiac fellowship procedures on one
page, rather than breaking up each page into your different
categories, I am posting these sites at the top of my answer. That way
you can easily determine what is required for each specialty on one

     According to Stanford ?Clinical training in areas of
certification, special (electrophysiology, interventional) is accorded
on a selective basis during either a fourth or a fifth year of
training depending upon academic career goals. It is our intent that
clinical and investigative programs should be integrated and of
sufficient duration that the trainee will acquire the skills necessary
to begin a career in academic cardiology.?

?The Stanford training program seeks to provide a rich educational
environment. This includes weekly conferences on: basic science
research, electrophysiology and EKG, interventional cardiology,
interventional vascular radiology, cardiac transplantation, vascular
medicine, pediatric cardiology and cardiac catheterization. In
addition, the Division sponsors cardiovascular research conferences
and clinical conferences on a weekly basis.?

   The American Board of Internal Medicine guidelines can be found on
the link below. To become Board Certified, a medical student must
follow the guidelines and path outlined in the following. Please check
the site for complete information.

?Subspecialty Policies for Interventional Cardiology -
Eligibility for Certification and Board Policies:

   The Board's decision about a candidate's eligibility for
certification is determined by the policies and procedures described
in this document as they may be amended from time to time. The Board
reserves the right to make changes in its fees, examinations,
policies, and procedures at any time without advance notice. Admission
to the Board's examinations will be determined under policies in force
at the time of application.

Requirements for Certification
To become certified in the subspecialty of interventional cardiology,
physicians must:
?Be currently certified in cardiovascular disease by the ABIM
?Have satisfactorily completed the requisite training
?Demonstrated clinical competence in the care of patients
?Met the licensure and procedural requirements
?Passed the secure exam for that discipline
Additional requirements:
?Candidates must follow the training and practice pathways described
below (See link)

Clinical Competence Requirements
?The Board requires documentation that candidates for certification
are competent in (1) patient care (which includes medical
interviewing, physical examination, and procedural skills), (2)
medical knowledge, (3) practice-based learning and improvement, (4)
interpersonal and communication skills, (5) professionalism, and (6)
systems-based practice.

Through its tracking process, the Board requires verification of
fellows' clinical competence from both the training program director
and the chair of the department of medicine.

As outlined in the Program Director Ratings of Clinical Competence
table below, all fellows must receive satisfactory ratings of overall
clinical competence and moral and ethical behavior in each of the
required years of training. In addition, fellows must receive
satisfactory ratings in each of the components of clinical competence
and the requisite procedures during the final year of required
training. It is the fellow's responsibility to arrange for any
additional required training.?

?No credit will be granted toward certification for training that is
not accredited by the ACGME.
To be admitted to an examination, candidates must have completed the
required training in the subspecialty by October 31 of the year of the

   ?The Cardiology Fellowship is a three-year program with rotations
through Tulane University Hospital (TUHC), Charity & University
Hospitals (MCLNO), and Veterans Affairs Medical Center of New Orleans
(VAMC). The amount of time spent at each institution is determined by
the particular needs of the individual and the desire to provide a
balanced training experience. The training program includes rotations
on the cardiology ward and coronary care unit, the advanced heart
failure transplant service, the consultation service, the heart
station (Holter monitoring, exercise testing, and
electrocardiography), nuclear and vascular cardiology, cardiac
catheterization laboratories, the echocardiography laboratory,
electrophysiology, and cardiac rehabilitation. In addition, trainee
participation in basic or clinical cardiovascular research is highly
encouraged. During the program, the trainee will move from
participation in procedures under very close supervision to
independent activity. It is possible to participate in several Medical
Administration training programs offered through the Tulane School of
Public Health and Tropical Medicine.?

Michigan State
    ?The cardiology fellowship program at MSU has a long-standing
reputation of preparing talented internists for successful careers in
academic and private practice cardiology. Previous fellows have
attained faculty positions or opportunities for further training at
other prestigious institutions. They have also opened or joined
successful cardiology practices through out the United States.

