cardiovascular fellowshandbook (pdf) - university of kansas

The University of Kansas Medical Center

Division of Cardiovascular Diseases

Fellowship Handbook

2013-2014


Cardiovascular Fellowship Program Curriculum

FY2014

Table of Contents I. Introduction ............................................................................................................................................................. 3

II. Education and Training ......................................................................................................................................... 3

A. Educational Plan .............................................................................................................................. 3

B. Performance Expectations ............................................................................................................... 3

C. KU Rotations Goals and Objectives ................................................................................................. 3

1. Coronary Care Unit (CCU) ....................................................................................................... 4

2. Consultative Rotation (KU Cons) ............................................................................................. 13

3. Invasive Cardiology (Cath) ....................................................................................................... 21

4. Electrophysiology (EP) ............................................................................................................. 30

5. Echo (Echo) .............................................................................................................................. 39

6. Nuclear (Nuc) ........................................................................................................................... 50 7. CT Angiography (CTA)/Magnetic Resonance (CT/MRI) .......................................................... 56

8. Peripheral Vascular Ultrasound Rotation (PVUS) ..................................................................... 59

9. Cardiothoracic Surgery (CTS) .................................................................................................. 63

10. Pediatric Cardiology (Peds) ...................................................................................................... 66

11. Cardiovascular Research (Res) ................................................................................................. 70

D. VA Rotations ................................................................................................................................... 74

1. Expectations ............................................................................................................................. 74

2. CCU/ Consult Rotation (VA CCU) ........................................................................................... 76

3. Non-Invasive Cardiology Rotation (VANI) ............................................................................... 84

4. Invasive Cardiology Rotation (VA Cath) .................................................................................. 95

5. Consult Rotation (VA Cons) ..................................................................................................... 105 E. Clinic .............................................................................................................................................. 115

F. Conferences ..................................................................................................................................... 122

G. Scholarly Activity ........................................................................................................................... 122

H. Electives .......................................................................................................................................... 122

I. Deficiency and Remediation ............................................................................................................ 122

J. Evaluations ...................................................................................................................................... 124

K. Grievance ........................................................................................................................................ 126

L. Professionalism ............................................................................................................................... 126

M. Impairment ...................................................................................................................................... 127

III. Department Rules/Understandings ...................................................................................................................... 128

A. Duty Hours ....................................................................................................................................... 129

B. Eligibility and Selection .................................................................................................................. 130 C. Supervision ..................................................................................................................................... 132

D. Work Environment .......................................................................................................................... 133

E. Moonlighting ................................................................................................................................... 136

IV. Benefits ..................................................................................................................................................................... 136

A. Vacation Days ................................................................................................................................. 137

B. Sick Days ........................................................................................................................................ 137

C. Professional Days ............................................................................................................................ 137

D. Maternity Leave .............................................................................................................................. 137

E. Paternity Leave/Adoption ................................................................................................................ 138

F. Pay .................................................................................................................................................. 138

G. Medical Insurance ........................................................................................................................... 138 H. Life Insurance ................................................................................................................................. 138

I. Malpractice Insurance ...................................................................................................................... 138

J. Disability Insurance ......................................................................................................................... 139

K. Parking ............................................................................................................................................ 139

L. White Coats ..................................................................................................................................... 139

M. Access to Medical Literature and Board Prep Materials ................................................................... 139

N. Fitness Center .................................................................................................................................. 139

O. Meetings ......................................................................................................................................... 140

P. Meal Cards ...................................................................................................................................... 140

Q. Resident Assistance and Access to Counseling ................................................................................ 140



FY2014

I. INTRODUCTION

The Division of Cardiovascular Diseases will educate qualified physicians with a structured scholarly

experience in clinical and experimental cardiology in an environment that is one of the top

cardiovascular programs nationally.

The faculty in the Division of Cardiovascular Diseases will train fellows in every aspect of academic

cardiovascular medicine as defined by the six core competencies. The training includes curriculum

in patient care, teaching, and the use of noninvasive and invasive techniques in cardiovascular

diagnosis and management. The fellowship consists of three years of training, at the end of which

the fellow will have met or exceeded the requirements for the qualifying board examination in

cardiovascular medicine.

II. EDUCATION AND TRAINING

A. EDUCATIONAL PLAN

The Division has established a written curriculum (rotational goals and objectives) for all aspects of its fellowship education and training which is distributed electronically to fellows and faculty on a

monthly basis by way of the e-value system; in addition, the curriculum is available to the fellows and faculty for review on our website. The curriculum contains sites of training, diagnostic and therapeutic

procedures, and a listing of the scheduled divisional conferences that a fellow should avail themselves. Most importantly, the curriculum contains a list of objectives for each level of training. These learning

objectives are meant to be the minimum achieved while on each service.

As noted, all fellows are expected to become familiar with the American Board of Internal Medicine

(ABIM) requirements for Cardiovascular Diseases, as well as those areas required by the Fellowship

Review Committee (RRC). Individual fellows will be given every opportunity to choose electives

and opportunities to become proficient in procedures and skills that may be important or required for

their particular career pathway.

B. PERFORMANCE EXPECTATIONS The Division of Cardiovascular Diseases utilizes performance criteria for the advancement/promotion

of its fellows. The Division has adapted the American Board of Internal Medicine’s educational milestones to create overall educational goals and objectives for fellows at each level of training. These milestones serve as the basis for performance expectations and evaluation of fellows, and are

available for review by fellows and faculty online at any time. They are also distributed at the start of each academic year. The final decision of whether to promote or graduate a fellow is determined by

the Fellowship Program Director, taking into consideration input received from the Associate Program Director as well as the faculty.

C. KU ROTATION GOALS AND OBJECTIVES

At the University of Kansas Medical Center there are 11 rotations which include: Coronary Care Unit, Consultative, Invasive Cardiology, Electrophysiology, Echocardiography, Nuclear, CT Angiography/

Magnetic Resonance, Peripheral Ultrasound, Cardiothoracic Surgery, Pediatric Cardiology, and Cardiovascular Research. Each of the rotations has goals and objectives at each PGY level. Fellows

may have up to four of a single rotation in an academic year, unless authorized by the program director.



FY2014


Coronary Care Unit Rotation (CCU)

The educational purpose of this rotation is to train and acquire expertise in the evaluation and

treatment of patients with all types of adult cardiovascular diseases including: acute coronary

syndromes, arrhythmias, hypertension, cardiomyopathy, valvular heart disease, pericardial disease,

pulmonary hypertension, peripheral vascular disease, adult congenital heart disease, and

cerebrovascular disease.

This rotation is also a training venue for fellows in the evaluation of patients with heart disease

during pregnancy, multiorgan failure, and trauma. Approximately half of the patients have acute

coronary syndromes. The fellow is involved in the initial evaluation, management, and subsequent

treatment of patients. This includes evaluation and management of risk factors, in particular,

dyslipidemia, smoking, and obesity.

During this rotation the fellow is under the supervision of an attending responsible for the

cardiology inpatient service. The fellow helps teach medical students, interns and residents.

The educational experience consists of initial evaluation of patients by the fellow, along with the

resident and the attending physician. The attending and fellow review pertinent features of the

history, physical examination, and establish diagnostic and therapeutic plans for the patient. All

cases are discussed on a daily basis during rounds with the attending.

In addition, the fellow attends a daily cardiology conference at 7:00 am where admissions on the

service are discussed and reviewed in the presence of faculty. It is of note that during this rotation

the fellows care for patients at all stages of illness, following them from their initial acute stage to a

more stable stage.

Duration : PGY 4 fellows spend approximately 2 months on this rotation.

PGY5 fellows spend approximately 1-2 month on this rotation.

PGY6 elective 1 month rotation

Supervision (Interaction

with faculty):

During this rotation the fellows are under the supervision of an attending responsible for the cardiology inpatient service

Rotation Facility: The University of Kansas Medical Center Coronary Care Unit

Required

Didactics/conferences:

7:00 am on Monday, Tuesday, Thursday and Friday at the University of Kansas Medical Center 7:00 am Research Conference Wednesday once a month.

12:00pm NonInvasive Imaging Thursday twice a month.

Legend for Learning Activities for Fellows

AR Attending Rounds IMGR Internal Medicine Grand Rounds



FY2014

CCON Morning Cardiology Conference - These may have sub-types: (EP) Electrophysiology, (CAC) Cardiac Catheterization and Cardiothoracic Surgery Conference, (EKG) EKG Conference, (CORE) Core Curriculum, (RSCH) Research Conference, (JC) Journal Club, (MM) Morbidity and Mortality Conference

IMMM Internal Medicine Patient Safety Conference

CPC Internal Medicine Clinicopathogenic Conference

IMNC Internal Medicine Noon Conference

DPC Direct Patient Care KOF Cardiology Outpatient Service

DSP Directly Supervised Procedure NCC Nursing Care Coordinator

FS Faculty Supervision NIC Non-Invasive Imaging Conference

Legend for Evaluation Methods for Fellows

AE Attending Evaluation PL Procedure Logs

DSP Directly Supervised Procedures SE End of Rotation Self Evaluation

EVAL Educational Committee Review (every 6 months)

The principal educational goals and objectives for fellows on this rotation are indicated in the tables

below in the first column. The second column of the table lists the most relevant learning activities

for that goal, and the third column indicates the correlating evaluation methods for that goal.

Specific issues that will be discussed by the attending during the CCU rotation include and are not

limited to those listed below.

PGY 4 Coronary Care Unit Rotation

CORE COMPETENCY: PATIENT CARE

Goal: Demonstrate understanding and ability to apply appropriate evaluation diagnosis and patient care plan to patients with chest pain and acute coronary syndromes.

Objectives: Learning

Activities

Evaluation

Methods

Pharmacology of cardiovascular drugs CCON

(CORE), AR

AE

Cardiac emergencies, evaluation and treatment DPC, CCON

(CORE), AR

AE

Dilated cardiomyopathy CCON

(CORE),

(CAC), DPC,

NIC, IMNC

AE



FY2014

Risk stratification after myocardial infarction CCON,

(CORE),

(CAC), DPC,

IMNC

AE

Evaluation of valvular heart disease and of indications for surgical treatment

CCON,

(CORE),

IMNC, (CAC),

DPC, NIC

AE

Initial evaluation and treatment of acute coronary syndromes including ST segment and non-ST segment elevation myocardial infarction

CCON

(CORE), DPC,

AR, (CAC),

IMNC

AE

Use of thrombolytics for the treatment of acute coronary syndromes

CCON

(CORE), AR,

(CAC) IMGR,

IMNC

AE

Diagnosis, management and prevention of stroke in patients with atrial fibrillation

CCON

(CORE), AR,

IMNC, (EP)

AE

Medical therapy of systolic and diastolic congestive heart failure

DPC, AR,

IMNC, CCON

(CORE)

AE

CORE COMPETENCY: MEDICAL KNOWLEDGE

Goal: Demonstrate understanding and management of acute coronary syndromes.


Activities

Evaluation

Methods

Understand mechanism of action and indication for anticoagulation and antiplatelet agents.

CCON, AR AE

Understand physiologic and pathophysiology of invasive hemodynamic monitoring.

CCON, (CAC),

AR, DPC

AE

Understand indications and principles for ECG, echocardiography, nuclear imaging, stress testing, and right and left heart catheterization.

CCON, (CAC),

NIC, DPC

AE

CORE COMPETENCY: INTERPERSONAL AND COMMUNICATION SKILLS

Goal: Demonstrate interpersonal and communication skills in medical practice that develop and maintain effective information exchange and collaboration with cardiology patients and family members as well as other professional associates.



FY2014


Activities

Evaluation

Methods

Communicate effectively with patients and families in a critical care setting

DPC, AR, NCC AE

Communicate effectively with other physicians and other members of the health care team.

DPC, AR AE, SE

Communicate effectively with colleagues when signing out service.

DPC, AR AE, EVAL

CORE COMPETENCY: PROFESSIONALISM

Goal: Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse cardiology patient population.


Activities

Evaluation

Methods

Interact in a professional manner with patients, families and members of the health care team.

DPC, AR AE, EVAL

Appreciate the social and psychological context of cardiac disease.

DPC, AR AE, EVAL

CORE COMPETENCY: PRACTICE BASED LEARNING AND IMPROVEMENT

Goal: Learn to investigate and evaluate personal patient care practices, appraise and assimilate scientific evidence related to Cardiology, and improve personal patient care practices.


Activities

Evaluation

Methods

Identify and acknowledge gaps in personal knowledge and skills in care of cardiac patients.

DPC, IMNC,

CCON, (MM)

AE

Begin to pursue professional scholarship integrating basic science with clinical medicine with principles of evidence based medicine.

DPC, CCON,

(JC)

AE

CORE COMPETENCY: SYSTEM BASED PRACTICE

Goal: Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care in that is of optimal value to their cardiology patients.

Objective: Learning

Activities

Evaluation

Methods

Understand and utilize multidisciplinary resources to care for acutely ill cardiac patients.

DPC, CCON AE

PGY 5 KU Coronary Care Unit Rotation


Goal: Demonstrate understanding and ability to apply and manage appropriate evaluation diagnosis and patient care plan to patients with chest pain and acute coronary syndromes.



FY2014


Activities

Evaluation

Methods

Use of interventional approaches for the treatment of acute coronary syndromes

CCON (CORE), IMGR, DPC, (CAC), IMNC

AE

Pathogenesis and treatment of supraventricular and ventricular arrhythmias

CCON (EP), IMNC

AE

Pathogenesis of congestive heart failure AR, CCON (CORE), IMNC

AE

Pathogenesis of atherosclerosis CCON, AR, IMNC

AE

Diseases of the aorta (CAC), IMNC, CCON, AR

AE

Peripheral vascular disease including carotid, renal, and peripheral arteries

NIC, (CAC), IMNC

AE

Hyperlipidemia and other risk factors for atherosclerosis IMGR, DPC, CCON (CORE), IMNC

AE

Pulmonary hypertension and pulmonary embolism CCON (CORE), (CAC), DPC, IMNC

AE

Endocarditis CCON (CORE), (CAC), DPC

AE

Evaluation of patients with hypertrophic and restrictive cardiomyopathy

CCON, NIC AE

Evaluation of patients with pericardial disease CCON, (CAC), DPC, NIC

AE

Evaluation of the cardiac risk for non-cardiac surgery FS, CCON (CORE), DPC, IMNC

AE

Criteria for implantation of pacemakers CCON (EP), AR

AE

Overview and evaluation of pacemakers and cardioverter defibrillators

CCON (EP), AR

AE

Mechanisms of sudden death CCON (EP), AR

AE


Goal: Demonstrate skills to apply understanding and management of patients with acute coronary syndromes.



