Download Curriculum for Adult Interventional Cardiology Training Program

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Curriculum for Adult Cardiovascular Disease Training
American University of Beirut Medical Center
Core Physician Committee:
1. Samir Alam, M.D., Chair
2. Bernard Abi-Saleh, M.D.
3. Marwan Refaat, M.D.
4. Hussein Ismaeel, M.D.
5. Walid Gharzuddine, M.D.
6. Antoine Abchee, M.D.
Clinical competency committee:
Committee:
1. Wael AlJaroudi, M.D.
M.D.
2. Hussein Ismaeel, M.D.
M.D.
3. Maurice Khoury, M.D.
Program evaluation
1. Hussein Ismaeel,
2. Abdallah Rubeiz,
3. Cardiology fellow
Full-time faculty:
1 Samir Alam, M.D. Chief, Division of Cardiology
2 Wael AlJaroudi, M.D. Director, Cardiovascular Training Program
3 Ziad Ghazzal, M.D.
4 Hadi Skouri, M.D.
5 Abdallah Rubeiz, M.D.
6 Samir Arnaout, M.D.
7 Antoine Abchee, M.D.
8. Maurice Khoury, M.D.
9. Walid Gharzuddine, M.D.
10. Habib Dakik, M.D.
11. Bernard Abi-Saleh, M.D.
12. Marwan Refaat, M.D.
13. Hussein Ismaeel, M.D.
Part-time faculty
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1. Jaber Sawaya M.D.
2. Sami Kaedbey M.D.
PROGRAM DISCRIPTION
American University of Beirut Medical Center
Department of Internal Medicine
Division of Cardiovascular Diseases
Fellowship Training Program
P.O. Box: 11-0236 Riad El Solh
1107 2020 Beirut, Lebanon
Telephone: +961-1-1374 374 extension:5420
Fax: +961-1-370814
Program Director:
Wael AlJaroudi, M.D.
Email: [email protected]
History/Background:
The Cardiovascular Disease Training Program at the American University of
Beirut first started in 1983. Since the program inception , over 40 individuals
have been trained. The program constitutes an integral component of the
Department of Internal Medicine at the American University of Beirut. The
program is committed to education, research and excellence in patient care.
The program covers a wide variety of acute and chronic cardiovascular
diseases and prepares the trainee to function independently as cardiovascular
specialists.
Duration:
The Duration of the Cardiovascular Diseases Program is three years with 7
positions ( with the aim in expanding to 9 fellows) over the three year
general cardiology training. Comprehensive training in all major aspects of
clinical cardiology is combined with training in clinical cardiovascular
research. It is the program‟s responsibility to ensure that the educational
resources are adequate to support the number of fellows appointed to the
program. Trainees rotate exclusively at the American University of Beirut
Medical Center and the Outpatient Department.
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Prerequisite Training/Selection Criteria:
All applicants to the Cardiovascular Diseases Fellowship Training Program
at the American University of Beirut Medical Center are required to have
completed three year internal medicine at well-recognized residency
programs. The fellowship program constitutes seven position for the three
training years. Two fellows are selected each year with a third fellow every
third year (plan to expand to 3 fellows per year and each year). Each
applicant should submit an application to the Graduate Medical Education
Office with the required documentation:
1- an authenticated copy of the medical school diploma
2- an authenticated copy of the internal medicine diploma
3- a recent Passport size colored photograph of the applicant
4- an official medical school transcript[s],impressed with original
medical school seal[s].
5- a copy of a valid identification card and /or passport
6- A curriculum vita prepared within three months of the application.
7- A minimum of three letters of reference from faculty members from
the Internal Medicine Residency program from which the applicant
has been trained. These letters of reference must be written in English
or be accompanied by certified translations.
8- Score reports on steps in the United States Medical Licensure
Examination (IF Applicable)
9- Letter of Intention
10-Score reports of the English Language Proficiency examination from
Graduates of schools/residency programs outside the United states other
than the American University of Beirut/Lebanese American University.
11-Any other information that the Faculty of Medicine may request in
connection with the applicant‟s credentials.
The deadline for submitting applications is the end of February of each
academic year. Selections will be completed by mid May of each year at
which selected individuals will be informed by our program.
The selection process will take place as follows: A review committee will
be appointed. This committee includes the program director and two
other full time cardiology faculty. The applications will be screened first
by the program director and the chief fellow. Based on specific criteria
agreed upon by the committee, a decision is made whether to invite the
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applicant to a personal interview. Preference will be given to applicants
who choose cardiology fellowship as their first choice. Each applicant
will be interviewed by all faculty members who will be sitting in one
room and administering questions. A second interview will be one on one
with the applicant and the Director, in addition to the chief fellow.
Applicants will be scrutinized for adequate clinical experience since
graduation from medical school and residency training. Clarification of
any gaps will be requested from otherwise competitive applicants.
Exceptionally and at the discretion of the program director, applicants
unable to visit due to extenuating circumstances will be offered the
opportunity to complete a telephone or video-conference interview.
