TheBJCANationalCardiologyInductionHandbook-August2016

‘Atoolkitfortrainees’

Note:Theinformationcontainedinthisdocumentwascorrectatthetimeofwritingto the best of our knowledge. We recommend checking the relevant websites(listed)forthemostuptodateinformation.

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WelcomeCongratulationsonyourappointmenttoacardiologytrainingprogramme.There ismuch to look forward toover thenext few years but also a considerableamountoforganisationandplanningrequiredtomakethemostofyourtraining.Navigating your way through specialty training can be a daunting task, and asregistrarscurrentlyintraininginordertopreparethisdocumentweaskedourselves:“whatwewishwe’dknownthedaywestartedcardiologytraining.”Onthatbasis,theBritishJuniorCardiologists'Association(BJCA)haveproducedthistoolkitfortrainees,whichoverthepastfewyearshasevolvedintoanessentialguideintohowtosuccessfullysteeryourwaythroughtheearlypartsofspecialisttraining.Theinformationinthisdocumentisbasedonthepersonal,collectiveexperienceofregistrars in trainingwithendorsement from theBJCAandBCS.Aswith all things,althoughaccurateatthetimeofwritingthedetailscontainedinthisdocumentarelikelytochangeduringyourtraining.WewillkeepallBJCAmembersupdatedwithsignificantchangesintrainingrequirementsandneweducationalopportunitiesthatmay be of interest.We hope you will find it informative and a useful aid as youembarkonanexcitingcareer.Please letusnow if youhaveany feedbackor suggestions for improvement.Onceagain,congratulationsandbestwishes!JubinJosephBJCAPresidentAUTHORS:RaveenKandan DavidHoldsworthCardiologyST7 CardiologyResearchFellowBristolHeartInstitute JohnRadcliffeHospital,Oxfordraveen.kandan@uhbristol.nhs.uk davidholdsworth@doctors.org.ukCONTRIBUTORS:AfzalSohaib MatthewBatesBHFClinicalResearchFellow ConsultantCardiologistImperialCollegeLondon JamesCookUniversityHospitalThomasTreibel AnanthKidambiNIHRDoctoralResearchFellow ConsultantCardiologistBartsHeartCentre&UCL LeedsTeachingHospitalsNHSTrust

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Contents:1.TaskstocompleteonappointmenttoST32.Tipsforyourfirstpostandsubsequentrotation3.TrainingTimeline4.TheAssessmentSystem

• Curricula• NHSePortfolio• Logbooks• ARCP• EuropeanExaminGeneralCardiology

5.TrainingandEducation• Trainingdays• ST3cardiologysimulatortrainingcourses• Conferences,coursesandmeetings• Onlineresources• Recommendedreading

Appendices:A. BenefitsofBJCAandBCSmembershipB. ARCPDecisionAidforCardiovascularMedicineC. AdvancedModularTraining(ST6-ST7)D. BJCAGuidetoEchoAccreditationforRegistrarsE. CMRTraining–RequirementsandResources

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1.TaskstocompleteonappointmenttoST3A.RegistrationwithyourLETB/deanery o

Your Local EducationTrainingBoard (LETB inEngland) andDeanery in the devolved nations should automaticallyprovideyournationaltrainingnumber(NTN).Youwillneedto sign and return a Form R confirming your personaldetails. Ensure this happens and keep the document in asafeplace.B.EnrolmentwiththeJRCPTB ohttp://www.jrcptb.org.ukFollowing your appointment the JRCPTBshould automatically send you aninvitation to enroll. Enrolment andpayment of the enrolment fee ismandatoryandcanbedonevia the JRCPTBonlineenrollmentsystem.Thereare2optionsforpayment.Asingle,up-frontpaymentof£845maybepaidatthestartofST3or an annual feeof £169maybepaid in combinationwith aRoyal CollegeofPhysiciansCollegiatemembership.VisittheJRCPTBwebsiteforfurtherdetails.

C.UpdateyourePortfolio o

Contact the Education Centre at your firsthospitaloradesignatedrepresentativefromyourLETB/deanery at the earliest opportunity toupdatethis.ThesameaccountusedduringCMTwillbeupdated.EnrolmentwithJRCPTBwillalsobehighlightedonyouraccountoncecompleted.D.RegisterforanIR(ME)RCourse oIR(ME)R refers to the IonisingRadiation (Medical Exposure)Regulations2000.Thisregulationcontrols theuseofall ionisingradiationwithinmedicine in theUK– foryouthismeansanyworkinthecardiaccatheter/pacinglaboratory.ItisimportanttocompleteIR(ME)Rcourseassoonaspossible.Uponcompletionofacourse, the trainingbodywill issuean IR(ME)Rcertificate.A freee-learningcoursehas just been developed – go to: www.e-lfh.org.uk/programmes/radiation-protection-for-cardiology/

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E.Keysocietiestoconsiderjoining oTheBJCAThis isyoursociety.Weexist tosupporttrainingofall UK cardiology trainees. We are made up oftrainee members throughout the UK. We haveofficial representation on the councils of all thesubspecialty professional bodies and we representyour views on the national Cardiology SpecialityAdvisory Committee (SAC) and other groups thatorganiseour training.Thereare1235members (asofJune2016).TheBCSTheBCSisthenationalsocietyforcardiology,andtheBJCAisone of its affiliated groups. Discounted membership isavailabletoBJCAmembers.ThisincludesfreeregistrationfortheBCSAnnualConference,freeESCmembership,discountedregistration for the EEGC, and discounted course attendancefees.Furtherdetailsonwww.bcs.com.ThefulllistofBJCAandBCSmemberbenefitscanbefoundinAppendixA.Forinformationonjoiningpleasefollowthislink:http://www.bcs.com/pages/page_affiliate.asp?PageID=318&NewsCatID=856F.EnsureyourALScertificateisindatethroughoutyourtraining oG.Prepareforyourfirstpost

i.Obtaindetailsoffirstpost:contactLETB/deaneryorTrainingProgramme oDirector(TPD) ii.ContactthecoordinatorforcardiologyandGIMtrainingdaystoget oatimetableandtoregisterfortheemaildistributionlist iii.ContacttheGIM/CardiologyStRon-callrotamanagerintheHospital/Trust oiv.Planleave/studydays/courses/examswellinadvance o