FY2014

Objective: Learning

Activities

Evaluation

Methods

Understand principles of primary and secondary risk factor modification.

CCON, AR,

IMNC, IMGR,

DPC

AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL



Objective: Learning

Activities

Evaluation

Methods


DPC, AR AE, Eval


Goal: Learn to investigate and evaluate personal patient care practices, appraise and assimilate

scientific evidence related to Cardiology, and improve personal patient care practices.

Objective: Learning

Activities

Evaluation

Methods


DPC, IMNC,

CCON, (MM)

AE

CORE COMPETENCY: SYSTEMS BASED PRACTICE


Objective: Learning

Activities

Evaluation

Methods

Understand cost effectiveness of diagnostic and therapeutic strategies.

DPC, CCON AE



FY2014

PGY 6 KU Coronary Care Unit Rotation


Goal: Demonstrate understanding and ability to apply, manage and teach appropriate evaluation

diagnosis and patient care plan to patients with chest pain and acute coronary syndromes.


Activities

Evaluation

Methods

Adult congenital heart disease CCON, NIC, IMGR, AR

AE, DSP

Heart disease in the elderly patient and in women CCON (CORE), AR

AE

Neoplastic heart disease CCON (CORE), NIC, AR

AE

Cardiovascular reflex and humoral control of the circulation

CCON (CORE), AR

AE

Pathogenesis of endothelial dysfunction CCON (CORE), AR

AE

Evaluation of patients with cardiovascular disease during pregnancy

CCON, AR, IMGR

AE

Rheumatological heart disease including collagen vascular disease and the heart, rheumatic fever, and miscellaneous causes of heart disease including restrictive disease of the heart such as amyloidosis and hemochromatosis and infectious diseases of the heart such as HIV, Lyme carditis, and endocarditis

CCON, NIC, IMNC

AE


Goal: Demonstrate skills to apply and teach principals and care management of patients with acute coronary syndromes.


Activities

Evaluation

Methods


CCON, AR AE


CCON, (CAC), AR, DPC

AE


CCON, (CAC), NIC, DPC

AE


CCON, AR, IMNC, IMGR, DPC

AE



FY2014



Objectives Learning

Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL


Goal: Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse cardiology patient population

Objectives Learning

Activities

Evaluation

Methods


DPC, AR AE, EVAL


DPC, AR AE, EVAL



Objective: Learning

Activities

Evaluation

Methods

Pursue professional scholarship integrating basic science with clinical medicine with principles of evidence based medicine.

DPC, CCON, (JC)

AE


Goal: Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care in that is of optimal value to their cardiology patients


Activities

Evaluation

Methods


DPC, CCON AE


DPC, CCON AE



FY2014

Suggested Reading:

1. Zipes DP, Libby P, Bonow RO, Braunwald E, editors. Braunwald’s Heart Disease. A

Textbook of Cardiovascular Medicine, Single Volumn. 9th edition. Philadelphia, PA:

WB Saunders Company; 2011

2. Murphy JG, Lloyd MA (eds): Mayo Clinic Cardiology-Concise Textbook. 3rd

edition

Rochester, MN, Mayo Clinic Scientific Press, 2006



FY2014


Consultative Rotation (KU Cons)

The educational purpose of this rotation is to acquire expertise in consultative management of a wide

variety of clinical disorders in cardiology in a tertiary care medical center. This includes patients

with cardiology problems on the medical services as well as pre-operative evaluation and post-

operative management of patients undergoing non cardiac surgery. They will see patients on other

services such as neurology, psychiatry and obstetrics/gynecology.

The fellow will function under the supervision of the assigned staff cardiologist while supervising

medical residents and medical students assigned to this rotation. The assigned staff cardiologist will

make daily rounds with team members. The fellow will develop skills in providing patient

management as a consultant and enhance their communication skills with non- cardiology

physicians and medical professionals. The staff cardiologist reviews cardiac testing results on

cardiology consult patients with all team members on daily rounds.

He/she must write notes on critically ill patients or those with recent worsening in condition

when the residents on the primary team are unavailable. He/she responds to all consults and

writes notes on all new consults that are not seen by the cardiology consult resident.

Duration : PGY4 fellows spend approximately 1 month on this rotation.

PGY5 fellows spend approximately 1-2 months on this

rotation.

PGY6 fellows spend approximately 1 month on this rotation.


with faculty):

During this rotation the fellows are under the supervision of an attending responsible for the cardiology inpatient service.

Rotation Facility: The University of Kansas Medical Center

Required


7:00 am on Monday, Tuesday, Thursday and Friday at the University of Kansas Medical Center 7:00 am Research Conference Wednesday once a month.

12:00pm Non-Invasive Imaging Conference, Thursday twice

a month





FY2014

CCON Morning Cardiology Conference - These may have sub-types: (EP) Electrophysiology, (CAC) Cardiac Catheterization and Cardiothoracic Surgery Conference, (EKG) EKG Conference, (CORE) Core Curriculum, (RSCH) Research Conference, (JC) Journal Club, (MM) Morbidity and Mortality Conference
















PGY 4 KU Consult Rotation


Goal: Demonstrate ability to understand and evaluate patients with cardiovascular disorders.


Activities

Evaluation

Methods

Understand the pharmacology of cardiovascular drugs CCON (CORE), AR

AE

Ability to respond to cardiac emergencies, evaluation and treatment

DPC, CCON (CORE), AR

AE


CCON, (CORE), IMNC, (CAC), DPC, NIC

AE

Complete preoperative evaluations of patients with cardiovascular disorders.

CCON (CORE), DPC, AR, (CAC), IMNC

AE



FY2014

Ability to complete diagnosis, management and prevention of stroke in patients with atrial fibrillation

CCON (CORE), AR, IMNC, (EP)

AE

Carry out medical therapy of systolic and diastolic congestive heart failure

DPC, AR, IMNC, CCON (CORE)

AE


Goal: Demonstrate ability to understand and carry out the approach to cardiac patient consult or clinic visit.


Activities

Evaluation

Methods


CCON, AR AE



AE



AE


Goal: Demonstrate interpersonal and communication skills in medical practice that develop and maintain effective information exchange and collaboration with cardiology patients and family members as well as other professional associates


Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, EVAL


DPC, AR AE, EVAL



FY2014

CORE COMPETENCY: PRACTISE BASED LEARNING AND IMPROVEMENT



Activities

Evaluation

Methods

Begin to understand and identify gaps in personal knowledge and skills in care of cardiac patients.

DPC, IMNC, CCON, (MM)

AE

CORE COMPETENCY: SYSTEM BASED PRACTISE



Activities

Evaluation

Methods

Understand and utilize multidisciplinary resources to care

for acutely ill cardiac patients.

DPC, CCON AE



Goal: Demonstrate ability to understand, evaluate and manage patients with cardiovascular disorders.


Activities

Evaluation

Methods


CCON (EP), IMNC

AE


AE


AE


AE


NIC, (CAC), IMNC

AE


AE


AE


CCON, NIC AE



FY2014


AE


AE


AE


CCON (EP), AR

AE


AE


Goal: Demonstrate ability to understand, carry out and manage the approach to cardiac patient consult or clinic visit.


Activities

Evaluation

Methods



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, EVAL





FY2014


Activities

Evaluation

Methods



AE




Activities

Evaluation

Methods


DPC, CCON AE



Goal: Demonstrate skills and ability to manage clinic, conduct clinical evaluation and basic treatment of patients with cardiovascular disorders and teach junior residents.


Activities

Evaluation

Methods


AE, DSP


AE


AE


CCON (CORE), AR

AE


AE


CCON, AR, IMGR

AE

Rheumatological heart disease including collagen vascular disease and the heart, rheumatic fever, and miscellaneous causes of heart disease including restrictive disease of the heart such as amyloidosis and hemachromatosis and infectious diseases of the heart such as HIV, Lyme carditis, and endocarditis

CCON, NIC, IMNC

AE


Goal: Demonstrate knowledge and skills and ability to teach and manage the approach to cardiac patient consult or clinic visit.


Activities

Evaluation

Methods



FY2014


CCON, AR AE



AE



AE



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, EVAL


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, CCON, (JC)

AE



FY2014




Activities

Evaluation

Methods


DPC, CCON AE


DPC, CCON AE

Suggested Reading:

1. Eugene Braunwald, ed., Heart Disease. A Textbook of Cardiovascular Medicine, eighth

edition, Philadelphia: W.B. Saunders Company, 2007.

2. Murphy JG, Lloyd MA (eds): Mayo Clinic Cardiology-Concise Textbook. 3rd edition


3. Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities:

Bethesda Conference 36 (Revision if BC 16 &26), April 19, 2005, J Am Coll Cardiol

2005;45:1318-73

4. Atrial Fibrillation: Performance Measures for Management of Patients with Nonvalvular

Atrial Fibrillation or Atrial Flutter, January 01, 2008, J Am Coll Cardiol 2008;51:865- 906

5. Atrial Fibrillation, Key Data Elements and Definitions for Measuring the Clinical

Management and Outcomes of Patients With, January 01, 2004, J Am Coll Cardiol.

2004;44:475-95

6. Guide to Warfarin Therapy, January 1, 2003, J Am Coll of Cardiol 2003;41:1633-52

7. Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Guidelines on,

November 02, 2009, J Am Coll Cardiol 2009;54:e13-118

8. Coronary Artery Bypass Graft Surgery: Guideline Update for, January 01, 2004, J Am Coll

Cardiol 2004;44:e213-e310

9. Peripheral Artery Disease: Adults With, November 29, 2010, J Am Coll Cardiol.

2010;56:2147-81

10. Thoracic Aortic Disease: Guidelines for the Diagnosis and Management of Patients With,

January 01, 2010, J Am Coll Cardiol;55:e27-130

11. Vascular Imaging with Computed Tomography and Magnetic Resonance, August 31,2007, J

Am Coll Cardiol 2007;50:1097-114

12. Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic):

Guidelines for the Management of Patients with, January 01, 2005, J Am Coll Cardiol

2006;47:1239-312


November 02, 2009;54:e13-118



FY2014


Invasive Cardiology Rotation (Cath)

During this rotation, the fellow gains expertise in understanding, interpreting, and performing

invasive cardiac catheterization procedures, including left heart catheterization with coronary

arteriography, right heart catheterization, left ventriculography, transvenous and transcutaneous

pacing, and pericardiocentesis.

The fellow trains in all aspects of invasive hemodynamic studies, including: measurement of cardiac

output by thermodilution and the Fick method; me asurement of intrapulmonary and intracardiac

pressures; evaluation of systemic and pulmonary vascular resistance; measurement of intracardiac

shunts; evaluation of stenotic and regurgitant valvular lesions including aortic stenosis and

regurgitation; and mitral stenosis and regurgitation. Also, the fellow learns about constrictive and

restrictive physiology.

The indications and complications of diagnostic coronary angiography and ventriculography are

reviewed in detail during this rotation and the morning cardiology conference.

During this rotation the fellow works daily in the catheterization laboratory performing cardiac

catheterization directly under the supervision of an attending. The fellow attends the morning

cardiology conference on a daily basis. He/she functions as an integral part of the interventional

cardiology service.

The fellow is often involved in the invasive and interventional treatment of patients with acute

coronary syndromes including emergency angioplasty. There are in-depth discussions on the

pathogenesis of coronary artery disease and altered coronary physiology. Thus, the fellows

obtain a detailed review in coronary artery anatomy and physiology as well as cardiovascular

metabolism. These subjects are also discussed during the daily morning lecture at 7:00 am. At the

end of the rotation an evaluation is performed by the attending and discussed with the

program director.

Duration : PGY 4 fellows spend approximately 1 month on this rotation

PGY5 fellows spend approximately 1-3 months on this rotation

PGY6 (Elective rotation) fellows spend necessary amount of

time to meet ACGME graduate requirements on this rotation


with faculty):

During this rotation the fellow works daily in the catheterization laboratory directly with a staff attending performing procedures


Required


7:00 am on Monday, Tuesday, Thursday and Friday at the University of Kansas Medical Center

7:00 am Research Conference Wednesday once a month.

12:00pm Non Invasive Imaging Conference, Thursday twice a

month.



FY2014



CCON Morning Cardiology Conference -These may have sub-types: (EP)

Electrophysiology, (CAC) Cardiac Catheterization and Cardiothoracic Surgery Conference, (EKG) EKG Conference, (CORE) Core Curriculum, (RSCH) Research Conference, (JC) Journal Club, (MM) Morbidity and Mortality Conference









DSP Directly Supervised Procedures SE Self-Evaluation





Specific issues that will be discussed by the attendings during the invasive cardiology rotation

include and are not limited to those listed below.

PGY4 Invasive Cardiology Rotation


Goal: Demonstrate understanding and competency in approach to pre-operative, peri-operative and post-operative patient care.


Activities

Evaluation

Methods

Pre-procedural patient evaluation, post procedural follow- up protocols.

CAC, CCON, FS, DSP

AE, PL

Interpretation of hemodynamic data and determination of aortic stenosis and shunt flow.

CAC, CCON, FS, DSP

AE, PL

Gain experience and assessment of pericardial disease including pericardiocentesis as well as constrictive pericarditis.

CAC, CCON, FS, DSP, NIC

AE, PL

Experience in performance of percutaneous endomyocardial biopsies.

CAC, CCON, FS, DSP

AE, PL



FY2014

CORE COMPETENCY: UNDERSTANDS INDICATIONS AND TECHNIQUES

Goal: Demonstrate understanding and ability to interpret coronary angiography.


Activities

Evaluation

Methods

Performance of left and right heart catheterization. CAC, CCON, FS, DSP

AE, PL

Experience and expertise in the performance of coronary

angiography and left ventriculography.