Cumulative evaluation scores are developed for each applicant and a rank
order is formulated by the committee. The cardiology rank order list is
sent to the Graduate Medical Education Committee and sent to the
Academic Committee for approval. The final rank list results are
announced by the Graduate Medical Education Office.
Program Certification:
The Cardiovascular Diseases Fellowship Training Program is certified by
the Lebanese Ministry of Health and the Lebanese Order of Physicians.
Fellowship trainees are not required to be licensed to practice Medicine in
Lebanon.
GENERAL INFORMATION
1. Mission Statement
The mission of the Fellowship Training Program in Cardiovascular Diseases
at the American University of Beirut Medical Center is to provide an
academically and clinically comprehensive training program in general and
clinical cardiology as well as cardiovascular research. The aims of the
program are to provide the trainee with the basic and clinical knowledge,
procedural skills, clinical judgment, professionalism and interpersonal skills,
and abilities necessary to continue to hone these skills through the course of
a long career, as required of a leader in cardiovascular medicine. The
curriculum is designed to provide a broad clinical exposure in acute and
chronic cardiovascular care occurring in the inpatient and outpatient settings,
as well as extensive experience in non-invasive and invasive cardiac
procedures. Fellowship training will prepare fellows to function as
outstanding cardiologists and prepare them to train in various sub specialists.
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Upon completion of this training program, trainees are expected to:
 understand the pathophysiology of acute and chronic heart
disease
 be clinically experienced in the diagnosis, evaluation and
management of patients with acute and chronic heart disease
 comprehend and have acquired experience in cardiovascular
pharmacology
 have developed an understanding of the indications and
contraindications of cardiac procedures and cardiac
interventions
 have acquired knowledge to develop the decision–making
process that leads to the selection of alternative treatment
options
 be able to recognize and manage treatment related
complications
 have acquired knowledge and expertise in patient education
and discharge planning
 have acquired the necessary skills that are needed to manage
acute hemodynamic resuscitation including use of
vasoactive agents, use of antiarrhythmic drugs, use of
thrombolytic agents, CPR, advanced life support,
pericardiocentesis, intra-aortic balloon pump
 understand and apply the latest methods of heart disease
prevention
 cultivate and maintain a quality approach to patient care
based on critical thinking, compassion and dedication
 promote scholarly research
 foster excellence in teaching
2. Training Structure
Fellowship training occurs over the course of 3 years. All fellows must be
intimately involved in a research project during the course of their
fellowship. Fellows maintain a half day continuity clinic per week at the
Outpatient Department (OPD).Fellows rotate on a variety of inpatient and
outpatient services as well as through the invasive and non-invasive
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laboratories. All fellows will achieve level 2 certification in Cath,
Echocardiography, and level 1 certifications in other rotations as outlined in
COCATS 2.
It is the intent of the fellowship administration to individualize training
within the framework of ACGME guidelines to optimize each fellow‟s
experience to achieve excellence in academic cardiology.
The core clinical training for the program is based on the ACC Revised
Recommendations for Training in Adult Cardiovascular Medicine Core
Cardiology Training II (COCATS II) published in 1995 and updated in
2008. Training is conducted in compliance with the Accreditation Council
for Graduate Medical Education (ACGME) program requirements for
general fellowship education in the subspecialties of Internal Medicine and
the specific requirements for fellowship education in Cardiovascular
Disease. These guidelines were last updated in July 2012 and can be
reviewed on the ACGME website (www.acgme.org) under the „Residency
Review Committee‟ tab, and are kindly attached.
3. Facilities
The hospital which form the core of this program functions are both primary
and tertiary care institution. The patients from this institution represent a
wide variety of common and rare cardiovascular disorders and provide
excellent exposure to all areas of cardiovascular medicine. AUBMC has a
CCU with 20 beds, 2 cardiac catheterization laboratories, one of which serve
as a electrophysiology (EP) laboratory, an echocardiography laboratory with
5 echocardiography machines (an extra machine has just been purchased)
and 2 staff reading per day, ECG and stress testing area, nuclear cardiology
perfusion imaging laboratory (managed by Cardiology division with the
department of Radiology), advanced cardiac imaging with cardiac CT and
cardiac MRI (1.5 and 3.0 T) (managed by Cardiology and Radiology
departments), a prevention outpatient clinic (Saturdays), and a congestive
heart failure/transplant clinic, hypertensive/vascular medicine, and smoking
cessation programs (to be initiated by mid 2013).
CURRICULUM
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1. Introduction:
The curriculum of the cardiovascular diseases fellowship consists of a
variety of clinical experiences and didactic conferences that take place at
AUBMC. Fellows rotate on several inpatient services and outpatient services
and provide both direct and consultative care. Fellows attend a weekly
continuity clinic at the OPD. Procedural skills are gained as fellows rotate
through the invasive and non-invasive laboratories at the hospital.