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2.TipsforyourfirstpostandsubsequentrotationMost trainees will spend their first 2-3 years in a district general hospital (DGH)learningcorecardiologycompetencies,withsomeGIMexperience,followedbytheirfinal2-3yearsinatertiarycentreundergoingadvancedtraining.TheorderinwhichtheDGHandtertiarycentreexperience isgained is flexibleanddeterminedbythespecialtytrainingcommitteesforeachtrainingprogramme.A.Inductionmeetingandpersonaldevelopmentplan Whenyoustartyour firstpost, inadditiontoageneral trust induction,youshouldhave a departmental induction. Youwill be allocated to an educational supervisor(ES).Arrangean inductionmeetingwithyourESwithinthefirst2weekstodiscussyoureducationalneeds.YoushouldwriteaPersonalDevelopmentPlan(whichyoucan enter on your ePortfolio) and bring this to the inductionmeeting for furtherdevelopmentwithyoursupervisor.You should aim to meet your supervisor for a mid-year appraisal and then mustcomplete an end-of-year assessment.Usually therewill additionalmeetings in theyearaswell.B.Weeklytimetable The content and wording of the following template for weekly training in corecardiology has been approved by the specialist advisory committee (SAC) incardiology.Your educational supervisor will provide a weekly timetable for you. Your weeklytimetable should aim to fulfil your curricular requirements and will typicallycomprise:Outpatients: usually 1 or 2 clinics per week – direct consultant supervision isexpected in early training and consultant support should always be availablethroughout(i.e.yourclinicislikelytobecancellediftheconsultantisaway).Wardrounds:usuallyatleast2perweek(atleast1consultantled,1StRled)CathLab: usually2 training lists/sessionsperweek– thesecanbothbepacingorangiography for limited time periods, e.g. 6 months, but should lead to requiredcompetenciesforbothproceduresduringST3-5.Echo:atleast1dedicatedechosessionperweekformostcoretraining.Meetings:thereshouldbeopportunitiestoattendandpresentatthegrandround,weeklydepartmentalmeetings,MDT/HeartTeammeetingsetcetera.

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C.Basicechocardiographytraining Thisistheskillyouwillbeexpectedtopickupmostquickly.Bookontoabasicechocourse early. Your study leave budget should support this. Try and organise someearly sessions in the echo department, but above all, go out and start scanning.FamiliariseyourselfwiththeportableechomachineandscanyourpatientsonCCU.Storetheimagesandreviewthemwiththeechocardiographersorechoconsultantforconstructivefeedback.Wehavewrittena“BJCAGuidetoEchoAccreditationforRegistrars”toprovidesomeguidanceandtipsforachievingBSEtransthoracicecho(TTE) accreditation (see Appendix D). BSE Accreditation is not mandatory tocompleting your registrar trainingbut is recommended. Theminimumstandardofdemonstrableechoexperienceistolog250TTEsandtogain6Level3(Independent)DOPSfromatleast2differentassessors.D.ThecardiaccatheterlaboratoryYouwill findthatevery labhas itsowndistinctatmosphereandculture.There isasteeplearningcurveatthebeginning.Valuableteachingisavailablefromavarietyofindividuals: your consultants, radiographers, physiologists, and nurses. Introduceyourself to everyone early on. Humility will pay dividends in terms of a patient,productivelearningrelationship.To make the most of your lab sessions, arrive early, read the patients notesbeforehandandunderstandtheindicationfortheirprocedures,aswellasobtainingwrittenconsent. If you feel there isan issue,whichmayprevent theprocedureorconstitutesanincreasedrisk,alertcolleaguesbeforethepatientisonthetable.Thisisaclinicalencounter,likeanyother,andnotanisolatedprocedure.The findings of investigations and plans for future management must be clearlycommunicatedtopatientsandcolleaguesbothverballyandinwriting.E.Temporarypacingwires(TPW)andpericardiocentesisThese are important procedures and gaining experience can be difficult. Speak topacingphysiologists/EPcolleaguesandtrytobeavailabletoinsertaTPWduringapacemaker‘boxchange’forpacing-dependentpatient.Donotbeafraidto letyoursenior registrar colleagues and supervising consultants know that youneedTPW/pericardiocentesisexperienceandasktobecontactedshouldtheprocedurebecomenecessarytoobserve,assistortoperformwithsupervision.AlwaysaskforaDOPSforeveryTPWorpericardiocentesisprocedure(makeyourrequesttocompleteaDOPSpriortotheprocedure).

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F.CardiologyorGIMon-callStRrota Werecommendcontactingyourtrust’sGIM/CardiologyStRon-callrotacoordinatoras soon as possible to obtain your on-call rota. In addition to planning leave, youmightneedtoarrangeswapstoallowyoutoattendimportanttrainingdays,coursesetcetera.G.CardiologyandGIMstudydays Each training programme should have a person (registrar, consultant oradministrator) that coordinates the cardiology and GIM training days (might beseparatepeople).We recommend contacting this person to inform them that youhavebeenappointedtothetrainingprogramme.Youshouldreceiveascheduleoftrainingdaysfortheyearandotherrelevanttrainingupdates.Anannualattendancerateofat least60%at locallyorganisedcardiologyteachingasdefinedintheARCPdecisionaid(AppendixB)isrequiredunlessthereareexceptionalcircumstances.H.Planningleave/studydays/courses/examsinadvance Planyouractivity6-12months inadvance. Inaddition toannual leave,youshouldinformyourdepartmentof the ‘mandatory’ cardiology andGIM trainingdays thatyou are required to attend.Most trusts require at least 6weeks notice to cancelfixedcommitmentssuchasclinics.Therearealsomanycoursesandconferencesinthetrainingyear,whichyoumightwishtoattend,astheymayprovideasignificantcontributiontoyoureducationandtraining.Most courses and conferences need to bebookedwell in advance, oftenwith ‘early-bird’ discounts on the registration fee. These are listed on the BJCAwebpagesandwillbeemailedtoyoubyyourlocalBJCArepresentative.http://www.bcs.com/pages/about.asp?PageID=152I.SubsequentrotationYoursubsequentrotationisdeterminedbyyourSpecialtytrainingCommitteechairedbyitsTPD.Themethodofallocationvariesacrossprogrammes.Itmaytakeintoaccountseniorityandpersonalpreferencesaswellastrainingneeds.Anewrotationshouldbeusedasanopportunitytobeplacedinalocationthatallowsyoutoaddressanytrainingdeficits.