CAC, CCON, FS, DSP

AE, PL

Experience and expertise in placement utilization and

indications for intra-aortic balloon counterpulsation

placement.

CAC, CCON, FS, DSP

AE, PL


Goal: Demonstrate proficient skills and ability to interpret/ perform invasive procedures to treat various cardiovascular illnesses.


Activities

Evaluation

Methods

Expand clinically applicable knowledge base of the basic

and clinical sciences underlying the care of patients with

chest pain and acute cardiac disease.

(CAC), DPC, FS

AE

Access and critically evaluate current medical information

and scientific evidence relevant to acute cardiac care.

(CAC), DPC, FS

AE

Understand indications for aggressive anticoagulant and

antiplatelet therapy as well as the mechanisms of action of

the various agents.

(CAC), DPC, FS

AE

Understand the physiologic and pathophysiologic principles

of invasive hemodynamic monitoring including indications.

(CAC), DPC, CCON, FS

AE

Develop and demonstrate in-depth knowledge of the

principles of diagnosis and management of ischemic heart

disease including unstable angina pectoris and myocardial

infarction; congestive heart failure; rheumatic heart disease,

and congenital heart disease.

(CAC), DPC, FS

AE


indications for, principles, complications, and interpretation

of right and left heart catheterization, coronary

angiography, ventriculography and percutaneous

interventions.

(CAC), DPC, FS

AE





FY2014


Activities

Evaluation

Methods

Communicate effectively with patients and families in a stressful critical care environment.

DPC, FS AE

Communicate effectively with physician colleagues and members of other health care professions to assure timely, comprehensive patient care.

DPC, FS AE

Communicate effectively with colleagues when discussing results of various cardiac catheterization and interventions and further management.

DPC, FS AE




Activities

Evaluation

Methods

Interact professionally toward patients, families, colleagues,

and all members of the health care team.

DPC AE

Appreciation of the social context of illness. DPC AE




Activities

Evaluation

Methods

Identify and acknowledge gaps in personal knowledge and

skills in care of acute cardiac patients.

DPC, (CAC) AE

Commitment to professional scholarship, including

systematic and critical perusal of relevant print and

electronic literature, with emphasis on integration of basic

science with clinical medicine, and evaluation of

information in light of the principles of evidence-based

medicine.

DPC, ( JC), (CAC)

AE




Activities

Evaluation

Methods

Understand and utilize the multidisciplinary resources

necessary to care optimally for acutely ill cardiac patients.

(CAC), DPC AE

Use evidence-based, cost-conscious strategies in the care of

patients with chest pain and other acute cardiac disease.

(CAC), DPC AE



FY2014

Consideration of the cost-effectiveness of diagnostic and

treatment strategies.

(CAC), DPC AE

PGY 5 Invasive Cardiology Rotation




Activities

Evaluation

Methods

Pre-procedural patient evaluation, post procedural follow-

up protocols.

CAC, CCON, FS, DSP

AE, PL


AE, PL



CAC, CCON, FS, DSP

AE, PL

Interpretation of hemodynamic data and determination of

aortic stenosis and shunt flow.

CAC, CCON, FS, DSP

AE, PL

Gain experience and assessment of pericardial disease

including pericardiocentesis as well as constrictive

pericarditis.


AE, PL

Experience in performance of percutaneous

endomyocardial biopsies.

CAC, CCON, FS, DSP

AE, PL



placement.

CAC, CCON, FS, DSP

AE, PL




Activities

Evaluation

Methods




(CAC), DPC, FS

AE



(CAC), DPC, FS

AE



the various agents.

(CAC), DPC, FS

AE




AE



FY2014






(CAC), DPC, FS

AE





interventions.

(CAC), DPC, FS

AE




Activities

Evaluation

Methods

Communicate effectively with patients and families in a

stressful critical care environment.

DPC, FS AE

Communicate effectively with physician colleagues and

members of other health care professions to assure timely,

comprehensive patient care.

DPC, FS AE

Communicate effectively with colleagues when discussing

results of various cardiac catheterization and interventions

and further management.

DPC, FS AE




Activities

Evaluation

Methods



DPC AE





Activities

Evaluation

Methods



DPC, (CAC) AE



FY2014





information in light of the principles of evidence- based

medicine

DPC, ( JC), (CAC)

AE




Activities

Evaluation

Methods



(CAC), DPC AE



(CAC), DPC AE



(CAC), DPC AE

PGY6 Invasive Cardiology Rotation




Activities

Evaluation

Methods

Pre-procedural patient evaluation, post procedural follow-

up protocols.

CAC, CCON, FS, DSP

AE, PL


AE, PL



CAC, CCON, FS, DSP

AE, PL

Interpretation of hemodynamic data and determination of

aortic stenosis and shunt flow.

CAC, CCON,

FS, DSP

AE, PL

Gain experience and assessment of pericardial disease

including pericardiocentesis as well as constrictive

pericarditis.


AE, PL

Experience in performance of percutaneous

endomyocardial biopsies.

CAC, CCON, FS, DSP

AE, PL



placement.

CAC, CCON, FS, DSP

AE, PL



FY2014




Activities

Evaluation

Methods




(CAC), DPC, FS

AE



(CAC), DPC, FS

AE



the various agents.

(CAC), DPC, FS

AE




AE






(CAC), DPC, FS

AE





interventions.

(CAC), DPC, FS

AE




Activities

Evaluation

Methods

Communicate effectively with patients and families in a

stressful critical care environment.

DPC, FS AE

Communicate effectively with physician colleagues and

members of other health care professions to assure timely,

comprehensive patient care.

DPC, FS AE

Communicate effectively with colleagues when discussing

results of various cardiac catheterization and interventions

and further management.

DPC, FS AE





FY2014


Activities

Evaluation

Methods



DPC AE





Activities

Evaluation

Methods



DPC, (CAC) AE





information in light of the principles of evidence-based

medicine.

DPC, ( JC), (CAC)

AE




Activities

Evaluation

Methods



(CAC), DPC AE



(CAC), DPC AE



(CAC), DPC AE

Suggested Reading

1. Baim DS, Grossman W: Grossman’s Cardiac Catheterization, Angioplasty, and Intervention.

Seventh Edition. Philadelphia, Lippincott Williams & Wilkins, 2006.

2. Topol EJ: Textbook of Interventional Cardiology. 5th Edition. Philadelphia, W.B. Saunders

Company, 12/2007.



FY2014


Cardiac Electrophysiology (EP)

During this rotation, the fellow acquires expertise and skill in evaluation of all types of cardiac

arrhythmias, including supraventricular and ventricular arrhythmias; invasive diagnostic

electrophysiological studies; and treatment of supraventricular and ventricular arrhythmias, including

pacemaker implantation and invasive therapeutic ablation techniques. He/she receives extensive

training in the selection and use of various antiarrhythmic drugs.

In order to provide a comprehensive training in cardiac rhythm disorders, the fellow and attending

review the basics of electrocardiography and cardiac cellular electrophysiology. Also, they review

indications for different electrophysiologic testing modalities, including tilt table testing; and

complications of electrophysiologic studies.

The fellow trains in the acute and chronic treatments of patients with supraventricular and ventricular

arrhythmias, including diagnosis and management of atrial fibrillation, atrial tachycardias, AV nodal

reentrant tachycardias, junctional tachycardias, and ventricular tachycardias. They review ventricular

tachycardias in detail, including those due to: arrhythmogenic right ventricular dysplasia, hypertrophic

cardiomyopathy, long QT syndrome, and proarrhythmias, as well as ventricular tachycardia in patients

with a structurally normal heart, and polymorphic ventricular tachycardia.

The fellow is instructed in the programming and follow-up surveillance of permanent pacemakers and

implantable cardioverter defibrillators. The fellow functions as an integral part of the

electrophysiology inpatient service. Second year fellows are expected to observe and be involved in 3

to 4 EP studies for VT assessment, an average of 2 device implantations per week, 1 atrial fibrillation,

1 atrial flutter ablation, 2 to 3 SVT ablations, device extractions, 2 to 3 tilt table tests, at least 10

pacemaker/ICD checks, outpatient clinic two days a week, and perform inpatient consults, which are

reviewed by the assigned electrophysiology attending.

Duration : PGY 4 elective (if fellow has special interest).


PGY 6 fellows spend approximately 1 month on this rotation


with faculty):

During this rotation the fellow works daily with a staff attending performing procedures.


Required





a month





FY2014

CCON Morning Cardiology Conference -- These may have sub-types: (EP) Electrophysiology, (CAC) Cardiac Catheterization and Cardiothoracic Surgery Conference, (EKG) EKG Conference, (CORE) Core Curriculum, (RSCH) Research Conference, (JC) Journal Club, (MM) Morbidity and Mortality Conference











The principal educational goals for fellows on the non-invasive rotation are indicated in the tables

below and numbered in the first column. The second column of the table lists the goal, the third

column lists the most relevant learning activities for that goal, and the fourth column indicates the

correlating evaluation methods for that goal. Specific issues that will be discussed by the attendings

during the non-invasive rotation include and are not limited to those listed below.

PGY 4 Clinical Electrophysiology Rotation


Goal: The fellow will recognize and effectively evaluate common electrophysiology problems including indications for further evaluation and treatment options.


Activities

Evaluation

Methods

Bradycardia and indications for pacing. CCON (EP), AR, DSP

AE, DSP

Pacemaker and ICD limitations on patients who have

devices.

CCON (EP), AR, DSP

AE, DSP

Evaluation of patient with sudden cardiac death (both

primary and secondary causes) including EP studies and T-

wave Alternans testing.

CCON (EP), AR, DSP

AE, DSP

Treatment of atrial fibrillation and atrial flutter.

Management with rate control, rhythm control, anti-

coagulation, and therapies such as pulmonary vein ablation

and pacing to prevent atrial fibrillation.

CCON (EP), AR, DSP

AE, DSP



FY2014

Evaluation of syncope including etiology, tilt table testing

as well as treatment. Assessment with holter monitors,

event recorders and reveal monitors.

CCON (EP), AR, DSP

AE, DSP

Evaluation of ventricular tachycardia in patients with

structurally normal heart and right ventricular dysplasia.

CCON (EP), AR, DSP

AE, DSP


Goal: The fellow will gain knowledge in the pathophysiology of cardiac arrhythmias.


Activities

Evaluation

Methods

Assessment of intracardiac electrograms and general

properties of AV node, SA node and His-Purkinje system.

CCON (EP), AR, DSP

AE, DSP

Supraventricular tachycardia mechanisms including reentry

and enhanced automatic triggered activity. Understanding

the difference between short RP versus long RP

tachycardias. Types of SVT’s including intracardiac versus

surface electrocardiograms. Appropriate management for

each arrhythmia will be reviewed. Types of SVT will be

differentiated by intracardiac electrograms vs. surface

electrocardiogram.

CCON (EP), AR, DSP

AE, DSP

Cardiac cellular electrophysiology action potentials, ion

channels and gap junctions.

CCON (EP), AR, DSP

AE, DSP

Arrhythmic diseases based on channelopathies such as

Brugada, long QT syndrome and Arrhythmogenic RV

Dysplesia.

CCON (EP), AR, DSP

AE, DSP

Antiarrhythmic medication indications and side effects. CCON (EP), AR, DSP

AE, DSP

Biventricular pacing. Indications and a review of the

literature. (Special considerations: narrow QRS, RBBB and

mitral regurgitation.)

CCON (EP), AR, DSP

AE, DSP


Goal: The fellow should be able to communicate treatment plans to other members of the healthcare team as well as to the patient and family.


Activities

Evaluation

Methods

Communicate effectively the consult findings with

physician, colleagues and other members of the health care

team in a timely fashion to assure a comprehensive patient

care.

DPC AE

Present professional findings to patient and family members

in a compassionate and informative manner.

DPC AE


Goal: The fellow should exhibit professionalism in all his/her interactions in the hospital.



FY2014


Activities

Evaluation

Methods

Interact professionally with patients, patients’ family,

colleagues, and other members of the health care team.

DPC, AR AE

Appreciation of the spiritual and social context of wellness

and illness.

DPC, AR AE


Goal: The fellow will utilize evidence based learning to help manage common cardiac arrhythmias.


Activities

Evaluation

Methods

Commitment to scholarship and the use of evidence based


CCON (JC), NIC

AE

Broad reading of the cardiovascular literature and access

and research of Medline and Internet tools.

CCON (JC), NIC

AE


Goal: The fellow will effectively collaborate with other members of the healthcare team and utilize multidisciplinary resources to optimally treat the patient.


Activities

Evaluation

Methods

Understand the complexities of cardiovascular disease

patients and utilize the multidisciplinary resources

necessary to care for them.

DPC, AR AE

Collaborate with other member of the health care team to

assure comprehensive cardiac care.

DPC, AR AE

Effective utilization of risk stratification using evidence-

based medicine.

DPC, AR AE

Consideration of cost effectiveness and outcome

measurements of tests and interventions associated with EP

study and device transplantation.

DPC, AR AE





Activities

Evaluation

Methods


AE, DSP


devices.

CCON (EP), AR, DSP

AE, DSP



FY2014

Evaluation of patient with sudden cardiac death both

primary and secondary including EP studies and T-wave

Alternans testing.

CCON (EP), AR, DSP

AE, DSP

Treatment of atrial fibrillation and atrial flutter.

Management with rate control, rhythm control, anti-

coagulation, new therapies such as pulmonary vein ablation

and pace and prevent atrial fibrillation.

CCON (EP), AR, DSP

AE, DSP

Evaluation of syncope including etiology tilt table testing as

well as treatment. Assessment with Holter monitors, event

recorders and reveal monitors.

CCON (EP), AR, DSP

AE, DSP


structurally normal heart and right ventricular dysplasia.

CCON (EP), AR, DSP

AE, DSP




Activities

Evaluation

Methods



CCON (EP), AR, DSP

AE, DSP

Supraventricular tachycardia mechanisms including reentry

and enhanced automatic triggered activity. Understanding

the difference between short RP versus long RP

tachycardias. Types of SVT’s including intracardiac versus

surface electrocardiograms. Appropriate management for

each arrhythmia will be reviewed. Types of SVT will be

differentiated by intracardiac electrograms vs. surface

electrocardiogram.