Several conferences occur throughout the week, and a core curriculum
lecture series that covers the entire cardiology curriculum (Mayo review
series) is covered over a two year rotating cycle. Additionally, journal club
takes place biweekly and provides a forum to critically review the literature
and to debate current topics in cardiology alternating with
invasive/noninvasive cardiology cases and case of the month discussions
with the expertise and Guidelines update. A cardiology Grand round will
take place weekly and presented either by a cardiology faculty, invited
speaker or fellows supervised by a preselected faculty member. In addition,
advanced ECG lectures will be done once a week and supervised by at least
one of the EP attendings, and will cover ECG interpretation (cardiology
fellows level) in addition to pacemaker/ICD programing, and intracardiac
electrocardiogram interpretation. CCU core lecture series have also been
initiated.
A final aspect of the curriculum involves fellow involvement in teaching.
This occurs in several settings, including direct clinical teaching of Internal
Medicine residents on the inpatient cardiology services (intensive care unit,
and consult service) as well as assisting in the early training of new
cardiology fellows. Fellows are expected to give didactic lectures at cath
conferences, cardiology clinical conference lecture series (cardiology grand
rounds), and morbidity and mortality conference.
COCATS 2 (Core Cardiology Training Symposium) is the curriculum
guiding document for fellowships in cardiovascular disease. This document
consists of the reports of individual task forces which reviewed and made
recommendations for training in each of 11 vital areas of cardiovascular
disease. A brief description will be given as to how the American University
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of Beirut Fellowship Program in Cardiovascular Disease addresses each
Task Force‟s recommendations.
Task Force 1: Training in Clinical Cardiology
Extensive training in general clinical cardiology occurs both in the inpatient
and outpatient and also in the laboratory and non-laboratory setting. The
cardiology fellow is primarily responsible for the management of inpatients
with cardiovascular diseases in the Emergency room,coronary care Unit and
consult service. Training in procedural skills is acquired at the division
facilities described above. Outpatient consults and management of chronic
cardiovascular disease takes place in the weekly continuity clinics at the
OPD. Fellows do at least 5-6 CCU rotations and 5-6 Consult rotations (1012 months of clinical cardiology) and meet the COCATS requirements.
Task Force 2: Training in Electrocardiography, Ambulatory
Electrocardiography, and Exercise Testing
Fellows interpret ECG during each of the clinical rotations (stress test, CCU,
consults, EP, and ECG conference) and Holter monitor recordings during the
EP rotation and ECG conference. Fellows interpret Holter monitor
recordings during electrophysiology rotation. Fellows interpret ECG and
stress tests on the electrophysiology and Nuclear Cardiology rotations and
stress echocardiography during echocardiography rotations. Fellows directly
supervise exercise stress tests. These studies are then reviewed by the
attending cardiologist.
Fellows meet the COCATS requirements and read more than 3500 ECG,
perform at least 300 stress tests (level 2), and 150 holters (level 1)
Task Force 3: Training in Diagnostic Cardiac Catheterization and
Interventional Cardiology
All fellows complete 10-12 months in the cath labs and receive level 2
training in Cath. Fellows receive extensive training in vascular access, left
and right heart catheterization, diagnostic coronary angiography, invasive
hemodynamics. A monthly Cath Conference is held during which faculty
and fellows present teaching case and review angiographic and
hemodynamic findings, discuss diagnostic and management issues, review
complications and promote discussion of specific cardiology topics
pertaining to invasive cardiology.
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Task Force 4: Training in Echocardiography
Transthoracic and transesophageal echocardiography training occurs during
the Echocardiography laboratory rotation and at any time the fellow will be
free. All fellows complete 6 months on these rotations to achieve level 2
certification, and are expected to read 300 studies and perform 150 cases.
All fellows receive training in exercise 9treadmill and recently acquired
bicycle) stress echocardiography and transesophageal echocardiography
after the first month of training in echocardiography. A bi-monthly
Echocardiography Conference is held that includes echocardiography case
reviews and case specific didactic teaching. A series of lectures in
echocardiography is also presented at the core curriculum lecture series.
Didactic teaching is also expected during the one-one reading with the
attending.
Task Force 5: Training in Nuclear Cardiology
All fellows complete 2 months in the Nuclear Cardiology Lab, and read with
attending. They are expected to learn about radiation safety, handling
radioactive material, imaging patients, image processing and interpretation.
Lectures in nuclear cardiology are provided at the core curriculum course
series. They will achieve level 1 training.
Task Force 6: Training in Specialized Electrophysiology, Cardiac
Pacing, and Arrhythmia Management
All fellows complete 2 months on the Electrophysiology (EP) service to
achieve Level 1 EP training. The EP service covers all EP consults and
procedures. Fellows evaluate inpatient consults; perform device
interrogations with dedicated personnel for device interrogation and/or with
the EP faculty physician, and are active in the EP lab during procedures such
as ablation or device implantation/extraction. Fellows obtain informed
consents, explain indications and contraindications of procedures and may
assist with procedures performed in the EP laboratory usually during the
senior year of training. Also, basic EP topics are addresses during the core
curriculum conference series and the advanced ECG conference.