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J.Addressingdifficultiesintraining.Itislikelythatyouwillencounterdifficultiesduringyourtraining.TheTPDshavetosatisfy the varying and complex training needs of a large number of trainees,accommodatingpaternityandmaternityleave,sicknessabsenceandout-of-programactivity.Throughout thisprocess theymustcontinueto fulfill therequirements forservice provision. It is important therefore that you learn how to cope withperceivedproblemsandanydeficienciesinyourtraining.Bepolite,reasonableandpatient, BUT remember: your trust is paid to train you and you need to takeresponsibilityforensuringyouaretrainedproperly.Ifthereisaproblem,seekhelpearly.Asktheadviceofcolleaguesandmoreseniortraineesbut,ifyoucannotfixtheproblem alone, you must be ready to speak to your educational supervisor insufficienttimetoallowasolutiontobefoundandthetraininggoalsachieved.3.TrainingTimeline

CARDIOLOGYCORETRAINING ADVANCEDMODULES

ST3 ST4 ST5 ST6 ST7

BSEACCREDITATIONINTTE

PRACTICALEXAM Assessment¬------------X----------------------------®X

24MONTHSTOCOLLECTCASES

EEGC(1stattemptinST5)

WORKBASEDPLACEDASSESSMENTS

DOPS,MINI-CEX,CBD,ACAT,MSF,MCR,PSetc-seeARCPDecisionAidforfurtherdetailsonannualrequirements-

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4.TheAssessmentSystemA.Curricula

The most recent curricula for Cardiology (2010, amended 2015) and GeneralInternalMedicine(2009,amended2012)areshownbelow:

Both curricula and other important forms and guidance can be found on theJRCPTBwebsite:https://www.jrcptb.org.uk/specialties/cardiologyhttps://www.jrcptb.org.uk/specialties/general-internal-medicine-gimi.CardiologycurriculumThisisalongdocument,whichrewardscarefulreading.Itincludes:a. Theoutlineofthe5-yearcardiologytrainingplan(ST3-ST7).

b. The assessment system – the type of assessment methods and how they are

applied.

c. Guidanceontheuseofworkplacebasedassessments(WPBAs).

d. Guidance on the ARCP process and the penultimate year assessment (PYA),whichfallsattheendofST6.

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e. Detailsofthe“ModularSpecialistAreaTrainingModel”.Thisdefinesthenumberof‘units’,whichcomprisethe2yearsofadvancedmodulartraining(ST6-ST7):atotalof4or5units.Eacharea(5cardiologysubspecialtiesandGIM)requirestheinvestmentofacertainnumberofunitsoftrainingtime,toachieveatotalof4-5within the final two years of training and qualify for CCT (see Appendix C fordetails). During these 2 years approximately 60%of your timewill be in theseadvanced modules with the remaining time completing a broad generalcardiologytrainingincludingoncall.

A goodplace to begin in the curriculum is the “ARCPDecisionAid” (page37/178)whichisatablerepresentingtherequirementstoreceiveasatisfactoryARCPattheendofeachyearoftraining(seeAppendixB).2015AmendmentstotheCardiology2010CurriculumAdocumentsummarisingchangestotheCardiology2010curriculumisavailableontheJRCPTBwebsite(linkbelow):https://www.jrcptb.org.uk/sites/default/files/Cardiology%202015%20curriculum%20changes%20guidance%20181115.pdfAdultCongenitalHeartDisease(ACHD)From August 2015, there is a requirement for trainees to complete an ACHDchecklisttoconfirmcompletionofcoretraining inACHD.ThischecklistandfurtherguidanceisavailableontheJRCPTBwebsite(linkbelow):https://www.jrcptb.org.uk/sites/default/files/ACHD%20checklist.docxCMRTraining–RequirementsandResourcesAsummaryofCMRtrainingrequirementsandresourcescanbefoundinAppendixE.ii.GeneralMedicineCurriculumIt isenvisaged (SAC) thatall cardiology traineeswill complete1-2yearsofgeneralmedicine trainingat the startof their corecardiology training. Thiswould includeparticipating in the acute medicine rota. This training is currently planned tocontinue for all core cardiology trainees, even thosewhodonot intend topursuedualaccreditation.FurtherguidanceonhowtoundertakedualtrainingwithGeneralInternalMedicinecanbefoundontheJRCPTBwebsite.iii.TheGoldGuideAReferenceGuideforPostgraduateSpecialtyTrainingintheUK(alsoknownastheGoldGuide) setsout thearrangementsagreedby the fourUKhealthdepartmentsforspecialtytrainingprogrammes.ItismaintainedbyCOPMeDonbehalfofthefourUKHealthDepartmentsandprovidesgenericinformationontrainingrequirements:http://www.copmed.org.uk/publications/the-gold-guide

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B.TheJRCPTBePortfolioandworkplacebasedassessmentsYouwillbefamiliarwiththeePortfoliofromcoremedicaltraining.ArepresentativefromyourLETB/deaneryshouldsetupyourePortfoliotoshow:

• Yournewpost• Yoursupervisor’sdetails• Thecorrectcurriculum

Youmustpersonallyinput,orchaseup:

• Inductionmeeting• PDP• RegistrationwithJRCPTB www.nhseportfolios.org

The ePortfolio is essentially a record of your training. It is therefore criticallyimportant to embrace it and utilise it regularly to record all activity – formative,summative and (in particular) reflective. It will be reviewed by your educationalsupervisor duringmeetings and scrutinised by the ARCP panel at the end of eachtrainingyear.Thistypicallyrequirestwohoursaweekofdedicatedtime.GuidanceonhowtousetheePortfoliocanbefoundonline:http://guide.nhseportfolios.org/

AssessmenttoolswillbefamiliartoyoufromCMT(CBD,MiniCEX,DOPS,ACAT,MSF),withsomenewerformsofassessmentnowactive.(TeachingObservation(TO),AuditAssessment(AA),PatientSurvey(PS),QualityImprovementProjectAssessmentTool(QIPAT)). TheMultiple ConsultantReport (MCR)was introduced in 2014.DifferentminimumrequirementsexistforcardiologyandGIM.CardiologyAssessmentsThe Cardiology SAC has providedguidance on workplace based assessments tosupportrecent(2015)changestospecialtytrainingassessment.ThisguidancecanbefoundontheJRCPTBwebsiteandviathelinkbelow:https://www.jrcptb.org.uk/sites/default/files/Cardiology%20WPBA%20guidance%20181115.pdf

GIMAssessmentsGuidanceonthetypesandminimumnumbersofGIMassessmentsrequiredforeachtrainingyearcanbefoundintheGIMCurriculum2009(revised2012)We strongly recommend scrutinising the relevant curriculums and assessmentguidanceontheJRCPTBwebsite.Makesureyoucompletethesethroughouttheyear.

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Setaminimumtargetforeachmonth.ThiswillavoidalastminuterushbeforeyourARCP.FailuretoachievetherequiredassessmentsforeachtrainingyearwilllikelyleadtoanunsatisfactoryARCPoutcome.C.Logbooksofprocedures&otherclinicalactivityInadditiontotheePortfolio,itisessentialthatyoumaintainalogbookofproceduresandlogallclinicalactivity(outpatientsetc.)overtheyear.CardiologyLogbookKeep a record of ALL cardiology procedures you perform during your training.Ensureany logbooksareappropriatelyanonymised. Thiswill need topresentedatyourARCP.Itisalsogoodpracticetokeeparecordofproceduralcomplicationsandoutcomes.We have extracted the following procedure numbers from the 2010 curriculum(numbersoverthecourseoftraining):

• Atleast250cardiaccatheterisations• 250Transthoracicechocardiograms• NuclearCardiology:at leastonestressandoneSPECTacquisitionsessionof

atleastsixpatientseach,andeightreportingsessionsofatleastsixpatientseach

• CardiacMRI:SeeAppendixE• CardiacCT:50casesand8halfdaysessions• Involvementin25permanentpacemakerimplants• Involvementin20invasiveelectrophysiologicalstudies• InvolvementinatleastfiveICDimplantsandfiveCRTprocedures

GIMLogbookWehaveextractedthefollowingprocedurenumbersfromthe2009GIMcurriculum(numbersoverthecourseoftraining):

• 1000acutemedicaladmissions• 186clinicpatients(Thereasonforthisprecisenumberisnotclear)

SamplelogbooksareavailableontheGIMpagesoftheJRCPTBwebsite.

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D.TheARCPWesuggestthefollowingtipsfortraineespreparingfortheARCP:i. Start preparation for your ARCP at the start of your training year. Having

completed your PDPand inductionmeeting, review theARCPdecision aid andtheCardiologyCurriculumdocumenttobeawareofwhatisexpectedfromyouintheyear.

ii. Ensure that you work throughout the year to achieve the required type and

numberofWBPAsandcompetencylevelsforyourtrainingyear.Organiseamid-pointreviewwithyoureducationalsupervisortocheckyourprogress.

iii. In the “CURRICULUM”sectionof yourePortfolio, youneed tobe signedoffby

youreducationalsupervisoras‘Level3or4competent’inaminimumnumberofcommoncompetencies(1/3forST3)andsignedoffas‘Achieved’foranumberofcorecardiologyandGIMtopics.Thissign-offisbasedonsatisfactoryscoresfromWBPAs, hence the importance of accumulating a sufficient number ofassessments throughout the year and linking them to the curriculum. You canalso link evidence from training days/courses attended and reflective practice.Ensurethatthissign-offprocessstartswellinadvanceofyourARCPasitcantakeaconsiderableamountoftimeforboththetraineeandeducationalsupervisor.

iv. Prior to the ARCP, you need to have an end-of-year meeting with your

educational supervisor, who will then provide an Educational Supervisor’sReport.Youmaywishtomeetyoursupervisorbrieflyamonthorsobeforethis,toaddressanyoutstandingfinalissues,whilethereisstilltimetorectifythem.

AfinalchecklistforyourARCP:• SufficientnumberofWBPAs• LinkedWBPAstocurriculum• Supervisorsign-offforePortfoliocurriculumcompetencies• Recorded some reflectivepractice fromcourses/trainingdays/ teaching/clinical

eventsetc• Finaleducationalsupervisorsreport• Anup-to-dateCV(uploadcopytoePortfolio)• Anup-to-datelogbookofprocedures(uploadcopytoePortfolio)• Asummaryofyouractivityfortheyeare.g.audits,publications,(uploadcopyto

ePortfolio)• Presentations,teaching,managementroles,etc.(uploadtoePortfolio)• Acopyofyourweeklytimetable(uploadtoePortfolio)

