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SCOPE OF TRAINING Training Components Overview The Cardiology Training Program includes 24 months of clinical training which consists of:
The fellows participate in a continuing ambulatory care clinic of ˝ day a week during their entire training of at least three years. The Cardiology Training Program is designed to provide sufficient experience for the fellow to acquire the technical and other skills required for the clinical practice of cardiology. These include the performance and interpretation of:
The Program provides sufficient experience for fellows to acquire skill in the interpretation of
Additional one to three years of research training is provided to prepare the fellow for a academic career in their area of interest. Attendance at year round cardiology lecture series is integrated into the Cardiology Fellowship Training Program to provide formal instruction. Fellows attend a cardiology core curriculum lecture each week, a cardiology fellows diagnostic conference, a cardiology fellow’s clinical conference, and a cardiology division research conference. In addition, there is a weekly cardiac catheterization conference, and weekly medical grand rounds, and weekly cardiothoracic surgery grand rounds. Selected nuclear medicine, anesthesiology, internal medicine, and speciality research conferences are also available. Visiting faculty are present at many of these lectures and provide for scholastic stimulation and feedback. Cardiology Fellows in the program play an active role in the planning and production of many of the conferences. Trainees present clinical and research lectures as part of the core curriculum and division conferences. In addition a journal review is incorporated into the weekly fellow’s clinical conference which is planned and conducted by the cardiology trainees. There is also clinical case conferences run by the cardiology trainees. The lecture series includes instruction in the following:
Specific Training Components The following educational objectives and characteristics are incorporated into the fellowship training program: Training in Patient Care and Management Trainees are given extensive exposure and supervision to become skilled in obtaining a history and performing a complete cardiovascular physical examination. The trainee is given considerable experience acting as a consultant to other physicians and has extensive direct patient care responsibilities. The trainees receives extensive outpatient training with general cardiology continuity clinic and rotations in outpatient speciality clinics such as heart failure, post transplantation, adult congenital heart disease, arrhythmia, lipid disorders, and cardiac rehabilitation clinic. Fellows are given the opportunity to become familiar with the roles of aging and psychogenic factors in the production of symptoms and the emotional and physical response of patients to cardiovascular disease. They are educated in the importance of preventive and rehabilitative aspects of the management of patients with known or potential cardiovascular disease. This includes training on the cultural, social, family, behavioral, ethical, and economic aspects of cardiology. Training in Understanding, Diagnosis, Prevention and Treatment of Cardiovascular Disease A major objective of the fellowship training program is that the trainee must become well educated in pathogenesis, pathology, risk factors, natural history, diagnosis by history, physical examination and laboratory methods, medical and surgical management, complications and prevention of cardiovascular conditions, including coronary artery disease, hypertension, valvular heart disease, congenital heart disease, cardiac arrhythmias, heart failure, cardiomyopathy, involvement of the cardiovascular system by systemic disease, infective endocarditis, diseases of the great vessels and peripheral blood vessels, diseases of the pericardium, pulmonary heart disease, the interaction of pregnancy and cardiovascular disease, cardiovascular complications of chronic renal failure, traumatic heart disease and cardiac tumors. Training in Intensive Care The UCLA Cardiology Fellowship includes at least 4 months of full-time experience with patients undergoing intensive care for acute cardiovascular disorders and acute coronary care. The fellows will receive extensive experience in the diagnosis and management of acute myocardial infarction, unstable angina, chest pain of unclear etiology, cardiogenic shock, congestive heart failure, pulmonary edema, respiratory failure, atrial arrhythmias, ventricular arrhythmias, and cardiac transplant rejection. The fellows will be exposed to and obtain an understanding of the indications, risks and benefits of cardiac surgery, coronary angioplasty and the various phases of cardiac rehabilitation. They will be involved in pre and post angioplasty and coronary stent management in the intensive care setting. Training in Ambulatory, Outpatient and Follow-Up Care During their entire training the fellows have continued responsibility for outpatient cardiovascular patient management and consultations at least ˝ day/week (a minimum of 36 months). Ambulatory continuity clinic is considered to be essential for the duration of training. A major objective of this training is that there will be exposure to a wide age span of patients from adolescence through old age with a spectrum of cardiovascular diagnoses, including postoperative patients, patients with congenital heart disease and patients for evaluations and management related to pregnancy. Additional ambulatory experience in specialty clinics and the hospital-based settings is included. Fellows rotate through adult congenital heart disease clinic, heart failure clinic, heart transplantation clinic, and electrophysiology clinic. Fellows also participate in same-day diagnostic or therapeutic procedures such as transesophageal echocardiography, cardioversions, and catheterizations done on an outpatient basis during their clinical rotations and electives. Training in Electrocardiography A fundamental objective for the training program is for all cardiovascular fellows to be skilled in the interpretation of ECGs. During ECG rotations the fellows read extensive numbers of