Task Force 7: Training in Cardiovascular Research
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The Cardiology Division is active in both clinical and basic science research.
All fellows are encouraged to become involved in ongoing research projects.
Research is an important and critical component of training in
cardiovascular disease. There are several databases that are being build and
several projects already in process with fellows being actively involved. The
fellows are carefully paired with mentors depending on fellow‟s research
interests. The cardiology fellowship is part of the Research Fellowship
Program, and each fellow is expected to have a proposal, mentor, and initiate
a research and end up in at least one publication of an original research
topic. In the future, we hope to expand the fellowship program to allow each
fellow to have dedicated 4 months of research.
Task Force 8: Training in Heart Failure and Transplantation.
At the time being there is no such rotation. Soon, the Heart Failure
outpatient Unit will start and fellows interested will rotate in this unit.
Fellows on this service admit and manage patients with decompensated heart
failure. Outpatient consults will be performed (in the near future) on patients
referred to the heart failure/ transplant clinic for assistance with heart failure
management or for consideration of cardiac transplantation. Fellows may
perform right heart catheterizations procedures.
Task Force 9: Training in the Care of Adult Patients with Congenital
Heart Disease
There is no specialized Adult Congenital Heart Disease at our center but our
fellows will participate in the Pediatric Congenital Heart disease procedures.
Additionally, lectures on congenital heart disease and their associated
surgical procedures are given as a part of the core curriculum lecture series.
In the near future, if we expand the program and number of fellows, we will
have the opportunity to offer the fellows a dedicated month in congenital
heart disease in collaboration with the pediatric department
Task Force 10: Training in Preventive Cardiovascular Medicine
In addition to discussing prevention-related issues relevant to individual
patients seen on the inpatient services or in the outpatient clinics, dedicated
lectures on Preventive Cardiovascular Medicine are provided to the fellows
as a part of the core curriculum lecture series. These lectures cover
cardiovascular (CV) genetics, clinical epidemiology and biostatistics,
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principles of clinical trials, principles of outcomes research, principles of
clinical pharmacology, principles of behavior change and aspects of
compliance, and principles of disease management and multidisciplinary
system development. The specific content areas defined by the task force are
HTN, hyperlipidemia, thrombosis/hypercoagulable states, smoking
cessation, cardiac rehabilitation, exercise physiology, nutrition, psychosocial
and behavioral aspects of CV disease, metabolic disorders, gender and racial
differences as related to CV disease, and population demographics as related
to CV disease. Over a rotating two year period, the content areas outlined by
this task force are addressed through core curriculum conference series,
review of current literature in the journal cub setting, state of the art review
and controversial topics in the cardiology grand rounds lecture series.
Also, a prevention clinic has recently opened every Saturday morning and
fellows will be encouraged to attend. Smoking cessation, nutrition and
weight loss programs will also be launched soon and will offer additional
resources to the fellows‟ training.
Task Force 11: Training in Vascular Medicine and Peripheral Catheterbased Interventions
Although a dedicated rotation in Vascular Medicine is currently not
available; a vascular medicine/hypertension outpatient clinic is opening
soon. Fellows will be encouraged in their spare time to go to the vascular lab
and learn how to interpret vascular US (carotids..), attend vascular
interventions and surgeries, go to the vascular clinic and have exposure to
peripheral vascular disease (arterial and venous) and different aspects of
vascular medicine (thrombosis, hypercoaguable states..). We would like to
create at least 1 month of such rotation, but currently we are limited by the
number of fellows.
Procedure Certification:
Certification levels are defined by COCATS 2 as follows:
Level 1: Basic training required of all trainees to be competent consultant
cardiologists.
Level 2: Additional training in one or more specialized areas that enables the
cardiologist to perform or interpret (or both) specific procedures at an
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intermediate skill level or engage in rendering cardiovascular care in
specialized areas.
Level 3: Advanced training in a specialized area that enables a cardiologist
to perform, interpret, and train others to perform and interpret specific
procedures at a high skill level.
In general, level 2 certification is required to independently interpret and/or
perform a specific cardiac procedure and level 3 certification is required to
run a procedure-related laboratory.
All fellows are required to maintain detailed documentation of the
procedures they perform as described in the “Procedure Documentation”
section of this manual. This procedure log is to be turned in monthly to be
reviewed by the program director. There will be quarterly meetings with all
the fellows and program director to discuss problems, areas for
improvement.. In addition, each fellow will have a biannual evaluation with
the program director. A new set of evaluation tailored to each rotation will
be implemented and required to be submitted on a monthly basis for each
fellow. Also, fellows will be evaluating the attending on a monthly basis.