The primary goal of the Cardiology Fellowship Program is to prepare
physicians to become accomplished sub-specialists in Cardiovascular
Disease. Our education program has been developed in order to allow
individual fellows to become skilled as clinicians, teachers and
investigators. The fellowship program begins with an intensive
experience in Clinical Cardiology as a broad base for further
specialized activities. The training program emphasizes the
development of particular skills to foster a life-long enthusiasm for
clinical or basic science research that will lead to improved
understanding of disease processes and, ultimately, toward
advancements in the prevention, diagnosis and treatment of patients
with cardiovascular disease.
Our program has earned accreditation through A.C.G.M.E. and we strive
to give our fellows the best education possible.?

UCLA, David Geffen School of Medicine
 The 24 month program is outlined on this site, and says that after
the 2 years ?Additional one to three years of research training is
provided to prepare the fellow for a academic career in their area of

Stanford School of Medicine
   ?New fellows receive an orientation notebook which contains the
policies of the fellowship and the requirements of ABIM and ACGME. In
addition, the Division of Cardiovascular Medicine maintains a web site
with all this information so that fellows and faculty are able to gain
access easily and rapidly to clarify issues regarding these policies.?

Procedure Documentation
Each fellow is required to document the number of procedures performed
during the 3 years of accredited training.  These procedures include:

Elective cardioversions* 
?Tilt table tests* 
?Ambulatory ECG recordings (ACGME minimum = 75) 
?ECG interpretation (ACGME minimum = 3,500) 
?Programming and follow-up surveillance of PPM and AICD 
?Left heart catherization, including coronary arteriography* (ACGME minimum = 100) 

?IABP placement* 
?PTCA and interventional procedures* 
?Intracardiac EP studies* 
?PPM and AICD implantation* 
?Transvenous pacemaker insertion* 
?Transthoracic echocardiogram (performance and interpretation) 
?Transesophageal echocardiogram (performance and interpretation)*
(ACGME minimum for TTE and TEE = 150)
?Radionuclide study interpretation 
?Exercise stress testing (ACGME minimum = 50) 

    For the procedures followed by an *, the fellow is also expected
to provide documentation of the patient's name, medical record number,
date performed, and supervising physician. ?

   Here is a check list where fellows record the number of procedures
performed. The number of procedures required may be different at each

The Washington Hospital Center
 Has accredited subspecialty training programs in internal medicine
including cardiology.

Typical Fellow's Schedule
Year One 
?  Clinical	2 Months
?  CCU	2 Months
?  Cath Lab	3 Months
?  Noninvasive Lab	3 Months
?  Nuclear Cardiology	1 Month
?  Arrhythmia	1 Month

Year Two/Three 
?  Clinical	4 Months 
?  Cath Lab	1 Months 
?  Arrhythmia/EPS	1 Months 
?  Nuclear Cardiology 	1 Months 
?  Research	6 Months
?  Elective	11 Months

More requirements are seen on this page:

Duke University?s Cardiology Fellowship program 
   ?The Cardiology Fellowship Program is a four-year, ACGME-approved
program with two clinical and two research years. Additional time may
be selected for training in basic sciences, interventional cardiology,
electrophysiology, adult congenital heart disease and magnetic
resonance imaging training.

The patient care clinic and laboratory rotations for Cardiology
Fellows follow the American College of Cardiology guidelines and
comply with all ACGME requirements. All areas of training in
cardiovascular diseases are available.? It covers 6 specialty cardiac
laboratory modules.

Conferences for cardiac fellows:

Ohio State

   ?The fully-accredited fourth-year Cardiovascular Interventional
Fellowship offers advanced training in the discipline of
interventional cardiology to individuals who have completed 3 years of
standard cardiology training and who are currently eligible for board
certification in Cardiovascular Diseases?

?Fellows will be expected to develop the skills required to select
appropriate patients for specific interventional techniques and will
be involved in post-procedural care. They will also acquire the skills
in performing and interpreting coronary angiographic films,
hemodynamics, intravascular ultrasound, and intracoronary Doppler flow
and intracoronary pressure monitoring. The interventional fellowship
program also offers a post-procedure ambulatory clinic for long-term
risk factor modification and assessing outcomes in patients undergoing
coronary or peripheral vascular intervention.

Interventional fellows will be required to vigorously pursue and
submit grants for research support, and will be expected to submit
their research for publication in peer-reviewed journals. In addition,
presentations at lectures, conferences, journal clubs, or medical
grand rounds regarding their research is required. Fellows will work
closely with the research laboratory coordinator in the preparation of
grants, and will work with assigned faculty members to carry out
specific interventional projects. The fellow will be expected to
participate in animal as well as clinical research.?