CCON (EP), AR, DSP

AE, DSP

Cardiac cellular electrophysiology action potentials, ion

channels and gap junctions.

CCON (EP), AR, DSP

AE, DSP

Arrhythmic diseases based on channelopathies such as

Brugada syndrome, long QT syndrome and arrhythmogenic

RV Dysplasia.

CCON (EP), AR, DSP

AE, DSP


AE, DSP

Biventricular pacing. Indications and a review of the

literature. (Special considerations: narrow QRS, RBBB and

mitral regurgitation.)

CCON (EP), AR, DSP

AE, DSP





FY2014


Activities

Evaluation

Methods

Communicate effectively the consult findings with

physician, colleagues and other members of the health care

team in a timely fashion to assure a comprehensive patient

care.

DPC AE

Present professional findings to patient and family members

in a compassionate and informative manner.

DPC AE




Activities

Evaluation

Methods

Interact professionally with patients, patients’ family,

colleagues, and other members of the health care team.

DPC, AR AE

Appreciation of the spiritual and social context of wellness

and illness.

DPC, AR AE


Goal: The fellow will utilize evidence based learning to help manage common cardiac arrhythmias.


Activities

Evaluation

Methods

Commitment to scholarship and the use of evidence based


CCON (JC), NIC

AE

Broad reading of the cardiovascular literature and access

and research of Medline and Internet tools.

CCON (JC), NIC

AE




Activities

Evaluation

Methods

Understand the complexities of cardiovascular disease

patients and utilize the multidisciplinary resources

necessary to care for them.

DPC, AR AE

Collaborate with other member of the health care team to

assure comprehensive cardiac care.

DPC, AR AE

Effective utilization of risk stratification using evidence-

based medicine.

DPC, AR AE

Consideration of cost effectiveness and outcome

measurements of tests and interventions associated with EP

study and device transplantation.

DPC, AR AE



FY2014





Activities

Evaluation

Methods


AE, DSP


devices.

CCON (EP), AR, DSP

AE, DSP

Evaluation of patient with sudden cardiac death both

primary and secondary including EP studies and T-wave

Alternans testing.

CCON (EP), AR, DSP

AE, DSP

Treatment of atrial fibrillation and atrial flutter management with rate control, rhythm control, anticoagulation, new therapies such as pulmonary vein ablation and pacing to prevent atrial fibrillation.

CCON (EP), AR, DSP

AE, DSP

Evaluation of syncope including etiology, tilt table testing

as well as treatment. Assessment with Holters, event

recorders and reveal monitors.

CCON (EP), AR, DSP

AE, DSP


structurally normal hearts and right ventricular dysplasia.

CCON (EP), AR, DSP

AE, DSP




Activities

Evaluation

Methods



CCON (EP), AR, DSP

AE, DSP

Supraventricular tachycardia mechanisms including reentry and enhanced automatic triggered activity. Understanding the difference between short RP versus long RP tachycardias. Types of SVT’s including intracardiac versus surface electrocardiograms. Appropriate management for each arrhythmia will be reviewed. Types of SVT will be differentiated by intracardiac electrograms vs. surface electrocardiogram.

CCON (EP), AR, DSP

AE, DSP

Cardiac cellular electrophysiology action potentials, ion channels and gap junctions.

CCON (EP), AR, DSP

AE, DSP

Arrhythmic diseases based on channelopathies such as Brugada, long QT syndrome and arrhythmogenic RV Dysplasia.

CCON (EP), AR, DSP

AE, DSP


AE, DSP



FY2014

Biventricular pacing. Indications and a review of the literature. (Special considerations: narrow QRS, RBBB and mitral regurgitation.)

CCON (EP), AR, DSP

AE, DSP




Activities

Evaluation

Methods

Communicate effectively the consult findings with physician, colleagues and other members of the health care team in a timely fashion to assure a comprehensive patient care.

DPC AE

Present professional findings to patient and family members in a compassionate and informative manner.

DPC AE




Activities

Evaluation

Methods

Interact professionally with patients, patients’ family, colleagues, and other members of the health care team.

DPC, AR AE

Appreciation of the spiritual and social context of wellness and illness.

DPC, AR AE


Goal: The fellow will utilize evidence based learning to help manage common cardiac arrhythmia


Activities

Evaluation

Methods

Commitment to scholarship and the use of evidence based cardiovascular medicine.

CCON (JC), NIC

AE

Broad reading of the cardiovascular literature and access and research of Medline and Internet tools.

CCON (JC), NIC

AE




Activities

Evaluation

Methods

Understand the complexities of cardiovascular disease patients and utilize the multidisciplinary resources necessary to care for them.

DPC, AR AE

Collaborate with other member of the health care team to assure comprehensive cardiac care.

DPC, AR AE



FY2014

Effective utilization of risk stratification using evidence- based medicine.

DPC, AR AE

Consideration of cost effectiveness and outcome measurements of tests and interventions associated with EP study and device transplantation.

DPC, AR AE

Suggested Reading 1. Zipes DP, Jalife J: Cardiac Electrophysiology – From Cell to Bedside. Philadelphia, W.B.

Saunders Company, 5th

Edition, c5/2010.

2. Murphy JG: Mayo Clinic Cardiology Review. Second Edition. Philadelphia, Lippincott

Williams & Wilkins, 2000, including the following chapters:

a) Chapter 34 – Electrocardiographic Diagnosis, pages 549-597

b) Chapter 35 – Cardiac Cellular Electrophysiology, pages 597-621

c) Indications for Electrophysiologic Testing, page 621-633

d) Atrial Fibrillation, page 633-647

e) Supraventricular Tachycardia, page 647-655

f) Ventricular Tachycardia, page 655-669

g) Pacemakers, page 669-685

h) Overview of Implantable Cardioverter Defibrillators, page 685-693

i) Sudden Cardiac Death, page 693-699

3. Fogoros RM: Electrophysiologic Testing. 4th

Edition. Edited by S Dudziak. Malden, MA,

Blackwell Publishing, 2006.

4. Josephson, ME: Clinical Cardiac Electrophysiology. 42nd

Edition. Edited by FR DeStefano, C

Potash. Philadelphia, PA, Lippincott Williams and Wilkins, 2008.



FY2014


Echocardiography Rotation (Echo)

The fellow functions as an integral member of the Echocardiography Laboratory, performing and

interpreting echocardiograms, and serving as a clinical resource for the technical and nursing staff.

The fellow arrives in the Lab at 8:00 AM on Monday, Tuesday, Thursday, and Friday, immediately

after morning conference, and remains in the area until 5:00 PM. The fellow arrives to the Lab at 9:00

AM on Wednesday, immediately after the Department of Medicine Grand Rounds, and remains in the

area until 5:00 PM. Second and third-year fellows spend Thursday mornings in the operating rooms

performing and interpreting intraoperative transesophageal echocardiograms supervised by

Anesthesiology staff. Third-year fellows spend Thursday afternoons in the Pulmonary Function

Laboratory observing and interpreting cardiopulmonary exercise tests supervised by Pulmonary staff.

The fellow performs 2 transthoracic echocardiograms in the Lab each day and enters the unsigned

interpretations in the electronic medical record.

The fellow performs 2 portable transthoracic echocardiograms each day and enters the unsigned

interpretations in the electronic medical record. These studies can be performed with a sonographer

present, or perform the study independently and call the sonographer to review and, if necessary,

complete the study.

Second and third-year fellows participate in all of the transesophageal echocardiograms performed.

The faculty member determines the level of the fellow’s participation based on the fellow’s

experience and the complexity of the study. Interpretation and reporting of TEE findings are done

immediately after completion of the study. The fellow needs to maintain a TEE procedure log

throughout training for documentation of the number of studies performed.

In addition to the 4 transthoracic studies performed by the fellow, he/she independently interprets 4

resting transthoracic echocardiograms and 4 stress echocardiograms. The fellow enters the unsigned

interpretations in the electronic medical record.

Fellows are encouraged to participate in research using echocardiography during this rotation. The

fellow needs to meet with their research mentor in advance of their assigned month to discuss ideas,

and develop a project.

Time not spent performing and interpreting echocardiograms will be spent conducting research or

reading about echocardiography and related topics. (See reading list below. All required and

recommended readings, except for textbooks, will be given to the fellow in digital format.)

At 4:00, the fellow and faculty meet to review the 12 studies interpreted by the fellow.

By the time the fellow completes the program, in most cases, the fellow receives Level II training in

echocardiography and exercise testing. Fellows are encouraged to sit for the American Board of

Echocardiography examination for certification in comprehensive adult echocardiography.



FY2014

On or about the middle of the month, the fellow meets with the Medical Director of the

Echocardiography Laboratory to discuss the fellow’s progress. At the end of the month, the fellow

meets with the Medical Director and receives a written, summary evaluation from the faculty

members who worked with the fellow.

Curriculum content: Procedures are performed under the supervision of a physician or a senior

technologist.

Duration : PGY 4 fellows spend 1 month on this rotation

PGY5 fellows spend 1 month on this rotation

PGY6 fellows spend 1 month on this rotation


with faculty):

This rotation is under the supervision of an echo cardiologist.

Supervisional procedures are done under supervision of a

physician or senior technologist.


Required




12:00pm Non-Invasive Imaging Conference, Thursday twice a

month



CCON Morning Cardiology Conference -These may have sub-types: (EP) Electrophysiology, (CAC) Cardiac Catheterization and Cardiothoracic Surgery Conference, (EKG) EKG Conference, (CORE) Core Curriculum, (RSCH) Research Conference, (JC) Journal Club, (MM) Morbidity and Mortality Conference













FY2014




PGY4 Echo Rotation


Goal: Demonstrate understanding of basic indications for cardiac ultrasound in patient care.


Activities

Evaluation

Methods

Observed and performed echocardiography in congenital heart disease patients.

CCON, DSP AE, DSP, FS

Observation and interpretation review of operative notes from, angiography and echocardiography on patients with congenital heart disease.

CCON, DSP AE, DSP, FS


Goal: Demonstrate understanding of ultrasound imaging and be able to perform limited

transthoracic echocardiography.


Activities

Evaluation

Methods

Increasing skills in echo evaluation of valvular heart disease, cardiac systolic and diastolic function, pericardial disease, cardiomyopathies, and disease of the aorta.

CCON, DSP AE, FS

Understands the echocardiographic evaluation of congenital heart disease, infective endocarditis, cardiac masses and tumors.

CCON, DSP AE, FS

Understands the indications, contraindications, potential complications and benefits for performing transthoracic, transesophageal and stress echos.

CCON, DSP AE, FS

Understands the methods and technical aspects of two-dimensional echo, color flow Doppler, tissue Doppler, contrast and stress echocardiography.

CCON, DSP AE, FS


Goal: Demonstrate interpersonal and communication skills in medical practice that develop and

maintain effective information exchange and collaboration with cardiology patients and family

members as well as other professional associates.


Activities

Evaluation

Methods

Communicates effectively with physician colleagues and members of other healthcare professions to assure timely, comprehensive patient care.

DPC AE, FS

Communicates effectively with colleagues when reporting pertinent findings of echocardiographic studies.

DPC AE, FS



FY2014


Goal: Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population with cardiac disease.


Activities

Evaluation

Methods


DPC AE, FS, EVAL





Activities

Evaluation

Methods

Fellow can identify and acknowledge gaps in personal knowledge and skills in performing and interpreting echocardiographic studies.

CCON (JC), NIC, Echo

AE, SE, EVAL


Goal: Demonstrate an awareness of and responsiveness to the larger context of the health care system, provide adequate database understanding with importance to appropriate encounter

documentation and the ability to effectively call on system resources to provide care in that is of

optimal value to their cardiology patients.


Activities

Evaluation

Methods

Understands and utilizes the multidisciplinary resources necessary to perform echocardiographic studies optimally on acutely ill cardiac patients.

DCP, AR, Echo AE, FS

Use evidence-based, cost-conscious strategies in the appropriate performance of echocardiographic studies.

DCP, AR, Echo AE, FS

PGY5 Echo Rotation


Goal: Demonstrate ability to perform transthoracic echocardiography and interpret stress echo and perform TEE on patients with cardiovascular disorders.


Activities

Evaluation

Methods


CCON, DSP, Echo

AE, DSP


CCON, DSP, Echo

AE, DSP


Goal: Demonstrate ability to understand principles of two dimensional and Doppler ultrasound imaging including color flow imaging of the heart as relates to patient management.



FY2014


Activities

Evaluation

Methods


CCON, DSP, Echo

AE, FS


CCON, DSP, Echo

AE, FS


CCON, DSP, Echo

AE, FS


CCON, DSP, Echo

AE, FS



maintain effective information exchange and collaboration with cardiology patients and family members as well as other professional associates.


Activities

Evaluation

Methods


DPC AE, FS


DPC AE, FS


Goal: Demonstrate commitment to carrying out professional responsibilities, adherence to

ethical principles, and sensitivity to a diverse cardiology patient population.


Activities

Evaluation

Methods


DPC AE, Echo


Goal: Learn to investigate and evaluate personal patient care practices, appraise and assimilate scientific evidence, participate in clinical research related to Cardiology, and improve personal patient care practices.


Activities

Evaluation

Methods

Fellow can identify and acknowledge gaps in personal knowledge and skills in performing and interpreting echocardiographic studies

CCON, NIC, Echo

AE, FS, EVAL, SE



FY2014


Goal: Demonstrate an awareness of and responsiveness to the larger context of the health care

system, provide adequate database understanding with importance to appropriate encounter documentation and the ability to effectively call on system resources to provide care in that is of



Activities

Evaluation

Methods


DCP, DSP AE, FS, SE


DCP, DSP AE, FS, SE

PGY6 Echo Rotation


Goal: Demonstrate understanding of emergency TEE indications, to be able to recognize

importance of the right test for the right patient at the right time.


Activities

Evaluation

Methods


CCON, DSP AE, DSP


CCON, DSP AE, DSP


Goal: Demonstrate understanding of TEE and stress echocardiography for cardiac patients.