2. The ACGME Core Competencies
This fellowship training program at the American University of Beirut
is committed to comply with the following six core competencies,
which are detailed by the Accreditation Commission of Graduate
Medical Education:
 Patient Care
 Medical Knowledge
 Practice–Based Learning and Improvement
 Interpersonal and Communication Skills
 Professionalism
 Systems–Based Practice
Patient Care
Fellows must be able to provide patient care that is compassionate,
appropriate, and effective for the treatment of health problems and the
promotion of health
Medical Knowledge
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Fellows must demonstrate knowledge about established and evolving
biomedical, clinical, epidemiological and social behavioral sciences,
as well as the application of this knowledge to patient care
 systematically analyze practice, using quality improvement
methods, and implement changes with the goal of practice
improvement
 incorporate formative evaluation feedback into daily practice
 locate, appraise, and assimilate evidence from scientific studies
related to their patients‟ health problems
 use information technology to optimize learning
 participate in the education of patients, families, students,
residents and other health professionals
Interpersonal and Communication Skills
Fellows must demonstrate interpersonal and communication skills that
result in the effective exchange of information and collaboration with
patients, their families, and other health professionals. Fellows are
expected to:
 communicate effectively with patients, families, and the public,
a appropriate, across a broad range of socioeconomic and
cultural backgrounds;
 communicate effectively with physicians, other health
professionals, and health–related agencies;
 work effectively as a member or leader of a health care team or
other professional group;
 act in a consultative role to other physicians and health
professionals
 maintain comprehensive, timely, and legible medical records
Professionalism
Fellows must demonstrate a commitment to carrying out professional
responsibilities, an adherence to ethical principles, and sensitivity to
patients of diverse backgrounds. Fellows are expected to demonstrate:
 compassion, integrity, and respect for others;
 responsiveness to patient needs that supersedes self interest;
 respect for patient privacy and autonomy;
 accountability to patients, society and the profession; and
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 sensitivity and responsiveness to a diverse patient population,
including but not limited to diversity in gender, age, culture,
race, religion, disabilities and sexual orientation
Systems–Based Practice
Fellows must, as manifested by actions that demonstrate an awareness
of and responsiveness to the larger context and system of health care,
as well as the ability to call effectively on other resources in the
system to provide optimal health care. Fellows are expected to:
 work effectively in various health care delivery settings and
systems
 coordinate patient care within the health care system
 incorporate considerations of cost awareness and risk benefit
analysis in
 patient and/or population-based care
 advocate for quality patient care and optimal patient care
systems
 work in inter-professional teams to enhance patient safety and
improve patient care quality
 participate in identifying system errors and in implementing
potential systems solutions
3. Rotations
The clinical rotations are divided as follows:
1st year
2nd year
3rd year
Cath
4months
3 months
3 months
Echo
2 months
2 months
2 months
EP
1 months
1 months
2months
Nuclear
0 months
1 month
1 month
Consult
2 months
2 month
1 month
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CCU
2 months
2 month
1 month
Research/elective
0 months
0 month
1 month
Vacation
1 month
1 month
1 month
First year fellows
F1a & F1b& F1c
Second year fellows F2a & 2b
Third year fellows F3a & F3b
The specific curriculum for each rotation of the cardiovascular disease
fellowship is summarized in Appendix I. For each rotation, the overall
purpose, the fellow responsibilities and specific duties, method of
supervision, learning objectives, patient characteristics, mix of diseases
encountered, types of clinical encounters and procedures performed,
teaching methods, and evaluation methods will be described. (See Appendix
I)
Faculty
JuneJuly
JulyAug
AugSep
SepOct
OctNov
NovDec
Dec-Jan
Jan-Feb
FebMarch
MarchApril
AprilMay
MayJune
F3a
Echo
LHC
LHC
Echo
Elective
EP
LHC
consult
CCU
EP
Vacation
nuclear
F3b
LHC
Consult
CCU
LHC
Echo
Elective
EP
nuclear
EP
LHC
Echo
Vacation
F2a
CCU
nuclear
consult
EP
LHC
Echo
CCU
LHC
consult
Vacation
LHC
Echo
F2b
consult
CCU
nuclear
Echo
EP
LHC
consult
CCU
LHC
Echo
Vacation
LHC
F1a
LHC
EP
Echo
LHC
consult
CCU
LHC
vacation
echo
LHC
consult
CCU
F1b
Echo
LHC
EP
CCU
LHC
consult
Echo
LHC
vacation
CCU
LHC
consult
F1a
EP
Echo
LHC
consult
CCU
LHC
vacation
Echo
LHC
consult
CCU
LHC
Supervision by faculty members is expected throughout the academic year
and during all aspects of the educational experiences. The cardiology trainee
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and the supervising cardiology faculty must carry out each component of
patient care jointly. There is a faculty call schedule that can be accessed
through the intranet.