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LinkforARCPdecisionaids:Cardiology–*Amendments2015(DecisionaidatAppendixB):https://www.jrcptb.org.uk/sites/default/files/2010%20Cardiology%20ARCP%20Decision%20Aid%20%28revised%202015%29.pdfGIM-*RevisedNovember2014:http://www.jrcptb.org.uk/sites/default/files/2009%20GIM%20ARCP%20Decision%20Aid%20%28revised%2017.11.14%29.pdfE.EuropeanExaminGeneralCardiology(EEGC)TheEEGC(formerlyknownastheKnowledgeBasedAssessmentorKBAintheUK)isan obligatory part of cardiology training in the UK. The KBA’s origin, aims andconditionsareclearlydefinedinthe2010cardiologycurriculum:“Theaimofthisassessmentistoassessatrainee’sunderstandingofthenecessaryknowledge components of the core cardiovascularmedicine curriculum to a levelappropriateforanewlyappointedconsultant.AsatisfactoryperformanceintheKBAis expected during core training, usually in ST5, and satisfactory performance ismandatorybeforeattainmentoftheCCT.Traineeswhofailtoachievetherequiredstandard in theKBA in ST5will notbeprevented fromproceeding to ST6andST7providedtheirotherelementsofperformancearejudgedadequateattheARCP.Theperformance in the KBA is only a small component of assessment for the ARCP,which will be dominated by theWPBAs. The KBA performance will not be a keycriterion for allocation to sub-specialty modules. The KBA will be offered on anannualbasis,thusatraineewill,ifnecessary,havefurtheropportunitiestore-sittheKBAinST6andST7.”In 2015, the KBA evolved into the European Exam in General Cardiology. Furtherinformation on registration and preparation for the EEGC is available on the BCSwebsite:http://www.bcs.com/pages/page_box_contents.asp?PageID=526

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5.TrainingandEducationA.TrainingdaysRegional cardiology training days. Ensure that you are registered for local andregional cardiology training. The timetable should be available well in advance.Attendance is important not just for education but also to complywith the ARCPrequirementof>60%attendance.TheBCSorganises2NationalCardiologyTrainingDaysperyear, inJuneduringtheBCSAnnualConferenceand later intheyear(Sept-Nov).Thenationaltrainingdayscover topics from the current cardiology curriculum but also focus on addressinggaps in the training programme. They typically feature prominent speakers fromacrossthefieldofcardiology.GIM.Attendanceat100hoursofexternal training is requiredduringthecourseofyour training. This can include regional training days, other courses (eg RCP) andsomeofyourcardiologytrainingdays.B.ST3cardiologysimulatortrainingcoursesSimulation based learning has come to the forefront of cardiology training. TheBritish Cardiovascular Society, through local LETB/deaneries and trusts offer anumber of simulator training courses to newly appointed trainees. Trainees arehighlyencouraged to register foroneof thesecoursesearly,asplacesare limited.FurtherinformationisavailableontheBCSwebsite:http://www.bcs.com/pages/page_box_contents.asp?PageID=972C.Conferences,CoursesandMeetingsThere are numerous courses, conferences and meetings that provide significanteducationalvaluetocardiologytrainees.Itisimpossibletoprovideanexhaustivelistofalltheseeventsbutwehaveputtogetheralistofpopulareducationaleventsforcorecardiologytraineesonthefollowingpage.

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NationalCourses,Conferences,Meetingsfor2016–2017

Date Event Location

27Sep2016 BCSNationalTrainingDay(BCSendorsed)

RoyalCollegeofPhysicians,London

11-12Oct2016

HeartRhythmCongress(BCSapproved) ICC,Birmingham

17-19Oct2016

Cases,ControversiesandUpdatesinCardiovascularMedicine(BCSendorsed)

RoyalCollegeofPhysicians,London

29-30Oct2016 BJCAHeadStartinCardiology* RoyalFreeHospital,London

4Nov2016 EssentialSurgicalSkillsforCardiologists(BCSendorsed)

RoyalCollegeofSurgeons,London

11-12Nov2016

BSE(BritishSocietyofEchocardiography)AnnualMeeting(BCSapproved)

QueenElizabethIIConferenceCentre,London

24-25Nov2016

BritishSocietyforHeartFailure18thAnnualAutumnMeeting(BCSapproved)

QueenElizabethIIConferenceCentre,London

16Dec2016 AYearinCardiology(BCSendorsed)

RoyalCollegeofPhysicians,London

18-20Jan2017 BCISAdvancedCardiovascularIntervention2016(BCSapproved) LondonHiltonMetropoleHotel

2Mar2017 BritishSocietyforHeartFailure–HeartFailureDayforTraining&Revalidation(BCSapproved)

Regent’sConferenceandEvents,London

6-10Mar2017 BCS&MayoClinicCardiologyReviewCourse(BCSendorsed)

RoyalCollegeofPhysicians,London

Mar2017(TBC)

BCSNationalTrainingDay(BCSendorsed)

RoyalCollegeofPhysicians,London

5-7June2017 BCSAnnualConference(BCSapproved)

ManchesterCentral,Manchester

June2017(TBC) EuropeanExaminGeneralCardiology Variousvenues

*TheBJCAHeadStart inCardiologyCourseisaFREE,two-daycourse,coveringCardiologyEmergencies, Echo and Procedures (angiography, pacemakers and pacing wires).ItsdesignedforthoseintheearlyyearsoftheirCardiologytrainingbutitisopentoall.ThecoursewillbedeliveredbyeminentUKfaculty.Ticketswillselloutquickly-solookoutfortheBJCAemailwhentheybecomeavailable.

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SelectedInternationalMeetingsfor2016-2017

Date Event Location

27-31Aug2016 ESCCongress2016 Rome,Italy

12-16Nov2016 AmericanHeartAssociation(AHA)ScientificSessions2016 NewOrleans,USA

7-10Dec2016 EuroEcho-Imaging2016 Leipzig,Germany

17-19Mar2017 ACC.17(AmericanCollegeofCardiology) Washington,USA

16-19May2017 EuroPCR2017 Paris,France

29Apr-2May2017 HeartFailure2017 Paris,France

18-21Jun2017 Cardiostim-EHRAEuropace2017 Vienna,Austria

Financingcourses,conferencesandmeetingsSomeoftheseeventsarefreebutyouwillsoonfindthattrainingincardiologyisanexpensivebusiness.Tohelpreducecosts,wewouldrecommendthefollowing:

1. Fulluseofanystudyleavebudget.2. EnquirewithyourLETB/deanery/Trust if there isanopportunity toapply

forfurtherfundingifthereisanunder-spendinthebudget.3. Registerearlytoqualifyforearly-birdregistrationdiscounts.4. Joinasocietytobecomeentitledtoasubsidisedregistrationfee.5. ApplyforaBCS‘TravelBursary’,aschemedesignedtoassistandpromote

attendanceatcertain internationalcongresses(ESC/AHA/ACC)topresentabstracts.(seeBCSwebsiteformoreinformation).