?The one-year Electrophysiology Fellowship offers training in the
management of patients with complex arrhythmias and corresponding
device placement and management. Candidates must have completed, or be
in the process of completing, a formal 3 year ACGME accredited CV
fellowship. ?

?Formal didactic sessions, journal clubs, or research conferences
involving electrophysiology topics are held on a regular basis.  In
addition, there are ECG conferences twice a month, during which
electrophysiology fellows and general cardiology fellows participate
in the interpretation of complex electrocardiograms under the guidance
and supervision of Dr. Schaal.
The EP fellows are mentored and supervised by faculty members in the
conduct of research. Fellows are encouraged and supported in enhancing
their scholarly activities through publication of manuscripts or
abstracts in peer-reviewed journals and/or abstracts presented at
national specialty meetings such as the Heart Rhythm Society, ACC and
AHA meetings.?

UTMB, University of Texas
?The three-year cardiology fellowship is accredited by the ACGME and
consists of 24 to 30 months of clinical cardiology and 6 to 12 months
of research. Following completion, fellows will be eligible for
certification in Cardiovascular Diseases by the American Board of
Internal Medicine.?

St. Luke?s Episcopal Hospital
   ?Any fellow who wishes to obtain a license to use radioactive
materials (RAM) should contact the Chief of the Nuclear Medicine
Service (Dr. Warren Moore, 832-355-3126) as soon as possible during
the fellowship to discuss the requirements for such licensure. Though
likely to change in the relatively near future, current requirements
for licensure in Texas include 200 hours of didactic training in the
use of radioactive materials and approximately 600 hours (4-5 months)
of clinical training. (Specific requirements vary from state to state
and are subject to change by the licensing agencies. For example:
Texas requires that all training be obtained in an ACGME-approved
facility and does not accept CBNC certification for automatic
licensure; original licensure in Georgia requires six months of
training in an ACGME-approved program.) The additional training that
is required for RAM licensure is not a required part of the fellowship
and acceptance for such training is not guaranteed (due to space,
personal performance, and other considerations).?

Duke University
   ?The Interventional Cardiology Training Program is a separate
ACGME-approved program. All interventional coronary and select
peripheral procedures on adult patients are performed in the
Interventional Cardiac Catheterization Laboratory by the
Interventional Fellows. Several investigational stents, drug delivery
devices, radiation catheters, laser catheters, thrombectomy catheters,
and distal protection devices are being evaluated in the lab. The
interventional cardiac catheterization Fellow evaluates each patient
before the procedure, performs the procedure, and follows the patient
during his hospitalization, all in conjunction with a senior staff
member. Morning interventional review conferences, weekly interesting
case conferences, monthly journal reviews, and monthly morbidity and
mortality conferences complement the rotation.?

At Duke University:
?General Training - Level I: This level of training makes the trainee
familiar with the field of nuclear cardiology for application in
general clinical management of cardiovascular patients.
Specialized Training - Level II: This type of training provides the
trainee with special expertise to practice nuclear cardiology.
Advanced Training - Level III: This advanced level of training
provides the nuclear cardiology fellow with sufficient training to
pursue an academic career or direct a nuclear cardiology laboratory.?

At Duke University
?A typical Fellow-rotation is four months in two 2-month blocks
including 2 months of chest wall echo, 1 month of stress echo, and 1
month of transesophageal echo. Fellows wishing to fulfill Level III
training criteria in echocardiography are welcome to spend additional
clinical time in this laboratory.?

Pediatric Cardiac Catheterization:
?There are no studies relating training experiences to subsequent
clinical skill in pediatric cardiac catheterization. Therefore, the
recommendations in Task Force 3 represent the opinions of the
authors.? ?Training in cardiac catheterization should occur within a
pediatric cardiology fellowship program that is accredited by the
ACGME.? ?The core training should involve each clinical fellow in a
minimum of 100 cardiac catheterizations, at least 20 of which include
an interventional component?