The majority of key clinical faculty must be involved in scholarship defined
as one of the following:
a) the scholarship of discovery, as evidenced by peer-reviewed funding
or by publication of original research in a peer–reviewed journal;
b) the scholarship of dissemination , as evidenced by review articles or
chapters in textbooks;
c) the scholarship of application, as evidenced by the publication or
presentation of, for example, case reports or clinical series at local,
regional, or national professional and scientific society meetings
Faculty members:
 Include the Chief of Cardiology and the Cardiology Training Program
Director, who are full-time faculty of the Department of Medicine of the
American University of Beirut, are American Board Certified and have
extensive experience in General Cardiology.
 there is a total of 13 full time faculty members dedicated to the
Cardiology training program throughout the year
 participate in all aspects of academic activities including conferences,
national meetings, educational courses and activities designed to enhance
their teaching effectiveness
 assist in the preparation of the written curriculum and the general
administration of the training program
 provide appropriate supervision throughout the clinical and technical
experience of the trainee and assist in monitoring stress as well as nurture
the attributes and qualities of a well rounded physician
 are always available for immediate feedback, advice, support and
counseling
Clinical Experience
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 The trainee is given the responsibility to care for acute and chronically ill
patients throughout the length of hospitalization, under the supervision of
faculty members in Cardiology
 Care of patients includes all intensive care settings (emergency
department, coronary care unit, medical intensive care unit and post
surgical intensive care units)
 Pre procedure evaluation and planning are conducted with the
supervising faculty member
 Cognitive knowledge and critical decision making should be acquired
throughout the training process in areas that include: randomized clinical
trials, short and long–term benefits, strengths and limitations of different
treatment modalities
 The trainee will be actively involved in patient education, including risk
factor modification and discharge planning
 The trainee will acquire an understanding in cardiovascular rehabilitation
 The trainee will develop experience in providing consultation services
and communicating with members of other health–care teams
 Each trainee will participate in the out–patient follow–up cardiology
clinic one–half day each week, and is expected to evaluate at least one
new patient and two return patients under the supervision of a faculty
member
 Patient mix for in-patients and ambulatory settings: adult patients
including geriatrics, both sexes and all races
 Fellows will evaluate rotation, faculty members, residents (monthly),
peers/self/training program (biannually) in a 360 degree evaluation
system ( see appendix II )
Technical experience and other skills
Fellows must have formal instruction, clinical experience, and must
demonstrate competence in the performance of the following:
 elective cardioversion;
 insertion and management of temporary pacemakers, including
transvenous and transcutaneous;
 programming and follow-up surveillance of permanent pacemakers
 bedside right heart catheterization;
 right and left heart catheterization including coronary arteriography
(fellows must participate in a minimum of 100 catheterizations.);
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 exercise stress testing; fellows must perform a minimum of 50 stress
ECG tests;
 echocardiography (fellows must perform a minimum of 150 and
interpret a minimum of 300 studies, including transesophageal cardiac
studies).
 chest x-rays;
 electrocardiograms; a minimum of 3500 electrocardiograms;
 ambulatory ECG recordings; a minimum of 150 ambulatory ECG
recordings;
 radionuclide studies of myocardial function and perfusion.
 intracardiac electrophysiologic studies;
 intra-aortic balloon counterpulsation;
 percutaneous transluminal coronary angioplasty and other
interventional procedures;
 programming and follow-up surveillance of ICDs;
 pericardiocentesis.
Didactic Curriculum
Basic topics:
o Cardiovascular anatomy, physiology and metabolism
o Molecular biology of the cardiovascular system
o Cardiovascular pharmacology and complications of therapy
o Cardiovascular pathology
Prevention of cardiovascular disease:
o Epidemiology and biostatistics
o Risk factors modification
o Lipid disorders
Diagnosis, evaluation and management of patients with:
o Acute and chronic ischemic heart disease
 Acute myocardial infarction
 Acute coronary syndrome
o Acute and chronic heart failure
 Cardiomyopathy
o Arrhythmias
o Hypertension,
o Valvular heart disease,
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o
o
o
o
o
o
o
Pulmonary heart disease,
Peripheral vascular disease,
Infections and inflammatory heart disease
Adult congenital heart disease.
Pericardial disease
Cerebrovascular disease
Heart disease in pregnancy
Management of:
o Pre-operative and post-operative patients
o Cardiopulmonary arrest
Diagnostic techniques, including:
o ECG
o MRI, PET
o Nuclear cardiology
o Echocardiography and doppler
o Cardiac catheterization
o Pacemaker interrogation
Conferences
 Weekly cardiology grand round: clinical topics, clinical research, basic
science research, morbidity and mortality. (Wednesday noon). Speakers
will include Cardiology faculty, Cardiology fellows and invited faculty.