Activities

Evaluation

Methods


CCON, DSP AE


CCON, DSP AE


CCON, DSP AE


CCON, DSP AE



FY2014




Activities

Evaluation

Methods


DPC AE, SE, EVAL


DPC AE, SE, EVAL




Activities

Evaluation

Methods


DPC AE, SE, EVAL, FS





Activities

Evaluation

Methods

Fellow can identify and acknowledge gaps in personal knowledge and skills in performing and interpreting echocardiographic studies.

CCON, NIC AE, SE, EVAL, FS






Activities

Evaluation

Methods


DCP AE, SE, EVAL, FS


DCP AE, SE, EVAL, FS

Suggested Readings

PGY 4:

1. Abhayaratna WP, Seward JB, Appleton CP et al. Left atrial size: physiologic determinants

and clinical applications. J Am Coll Cardiol 2006;47:2357-2363. *



FY2014

2. Baumgartner H, Hung J, Bermejo J et al. Echocardiographic assessment of valve stenosis:

EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23. *

3. Bonow RO, Carabello BA, Chatterjee K et al. 2008 focused update incorporated into the

ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of

the American College of Cardiology/American Heart Association Task Force on Practice

Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With

Valvular Heart Disease). J Am Coll Cardiol 2008;52:e1-142. Available at:

http://www.cardiosource.com

4. Cerqueira MD, Weissman NJ, Dilsizian V et al. Standardized myocardial segmentation and

nomenclature for tomographic imaging of the heart: a statement for healthcare professionals

from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American

Heart Association. Circulation 2002;105:539-542. *

5. Cheitlin MD, Armstrong WF, Aurigemma GP et al. ACC/AHA/ASE 2003 guideline update for

the clinical application of echocardiography: a report of the American College of

Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE

Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography).

2003. American College of Cardiology website. Available at: http://www.cardiosource.com

6. Douglas PS, Khandheria B, Stainback ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR

2008 appropriateness criteria for stress echocardiography. J Am Coll Cardiol 2008;51:1127-

1147. *

7. Douglas PS, Khandheria B, Stainback RF, and Weissman NJ.

ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic

and transesophageal echocardiography. J Am Coll Cardiol 2007;50:187-204. *

8. Fletcher GF, Balady GJ, Amsterdam EA et al. Exercise standards for testing and training: a

statement for healthcare professionals from the American Heart Association. Circulation

2001;104:1694- 1740. *

9. Gibbons RJ, Balady GJ, Bricker JT et al. ACC/AHA 2002 guideline update for exercise

testing: a report of the American College of Cardiology/American Heart Association Task Force

on Practice Guidelines (Committee on Exercise Testing). 2002. American College of Cardiology

web site. Available at: http://www.cardiosource.com *

10. Gilman G, Khandheria BJ, Hagen ME et al. Strain rate and strain: a step-by-step approach to

image and data acquisition. J Am Soc Echocardiogr 2004;17:1011-1020.

11. Gorscan III J, Abraham T, Agler D et al. Echocardiography for cardiac resynchronization

therapy: recommendations for performance and reporting—a report from the American Society

of Echocardiography Dyssynchrony Writing Group. J Am Soc Echocardiogr 2008;21:191-213.

12. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report

from the American Society of Echocardiography’s Guidelines and Standards Committee and the

Chamber Quantification Writing Group, Developed in Conjunction with the European

Association of Echocardiography, a Branch of the European Society of Cardiology. J Am

Soc Echocardiogr 2005;18:1440-1463. *

PGY 5:

1. Abhayaratna WP, Seward JB, Appleton CP et al. Left atrial size: physiologic determinants and

clinical applications. J Am Coll Cardiol 2006;47:2357-2363.


EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23.


http://www.cardiosource.com/






FY2014









Heart Association. Circulation 2002;105:539-542.





2003. American College of Cardiology web site. Available at: http://www.cardiosource.com

6. Douglas PS, Khandheria B, Stainback ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR

2008 appropriateness criteria for stress echocardiography. J Am Coll Cardiol 2008;51:1127-

1147.



and transesophageal echocardiography. J Am Coll Cardiol 2007;50:187-204. *



2001;104:1694- 1740.

9. Gibbons RJ, Balady GJ, Bricker JT et al. ACC/AHA 2002 guideline update for exercise testing:

a report of the American College of Cardiology/American Heart Association Task Force on

Practice Guidelines (Committee on Exercise Testing). 2002. American College of Cardiology

web site. Available at: http://www.cardiosource.com


image and data acquisition. J Am Soc Echocardiogr 2004;17:1011-1020. *



of Echocardiography Dyssynchrony Writing Group. J Am Soc Echocardiogr 2008;21:191-213. *





Soc Echocardiogr 2005;18:1440-1463.

PGY 6

1. Abhayaratna WP, Seward JB, Appleton CP et al. Left atrial size: physiologic determinants and

clinical applications. J Am Coll Cardiol 2006;47:2357-2363.


EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23.











FY2014






Heart Association. Circulation 2002;105:539-542.





2003. American College of Cardiology web site. Available at: http://www.cardiosource.com


ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress

echocardiography. J Am Coll Cardiol 2008;51:1127-1147.



and transesophageal echocardiography. J Am Coll Cardiol 2007;50:187-204.



2001;104:1694- 1740.

9. Gibbons RJ, Balady GJ, Bricker JT et al. ACC/AHA 2002 guideline update for exercise

testing: a report of the American College of Cardiology/American Heart Association Task Force

on Practice Guidelines (Committee on Exercise Testing). 2002. American College of Cardiology

web site. Available at: http://www.cardiosource.com


image and data acquisition. J Am Soc Echocardiogr 2004;17:1011-1020.



of Echocardiography Dyssynchrony Writing Group. J Am Soc Echocardiogr 2008;21:191-213.





Soc Echocardiogr 2005;18:1440-1463.

13. Myers J, Arena R, Franklin B et al., on behalf of the American Heart Association

Committee on Exercise, Cardiac Rehabilitation, and Prevention of the Council on Clinical

Cardiology, the Council on Nutrition, Physical Activity, and Metabolism, and the Council on

Cardiovascular Nursing. Recommendations for clinical exercise laboratories: a scientific

statement from the American Heart Association. Circulation 2009;119:3144-3161.

14. Nagueh SF, Appleton CP, Gillebert TC et al. Recommendations for the evaluation of left

ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-133. *

15. Otto CM. Textbook of Clinical Echocardiography, 4th Ed. Philadelphia, W. B. Saunders Co.,

2009. Quinones MA, Otto CM, Stoddard M et al. Recommendations for quantification of

Doppler echocardiography: a report of the Doppler Quantification Task Force of the

Nomenclature and Standards Committee of the American Society of Echocardiography. J Am

Soc Echocardiogr 2002;15:167-184. *

16. Shanewise JS, Cheung AT, Aronson S et al. ASE/SCA guidelines for performing a







FY2014

comprehensive intraoperative multiplane transesophageal echocardiography examination:

recommendations of the American Society of Echocardiography and the Society of

Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal

Echocardiography. J Am Soc Echocardiogr 1999;12:884-900. *

17. Wasserman K, Hansen JE, Sue DY, Stringer WW, and Whipp BJ. Principles of Exercise Testing

and Interpretation, Including Pathophysiology and Clinical Applications, 4th

Ed. Philadelphia,

Lippincott Williams and Wilkins, 2005. * 18. Zoghbi WA, Chambers JB, Dumesnil JG et al. Recommendations for evaluation of prosthetic

valves with echocardiography and Doppler ultrasound: a report from the American Society of

Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic

Valves, developed in conjunction with the American College of Cardiology Cardiovascular

Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the

European Association of Echocardiography, the Japanese Society of Echocardiography and the

Canadian Society of Echocardiography. J Am Soc Echocardiogr 2009;22:975-1014.

19. Zoghbi WA, Enriquez-Sarano M, Foster E et al. Recommendations for evaluation of the

severity of native valvular regurgitation with two-dimensional and Doppler echocardiography:

a report of the American Society of Echocardiography’s Nomenclature and Standards

Committee and the Task Force on Valvular Regurgitation. J Am Soc Echocardiogr

2003;16:777-802.



FY2014


Nuclear Rotation (Nuc)

This rotation is designed to allow the fellow to develop skills and perform in the

interpretation of exercise stress testing and radionuclide myocardial imaging for perfusion in

ventricular contractility. The fellow receives training the in anatomical and functional assessment of

ventricular myocardium, quantification of cardiac chamber of ventricular contractility and volumes.

He/she receives training in the safety and handling of radionuclides, preparation of radionuclide

tracers and calibration. The fellow learns about the maintenance of nuclear equipment, digital image

acquisition, digital processing, image interpretation and ongoing research in cardiology involving

nuclear techniques.

The goal of nuclear cardiology training is to achieve competence in exercise testing and to gain

general training in nuclear cardiology used in the practice of consultation in cardiology.

Additional training in physics is available through a course series conducted by the Department of

Radiology each year.

Curriculum content: Procedures are done under supervision of a nuclear cardiologist, physician

or senior technologist.

Duration : PGY 4 fellows spend approximately 1 month on this rotation

PGY5 fellows spend approximately 1 month on this rotation

PGY6 (Elective Rotation) fellows 1 month on this rotation.


with faculty):

This rotation is under the supervision of a nuclear cardiologist.

Procedures are done under supervision of a physician

or senior technologist.


Required



7:00 am Research Conference Wednesday monthly

7:00am Bimonthly Radiology Physics course

12:00pm Non-Invasive Imaging Conference, Thursday twice a

month







FY2014













PGY4 Nuclear Rotation


Goal: Understand principles of nuclear cardiology and learn to interpret studies.


Activities

Evaluation

Methods

Ability to assist in the performance of any stress test involving vital signs and EKG interpretation.

DPC, FS, CCON, NIC

AE

Ability to assess the adequacy of a study and its endpoint monitoring the patient in recovery and handling and injecting the radioisotopes.

DPC, FS, CCON, NIC

AE


Goal: Understand the use of cardiology results to guide patient care.


Activities

Evaluation

Methods

Beginning competency in use of basic operations of the computers and imaging cameras,

FS, NIC AE

Beginning competency in the principles of patient selection, performance monitoring interpretation and reporting of nuclear imaging stress tests

FS, NIC AE

Beginning competency in ability to acquire, reconstruct and analyze radionuclide ventriculograms in perfusion imaging.

FS, NIC AE



maintain effective information exchange and collaboration with cardiology patients and family

members as well as other professional associates



FY2014


Activities

Evaluation

Methods

Beginning competence in ability to communicate effectively the risks and benefits of procedures to patients before obtaining consent.

DPC, FS AE

Beginning competence in ability to accurately report test results to ordering physician.

DPC AE




Activities

Evaluation

Methods

Interact professionally with patients, patients’ families and other members of the health care team.

DPC, AR AE

Understand the social context of illness. DPC, AR AE




Activities

Evaluation

Methods

Begin to identify and acknowledge gaps in personal knowledge and skills in performing and interpreting nuclear cardiology procedures.

NIC, DPC, CCON

AE

Understand the importance of commitment to scholarship and use of evidence based medicine.

NIC, DPC, CCON

AE




Activities

Evaluation

Methods

Understand the importance of effective collaboration with other members of the health care team.

AR, DPC AE, EVAL



Goal: Understand and apply principles of nuclear cardiology and learn to interpret studies.



FY2014


Activities

Evaluation

Methods

Fellows may perform or assist in the performance of any stress test involving vital signs and EKG interpretation, assess the adequacy of a study and its endpoint monitoring the patient in recovery and handling and injecting the radioisotopes.

DPC, FS, CCON, NIC

AE


Goal: Understand and apply the use of cardiology results to guide patient care.


Activities

Evaluation

Methods

Continued competency in operations of the computers and imaging cameras.

FS, NIC AE

Continued competency in the principles of patient selection, performance monitoring interpretation and reporting of nuclear imaging stress tests

FS, NIC AE

Continued competency in ability to acquire, reconstruct and analyze radionuclide ventriculograms in perfusion imaging.

FS, NIC AE

Perform and interpret at least 25 radionuclide studies, to correlate with results of other clinical parameters assessed in the course of study on subsequent clinical management.

FS, NIC AE




Activities

Evaluation

Methods

Communicate effectively the risks and benefits of procedures to patients before obtaining consent.

DPC, FS AE

Accurately report test results to ordering physician. DPC AE




Activities

Evaluation

Methods

Interact professionally with patients, patients’ families and other members of the health care team.

DPC, AR AE

Appreciate the social context of illness. DPC, AR AE



FY2014




Activities

Evaluation

Methods

Identify and acknowledge gaps in personal knowledge and skills in performing and interpreting nuclear cardiology procedures.

NIC, DPC, CCON

AE




Activities

Evaluation

Methods

Effective collaboration with other members of the health care team.

AR, DPC AE, EVAL



Goal: Understand, apply and teach principles of nuclear cardiology and learn to interpret studies.


Activities

Evaluation

Methods

The fellow will be expected to review, interpret and understand the clinical data in history, exam, resting and stress ECG, exercise data, to discuss them with the attending. Fellows will develop an understanding the concepts of sensitivity and accuracy in interpretation of these tests.

DPC, FS, CCON, NIC

AE


Goal: Understand, apply and teach the use of cardiology results to guide patient care.


Activities

Evaluation

Methods

Perform and interpret at least 25 radionuclide studies, to correlate with results of other clinical parameters assessed in the course of study on subsequent clinical management.

FS, NIC AE





FY2014


Activities

Evaluation

Methods

Communicate effectively the risks and benefits of procedures to patients before obtaining consent.

DPC, FS AE

Accurately report test results to ordering physician. DPC AE




Activities

Evaluation

Methods

Appreciate the social context of illness. DPC, AR AE




Activities

Evaluation

Methods

Commitment to scholarship and use of evidence based medicine.

NIC, DPC, CCON

AE




Activities

Evaluation

Methods

Consider outcomes of tests and interventions associated with Nuclear cardiology.

