Download August 29, 2007 - University of Nevada, Reno School of Medicine

Revised February 19, 2008
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR CARDIOVASCULAR CARE ROTATION
Rotation Coordinator:
Robert Wesley, M.D.
Subspecialty Education Coordinator
Department of Internal Medicine
University of Nevada School of Medicine
2040 W. Charleston Blvd., Suite 300
Las Vegas, Nevada 89102
(702) 671-2345
OVERVIEW
Educational Purpose
The purpose of this four week rotation is to provide education about diagnosis,
management and prevention of cardiovascular disorders, including ischemic heart
disease, cardiac dysrhythmias, cardiomyopathies, valvular heart disease, pericarditis,
myocarditis, endocarditis, congenital heart disease in adults, hypertension and disorders
of the veins, arteries, and pulmonary circulation.
The primary goal of this cardiovascular rotation is to educate the general internist in the
appropriate initial management of common cardiovascular disorders.
Teaching Methods
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The cardiology service is divided into cardiovascular critical care and cardiology
consult services. The critical care service consists of two first year and two PGY2 or year residents. Each resident is on call every fourth day.
The cardiology consult service has two residents, PGY-1 to -3; there is no
overnight call for the consult service.
The critical care resident will provide care to patients with cardiovascular
disorders under the supervision of cardiologist and in conjunction with
cardiothoracic surgery, as needed.
The senior resident will supervise, lead, manage and teach junior residents and
medical students.
Consult service residents will see the patient, write the initial consult note and
then give final recommendations after reviewing the case with the cardiology
attending. The consult service resident and CCU interns will also go to outpatient
clinic each week.
Daily rounds will occur with the attending physician at which time instruction in
the unique aspects of the cardiac critical care and cardiac consultation will be
provided. Residents will be required to continue their regular morning report and
noon conference core curriculum. The resident and attending will review and
discuss any required reading.
Mix of Diseases
Patients present a wide variety of acute and chronic cardiac problems that a cardiology
consultant may be requested to evaluate and care for. These include chest pain, dyspnea,
acute coronary syndrome ST-segment and non-ST segment elevation myocardial
infarction, congestive heart failure, ischemic and non-ischemic cardiomyopathies,
valvular heart disease, and pericardial disease. Perioperative cardiac consultation and
care is also provided.
Patient Characteristics
The patient population is diverse, male and female, of all ages from adolescent to
geriatric, representing most ethnic and racial backgrounds, from all social and economic
strata. The hospital serves primarily the indigent population of the city of Las Vegas.
Types of Clinical Encounters
Acute coronary syndrome admissions are cared for in the cardiac care unit (CCU). Postcardiac surgery care is provided in the cardiovascular care unit (CVCU). Residents
supervise interns in the provision of care in these units. Inpatient consultations are
performed upon request in all units of the hospital. Cardiac catheterization is performed
in the cardiac catheterization laboratory. Outpatient care, both consultation and
continuing cardiac care, are provided in the Lied Specialty Clinic.
Close interaction with various other healthcare team members including care managers,
discharge planners, home health agencies, inpatient nurses, telemetry technicians,
respiratory therapists, physical therapists, and patient care technicians occurs daily.
Resident Supervision
Residents have constant on site supervision as well as daily personal supervision in their
patient care. An attending cardiologist sees all cases and is available 24 hours daily.
Procedures and Services
Residents may participate in or observe procedures with the cardiologist including
bedside right heart catheterization, cardiac catheterization, echocardiogram performance
and interpretation, stress testing, and arterial blood gas sampling.
Cardiology Didactics
1.
2.
Morning Report: Critical care service and consult service residents are each
required to present one cardiology case the month after rotation.
Noon Conference: Each resident is required to give a presentation on topic
assigned by attending.
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3.
4.
Rounds: Each resident is required to present articles/clinical trials as
assigned by attending. Resident will be given written feedback about their
presentation by attending physician.
Cardiology Conference: Every first Tuesday and last Friday of the month.
Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 16th ed., McGraw Hill
Cardinal Manifestations of Disease, pp. 53 - 360.
Disorders of the Cardiovascular System, pp. 1229 - 1345.
Disorders of the Respiratory System, pp. 1407 - 1419.
Arrhythmia - A guide to Clinical Electrocardiography, Sandoe E, Sigurd B;
Verlag GmbH, Bergan, 1991
Heart Disease - A Textbook of Cardiovascular Medicine. Braunwald E. (ed),
8th ed., W.B. Saunders, Philadelphia, 1
The Washington Manual of Medical Therapeutics, 32nd ed.
Housestaff Syllabus, 1999
Preoperative Cardiac Assessment and Preoperative Evaluation
Resident EKG packet, available in departmental office
Rapid Interpretation of EKG’s, Dubin, D, 6th ed., Cover publishing, 1998
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
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Medline and GratefulMed Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they
have consulted or cared and to follow the hospital care of those patients. If a patient for
whom the resident has consulted or cared should die and have an autopsy, the resident is
encouraged to attend the post-mortem session.
Training Sites
University Medical Center
All of the inpatient cardiology consultation experience occurs at University
Medical Center (UMC) under the supervision of one of the full-time cardiology
attendings.
Acute coronary care will occur in the coronary care unit at UMC.
UNSOM Lied Specialty Care Clinic
The resident will participate in the UMC outpatient cardiology clinic weekly
under the supervision of the full-time cardiology attending.
Competency-based Goals and Objectives
Cardiovascular Rotation
Learning Venues
Evaluation Methods
1.
2.
3.
4.
5.
Direct patient care/consultations
Attending Rounds
Residency core lecture series
Self study
Morning Reports
Competency: Patient Care
Obtain an accurate history including
history of present illness, cardiac risk
factors, prior cardiac history including
hospitalizations, cardiac workup stress
testing, and cardiac catheterization if
applicable.
Perform an accurate physical exam on
A.
B.
C.
D.
E.
F.
Level Specificity
Attending evaluation
Direct Observation
Nurse evaluations
Written Examination
Resident/Self Evaluation
Patient Evaluation
R-1 = 1
R-2 = 2
R-3 = 3
Learning
Venues
1,2
Evaluation
Methods
A, B, C, E
Level
1, 2, 3
1, 2
A, B, C
1, 2, 3
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patients with known or suspected
cardiovascular disease.
Obtain old records including, but not
limited to, discharge summaries, results
of prior echocardiography, EKG, stress
testing results, and cardiac catheterization
reports.
Generate a differential diagnosis, define
and initiate therapeutic plan, and modify
therapy, as needed.
Appropriately initiate pharmacological
treatment, modify dosing based on
clinical scenario, and manage adverse
effects.
Respond immediately to “CODE
HEART” (Acute Myocardial Infarction).
Initiate management (Oxygen, Aspirin,
Nitrates, Beta Blockers, etc., as
indicated), inform attending immediately,
discuss further treatment plan and
facilitate transport to catheterization lab
within time guidelines.
Provide initial consultation and direct the
management of patient with
cardiovascular disorders.
Recognize and initiate appropriate
treatment and notify attending for
specific cardiovascular emergencies.
Monitor patient progress, respond to
change in patient condition during
medical treatment and interventional
procedures.
Identify and initiate corrective action for
common laboratory abnormalities and
procedure complications.
1, 2
A, E
1, 2, 3
1, 2, 3, 4, 5
A, B, D, E
1, 2, 3
1, 2, 3, 4, 5
A, B, C, D, E
2, 3
1, 2, 3, 4, 5
A, B, C, D, E
2, 3
1, 2
A, B, E
2, 3
1, 2, 3
A, E
2, 3
1, 2
A, B, C, E
1, 2, 3
1, 2, 3, 5
A, B, C, D, E
1, 2, 3
Competency : Knowledge
Learning
Venues
Evaluation
Methods
Level
Know presentation and management of
common cardiovascular diseases (i.e.
stable/unstable angina, acute myocardial
infarction, aortic dissection, arrhythmias,
congestive heart failure).