 Weekly cardiology conference: journal club, case reviews
invasive/noninvasive and Guidelines updates (Tuesday 5:30 pm)
Presented by Cardiology fellows
 Combined cardiology and cardiothoracic surgery conference. (One per
trimester)
 Core lecture series (didactic curriculum) presented mainly by cardiology
fellows (Wednesday 7:30 AM)
 Advanced ECG conference (Thursday 5:30 PM)
 Clinical cardiology research conference: progress report on research
projects and proposal of new projects (One per trimester)
 Internal Medicine grand round (Tuesday noon)
Fellows are expected to all conferences (mandatory unless there are
emergencies and sick patients)
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In-service examination
The ACC in-service examination will be administered on October 15th and
16th (4-6 hrs) under the supervision of the NBME, each year for all fellows
(mandatory)
Research
 Trainees are required to complete at least one research project during the
fellowship including preparation of a manuscript for submission to a
peer–reviewed journal
 Trainees will participate in the enrollment of patients in clinical trials
 Trainees are required to submit abstracts to scientific meetings
 Protected time for research is currently limited given the number of
fellows. However, the fellows in general have been proactive with
several research and publications in the pipeline(See Appendix III)
 Fellows will meet on a regular basis with the mentors and at least once a
month with Dr Marwan Refaat who will be in charge of the cardiology
research program and will follow-up on the fellows progress.
Teaching
 Trainees will make presentations at conferences, journal clubs research
and national meetings
 Trainees will be responsible for teaching nurses, medical and other
students rotating on the different services
Duty Hours in the Learning and Working Environment
(See Appendix IV)
The program is committed to and be responsible for promoting patient safety
and trainees well being. Faculty and fellows should be educated to recognize
the signs of fatigue and sleep deprivation.
 Duty hours must be limited to 80 hours per week, averaged over a
four–week period, inclusive of all in–house call activities, including
moonlighting
 Fellows are provided with 1 day in 7 that is free from all educational
and clinical responsibilities, averaged over a 4–week period, inclusive
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of call. (One day is defined as 1 continuous 24–hour period free from
all clinical, educational, and administrative duties.)
 Adequate time for rest and personal activities is provided, which
consists of a 10–hour time period provided between all daily duty
periods
Vacation and Attendance of National Meetings
A total of 4 weeks of vacation will be given during each academic year.
House Staff Policies
The Cardiovascular Training Program follows all the rules and regulations
outlined in the Policies and Procedures of the American University of Beirut
Medical Center.
GENERAL FELLOWSHIP RESPONSIBILITIES
Responsibilities specific to individual rotations are described in each
rotation‟s curriculum. General responsibilities that apply to the daily
performance of fellowship duties will be listed in this section.
1. In general, daily work hours are from 8:00 am to 5:00 pm Monday
through Friday. Obviously, work hours will vary based on the required
duties of each rotation. Fellows on inpatient services with early morning
rounds will need to arrive at a time that allows adequate preparation for
rounds. Fellows on procedure rotations are expected to arrive in time to
evaluate the patient prior to starting the planned procedure.
2. Fellows will provide timely, safe, and effective care for all patients he/she
is responsible for.
3. Fellows will document all patient care in the medical record in a timely
fashion.
4. Fellows will attend scheduled cardiology teaching conferences and initial
attendance documentation sheet.
5. Fellows will review each rotation‟s curriculum with the attending at the
beginning of the month and strive to achieve the outlined goals and
objectives.
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6. Fellows will keep an accurate and up-to-date procedure log. This log will
be reviewed at each 6 month evaluation with the program director.
7. Fellows will review the call schedule and perform all call duties as
scheduled. If fellows switch call, responsible staff must be notified.
8. Fellows are expected to carry their pagers at all times while on duty and to
respond to pages in a timely fashion.
9. Fellows are expected to supervise and teach all house staff members on
his/her team.
10. Fellows are expected to communicate with the attending physician,
house staff members of the team, the patient, and family members as
frequently as is necessary to facilitate excellent patient care. This includes
discussing urgent issues that arise on call with the on-call attending.
11. Fellows will check out all critically ill patients, pending test results, and
other pertinent information to the on-call fellow prior to leaving for the day.
12. Fellows will comply with the program‟s duty hour guidelines and report
any problems with compliance to the program director. This includes not
exceeding duty hours due to excessive moonlighting.
13. Fellows will notify the Chief Fellow (third year fellow) of any unplanned
absence in order to ensure that continuity clinics are cancelled and
rescheduled appropriately and that rotation/call duties are covered. Coverage
for scheduled vacation and conferences is pre-arranged at the beginning of
the year.
14. Fellows will conduct themselves in a professional manner at all times
and will treat all others, including colleagues, faculty, residents, medical
students, ancillary staff, referring health care providers, and patients and
their families, with the utmost respect.
15. Fellows will develop a personal self-study program that is guided by the
fellowship curriculum.
16. Fellows will adhere to all AUBMC GME-related policies.
17. Fellows will adhere to all AUBMC institutional policies.
18. Fellows will complete all rotation, faculty, and program evaluations in
an honest, constructive, and timely fashion.
19. Fellows will comply with the licensure requirements of the Lebanese
Law.
20. Fellows will comply with all state and federal laws governing the
practice of medicine.
21. Fellows will abide by the institutional order writing policy.
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CALL DUTIES RESPONSABILITIES
1. Call begins at 5 pm and ends at 8 am on weekdays. Saturday and Sunday
call is from 8 am to 8 am.
