Download Clinical Cardiology (CVS 801) - Joan C. Edwards School of Medicine

Cardiovascular Medicine
Course Department, Number & Title: CVS 801, Cardiovascular Medicine
Course credit or length: 4 Weeks
Course director: Paulette Wehner MD, FACC, FACP, FCCP, 304.691.1166, [email protected]
Course coordinator: Cindy Dailey, 304.691.8534; [email protected]
Course location: Cabell Huntington Hospital, St. Mary’s Hospital, Erma Byrd Center, Department of
Cardiovascular Services
Brief Course Description: Cardiovascular Medicine is an integral core component of training to be a
physician. Many cardiovascular disease processes are prevalent with the potential to be life
threatening. Recognition, triage, and appropriate therapy are vital to the internist, regardless of
specialty. During this elective, the student will have exposure to the majority of cardiovascular cases,
presentations, management and procedures. This will include exposure and education in: EKG
interpretations, stress testing, echocardiography and invasive procedures such as cardiac catheterization
and pacemaker placement.
Description of Duties
Students will be responsible for the following:
 Assisting with Consultation (No more than 5 new patients per day) including ICU and CCU
patients
 Completing rounds on inpatients service. You must maintain continuity with patients you have
performed initial consultation until discharged from the hospital.
 Rounding on one weekend day per week (day off to be decided by the cardiology resident,
fellow or cardiology attending)
 Working until at least 5:00 p.m. Minimum workday requires in-house presence until 5 p.m. and
appropriate sign out with cardiovascular medicine fellow prior to leaving the hospital (There is
no guaranteed conclusion to the work day).
 Reporting consultation data to resident or Fellow responsible for the patient or the attending.
The student will routinely report and interact with both residents and fellows on the service and
the attending physician.
Conferences
Attendance is mandatory to all cardiology conferences. These conferences are held on Wednesday at
5:00 p.m. and Thursday from 8:00 to 10:00 a.m. at St. Mary’s Medical Center in the Heart Center room
205. The student is also expected to attend morning report on Wednesday morning at 7:00 a.m. and
medicine grand rounds on Tuesday morning at 8:00 a.m. respectively. Attendance at Dr. Cansino’s
teaching attending is mandatory and occurs Wednesday afternoon (please contact fellow for location).
Self-Directed Learning
As a medical student, you are encouraged to use any unstructured time as an opportunity to read about
your patients, research questions that arise during the day, prepare for case conferences, and prepare
for student-faculty rounds. Preceptors have been specifically asked to look for evidence that you have
read articles and books between clinic sessions. Use this time to build your knowledge of medicine and
learn from your patients.
CARDIOVASCULAR MEDICINE
Institutional Objective
Patient Care - Students must demonstrate the ability to provide patient care that is compassionate,
appropriate, and effective for the treatment of health problems and the promotion of health.
Course Objective
The student will improve cardiac examination and cardiac patient management skills and understand
the basic rationale for diagnostic testing.
Outcome Measure
The student will be able to demonstrate to the faculty ability to:
1. Obtain at least two patient histories with emphasis on cardiovascular and at least one patient
history with undiagnosed chest pain.
2. Perform at least two basic physical examinations and recognize pertinent signs of cardiac
disorders, one examination of which must be of a patient with undiagnosed chest pain.
3. Interpret diagnostic data and the use of diagnostic testing for the above patients, including
electrocardiograms.
4. Orally explain to faculty the rationale behind their choice of treatment with consideration for
resistance, adverse drug effects and cost.
5. Demonstrate to faculty the ability to monitor and appropriately respond to signs of
improvement or deterioration.
The student will write up a brief case report (medical history, physical examination, diagnostic data,
clinical impression including differential diagnosis and plan). The case will be assigned by faculty at the
start of the elective.
Course Objective
The student will be able to evaluate and manage patients with acute cardiac illness.
Outcome Measure
The student will be able to demonstrate to faculty the basic ability to evaluate and manage
patients with the following acute cardiac illnesses:
 Acute coronary syndromes
 Acute myocardial infarction
 Congestive heart failure
 Pulmonary edema, and
 Acute valvular heart disease
Course Objective
The student will be able to evaluate and manage patients who have undergone
procedures.
Outcome Measure
The student will orally demonstrate basic ability to the faculty.
Course Objective
The student will be able to perform procedures relevant to cardiovascular medicine.