6. Make contact with local drug representatives. They may help out withtravel or accommodation costs for scientific meetings or provideinvitationstocertainsponsorededucationalevents.

7. IfyouarepayingyourownwayforapopularconferencesuchastheESCcongress, book flights and accommodation early as prices climb rapidlyclosertotheevent

TheBJCATravelScholarshipSchemewaslaunchedinApril2016tosupportmemberswhohavedemonstratedexcellence inanyaspectofour specialtywith support fortravelandregistrationtomajorcardiologycongresses.LookoutfortheBJCAemailwhentheybecomeavailable.

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C.OnlineCourses&ResourcesBritishCardiovascularSociety:www.bcs.comWebcastsfromtheBCSAnnualConference2009-2016Twoonlinecourses(availabletoBJCA/BCSmembers)• CMRTrainingModulefromSCMR• GeneticsinCardiologyCourseRadiationProtectionforCardiologye-learningcourse:www.e-lfh.org.uk/programmes/radiation-protection-for-cardiology/The course specifically addresses the requirements of the Training Curriculum inCardiology, in particular the need for trainees to have completed a course on theIonisingRadiation(MedicalExposure)Regulations[IR(ME)R].BritishSocietyofEchocardiography:www.bsecho.org/educationThe Education section has a wealth of resources on echo protocols, guidelines,distance learningmodulesandclinicalcases. Inaddition, theextensiveecho imagelibrary can be used for ongoing learning by those seeking accreditation and forreferencebymoreexperiencedmembers.EuropeanSocietyofCardiology:www.escardio.orgESCClinicalPracticeGuidelines–NewguidelinespublishedannuallyESC Congress 365 - an online library of ESC Congress scientific and educationalcontentclassifiedaccordingtoyourfieldsofinterestESCDistanceLearning–Webinars,webcasts,clinicalcases,slideresourcesESCeLearningPlatform–LaunchedatESCCongress2012:aweb-basedtool,whichfacilitates theharmonisationof cardiovascular trainingacross sub-specialtiesofcardiology,aswellasatnationallevelPublishedproceduralguides:PacemakerInsertion:http://heart.bmj.com/content/95/3/259.fullhttp://heart.bmj.com/content/95/4/334.fullAngiography:http://heart.bmj.com/content/91/7/968.full

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D.Recommendedreading

Journals:Heart heart.bmj.comFreeonlineaccesswithsubscriptiontoBJCA/BCS

TheBritishJournalofCardiologybjcardio.co.ukFreeonlineaccess

EuropeanHeartJournaleurheartj.oxfordjournals.orgFreeonlineaccesswithregistrationtotheESCCongress

Books:CardiologyTextbooks

ReferenceBooks:1) ESCTextbookofCardiovascularMedicine2) Braunwald’sHeartDisease

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OxfordHandbooksinCardiology:

Echocardiography:

EEGC(KBA)Preparation

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APPENDIXAtoCardiologyTrainees’Toolkit(August2016)MEMBERSHIPOFTHEBRITISHJUNIORCARDIOLOGISTS’ASSOCIATION(BJCA)TheBritishJuniorCardiologists’Association(BJCA)isthevoiceofcardiologytraineesin the UK with respect to training, education and research issues. Becoming amember of the Association offers trainees (all registrars in training - LATs andresearchfellowswithincardiology)significantbenefits.BENEFITSBJCAOnlyMembership(Cost:Freeforaslongasyouareintraining)• EstablishedregionaltraineedeaneryrepresentativesinallUKdeaneries.• Established representation on all major national cardiology committees (SAC,

BMA,BritishCardiovascularSociety,BCIS,BSCMR,BSE,BSH,HRUK,BHVS)• Regular news updates (e.g. relevant courses/conferences/events) Support for

localeducationalevents• 20%discountonselectedOUPMedicalHandbooks• Free administrative and web management support for communication and

educationresourcesBCSMembership(Costfortrainees:£105peryearincludingVAT)• FreeaccesstoHeartonline• PaperHeartatadiscountedsubscriptionof£80• FreeregistrationtotheBCSAnnualConference• Complimentary ESC Textbook of CardiovascularMedicine (renewable one year

accessuponrequesttoBCSmembershipcoordinator:membership@bcs.com)• FreeaccesstoCardioSourceincollaborationwiththeACC• DiscountedratesforallBCSCourses(e.g.CardiologyReviewCourse)• AutomaticmembershipoftheESC• Membershipe-bulletinswithnewsfromtheworldofCardiology• ProfessionalrepresentationwiththeRoyalCollegeofPhysiciansandDepartment

ofHealth.HowtojoinVisit:www.bcs.com/bjcaorcontacttheAffiliatesCoordinator,bjca@bcs.comor+44(0)2073801918.

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APPENDIXBtoCardiologyTrainees’Toolkit(August2016)ARCPDECISIONAID–Amended2015

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APPENDIXCtoCardiologyTrainees’Toolkit(August2016)MODULARSPECIALISTAREATRAININGMODEL(ST6-ST7):•Traineesmustcombine4or5“units”forCCT.Modulestobetakeninfull•ModularWeightings:

Subspecialty Units1a ACHD 2or41b HeartDiseaseinPregnancy(mustbewithACHD) 12a AdvancedRhythmManagementEP+Devices 42b AdvancedRhythmManagementDeviceTherapy 23 HeartFailure 24 CoronaryIntervention 45a AdvancedEchocardiography1 2

AdvancedEchocardiography2 45b Nuclear 5c CardiacCT 25d CardiacMR 26 AcademicCardiology(Academicpost-holders) Upto47 GIM 2