University of Washington School of Medicine

Cardiac Catheterization (VAPSHCS)
?	Evaluate, write a brief history and physical, and develop the
initial management plan on patients admitted for cardiac
catheterization. Goal is 12 cases per week (total 144 per 12-week
?	Perform and interpret diagnostic catheterization with the attending
?	Perform post-procedure patient evaluation and discuss results with
the housestaff. Maintain communication with the physicians on the
Cardiology service and the Catheterization Lab.
?	Observe coronary angioplasty procedures if time allows.
?	Correlate angiographic and clinical findings. Discuss impact of
angiographic findings on patient management.
?	Attend Cardiology Clinic 1/2 day per week.
?	Plan and participate in the Friday VAPSHCS Cardiology Conference.
?	Read and study recommended textbooks and articles on cardiac
catheterization and clinical cardiology.

Cardiovascular imaging at University of Pennsylvania
   ?Each fellow spends a 12 months in the training program. The
rotations are undertaken mainly at the Hospital of the University of
Pennsylvania and Presbyterian Hospital. There will be an optional
rotation at the Children's Hospital of Philadelphia.

Average fellow workweek is 50-55 hours; that will be spent mostly in
the CV section which is equipped with two dedicated workstations,
which allow visualization and rendering of datasets acquired in
Computed Tomographic Angiography (CTA) and Magnetic Resonance
Angiography (MRA).?
?The program director of CV fellowship will verify that the program
meets the level 3 (highest) criteria for credentialing in the practice
requirements developed by the Clinical Practice Committee of the
Society of Cardiovascular

Magnetic Resonance (SCMR): 
1.	A total of 1 year of full time training in CMR
2.	Supervised interpretation of a total of at least 300 CMR studies
representing the range of abnormalities observed in practice, but to
include substantial proportions (>25%) of both cardiac and vascular
studies. For at least 100 of these, the trainee should perform the
analysis and make the initial interpretation.
3.	Participation in an ongoing quality assurance or improvement
program for the laboratory or facility in which he or she is
4.	Continuing Medical Education (ACGME-approved) in CMR for at least
40 hours every 2 years
5.	Primary interpretation of at least 100 cases per year

Each fellow is evaluated by the faculty of CVI section.
Counseling/guidance/feedback are provided to each fellow twice a year
during a one-on-one meeting with the fellow's supervisor and program
director. Areas of weakness are identified and approaches to address
these weaknesses are suggested at these evaluation meetings. Fellows
also evaluate the program in general and the supervisor and other
mentors in particular.
At the end of the training, the director of the training program will
certify that the requirements at a particular level of skills have
been met. The levels of skills needed are determined a priori for each
individual fellow depending on their training needs as well as the
skills they have already obtained. A certificate of completion of
fellowship training in Cardiovascular Imaging is awarded to each
fellow at the end of the training period.?

University of Cincinnati Fellowship Program

University of Washington School of Medicine
??Perform 150 echocardiograms under the supervision of a qualified sonographer.
?Interpret 150 echocardiograms under the supervision of an
appropriately qualified physician.
?Perform scheduled treadmill exercise tests and review the results
with an attending.
?Read and study recommended books and articles on echocardiography.
?Perform stress (exercise and pharmacological) echocardiograms.
?Correlate echocardiographic findings with physical examination
findings and other clinical data. Interact with referring physicians
when echocardiograms are requested and when further interpretation of
echocardiographic results is needed.


This actual rotation schedule might give you some insight into how
fellows at on school spend their time:

If you have MS Excel on your computer, you can view several rotation
schedules from MSU

Some ACGME sites

There you go Toya. If I have omitted anything, or something is not
clear to you, please do not rate this answer. Simply ask for a
clarification, and allow me to respond, before you rate. I will be
glad to respond to your clarification as soon as possible.

Sincerely, Crabcakes

Search Terms
ACGME + cardiac procedures
cardiology fellowships
Cardiac fellowship competencies
toyanukenut-ga rated this answer:5 out of 5 stars and gave an additional tip of: $15.00
An exceptionally researched answer with profound attention to detail.
I am amazed and ecstatic.

Subject: Re: Cardiology procedures denoting proficiency
From: crabcakes-ga on 13 Aug 2006 20:46 PDT
Thank you for the 5 stars and the generous tip! I'm pleased you are
happy with my answer.
Regards, Crabcakes

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