Outcome Measure
The student will demonstrate to the faculty the ability to insert central venous lines and arterial
lines with proper technique.
Medical Knowledge- Students must demonstrate knowledge of established and evolving biomedical,
clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to
patient care.
Course Objective
The student must demonstrate a clinically applicable knowledge base of the basic and clinical
sciences underlying the care of patients with chest pain and acute cardiac disease.
Outcome Measure
The student must demonstrate basic knowledge to the faculty.
Course Objective
The student must access and critically evaluate current medical information and scientific
evidence relevant to acute cardiac care.
Outcome Measure
The faculty will select a cardiovascular topic for which the student must access and critically
evaluate and present to the faculty the current medical information and scientific evident
relevant to the topic.
Course Objective
The student will understand indications for aggressive anticoagulant and antiplatelet therapy as
well as the mechanisms of action of the various agents.
Outcome Measure
The student will orally demonstrate to faculty a basic understanding of the above indications.
Course Objective
The student will understand the physiologic and pathophysiologic principles of invasive
hemodynamic monitoring including indications.
Outcome Measure
The student will orally demonstrate knowledge to the faculty.
Institutional Objective
Practice-based Learning and Improvement - Students must demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and life-long learning.
Course Objective
The student will identify and acknowledge gaps in personal knowledge and skills in the care of
acute cardiac patients.
Outcome Measures
The student must acknowledge to the faculty gaps in personal knowledge and skills in the care
of acute cardiac patients. The demonstration must include a review of a case that the student
presented early during the rotation with a list of changes that the student would make as a
result of knowledge obtained during the rotation.
Course Objective
The student will develop real-time strategies for filling knowledge gaps that will benefit patients
in the coronary care unit.
Outcome Measures
The student will orally present the strategies to the faculty and must include:
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Analyzing performance in light of evolving practice guidelines
Applying up-to-date scientific evidence to patient care
Critically appraising literature
Gathering of up-to-date scientific evidence
Teaching of residents, nurses, off-service physicians, patients and families.
Institutional Objective
Interpersonal and Communication Skills- Students must demonstrate interpersonal and communication
skills that result in the effective exchange of information and collaboration with patients, their families,
and health professionals.
Course Objective
The student will be able to communicate information effectively with patients and other care
providers with regard to evaluation and management of Cardiovascular Diseases.
Outcome Measure
The student will be able to demonstrate to faculty:
 Communicate effectively with patients and families in a stressful critical care
environment.
 Communicate effectively with physicians, colleagues and members of other health care
profession to assure timely, comprehensive patient care.
 Communicate effectively with attending and colleagues when presenting patients.
 Work as a team member and leader.
Institutional Objective
Professionalism- Students must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles.
Course Objective
The student will behave in an ethical, responsible, reliable and dependable manner and be able
to accept constructive feedback to improve performance. The student must demonstrate
professionalism in interacting with patients and other care providers.
Outcome Measure
The student will be directly observed and assessed as part of the final grade by faculty to
determine ethical behavior, reliability and level of dependability of the student and the
student’s ability to accept criticisms or suggestions. The student will also be evaluated by
faculty on:
 Professional behavior toward patients, families, colleagues and all members of the health
care team
 Exhibition of integrity and honesty in all aspects of patient care
 Acceptance of responsibility one’s own actions and decorum
 Action that is in patient’s interest at all times
 Sensitivity to patient diversity
Institutional Objective
Systems-based Practice - Students will be able to recognize and better understand the role of other
health care professionals in the overall care of the patient.
Course Objective
The student will better understand health-care delivery systems and social service agencies
which are critical to the care of cardiovascular patients.
Outcome Measure
The student will orally demonstrate to faculty the ability to:
 Work with interdisciplinary teams to improve care (e.g. social workers, nurses, care
coordinators, OT/PT, respiratory services)
 Understand and utilize the multidisciplinary resources necessary to care optimally for
acutely ill cardiac patients.
 Collaborate with other members of the health care team to assure comprehensive coronary
care.
 Use of evidence-based, cost-conscious strategies in the care of patients with chest pain and
other acute cardiac disease.
Basic Science Objective
The student will increase knowledge of the anatomy and pathophysiology of cardiac illnesses.