The cardiology SAC has produced guidance to TPDs and trainees on therecommendedproceduresforallocatingtraineestotheadvancedtrainingmodulesfor training years ST6 and ST7. Please refer the JRCPTB website:https://www.jrcptb.org.uk/sites/default/files/ALLOCATION%20TO%20CARDIOLOGY%20ADVANCED%20MODULES%202012.pdf for links to the document: ‘Allocationto cardiology advancedmodules 2012’ and the person specifications for each oftheadvancedmodules. ThetwooptionsfortraineesundertakingdualtrainingincardiologyandGIMtrainingareshowninthetablebelow.

aVariableproportionsofGIMtoCardiologytrainingdependingonLETBbMinimum of 30% training time spent in cardiology to maintain competencies, but may require a higherpercentagedependingoncompetenciesachievedbytheendofST7

Options ST3-ST5 ST6 ST7 ST8 Maximumtrainingtime

A CardiologyGIMa

Cardiology advanced specialist areamodules(4units)

CardiologyGIMb 72months

B CardiologyGIMa

Cardiology advanced specialist areamodules(2units)/GIM(2units) N/A 60months

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APPENDIXDtoCardiologyTrainees’Toolkit(August2016)BJCAGUIDETOECHOACCREDITATIONFORREGISTRARS

The BSE accreditation is a formal process tocertify competence in basic echocardiography.Itisahighlydesirablequalificationthateachcorecardiologytraineeshouldaspiretoachieve.AccreditationisrecognisedthroughouttheUnitedKingdomandinEurope.Inaddition,BSEaccreditationinadulttransthoracicechocardiographycanbeusedinplace of DOPS assessments (i.e. no further DOPS in echo are required onceaccreditationhasbeenachieved).Accreditation involves awritten examandpractical assessment. Full details of theprocessesrequiredforBSEaccreditationareavailableatwww.bsecho.orgA diagrammatic representation of the accreditation process/pathway with helpfulpointersfortrainees(TimelinefromST3)isshownbelow:StartofST3 Learntoperform,interpretandreportechocardiograms

• Ensureyouhaveadedicatedechotraininglist• Purchase(andread)anechobook–seesection5D• Consider attending anecho course – seeBSEwebsite for

listofcourses:www.bsecho.org• Performbedsideechocardiogramsateveryopportunity(in

andoutofhours)tofurtherdevelopechoskillsConsider registration with the British Society ofEchocardiographynow–therearemanyeducationalbenefits(see BSE website) and you will need to be a registeredmembertoundertaketheaccreditationprocess

Start compiling your logbook of 250 cases of a specific case

mix (see guidance on BSEwebsite). Look out for and collectcasesofrareandinterestingpathology(myxoma,hypertrophiccardiomyopathy).Aimtocollect100casesinyourfirstyearoftraining.

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StartofST4 Registerandstartpreparingforthewrittenassessmentpartoftheaccreditationprocess • TheBSEwrittenassessmentisheldontwooccasionseach

year:aspringexaminationandanautumnexaminationinmultiplelocations.

• Thewrittenassessmentcomprisesoftwoparts:theTheorysectionandReportingsection.Itisnecessarytopassbothsections in the same sitting. Refer to the BSE TTEaccreditation information pack (BSE website) for moredetails

• 2-3monthsofpreparation time inaddition toexperiencegainedinyourST3yearshouldbesufficient

• ConsiderattendingaBSEexampreparationcourse

Sitfor(andhopefullypass)theBSEwrittenassessment• If you are concerned that you do not have sufficient

knowledge and experience to pass the written exam ormay struggle to complete your logbookwithin 2 years ofsittingtheexam,considerdeferringtothenextsitting

• You must pass the written assessment before attendingthepracticalassessment.

Focus on the practical assessment immediately after passingthewrittenexam• The logbook and video cases shouldbe collectedover a

periodof24monthswiththeexaminationbeingtakenatanypointwithinthisperiod

• Compileyourlogbookof250reportsofaspecificcasemix.Ensureyoukeepa tallyof theprimarydiagnosis foreachcase and actively seek to obtain the specified number ofcasesforeachsection.(nomorethan25studiesshouldbecompletelynormal).

• Start collecting your 5 video cases of the requireddiagnoses: [1]anormalstudy,[2]moderateorsevereAS,[3]moderateorsevereARorMR,[4]regionalwallmotionabnormality, [5] another pathology (prosthetic valve,mass/thrombus,simplecongenital,significantLVH)

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StartofST5 Intensify efforts to complete logbook.Donot leave it till the

lastminute–youonlyhave3-4monthsleft.

Be very mindful of booking a date to attend the practicalassessment (held4timesayear)at theendof the24monthcasecollectionperiod.

FulldetailsofthepracticalassessmentareavailableintheBSE

TTE accreditation pack (effective March 2015). Essentiallythereare3stations1. Review of Logbook – ensure the logbook is fully

anonymisedandsubmittedin1ringbinder/filefolderwiththedifferentcategoriesseparatedbydividers

2. Acquisition of a number of echo views on a normalvolunteer

3. Vivaassessingvideocases

EndofST5 Hopefully you would have achieved BSE accreditation in

transthoracicechocardiography!BSEAppEchoCalc is the official App of the British Society ofEchocardiography (BSE) made freely available todownload. It contains all of the BSE normal referencevalues for transthoracic echocardiography and otherwidely used reference values, including those forprostheticaorticandmitralvalves.

Currently free to download, it is available foriPhone/iPod Touch/iPad users, Andriod users andBlackberryPlaybookusers.

PleasevisittheBSEwebsiteforfurtherinformation

www.bsecho.org/bse-app/

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Furthertips,tricksandpointersforachievingBSETTEaccreditation

Preparationandlearningechocardiography

AchievingBSEaccreditationintransthoracicechocardiographybytheendofcoretraining(ST5)ispossiblebutrequiresalotoforganisationandeffortovera2.5yearperiod.Startpreparing early as suggested by the timeline above and refer to the BSE website andInformationPackonAccreditationinAdultEchocardiography

Maximise your opportunity to perform, interpret and report echocardiograms byperforming bedside echo’s out of hours/on call, review images withsonographers/consultants, consider attending/participating in echo waiting lists clinicsandattenddepartmental,regionalornationalechomeetings.