Know indication for and interpretation of
1, 2, 3, 4, 5
A, B, D
1, 2, 3
1, 2, 3, 4
A, B, D, E
1, 2, 3
5
EKG, Chest X-ray, echocardiography
(recognize tamponade), and cardiac
catheterization.
Know types and indications of stress tests
(interpretation optional).
Know indications, doses, and side effects
of common cardiovascular medications.
Know BLS and ACLS protocols.
Know indications and understanding of
ambulatory EKG monitoring,
echocardiography, electrophysiological
testing (optional), left and right heart
catheterization and tilt table testing
(optional).
Competencies: Interpersonal and
Communication Skills
1, 2, 3, 4
A, B, C, D, E
1, 2, 3
1, 2, 3, 4
A, B, D
1, 2, 3
1, 2, 3, 4
1, 2, 3, 4
A, B, D
A, D
1, 2, 3
2, 3
Learning
Venues
Evaluation
Methods
Level
Interact in an effective way with
physicians, residents, nurses and medical
support staff.
Demonstrate understanding of patient
preferences in diagnostic evaluation and
management of cardiovascular disorder.
Maintain accurate medical records.
Serve as a patient advocate.
Ensure adequate transfer of information
when transferring patient to care of
another physician.
Communicate efficiently and effectively
with referring physician, regarding
diagnosis, treatment and follow-up.
1, 2
A, B, C
1, 2, 3
1, 2
A, B, C, D, E, F
1, 2, 3
1, 2
1, 2
1, 2
A, B, C
A, B, C, E, F
A, B, C, E
1, 2, 3
1, 2, 3
1, 2, 3
1, 2
A, B, C, E
1, 2, 3
Competency: Professionalism
Learning
Venues
Evaluation
Methods
Level
Treat team members, primary caregivers,
and patients with respect and empathy.
Understand, practice and adhere to a code
of medical ethics.
Participate actively in consultations and
during rounds.
Attend and participate in all scheduled
conferences.
1, 2
A, B, C, E, F
1, 2, 3
1, 2
A, B, C, E
1, 2, 3
1, 2
A, B, C
1, 2, 3
3, 5
Attendance A
1, 2, 3
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Competency: Practice-Based Learning Learning
Venuses
Incorporate case studies with relevant
1, 2, 4, 5
research outcomes and report those
findings during clinical rounds.
Review the outcomes of patient care in
1, 2, 4, 5
order to reflect on the approach taken in
the delivery of care.
Utilize established practice guidelines for 1, 2, 4, 5
individual diseases to devise care
strategies.
Identify limitations of one’s medical
1, 2, 4, 5
knowledge in evaluation and
management of patients with
cardiovascular disorders and use medical
literature (primary and reference) to
address these gaps in medical knowledge.
Competency: System-Based Practice
Learning
Venues
Understand need for effective
1, 2, 3, 4
communication between multiple
caregivers (i.e. emergency room, critical
care unit, nurses, physicians, transporters,
outpatient clinic, catheterization lab,
radiology, chest pain center, echo
technicians).
Understand clinical trial design and the
1, 2, 3, 4, 5
statistical methods for evaluating
scientific studies, in cooperation with
attendings and research nurses/personnel.
Competency in reporting adverse events, 1, 2, 4
near misses.
Evaluation
Methods
A, E
Level
A, E
2, 3
A, E
2, 3
A, E
1, 2, 3
Evaluation
Methods
A, E
Level
A, B, C, E
2, 3
A, B, E
2, 3
2, 3
1, 2, 3
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are encouraged to
provide face-to-face feedback with the residents. The night-float resident is
evaluated by one of the three service attending’s. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical
faculty member, at the completion of the rotation. This evaluation form is
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included at the end of this document. These evaluations are then converted to
type and shared anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
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Cardiology Rotation Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principals of cardiovascular care
6. Received verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising Attending Signature____________________ Date___________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the rotation’s end.
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