2. Each day there is one fellow on in-house call. Interventional call is
covered by the third year fellow if he is not on in-house call.
3. Each day will have an assigned attending on call to discuss consults. Two
attending are on call for the consult and ER/CCU services. Another
attending will be assigned to cover echo call (TEEs), and one interventional
attending will be on call to cover the cath lab who maybe the same on
CCU?ER or consult services. The attending call schedule will be published
at the beginning of each month.
5. The official daily and yearly call schedule is posted on the internet. Any
call changes should be marked on this schedule, and the hospital operator of
the appropriate facility should be notified.
6. A call room is available on the 6th floor of the General Hospital for
fellows on general cardiology call.
7. Fellows will see all urgent consults on call and page the responsible
attending to discuss the plan of care.
8. Fellows will provide assistance to the CCU residents Fellows are expected
to come in to see any critically ill patient.
9. Fellows will assist with vascular access, PA catheter placement, elective
cardioversion, and transthoracic echocardiography as needed. Once an
individual fellow has received the requisite training and has been deemed
competent in performing these procedures, he/she may perform the
procedures without a senior level fellow or attending directly present. The
results of procedures are discussed and reviewed with the appropriate
attending. Advanced procedures, including diagnostic cardiac
catheterization, transvenous pacemaker placement, coronary angiography,
and TEE are performed only under direct supervision of the attending.
10. The fellows on call Saturday and Sunday will follow-up with new
consults and any existing consults from the week. They are also responsible
for all EP consults, urgent TTEs, rounding with the attending on consults,
and taking overnight call.
11. always there is a second call fellow in case of any procedure that cannot
be done by the first year fellow
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Division of Cardiovascular Diseases Fellows’ Coverage Policy
The coverage policy has been developed to allow for continuous patient care without
any disruptions due to emergency situations. The protocol for coverage has several
features to allow for adequate coverage in all situations.
Fellows requiring coverage on an immediate basis must themselves be involved in an
emergent, unforeseeable incident that could not have been otherwise prevented. These
events will require the requesting fellow to contact the program director or associate
program director in person or via phone and discuss the specifics of the coverage
options. When the decision has been made by the program director to grant coverage,
the name of the available coverage fellow will be provided. For situations where the
requesting fellow is incapable of contacting the coverage fellow, the program/associate
program director will assist. Otherwise, it is then the responsibility of the fellow who is
requesting coverage to contact the coverage fellow either in person or via phone and
discuss the specifics of the coverage requirements. Also, it is the responsibility of the
fellow requiring coverage to provide full details regarding pertinent patient care issues
either over the phone or via email to the covering fellow.
The pool of fellows available to cover will depend on the time of day coverage is
required and the rotations from where fellows can be withdrawn. A hierarchial system
has been developed to determine the order of coverage. The order of coverage will be
first, the nuclear/EP fellow, second, the echo fellow (if there are two echo fellows),
and third, the CCU/Research fellow. Fellows maybe pulled from these services
Monday-Friday from 8am to 5pm when coverage is required.
For the rare circumstance where coverage is required on nights or weekends and the
back-up fellow is ill, coverage will have to be provided by the second call fellow.
Finally, to keep the coverage system equitable for all those involved, all coverage‟s
will be documented on a spreadsheet for future reference. Most importantly, the payback system will be tracked for all coverage issues except for vacation and conference
coverage.
The above policies are meant to serve as guidelines to be as fair as possible to all
fellows. Minor adjustments in the enforcement of the above policies will be at the
discretion of the fellowship program director. Issues of concern with regard to this
policy may be periodically reviewed and refined to suit the needs of the fellowship
program.
Curriculum for Cardiovascular Disease Training Program
American University of Beirut
January 2013 AlJaroudi/Ghazzal
24
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PROCEDURE DOCUMENTATION
Fellows are required to keep a detailed procedure log. An updated log is to be
presented to the program director for review at the biannual fellow evaluation.
1. The following procedures require documentation:
-ECG interpretation (patient identification information not required)
-elective cardioversion
-temporary transvenous pacemaker insertion
-programming and surveillance of permanent pacemakers and ICDs
-right heart catheterization
-left heart catheterization, including coronary angiography
-peripheral angiography and aortography
-exercise and pharmacologic stress testing
-transthoracic echocardiogram (2D and Doppler) acquisition and interpretation
-transesophageal echocardiograms
-stress echocardiograms
-ambulatory ECG recording (Holter) interpretation
-radionuclide studies of myocardial function and perfusion interpretation
-pericardiocentesis
-intra-aortic balloon pump placement
2. Specialized procedures requiring extra training:
-percutaneous cardiovascular interventions
-intravascular ultrasound (IVUS)
-intracardiac EP studies
-permanent pacemaker/ICD placement
3. Documentation must include the procedure performed, patient‟s name and medical
record number, date of the procedure, attending cardiologist, indication for the
procedure, results, and any complications.
Curriculum for Cardiovascular Disease Training Program
American University of Beirut
January 2013 AlJaroudi/Ghazzal
25