PreparingfortheBSEwrittenexam

Considerattendingabasicechocourseabout6-12months intoyourtrainingandaBSEexam preparation course prior to the written exam. In addition to consolidating yourknowledgeyouwill seeand learnaboutmoreunusualpathology,whichyoumightnotencounterinyourhospital.

Collectingcasesforyourlogbook

SeekoutsonographersinthedepartmentwhohaveBSEaccreditation.Thereismuchtolearnfromthemabouttheaccreditationprocessandtheycanhelpyouwithidentifyingsuitablecasesforyourlogbook.Keepacopyofallinitialreports(yourfirst100casescanbedoublereported)Startlookingforpatientswithgoodechowindowsandappropriateimagesearlyforyourvideocases.Allow1hourtoscanthesepatientstakingallnecessaryviewsanddata(donotforgettheuseofthestandaloneCWDopplerprobeforsevereAS).Youmightwishtocheck these viewswith a BSE accredited sonographer and bring the patient back for asecondscanifrequired.

Submissionandpracticalassessment

Findanefficientwaytoanonymiseyour250echoreports.Oneoptionistoexportreportsfrom TOMCAT to MS Word and remove the patient’s details electronically. A secondoption is to photocopy each reportwith the patients’ details covered by a ‘cut out’. Athirdoptionisto‘blackout’detailswithamarker(ensuredetailsaredefinitelynolongervisible). Inadditiontoechofindings,eachreportmusthavean indication,aconclusion,yourfullnameandsignature.Present the 5 video cases as digital loops and stills within a PowerPoint presentation.Although there are PCs available at the assessment centre it is strongly recommendedthatyoubringyourownlaptoptothecentrehavingcheckedthatyourcasesplayonthis.Reviewyour logbook,videocasesandtheirrespectivereportsa fewweekspriortothepracticalassessment (to facilitate lastminute improvements)and refreshyourmemoryagain just prior to the day. Try to arrange a mock practical assessment with a seniorechocardiographer(ideallyonewhoknowtheassessmentprocess)beforehand.

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APPENDIXEtoCardiologyTrainees’Toolkit-August2016CMRTRAINING–REQUIREMENTSANDRESOURCESIfyouneedfurther informationoryouarestrugglingtoget localtraining,pleasecontactyourDeaneryBJCAreportheBSCMRReps:A.Kidambi@nhs.net;Thomas.Treibel@gmail.comCoreTraining(ST3-5)Requirement: JRCPTB sets as a guidelineaonemonth full-timeattachment (orequivalentpart time) inCMR tocomplete core training.Whereverpossible, you should: supervise10stress tests, including each form of stress; observe the acquisition of 50 CMR scans, 5 ofwhich must be vascular; observe processing and supervised reporting of 50 studies in avarietyofconditions.Ifitisnotpossibletoperformafullattachment,thena‘Level1’orcorecompetencycoursecanbeusedtoprovideevidenceoftheabove.Youmayberequiredtoprovidesome‘hands-on’or‘livescanning’experience;therearelivescanningsessionsatBCSifthisisdifficulttoachievelocally.AdvancedImagingTrainingRequirement: 5x CbD/Mini-CEX; 2x ACATs are required each year across all subspecialitymodules.Theminimumrequirement forAdvancedCMR is tohave6xDOPSonacquisitionandreportingby2xdifferentassessors,acrosstherangeofconditions.GainingLevel2or3accreditation fromSCMRorEuroCMRwillenhanceyourePortfoliobut isnotamandatoryrequirement.CMRPocketGuides:GeneralCMR:https://www.escardio.org/static_file/Escardio/Subspecialty/EACVI/CMR-guide-2013.pdfCMRPhysics:https://www.escardio.org/static_file/Escardio/Subspecialty/EACVI/CMR%20Physics%20Pocket%20Guide%20iBook%20v1.0.pdfCongenitalCMR:https://www.escardio.org/static_file/Escardio/Subspecialty/EACVI/CMR-guide-CHD-2014.pdfCMRiPhoneApp:https://itunes.apple.com/gb/app/cmr-pocket-guide/id1050199934?mt=8IncludesacalculatorforcommonCMRcalculations.

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WebResources:http://www.bscmr.org/LinkstoUKandregionalactivities.https://www.escardio.org/The-ESC/Communities/European-Association-of-Cardiovascular-Imaging-EACVI/About/CMR-SectionEuroCMRConferencewebcasts,CMRaccreditationandmore.www.scmr.orgInternational Society – huge amount of resources including conference webcasts, case ofweekandguidelines.http://jcmr-online.biomedcentral.com/ThelatestCMRresearch(alsolookatImagingsub-journalsofEHJ,CirculationandJACC).SCMRLevel-1coursehttp://education.scmr.org/Freeonlinecourse(certificatecanonlybeobtainedifsigninginviatheBCSwebsite).Courses:PleaselookatBSCMRwebsiteforup-to-datecourselisting.Thereareanumberofnationalcourses, both for core and subspeciality training. The BCS conference each year provideshands-on scanning experience, and, in conjunction with the BSCMR course, covers themajorityofcorecompetenciesrequired.Conferences:BSCMR: A 1-day UK conference in March-April each year. Includes a core-competencycoursethedaybeforetheconference.EuroCMR: Takes place in May each year. The EuroCMR exam (typically held after theconference)isapartofEuroCMR/ESCLevel2andLevel3certification.SCMR:January-Februaryeachyear,thoughcombinedSCMR/EuroCMRmeetingsareheldinEuropeonceevery4years.RecommendedBooks:CardiovascularMagneticResonance(OxfordSpecialistHandbooksinCardiology)25Apr2013bySaulG.MyersonandJaneFrancisCardiovascularMRManual.17Oct2015bySvenPlein,JohnGreenwoodandJohnRidgway.DetailedexplanationsofCMRPhysics,aswellasclinicalapplications.