AR, NIC AE

Suggested Readings

1. Cardiac SPECT Imaging. 2nd ed. Edited by E. Gordon DePuey, MD, Ernest V. Garcia,

PhD, Daniel S. Berman, MD, 2001

2. Clinical Nuclear Cardiology, 4th Edition - State of the Art and Future Directions By Barry L.

Zaret, MD and George A. Beller, MD, 04/2010



FY2014


CT Angiography (CTA)/Magnetic Resonance Rotation (CT/MRI)

This month-long rotation allows the cardiovascular fellow to have the opportunity to learn

imaging protocols and clinical applications of cardiac CT in clinical practice. Also, the fellow

learns to use the hardware, software and other technical requirements to perform routine cardiac

exams. The fellow learns the imaging protocols and techniques for Coronary CT

angiography, coronary plaque detection and characterization.

Duration : PGY4 fellows may have a one month elective.

PGY5 fellows may have a one month elective.

PGY6 fellows spend one month on this rotation.


with faculty):

Fellows will be supervised by the attending.


Required


Monthly CT, MRI conferences.

7:00 am on Monday, Tuesday, Thursday and Friday at the

University of Kansas Medical Center


12:00 pm Every other Thursday, Non-Invasive Imaging

Conference



CCON Morning Cardiology Conference -

These may have sub-types: (EP) Electrophysiology, (CAC) Cardiac Catheterization and Cardiothoracic Surgery Conference, (EKG) EKG Conference, (CORE) Core Curriculum, (RSCH) Research Conference, (JC) Journal Club, (MM) Morbidity and Mortality Conference













FY2014

The principal educational goals and objectives for fellows on this rotation are indicated in the

tables below in the first column. The second column of the table lists the most relevant learning

activities for that goal, and the third column indicates the correlating evaluation methods for that

goal. Specific issues that will be discussed by the attendings during the CT Angiography

(CTA)/Magnetic Resonance Rotation include and are not limited to those listed below.

PGY 6 CT Angiography (CTA)/Magnetic Resonance Rotation


Goal: Demonstrate understanding and evaluation of the indications for cardiac CT, and cardiac MRI.


Activities

Evaluation

Methods

Ability to conduct medical interviews that are logical, thorough, and efficient.

CCON (EP), AR, DSP

AE, DSP

Gain experience and expertise in the performance of coronary CT angiographic imaging.

CCON (EP), AR, DSP

AE, DSP


Goal: Demonstrate proficient ability to interpret findings of coronary anomalies and cardiac disease.


Activities

Evaluation

Methods

Understands and applies principles of gated cardiac CT imaging, and applies principles of gated cardiac CT imaging.

CCON, AR, DSP

AE, DSP

Understands and applies principles of coronary CT angiographic imaging.

CCON, AR, DSP

AE, DSP

Understands and applies principles of calcium scoring. CCON, AR, DSP

AE, DSP

Developing skills in workstation management and image reconstruction.

CCON, AR, DSP

AE, DSP

Developing skills in image reconstruction and troubleshooting.

CCON, AR, DSP

AE, DSP




Activities

Evaluation

Methods

Communicated effectively with patients, colleagues and members of the health care team.

DPC AE



FY2014

Communicates effectively the consult findings with physician colleagues and other members of the health care team in a timely fashion to assure comprehensive patient care.

DPC AE




Activities

Evaluation

Methods

Interacts professionally toward patients, families, colleagues and all members of the health care team. Interacts with patients and families in a professionally appropriate manner.

DPC, AR AE

Appreciates the social context of Heart Disease screening. DPC, AR AE




Activities

Evaluation

Methods

Shows commitment to professional scholarship, including systematic and critical perusal of relevant print and electronic literature, with emphasis on integration of basic science with clinical medicine and evaluation of information in light of the principles of evidence based medicine.

CCON (JC), NIC

AE

Broad reading of the cardiovascular literature and access and research of Medline and Internet tools.

CCON (JC), NIC

AE




Activities

Evaluation

Methods

Effectively collaborated with other members of the health care team.

CCON (JC), NIC

AE

Understands cost effectiveness of diagnostic and therapeutic strategies to diagnose coronary artery disease.

CCON (JC), NIC

AE

Suggested Reading

1. Clinical Cardiac MRI, J Bogaert, S. Dymarkowski, A.M. Taylor, 2005 2. CT of the Heart Principles and Applications, U. Joseph Schoeph, MD, 2010



FY2014


Peripheral Vascular Ultrasound Rotation (PVUS)

Since there are no COCATS categorization of vascular ultrasound training the program is unable to

offer levels of training such as is done in echocardiography. However, the fellowship program

would like the outgoing fellows who wish to be proficient in interpretation of vascular studies

(including those who may lead other vascular laboratories) to meet the training requirements to be

eligible to sit for the RPVI examination (Registered Physician in Vascular Interpretation).

1. Report to the vascular ultrasound laboratory at 8:00AM daily unless there is a morning

conferences.

2. Generally the work day lasts till 5:00 PM unless the interpretation with attending staff is later

(All fellows will comply with the ACGME work hour requirements)

3. The fellow scans in the morning session with sonographers and a minimum of 3 scans each

morning.

4. The fellow pre-reads a minimum of 10 studies and then does the final read with the attending.

It is recommended that the fellow read all studies done during the day with the attending staff.

5. The fellow is professionally attired and exhibits professional behavior at all times.

6. Attend all cardiovascular division educational activities for the day even if not relating to the

vascular rotation including continuity clinic.

7. Conferences – cardiology conferences noninvasive imaging conferences

a. Didactic lectures/ Seminars/ CME:

i. Attend the physics of vascular ultrasound lecture series (2 lectures).

ii. Attend a minimum of 8 vascular ultrasound noon conferences during the course of

the fellowship training.

iii. Obtain 15 vascular CME’s during the fellowship.

iv. Attend the vascular medicine lectures as a part of the core curriculum lecture series

In order to acquire the above experience it has been ascertained the cardiovascular disease

fellows spend a minimum of 2 months in the vascular ultrasound laboratories (This can be

broken down as one full month where he/she spend a half day participating in the performance

of vascular studies and the half day interpreting. In the remainder two half months he/she

interprets the studies in the afternoon session). The half months can be combined with another

rotation such as echocardiography. It will be preferable to split these months over the three

years the fellowship.

The fellow keeps a formal log of all studies performed and interpreted.

However, if a fellow wants basic exposure to the field then a one month rotation is offered.

Fellow Orientation and Evaluation:

1. At the beginning of the rotation the fellow meets with the medical director of the vascular

laboratory or the assigned attending staff to go over the rotation goals and objectives and

responsibilities.

2. There is a similar mid rotation meeting between the fellow and the medical director to



FY2014

discuss progress and other issues.

3. At the end of the rotation an evaluation for the fellow is done by the medical director (or

assigned staff) in consultation with the other vascular staff that the fellow has worked with.

Duration : PGY4 have use as a one month long elective.

PGY5 have use as a one month long elective.

PGY6 have use as a one month long elective.


with faculty):

During this rotation the fellow works daily with a staff Cardiologist performing procedures.


Required




12:00 pm Non-Invasive Imaging Conference, Thursday twice

a month
















for that goal, and the third column indicates the correlating evaluation methods for that goal. Specific

issues that will be discussed by the attendings during the non-invasive rotation include and are

not limited to those listed below.



FY2014

PGY 4 / 5 /6 PVUS Rotation


Goal: Hands on scanning, develop basic scanning ability - hands on vascular ultrasound studies under the supervision of a registered vascular sonographer. The full morning session each day for the first month of the rotation with a minimum of 3 studies each day.


Activities

Evaluation

Methods

This should include a minimum of the following studies: i. 20 Carotid duplex scans

ii. 20 Visceral duplex studies iii. 20 Lower or upper extremity arterial duplex studies

iv. 10 Venous duplex studies

v. 20 resting and post exercise ABI studies

CCON (CORE), NIC, DSP, (CAC)

AE, DSP, PL

Understand the clinical implications and prognosis of the various abnormal examinations.


AE, DSP


Goal: To understand the principals of physics behind ultrasound and Doppler ultrasound that is relevant to the performing of clinical studies.


Activities

Evaluation

Methods

Develop an in-depth understanding of vascular anatomy (both arterial and venous).

CCON, FS, NIC, DPC

AE

Familiarize themselves with the various imaging protocols used in the vascular ultrasound laboratory and the data supporting their clinical use.

CCON, FS, NIC, DPC

AE

Be able to use alternate protocols available in literature and the relative sensitivity and specificity of the most commonly used protocols.

CCON, FS, NIC, DPC

AE

Develop competence and proficiency in the interpretation of the following vascular examinations in order to be an independent reader:

a. Extra-cranial Doppler examination

(carotid and vertebral arterial) b. Abdominal aorta examination

c. c. Lower extremity arterial

d. Upper extremity arterial

e. Assessment of Groin vascular anatomy (especially post catheterization and post thrombin

injection for pseudo aneurysm)

f. Lower extremity arterial graft surveillance g. Visceral arterial duplex (especially renal)

h. Lower extremity venous

i. Upper extremity venous

j. Rest and exercise ankle brachial indices assessment

(including toe brachial indices)

CCON, FS, NIC, DPC

AE



FY2014


Goal: To be able to query referring physicians for specific results they desire when ordering noninvasive imaging procedures.


Activities

Evaluation

Methods

Be able to elicit a disease specific history regarding peripheral vascular disease

DPC AE, SE

Be able to transmit test results to patients and referring physicians

DPC AE, SE


Goal: To interact professionally with sonographers, patients and referring physicians in a professional manner.


Activities

Evaluation

Methods

Appropriately convey study reports to referring physicians in a timely fashion

DPC AE


Goal: Understand limitations of vascular ultrasound.


Activities

Evaluation

Methods

Understand indications for alternative imaging techniques (CTA, MRI, angiography)

DPC, NIC AE


Goal: Work effectively with other members of peripheral vascular imaging team.


Activities

Evaluation

Methods

Understand cost limitations of invasive and noninvasive types of imaging procedures

DPC AE

Understand risks of invasive versus noninvasive imaging procedures

DPC, NIC AE

Recommended Reading: 1. Introduction to Vascular Ultrasonography 5th Edition. Zwiebel/ Pellerito, 2004

2. Peripheral vascular Ultrasound: How, When and Why. 2010. Ed: Timothy Hartshorne.

Abigail Thrush,

3. The complete guide to Vascular Ultrasound. Author(s): Arger, Peter. H.; DeBari Iyoob,

Suzanne. Lippincott Williams & Wilkins, 2004

http://search.barnesandnoble.com/booksearch/results.asp?ATH=Timothy%2BHartshorne

http://search.barnesandnoble.com/booksearch/results.asp?ATH=Abigail%2BThrush



FY2014


Cardiothoracic Surgery (CTS) Rotation

Cardiothoracic Surgery rotation is in conjunction with the Division of Cardiothoracic Surgery at

The University of Kansas Hospital. The cardiovascular fellow has the opportunity to participate in

pre-operative evaluation, observe surgical procedures and assist in post-operative care of patients

undergoing both cardiac and non-cardiac thoracic surgery procedures. He/she have the advantage

of seeing the direct hemodynamic response effects of various pharmacological interventions in the

Cardiac surgery suites. Extensive experience is available in transesophageal echo in patients

undergoing cardiovascular surgical procedures. Participation or observation in cardiac surgery is

available so that cardiac findings preoperative can be compared to surgical results.

Duration : PGY 5 or PGY 6 year, fellows will spend 1 month-in this

rotation.


with faculty):

Supervision will be provided by the attending Cardiothoracic Surgeon


Required




12:00pm Non-Invasive Imaging Conference twice a month













EVAL Educational Committee Review (quarterly)



FY2014




EVAL Educational Committee Review

(every 6 months)




PGY5 or PGY6 Cardiothoracic Surgery (CTS) Rotation


Goal: Understand principals for pre-operative and post-operative care of CT surgery patients.


Activities

Evaluation

Methods

Recognize the physical findings of valvular heart disease that require surgical correction.

DPC, CCON, NIC, (CAC), KOF

AE

Understand the indications for cardiac surgery in infective endocarditis and pericardial disease.

(CAC), NIC AE

Understand the indications for thoracic surgery in patients with non-cardiac illnesses such as lung neoplasms.

IMNC, CCON AE


Goal: Understand evaluation approaches and patient care approaches for preoperative and post-operative CT surgery care.


Activities

Evaluation

Methods

Understand parameters indicating valvular intervention in patients undergoing cardiac surgery.

(CAC), IMNC AE

Understand the goals of revascularization surgery in patients with coronary artery disease.

(CAC), KOF AE




Activities

Evaluation

Methods

Communicate effectively with patients and families in a pre and post-operative cardiothoracic surgery environment.

DPC, NCC AE



FY2014

Communicate effectively with students, colleagues and members of cardiothoracic surgery team to assume timely competence of patient care as a non-surgical consultant on their patients.

DPC, NCC AE




Activities

Evaluation

Methods

Interact professionally with patients, families, colleagues and other members of the health care team.

DPC, FS AE

Interact with patients families in a professionally appropriate manner.

DPC, FS AE

Appreciate the social context of the illnesses. FS, CCON AE




Activities

Evaluation

Methods

Commitment to scholarship and the use of evidence based cardiovascular medicine.

CCON (JC) AE, EVAL

Broad reading of the cardiovascular literature and access and research of Medline and internet tools.

CCON (JC) AE, EVAL


Goal: Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care in that is of optimal value to their cardiology patients


Activities

Evaluation

Methods

Understand available resources in this area to care optimally for post-operative cardiothoracic surgical patients.

DPC, AR AE

Cooperate effectively with other members of the cardiothoracic surgery team as well as members of other departments in the hospital to assure competence of patient care.

DPC, AR AE

Suggested Reading

4. Clinical Cardiac MRI, J Bogaert, S. Dymarkowski, A.M. Taylor, 2005

5. CT of the Heart Principles and Applications, U. Joseph Schoeph, MD, 2010



FY2014


Pediatric Cardiology Rotation (Peds)

The Department of Pediatrics at the University of Kansas Medical Center has two full-time

pediatric cardiologists who are active in out-patient clinics, including outreach clinics across the

State of Kansas and in-patient pediatrics. The fellow may participate in outpatient clinics and in-

patient cardiology rounds at the University of Kansas Medical Center. He/she may also participate

in the outreach clinics that Pediatric Cardiology conducts. The fellow may attend Friday morning

pediatric cardiology and cardiothoracic surgery conferences at Children’s Mercy Hospital. The

fellow experiences the nuances of pediatric cardiology physical examination and receives a series of

pediatric cardiology lectures in the cardiovascular morning conference over the course of a year.