ECGs and their interpretation is reviewed in detail by the attending. ECGs are reviewed on each clinical rotation. In addition there is a twice monthly ECG conference at UCLA and weekly conference at Olive View-UCLA Medical Center where fellows are called on to review ECGs and their skills are assessed. Once each year an ECG skills test is conducted and the results and performance of each fellow is discussed. All cardiology trainees are trained in the performance and interpretation of exercise ECG tests during their noninvasive laboratory rotations. Fellows are instructed in ambulatory and signal-averaged ECGs during the electrophysiology rotations. Training in Chest Radiography Fellows are trained in the techniques and interpretation in chest radiography and CT Scanning. Fellows review CXRs and CTs during clinical rotations with Faculty Radiologists. There is also a Chest X-Ray Conference where radiographic studies are reviewed and trainees read studies with an attending cardiologist. Training in the Cardiac Catheterization Laboratory Cardiology fellows receive direct experience under supervision in the UCLA and Olive View-UCLA Medical Center‘s adult cardiac catheterization laboratory. This laboratory performs both right and left heart catheterizations, endomyocardial biopsies, intracoronary ultrasound, and placement of intra-aortic balloon pumps. This initial experience in the cardiac catheterization laboratory emphasizes the fundamentals of cardiovascular physiology as it relates to clinical disease, the analysis of hemodynamic records and the interpretation of angiographic images. There is also emphasis on the problems in interpretation and analysis of such data and the importance of quality. All fellows attend a training course on the principles of radiation safety and become certified radiology and fluoroscopy operators. All trainees are expected to understand indications, risks, and benefits of interventional therapeutic procedures. Training in Echocardiography The Cardiology fellow participates in the performance of echocardiography and Doppler echocardiography, including at least 3 months of training. All trainees are expected to understand the indications, risks and benefits of transesophageal and stress echocardiography, as well as the principles of evolving techniques such as intravascular ultrasound. Training in Nuclear Cardiology All trainees receive training in the general principles, indications, risks and benefits of nuclear cardiovascular procedures, such as radionuclide ventriculography and myocardial perfusion and viability assessment. The fellows receive basic training in radiation safety. Training in Other Advanced Imaging Techniques Cardiology Fellows at UCLA also are exposed to advanced techniques for imaging including cine-MRI and cine computed tomography (cine-CT), electron beam CT, and positron emission tomography. Training in Cardiac Arrhythmia Device Management and Electrophysiology The fellows are expected to understand the diagnosis and management of cardiac arrhythmias. They participate in detailed discussions of the current indications for cardiac arrhythmia devices and the principles of management and follow-up of patients with implanted pacemakers and antiarrhythmic devices. Participation in implantation occurs during electrophysiology rotations. The fellows also become skilled in the selection of patients for specialized electrophysiologic studies, including catheter ablation of complex arrhythmias. Training in Cardiovascular Research UCLA/Olive View-UCLA Cardiology fellows receive extensive research experience obtaining a Ph.D. or equivalent during their training to prepare them for a career in academic career. All trainees are trained in understanding molecular cardiology and basic science techniques. Fellows also receive training in epidemiology, clinical trial design, and biostatistics. Training in Cardiovascular Rehabilitation UCLA/Olive View-UCLA Cardiology fellows receive training in cardiac rehabilitation medicine. UCLA has an on site cardiac rehabilitation program. Fellows receive training on the indications, evaluation, monitoring, and management of patient undergoing cardiac rehabilitation. They are given the opportunity to follow their individual patients through rehabilitation, receive lectures on this topic, and rotate through the cardiac rehabilitation program. Training in Heart Failure and Heart Transplantation UCLA/Olive View-UCLA Cardiology fellows receive extensive training in the diagnosis and management of patients with heart failure and of cardiac transplant recipients. UCLA evaluates 300 new patients for heart transplantation each year and performs approximately 100 heart transplants each year. Fellows participate in both inpatient and outpatient management of patients with heart failure and post cardiac transplantation. Training in Congenital Heart Disease in the Adult UCLA/Olive View-UCLA Cardiology fellows are trained to understand the diagnosis and management of adult patients with and without surgical repair of congenital heart disease. One of the pioneering programs in adult congenital heart disease is located at the UCLA Medical Center. Training in Peripheral Vascular Disease An objective of the program is for the trainees to develop sound knowledge of the clinical features and treatment of peripheral vascular disease, demonstrate competency in obtaining the history and in performing the physical examination of the arterial and venous systems and should become proficient in selecting and interpreting peripheral angiography, noninvasive imaging, Doppler vascular studies and impedance plethysmography. Training in Related Sciences The training program provides extensive opportunities for continuing education in basic sciences, including those aspects of anatomy, physiology, pharmacology, pathology, genetics, biophysics and biochemistry which are pertinent to cardiology. There are classes and seminars offered in vascular biology, thrombosis, and molecular biology among others. Educational programs, classes and seminars in biostatistics, computer sciences, biophysics, and biomechanics are also available. It is an essential objective of the core curriculum for trainees to acquire a thorough understanding of the normal physiology of the circulatory