Outcome Measure
The student will orally demonstrate to faculty a basic understanding of the anatomy and
pathophysiology and ability to recognize the physical findings of chronic congestive heart failure,
acute pulmonary edema, mitral regurgitation, mitral stenosis, aortic stenosis, aortic
regurgitation and tricuspid regurgitation.
ASSESSMENT METHODS
Mid Point Evaluation
In accordance with LCME standard ED-30, the Course Director will evaluate student performance at midpoint to review the student’s professional, clinical and academic performance up to that point. The
formative evaluation must be reviewed with the student and the student will have an opportunity to
discuss with the Course Director. The form must be signed by the student and returned to the Course
Director. The Course Director shall then forward a copy of the form to the Office of Academic Affairs.
The form will NOT however be included in the student’s official academic record. For two week
electives, oral feedback will be provided at the end of the first week.
Case Presentation- 25%
The student will be required to give a 10-15 minute case presentation on a case at a pre-arranged time
during their clinical rotation. The case must be pre-approved by the course director and the
presentation will be given to the course director and medical students. The student will be notified of
the date and time of their presentation one week in advance. The course director will assess the
presentation and assign a percentage score.
Attendance and Participation – 25%
Attendance and participation are expected every day. Failure to attend all sessions will result in a lower
grade.
Preceptor Evaluation- 50%
Grading
A= 90-100%
B= 80-89%
C= 70-79%
F= below 70%
The preceptors’ evaluation will be based, but are not limited to, upon the following factors:
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The demonstration of basic knowledge
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Informal Oral Case Presentations/Patient Workup
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Maturity and Professionalism
Each component mentioned above (case presentation, attendance and participation and preceptor
evaluation) must be passed in order to successfully complete the course.
MUJCESOM Policies: All medical students taking this course will comply with School of
Medicine policies given at http://musom.marshall.edu/students/policies. Individual policies can
be found at the following websites:
Student Infectious Material Exposure:
http://musom.marshall.edu/ups/postexposure.asp
MS-IV Attendance:
https://musom.marshall.edu/students/documents/policies/Yr4attendence.pdf
Academic Dishonesty Policy:
https://musom.marshall.edu/students/documents/policies/Standards-of-Professionalism-andHonor-Code.pdf
Academic Standards Policy:
https://musom.marshall.edu/students/documents/Policies/ASC-FINAL-POLICY.pdf
Policy for Students with Disabilities:
https://musom.marshall.edu/students/documents/Guidelines.pdf
University Computing Services’ Acceptable Use Policy:
http://www.marshall.edu/ucs/CS/accptuse.asp
Affirmative Action Policy:
pp. 16-17
http://www.marshall.edu/catalog/Graduate/S2008/gr_sp08.pdf
Inclement Weather Policy:
https://musom.marshall.edu/students/documents/policies/MUSOM-Inclement-WeatherPolicy.pdf
Notification of delays and cancellations of classes are posted on the Medical Education Home
Page when Marshall University Main Campus is not in session
https://musom.marshall.edu/weather
Required Reading:
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Atrial Fibrillation
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Aortic Stenosis
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Atrial Arrythmias after CABG
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Bradycardia
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Chronic Mitral Regurgitation
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Congenital Heart Disease in the Adult: Part 2
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Chest Pain in Women
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Cocaine and Heart Disease
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Left Ventricular Assist Device
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Myocarditis
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Palpitations
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Peripheral Vascular Disease
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Restrictive Cardiomyopathy
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Sudden Cardiac Death due to Arrythmia
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Supraventricular Tachycardia
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Transesophageal Echocardiography
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Treatment of Hypertrophic Cardiomyopathy
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Valvular Heart Disease
2.
American College of Cardiology and/or AHA Guidelines
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Management of Patients with Valvular Heart Disease
Perioperative Cardiovascular Evaluation for Noncardiac Surgery
Management of Patients with Acute Myocardial Infarction
Management of Paients with Unstable Angina and Non-ST-Elevation Myocardial Infarction
Management of Patients with Atrial Fibrillation
Recommendations for In Hospital Cardiac Monitoring for Detection of Arrythmias for Adults
Coronary Angiography
Coronary Artery Bypass Graft Surgery
Electrocardiography
Exercise Testing
Use of Radionuclide Imaging
Percutaneous Coronary Interventions
Tilt Table Testing for Assessing Syncope
Ethics in Cardiovascular Medicine
2. Cardiovascular MKSAP