The fellow gains knowledge in the various pediatric cardiovascular disorders as well as seeing

well children with heart murmurs, chest pain and palpitations.

Duration : This is a 1 month rotation for PGY6 fellows


with faculty):

Supervision is provided by the attending Pediatric Cardiologist at KUMC for outpatient and inpatient services.


Required




12:00 pm Non-Invasive Imaging, Thursday twice a month.












DSP Directly Supervised Procedures



FY2014





PGY 6: Pediatric Cardiology Rotation


Goal: Demonstrate understanding and approach to consult and continuum of care for the pediatric patient with congenital heart disease.


Activities

Evaluation

Methods

Understand the various common types of heart disease, the pathophysiology of these disorders and corrective intervention for these conditions.

CCON (PED), KOF, NIC

AE

Increase skills in cardiac physical examination, auscultation and physical findings in congenital heart disease.

CCON (PED), KOF

AE

Evaluation and management of adolescents and young adult patients with chest pain, exercise intolerance, syncope, hypertension and those with higher risk for adult coronary artery disease.


AE

Understand the management of adolescents and adults with congenital heart disease. Counsel on participation of athletes, work activities and issues related to reproduction.


AE

History and physical examination of patients who are being evaluated for congenital disease.

CCON (PED), KOF

AE

Observation and performance of echocardiography in congenital heart disease patients.

NIC, KOF, CCON (PED)

AE


NIC, KOF, CCON(PED)

AE


Goal: Demonstrate knowledge of anatomy and management of common congenital heart diseases.


Activities

Evaluation

Methods

Appreciate the genetic risk and various forms of congenital heart disease.


AE

Appreciate the hemodynamic complexities of common forms of congenital heart disease.


AE



FY2014


Goal: Demonstrate interpersonal and communication skills in medical practice that develop and maintain effective information exchange and collaboration with cardiology pediatric patients and family members as well as other professional associates.


Activities

Evaluation

Methods

Communicate effectively with pediatric patients and patient’s families in an office setting.

DPC, KOF, NCC

AE

Communicate effectively with patients, colleagues and members of the health care team.

DPC, KOF, NCC

AE




Activities

Evaluation

Methods

Interact rationally towards patients, colleagues and all members of the healthcare team.

DPC, KOF AE

Interact with patients families in a professionally appropriate manner.

DPC, KOF AE

Appreciate the social context of the illness including the context of congenital heart disease in the development of the child.

DPC, KOF AE




Activities

Evaluation

Methods

Identify gaps in personal knowledge and skills in complexities of congenital heart disease.

CCON (PED) AE



Objective: Learning

Activities

Evaluation

Methods

Understand and utilize reference resources necessary to understand the complex anatomy and pathophysiology of congenital heart disease.

NIC, CCON (PED)

AE

Understand when appropriate to submit pediatric patients to invasive cardiovascular diagnostic and therapeutic procedures.

NIC, CCON (PED), CCON (CAC)

AE



FY2014

Understand when to refer pediatric patients from an outreach clinic to Tertiary Care center for further evaluation for therapeutic procedures.

NIC, CCON (PED)

AE

Suggested Reading

6. Congenital Heart Disease in Adults. J.K. Perloff, J.S. Child, and J. Aboulhosn. 2008



FY2014


Cardiovascular Research Rotation (Res)

Cardiovascular research rotation is under the supervision of an experienced faculty investigator on

projects according to the institutional principles of ethics and realistic patient protection.

Research rotations are for a month long but research time may be taken as individual half days or

days as permitted by the rotations. The only rotation where research time is generally not given is

during the Coronary Care Unit rotation at the University of Kansas Medical Center. Fellows are

expected to submit an abstract to the American College of Physicians regional meeting and

eventually abstracts to a national meeting such as the American Society for Clinical Research,

American College of Cardiology or American Heart Association.

Funding for expenses regarding research presentations are generally provided by the Division of

Cardiovascular Diseases. Reading materials on this rotation are based on research project.

Duration : PGY 4 fellows spend approximately 1 to 2 months on this rotation.

PGY5 fellows spend approximately 1 to 2 months on this rotation.

PGY6 fellows spend approximately 1 to 2 month on this rotation.

Supervision

(Interaction with

faculty):

This rotation is under the supervision of an experienced faculty investigator on projects according to the institutional principles of ethics and realistic patient protection.


Required




12:00 pm Non-Invasive Imaging Conference, Thursday twice a month.



CCON Morning Cardiology Conference -- These may have sub-types: (EP)

Electrophysiology, (CAC) Cardiac

Catheterization and Cardiothoracic

Surgery Conference, (EKG) EKG

Conference, (CORE) Core

Curriculum, (RSCH) Research

Conference, (JC) Journal Club, (MM)

Morbidity and Mortality Conference


CPC Internal Medicine Clinicopathogenic

Conference IMNC Internal Medicine Noon Conference






FY2014










PGY 4, PGY 5, and PGY 6 Research


Goal: Understand principles of Cardiovascular research and investigation.


Activities

Evaluation

Methods

Ability to assist in the performance of clinical and basic science research projects and protocols

DPC, FS, CCON, NIC

AE

Ability to assess the adequacy of a study design and its outcomes as it relates to patient care

DPC, FS, CCON, NIC, IMGR

AE

Observation and interpretation review of published research projects and national guidelines documents


AE


Goal: Understand the role of cardiovascular research to guide patient care and advance the state of medical knowledge.


Activities

Evaluation

Methods

Understands the systematic and critical evaluation of Cardiovascular research projects


AE

Understands the appropriate evaluation of proper research study design and implementation. Beginning competency in the principles of patient selection, performance monitoring interpretation and reporting of clinical research


AE

Understands the methods and technical aspects of background information review, data acquisition, and data analysis for Cardiovascular research.


AE, SE

Beginning competency in use of basic operations of computers, spreadsheets, and statistical programs


AE



FY2014


Goal: Demonstrate interpersonal and communication skills in medical research that develop and maintain effective information exchange and collaboration with cardiology patients and family members as well as other professional associates and research personnel.


Activities

Evaluation

Methods

Beginning competence in ability to communicate effectively the risks and benefits of research protocols to patients before obtaining consent. Communicate effectively with physician colleagues and members of other healthcare professions to assure appropriate involvement in research activities.

DPC, FS, CCON

AE

Communicates effectively with colleagues when reporting pertinent findings of research studies. Beginning competence in ability to accurately and clearly report study results to medical professionals at seminars, meetings, and in publications

DPC, FS, CCON

AE


Goal: Demonstrate commitment to carrying out professional research responsibilities, adherence to ethical principles, and sensitivity to a diverse cardiology patient population while engaging in Cardiovascular research.


Activities

Evaluation

Methods


DPC, AR, CCON, FS

AE

Understand the social context of investigative research activities in the setting of an academic medical center

DPC, AR, CCON, FS

AE, SE


Goal: Learn to investigate and evaluate high quality research practices, appraise and assimilate scientific evidence related to Cardiology, and improve personal patient care practices which may derive from the involvement in research.


Activities

Evaluation

Methods

Begin to identify and acknowledge gaps in personal knowledge and skills in performing and interpreting nuclear cardiology procedures

DPC, AR, CCON, FS

AE, SE

Fellow can identify and acknowledge gaps in personal knowledge and skills in performing and interpreting research studies

DPC, AR, CCON, FS

AE

Understand the importance of commitment to scholarship and use of evidence based medicine when undertaking research activities.

FS, DPC, AR, CCON

AE, SE



FY2014


Goal: Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to perform cardiovascular research in a manner that is of optimal value to the medical community


Activities

Evaluation

Methods

Understands and utilizes the multidisciplinary resources necessary to perform Cardiovascular research studies optimally on cardiac patients in both inpatient and outpatient settings

FS, DPC, AR, CCON

SE, AE

Understand the importance of effective collaboration with other members of the research and health care teams.

FS, DPC, AR, CCON

AE, SE

Use evidence-based, cost-conscious strategies in the appropriate performance of Cardiovascular research studies

FS, DPC, AR, CCON

AE, SE



FY2014

D. VA ROTATIONS

1. CARDIOLOGY VA FELLOWSHIP GUIDELINES

General rules:

1. All fellows must be present in VA by 8.30 am 2. Must have computer and CPRS access prior to reporting at work. No access, no work

3. Must have CPRS and encounter completion training, Centricity and CART CL

4. BCLS, ACLS and fluoroscopy certification

5. All patients for procedures-

6. Must be assessed by the fellow on that rotation prior to the procedure,

a) Have an HP written, pre procedure orders written and consented prior to start of the

procedure.

b) Must write the procedure note with the findings, recommendation, appropriate orders

and consults and discuss it with the patient/significant other after discussing with

attending who supervised the procedure

c) Notify the requesting physician as well as an assigned cardiology NP as additional

signer and by phone in case of critical findings.

7. If running late, please call attending on that service and notify them of you temporary

absence.

8. May leave when the day’s work is done (after checking with the attending on that rotation

and co-fellows as some days will be short, some long and we want everyone to leave in

decent hour)

9. Review all alerts in am and pm and answer them appropriately.

10. Cross cover each other with due permission from the primary attending when one fellow is

away for any reason.

Invasive fellow

1. Must check on patients list the evening before and review for labs, meds orders etc so that there

are fewer surprises in am.

2. Will stay scrubbed during intervention to help as needed but is an operator during the cardiac

cath, pacemaker and ICD implantation. Prereading is expected. Enter all tests results in

computer and alerts requesting providers of results. Need to call provider and patient of

critical findings and document in chart. May need to see admission goes smoothly in those

that need admission. All encounter forms must be completed. Follow-up on all CABG

requests is mandatory

Non Invasive fellow: 1. All TEE and stress echo requests need to reviewed with full CPRS access prior to allowing it be

scheduled. Must have recent transthoracic echocardiogram; otherwise order one to be done

prior to TEE/stress echocardiogram

2. Must check TEE and stress echo list the evening before; and review CPRS esp. for labs, meds

orders etc so that there are less number of surprises in am.

3. Responsible for supervising (consents the patients /sign the forms) and reading stress tests,

Holters, EKG, pacemakers, echocardiograms and all graphic recordings. Prereading is

expected. Enter all tests results in computer and alerts requesting providers of results. Need to

call provider and patient of critical findings and document in chart.



FY2014

4. May need to see admission goes smoothly in those that need admission. All encounter forms

must be completed.

5. Help in cardiology clinic as needed.

Consult fellow

1. On call for cardiology when night float fellow’s duty is over. Takes sign-out from night float

and gives sign-out to night float

2. Make daily am rounds in cardiology service patients and evening sign out rounds with

residents. Write notes on critically ill patients or those with recent worsening in condition

3. Respond to all consults and write notes on all new consults. Supervise cardiology residents

4. Join cardiology clinics as assigned.

5. Supervises and read nuclear stress test. Consents the patients /sign the forms. Prereading is

expected. Enter all tests results in computer and alerts requesting providers of results. Need to

call provider and patient of critical findings and document in chart. May need to see admission

goes smoothly in those that need admission. All encounter forms must be completed.

6. Complete all encounter forms for event capture as needed for all outpatients.

7. Make rounds on weekends with the attending on call

Night float

1. Is responsible for all on call cardiology duty.

2. Take sign-out from the consult fellow at expected time of sign in.

3. Discusses patient with any provider that calls for advice from the VA hospital and give phone

advice as necessary.

4. Report promptly for cardiac procedures or any resident or ER or MOD request for emergent

cardiology help

5. Informs cardiology attending on call of all cardiac emergencies handled and discusses patients

with the attending who may consider seeing patient with the fellow as needed.

6. Provide documentation as needed in CPRS of services provided flagging note for cosigning for

the attending on call for that time as well as the provider that requested the consult.

7. Will note down patient’s name, last 4, requesting person name and number and reason for

consult for all non-emergent cases

8. Take on call responsibility for cardiology inpatients during VA off duty hours

9. Signoff patients and consults to the consult fellow in am at appropriate time.



FY2014

Kansas City Veteran’s Administration (KCVA) Medical Center

CCU/ Consult Rotation (VA Cons)

The educational purpose of this rotation is to acquire expertise in the evaluation and treatment of

patients with all types of adult cardiovascular diseases, including patients presenting with acute

coronary syndromes, arrhythmias, hypertension, cardiomyopathy, valvular heart disease, pericardial

disease, heart disease secondary to pulmonary pathologies, peripheral vascular disease, adult

congenital heart disease, and cerebrovascular disease.

This rotation is also a training venue for fellows in the evaluation of patients with heart disease

during pregnancy, multiorgan failure, and trauma. Approximately half of the patients have acute

coronary syndromes. The fellow is involved in the initial evaluation, management, and subsequent

treatment of patients. This includes evaluation and management of risk factors, in particular,

dyslipidemia, smoking, and obesity.

The fellow supervises cardiology residents and medical students on the CCU rotation. The

educational experience during this rotation consists of initial evaluation of patients by the fellows

concomitantly with the resident and the staff physician, who reviews pertinent features of the

history and physical exam, and establishes with the fellow a diagnostic and therapeutic plan for the

patient. All cases are discussed on a daily basis during rounds with the staff attending.

In addition, the fellow attends morning conferences at 7:00 am on Monday, Tuesday, Thursday and

Friday every week at the University of Kansas Medical Center, where admissions on the service

are discussed and reviewed in the presence of faculty attendings. They also attend a Research

conference on Wednesday at 7:00 am once a month. It is of note that during this rotation the

fellows care for patients at all stages of illness, following them from their initial acute stage to a

more stable stage.

The fellow takes sign-out from the night float and gives sign-out to night float. He/she makes

daily am rounds on cardiology service patients and evening sign out rounds with residents.



writes notes on all new consults that are not seen by the cardiology consult resident. He/she is

responsible for seeing all critical patients and notifying the appropriate VA staff.

