Download curriculum name: cardiovascular medicine

CURRICULUM NAME: CARDIOVASCULAR MEDICINE
I.
GOAL:
To graduate compassionate internists skilled in the art and science of cardiovascular medicine,
namely knowledgeable and skillful in the prevention, diagnosis and management of disorders of
the cardiovascular system (including ischemic heart disease, cardiac dysrhythmias,
cardiomyopathies, valvular heart disease, pericarditis and myocarditis, endocarditis, congenital
heart disease in adults, hypertension and disorders of the veins, arteries and pulmonary circulation.)
II.
CONTENT (See attached table)
A. Develop patient interactive skills including medical history taking, physical examination of
the cardiovascular system (arteries, veins, myocardium, pericardium, pulmonary circulation
and myocardial conduction system) and appropriate communications with patient and families.
B. Proficient in primary and secondary prevention of CV diseases including risk factor
modification.
C. Understand the indications and interpretations of cardiovascular lab data including: EKG’s,
echocardiogram, stress test, Holter monitor and cardiac catheterization data. Understand and
follow AHA/ACC guidelines for CV procedures.
D. Incorporate a knowledge of outcome research, patient preferences, cost and ethical management
strategies in the care of patients.
E. Recognize need for and become skilled in obtaining appropriate cardiovascular disease
consultation (medical and surgical)
III. TEACHING METHOD:
Medical residents care for and are taught cardiovascular disease in many sites:
A. Inpatient:
1. ICU Rotation: Taking care of cardiac admissions, assuming primary responsibility for their
management: diagnostically and therapeutically
2. Ward Rotation: Asking and receiving cardiology consultations
3. Cardiology Consultation Rotation: Working closely with the attending cardiologist including
consulting on patients and supervising their stress tests, reading their EKG’s and Echoes,
etc.
B. Outpatient:
1. ACC Cardiology Clinic as the primary or consulting cardiologist
2. Ambulatory rotations with cardiologists, other subspecialists and general internists
3. Cardiac Rehabilitation rotation (see special curricular rotation)
4. Peripheral vascular disease clinic
5. Resident continuity practice
C. Cardiology Lab Activities
Residents learn the indications and interpretation of EKG’s Echoes, Holters and stresses and
have adequate exposure to invasive procedures such as placement of Swan-Ganz catheters,
temporary pacemakers, cardiac catheterization and other interventional modalities.
D. Didactic Activities: Cardiovascular teaching rounds on the ICU and cardiology consultation
rotations and noon subspecialty conferences, Grand Rounds, journal clubs and case conferences.
Residents are expected to complete BLS and ACLS courses.
1. Cardiology Conference topics (See Appendix I)
2. Suggestions for self study (See Appendix II)
3. Most recent guidelines of cardiovascular diseases and cardiovascular lab test and diagnostic
and therapeutic guidelines, published by the American College of Cardiology and American
Heart Association
4. Contemporary literature as provided by the attending cardiologist
5. UH Cardiology Conferences at 7:30 Wednesday & Thursday
IV. EVALUATION
A. EVALUATION OF THE RESIDENT
Several evaluation methods are implemented at different levels of the program including:
1. Direct verbal and written evaluation of residents by the attending at the end of a rotation
(ward, ICU, rehab, ambulatory and/or consult) including at least two cardiac exam focused
mini-CEX on each cardiology subspecialty consultation rotation
K. EVALUATION OF THE PROGRAM
1. Informal evaluation by the Program Director and the Director of Medicine of the educational
aspects of the cardiovascular program
2. The residents’ composite performance on the cardiology portions of the in-service training
exam and the Internal Medicine Board exam
3. Review of the cardiology portion of the curriculum at the time of the annual resident
retreat.
4. Written evaluation of the attendings by the residents at the end of the subspecialty and
ICU rotations
Cardiology Appendix I
Conference Topics
1.
2.
3.
4.
5.
Basic cardiac physiology including cardiac cycle, sounds, murmurs, et cetera
ECG’s and electrophysiology
Arrhythmias: brady-, tachy, atrial and ventricular
Special cardiac procedures: indications and risks (stress, echo and cardiac cath)
Common cardiac treatments
a. Antihypertensive
b. ACE inhibition
c. Antianginal
d. Antiplatelet
e. Antiarrhthymic
f. Thrombolytic
g. Lipid lowering
h. Vasopressors
6.
7.
8.
9.
10.
11.
12.
13.
14.
Invasive treatments
a. Cardiac pacing
b. Cardioversion
c. Coronary angioplasty and stent placement
d. Coronary artery bypass surgery
e. Valve replacement
f. Transplant
Coronary artery disease (including acute MI), diagnosis and treatment
Valvular heart disease, diagnosis and treatment
Hypertensive cardiovascular disease, diagnosis and treatment
Congestive failure
Shock
Primary myocardial diseases
Pregnancy and the heart
Pericardial diseases
Cardiology Appendix II
Suggestions for Self Study
Textbooks
Harrison’s Principles of Internal Medicine
• Cardinal Manifestations of Disease Section V: pps 190-228
• Disorders of Cardiovascular Diseases Part VIII: pps 1229-1407
Cecil’s Textbook of Medicine
• Cardiovascular Diseases Part VII: pps 166-368
Braunwald’s Heart Disease 4th Edition 1992
Hurst’s The Heart 8th Edition 1994 R. Schlant & R. Alexander
Goldstein’s Principles of EKG
Lipman-Massie’s Clinical Electrocardiography M. Dunn/B. Lipman 1985
Marriott’s Practical Electrocardiography 9th edition 1994 G. Wagner
Z.E. Salcedo’s Atlas of Echocardiography 1985
Ellastad & Myrvin’s Stress Testing Principles and Practice 9th edition 1996
Dubin’s Rapid Interpretation of EKG’s 5th edition 1996
MKSAP: Cardiovascular Disease Section
Journals
Journal of the American College of Cardiology
Circulation
The Heart
New England Journal of Medicine
Lancet
Websites
ACC: www.acc.org
Physicians on line: www.po.net
AMA: www.ama/assn.org
Web MD: www.webmd.com