system, including the adaptation of the cardiovascular system to exercise, stress, pregnancy, aging and renal and pulmonary abnormalities, and the interpretation of tests of renal and pulmonary function. Training in medical economics, health care systems delivery, clinical decision making, preventive medicine and health care outcomes as they relate to cardiology are incorporated into the didactic lectures with detail training also available through the UCLA School of Public Health, General Internal Medicine and the RAND Corporation. Training in Related Fields of Medicine The Cardiology Fellowship Training Program also aims to provide the cardiology fellows with knowledge and experience in a number of related areas of medicine, including the following: Magnetic resonance imaging. Familiarity with the cardiovascular applications and interpretations of magnetic resonance images is essential to the training of a cardiovascular fellow. This imaging modality has many existing uses and considerable potential in noninvasive diagnosis. Radiology. The interpretation of cardiovascular X-ray films, with particular reference to vascular structures and special cardiovascular radiologic procedures. Surgery. The risks and benefits of cardiothoracic and cardiovascular surgery and the rationale for the selection of candidates for surgical treatment, as well as the natural history and the preoperative and postoperative management of patients with cardiovascular disease and various comorbid conditions. Anesthesia. Close collaboration with anesthesia colleagues in the preoperative and postoperative management of patients with cardiac disease for cardiac and noncardiac surgery, and cardiac procedures requiring anesthesia (e.g., cardioversion). Pulmonary disease. A solid knowledge of basic pulmonary physiology in addition to the interpretation of pulmonary and cardiopulmonary function testing, blood gases, pulmonary angiography and radioactive lung scanning methods and experience with the management of patients with acute pulmonary diseases. Obstetrics. A solid knowledge of the interrelations between pregnancy and heart disease, together with experience in the clinical management of patients with heart disease who are pregnant. Physiology. The physiology of the cardiovascular system, its response to exercise and stress and the alterations produced by disease. Pharmacology. The pharmacology and interactions of cardiovascular drugs and drugs affecting cardiovascular function. Pathology. Familiarity with the gross and microscopic pathology of all major forms of heart disease. Geriatrics. Familiarity with the effects of aging on cardiovascular disease and therapeutics. Teaching and Educational Experience It is expected that the trainees participate directly in the teaching of cardiology and become familiar with the fundamental principles of education, including skills in organization of conferences, lectures and teaching materials. The teaching experience includes a minimum of four conferences a week. The conferences are aimed to collate basic biomedical information with the clinical aspects of cardiology, including the integration of clinical management principles. The trainees are taught to use modern concepts of education and effective communication. Cardiology fellows are responsible for teaching and supervising residents in internal medicine as well as medical students, other cardiology trainees and allied health personnel and for working collaboratively with other health care professionals. There are regularly scheduled experiences in teaching including lectures, case conferences, journal clubs, and internal medicine housestaff lectures conducted by the fellows. The fellows are expected to attend and participate in at least one national cardiology meeting each year. Trainees are also expected to learn to prepare successfully through self-study and participation in continuing education, using various media, for certification, recertification and credentialing. Evaluation Process Cardiology fellows are closely evaluated during their training. All trainees are evaluated at the end of each month of rotation for both cognitive and patient management skills as well as procedural skills by the cardiology attending(s) for that rotation. The results of the evaluation are discussed individually by each attending with each trainee. Three times a year the fellow meets with the Director of the Fellowship Training Program where a summary of the clinical evaluations and comments are reviewed. Once a year a constructive review of the fellows’ educational progress takes place. A written record of the scores, fellows comments, and discussions are added to each trainee’s file. Clinical skills such as ECG reading and cardiac catheterization skills are also addressed in separate evaluations. For example, trainees are evaluated by the Medical Director or Associate Medical Director of the catheterization laboratory after the completion of the final catheterization laboratory rotation. This evaluation includes questions regarding cardiac catheterization indications, procedures, and data in general as well as specific cases. Fellows are also evaluated during their research rotations to independently judge their progress. The lectures conducted by the fellows are also evaluated and individual feedback is provided. There are quarterly meetings of the Fellowship Education Committee to ensure that reviews are taking place, program objectives are being met, and to provide guidance. The status of the program is reviewed at quarterly breakfast meeting between the director of the fellowship program, select faculty, the program coordinator, and all of the fellows.
Cardiology trainees are expected to provide
confidential evaluations of each faculty member they work with regarding the
quality of teaching and professional conduct. The evaluations are reviewed
as part of faculty advancement, without identifying the individual fellows.
The individual conferences and teaching series are also evaluated by the
fellows. Each year the fellows provide a written evaluation of each
rotation, lecture series, the program director, and overall training
program. These evaluations are anonymous and kept confidential. |
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