Duration : PGY 4 fellows spend approximately1- 2 months on this rotation.


rotation.

PGY6 fellows normally provide coverage on this rotation.


with faculty):


Rotation Facility: Kansas City Veteran’s Administration Medical Center



FY2014

Required


7:00 am on Monday, Tuesday, Thursday and Friday at the University of Kansas Medical Center 7:00 am Research Conference Wednesday once a month. 12:00 pm Non-invasive Imaging Conference, Thursday twice a month




IMMM Internal Medicine Patient Safety

Conference















PGY 4 KCVA CCU/ Consult Rotation




Activities

Evaluation

Methods

Understand the pharmacology of cardiovascular drugs CCON

(CORE), AR

AE



AE



FY2014



AE



AE



AE



AE




Activities

Evaluation

Methods


CCON, AR AE



AE



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL





FY2014


Activities

Evaluation

Methods


DPC, AR AE, Eval


DPC, AR AE, Eval




Activities

Evaluation

Methods



AE




Activities

Evaluation

Methods


DPC, CCON AE




Objectives: Learning Activities

Evaluation Methods


CCON (EP), IMNC

AE


AE


AE


AE


NIC, (CAC), IMNC

AE



FY2014


AE


AE


CCON, NIC AE


AE


AE

Criteria for implantation of pacemakers CCON (EP), AR AE


CCON (EP), AR AE

Mechanisms of sudden death CCON (EP), AR AE




Activities

Evaluation

Methods



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL





FY2014


Activities

Evaluation

Methods


DPC, AR AE, Eval




Activities

Evaluation

Methods



AE



Objectives: Learning Activities

Evaluation

Methods


DPC, CCON AE





Activities

Evaluation

Methods


AE, DSP


AE


AE

Cardiovascular reflex and humoral control of the circulation CCON (CORE), AR

AE


AE


CCON, AR, IMGR

AE



FY2014


CCON, NIC, IMNC

AE




Activities

Evaluation

Methods


CCON, AR AE



AE



AE



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, EVAL



FY2014


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, CCON, (JC)

AE




Activities

Evaluation

Methods


DPC, CCON AE


DPC, CCON AE

Suggested Reading:




edition.




FY2014

The Kansas City Veteran’s Administration Medical Center

Non-Invasive Cardiology Rotation (VANI)

The echocardiography curriculum includes training in the anatomical and functional assessment of

cardiac valves, myocardium, pericardium, quantitation of cardiac chamber dimensions, areas, and

chamber volumes. Expertise is obtained in the use of pulsed-wave, continuous-wave and color

Doppler imaging.

The fellow trains in the performance and interpretation of transesophageal echocardiography. More

specifically, he/she train to identify on TEE, left atrial myxomas, left atrial thrombus, patent

foramen ovale, spontaneous echo contrast, ruptured mitral valve chordae/papillary muscle, aortic

dissection, and aortic debris. The fellow is taught stress echocardiography using exercise as well

as dobutamine, and dipyridamole or adenosine infusion. The fellow learns the use of

intraoperative transesophageal echocardiography in order to plan and evaluate the results of surgical

procedures.

Specific disorders that fellows receive are: evaluation of aortic stenosis, mitral stenosis, aortic

regurgitation, mitral regurgitation, tricuspid regurgitation, evaluation of prosthetic valves,

hypertrophic cardiomyopathy, infective endocarditis, pericardial disease, and identification of

intracardiac and intravascular embolic sources.

The fellow is responsible for reading nuclear stress tests, Holters, EKG, pacemakers,

echocardiograms, and all graphic recordings. The staff cardiologist reviews all studies interpreted

and read by the noninvasive fellow. Pre-reading is expected. The fellow enters all tests results in

the computer and alerts requesting providers of results if required. The fellow is expected to call

provider and patient of critical findings and document in chart. It is recommended that a recent

transthoracic echocardiogram be done prior to TEE. If one has not been done, the fellow and

attending need to discuss if one should be done prior to TEE/stress echo (if there is an appropriate

indication for TTE to be done first). The attending signs consent on patient’s whom procedures they

interpreted or oversaw.

Fellows are expected to achieve a level II training entailing interpreting performance of 150

complete echocardiographic studies and interpretation of at least 300 echocardiographic studies

during their noninvasive rotations.

Duration : PGY 4 fellows spend approximately 1-2 months on this rotation.

PGY5 fellows spend approximately 1-2 months on this rotation.

PGY6 fellows may use as an elective.


with faculty):

Fellows are always supervised by faculty.

Rotation Facility: Kansas City VA Medical Center



FY2014

Required


7:00 am on Monday, Tuesday, Thursday and Friday at the University of Kansas Medical Center 7:00 am Research Conference Wednesday once a month. 12:00pm Non-Invasive Imaging Conference, Thursday twice a month



CCON Morning Cardiology Conference --

These may have sub-types: (EP)

Electrophysiology, (CAC) Cardiac

Catheterization and Cardiothoracic

Surgery Conference, (EKG) EKG

Conference, (CORE) Core

Curriculum, (RSCH) Research

Conference, (JC) Journal Club, (MM)

Morbidity and Mortality Conference

IMMM Internal Medicine Patient Safety

Conference

CPC Internal Medicine Clinicopathogenic

Conference IMNC Internal Medicine Noon Conference













PGY 4 KCVA Non-Invasive


Goal: Demonstrate understanding of basic indications for cardiac ultrasound in patient care.


Activities

Evaluation

Methods

Anatomical and functional assessment of cardiac valves. CCON (CORE), NIC, DSP, (CAC)

AE, DSP



FY2014

Assessment of ventricular contractility, systolic and diastolic function.


AE, DSP

Evaluation of pericardial disease. CCON (CORE), NIC, DSP, (CAC), IMNC

AE, DSP

Evaluation of cardiac chamber dimensions, areas and chamber volumes.


AE, DSP

Assessment of pulsed wave, continous wave, Doppler and color flow imaging for valvular stenosis and regurgitation.


AE, DSP

Identify intracardiac masses including atrial myxomas, atrial thrombi and aortic debris.


AE, DSP

Evaluation of ruptured mitral valve chordae and papillary muscle dysfunction.

CCON (CORE), NIC, DSP, (CAC), IMNC

AE, DSP

Identification of patent foramen ovale. CCON (CORE), NIC, DSP, (CAC)

AE, DSP

Evaluation of cardioembolic foci. CCON (CORE), NIC, DSP, (CAC), IMNC

AE, DSP


Goal: Demonstrate understanding of ultrasound imaging and be able to perform limited transthoracic echocardiography.


Activities

Evaluation

Methods

Understand the indications, contra-indications, potential complications, and benefits for performing transthoracic, transesophageal, and stress echos.

CCON, NIC, DPC

AE

Learn the methods and technical aspects of two-dimensional echo, color flow Doppler, pulse and continuous wave Doppler, tissue Doppler, contrast and stress echocardiography.

CCON, FS, NIC, DPC

AE

Master the echo evaluation of valvular heart disease, cardiac systolic and diastolic function, pericardial disease, cardiomyopathies, and diseases of the aorta.

CCON, FS, NIC, DPC

AE

Learn the echocardiographic evaluation of congenital heart disease, infective endocarditis, cardiac masses and tumors.

DPC, NIC, FS AE





FY2014


Activities

Evaluation

Methods

Communicate effectively with patients and families in a stressful critical care environment. Communicate effectively with physician colleagues and members of other health care professions to assure timely, comprehensive patient

DPC AE

Communicate effectively with colleagues when reporting pertinent findings of echocardiographic studies.

DPC, FS AE


Goal: Demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population with cardiac disease.


Activities

Evaluation

Methods

Interact professionally toward patients, families, colleagues, and all members of the health care team. Interact with patients and families in a professionally appropriate manner.

DPC AE





Activities

Evaluation

Methods

Identify and acknowledge gaps in personal knowledge and skills in performing and interpreting echocardiographic studies.

DPC, NIC AE

Develop real-time strategies for filling knowledge gaps that will benefit patients in the echo lab, coronary care units, or other intensive care units.

DPC, NIC, JC AE

Commitment to professional scholarship, including systematic and critical perusal of relevant print and electronic literature, with emphasis on integration of basic science with clinical medicine, and evaluation of information in light of the principles of evidence-based medicine.

DPC, NIC, JC AE


Goal: Demonstrate an awareness of and responsiveness to the larger context of the health care system, provide adequate database understanding with importance to appropriate encounter documentation and the ability to effectively call on system resources to provide care in that is of optimal value to their cardiology patients.


Activities

Evaluation

Methods

Understand and utilize the multidisciplinary resources necessary to perform echocardiographic studies optimally on acutely ill cardiac patients.

DPC AE



FY2014


DPC AE

Consideration of the cost-effectiveness of diagnostic and treatment strategies.

DPC AE



Goal: Demonstrate ability to perform transthoracic echocardiography and interpret stress echo and perform TEE on patients with cardiovascular disorders.


Activities

Evaluation

Methods


AE, DSP



AE, DSP


AE, DSP



AE, DSP



AE, DSP



AE, DSP



AE, DSP


AE, DSP


AE, DSP


Goal: Demonstrate ability to understand principles of two dimensional and Doppler ultrasound imaging including color flow imaging of the heart as relates to patient management



FY2014


Activities

Evaluation

Methods


CCON, NIC, DPC

AE


CCON, FS, NIC, DPC

AE

Master the echo evaluation of valvular heart disease, cardiac systolic and diastolic function, pericardial disease,

cardiomyopathies, and diseases of the aorta.

CCON, FS, NIC, DPC

AE


DPC, NIC, FS AE




Activities

Evaluation

Methods


DPC AE


DPC, FS AE




Activities

Evaluation

Methods

Interact professionally toward patients, families, colleagues, and all members of the health care team.

Interact with patients and families in a professionally appropriate manner.

DPC AE



Goal: Learn to investigate and evaluate personal patient care practices, appraise and assimilate scientific evidence, participate in clinical research related to Cardiology, and improve personal patient care practices.



FY2014


Activities

Evaluation

Methods


DPC, NIC AE


DPC, NIC, JC AE


DPC, NIC, JC AE


Goal: Demonstrate an awareness of and responsiveness to the larger context of the health care system, provide adequate database understanding with importance to appropriate encounter documentation and the ability to effectively call on system resources to provide care in that is of optimal value to their cardiology patients.


Activities

Evaluation

Methods


DPC AE


DPC AE


DPC AE



Goal: Demonstrate understanding of emergency TEE indications, to be able to recognize importance of the right test for the right patient at the right time.


Activities

Evaluation

Methods


AE, DSP



AE, DSP



FY2014


AE, DSP



AE, DSP



AE, DSP



AE, DSP



AE, DSP


AE, DSP


AE, DSP


Goal: Demonstrate understanding of TEE and stress echocardiography for cardiac patients.


Activities

Evaluation

Methods


CCON, NIC, DPC

AE


CCON, FS, NIC, DPC

AE

Master the echo evaluation of valvular heart disease, cardiac systolic and diastolic function, pericardial disease, cardiomyopathies, and diseases of the aorta.

CCON, FS, NIC, DPC

AE


DPC, NIC, FS AE





FY2014


Activities

Evaluation

Methods


DPC AE


DPC, FS AE




Activities

Evaluation

Methods

Interact professionally toward patients, families, colleagues, and all members of the health care team. Interact with patients and families in a professionally appropriate manner.

DPC AE





Activities

Evaluation

Methods


DPC, NIC AE


DPC, NIC, JC AE


DPC, NIC, JC AE







FY2014


Activities

Evaluation

Methods


DPC AE


DPC AE


DPC AE

Suggested Reading:

1. CHAPTER 14 – Echocardiography by Heidi M. Connolly & Jae K. Oh in Braunwald's Heart

Disease- Coauthors of the book Peter Libby; Robert O. Bonow Publisher: Saunders Pub Date:

10/2007. 8th

edition

Select one of these textbooks to read during the rotation and use others for references

1. The Echo Manual Jae K. Oh; James B. Seward, Publisher: Lippincott, Williams and Wilkins Pub

Date 2006. 3rd

edition

2. Textbook of Clinical Echocardiography Catherine M. Otto, Publisher: SAUNDERS W B CO

Pub Date: 08/2004. 3rd

edition

3. Feigenbaum's Echocardiography Harvey Feigenbaum; William Armstrong, Publisher:

Lippincott Williams & Wilkins. 2009 5th

edition

4. The Echocardiographer's Pocket Reference Terry Reynolds, Publisher: ARIZONA HEART

INSTITUTE, Pub Date: 12/2007 3rd

edition

5. Weyman AE. Principles and practice of echocardiography. Philadelphia:Lea and Febiger. 2nd

edition

Additional referenced readings:

1. Color flow imaging by Joseph Kisslo 2. Doppler echocardiography by Liv Hatle.

Articles to read:

1. Cheitlin MD, Armstrong WF, Aurigemma GP, et al: ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography- summary article: A report of the American College of

Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J

Am Coll Cardiol. 2003; 42:954. 2. Quinones MA, Douglas PS, Foster E, et al: American College of Cardiology/American Heart

Association clinical competence statement on echocardiography: A report of the American

College of Cardiology/American Heart Association/American College of Physicians- American

Society of Internal Medicine Task Force on Clinical Competence. Circulation. 2003; 107:1068.

3. Stress Echocardiography: ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008

Appropriateness Criteria for (J Am Coll Cardiol 2008;51:1127-47)

4. COCATS 3: ACCF 2008 Recommendations for Training in Adult Cardiovascular Medicine Core

http://www.cardiotext.com/search/searchword%3DPeter%2BLibby%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DRobert%2BBonow%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DJae%2BOh%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DJames%2BSeward%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DCatherine%2BOtto%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DHarvey%2BFeigenbaum%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DWilliam%2BArmstrong%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1

http://www.cardiotext.com/search/searchword%3DTerry%2BReynolds%26sord%3D%26searchnow%3D1%26searchop%3Dauthor%26filter%3D1



FY2014

Cardiology Training (Revision of the 2002 COCATS Training Statement)

5. Echocardiography: ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 Appropriateness Criteria

for Transthoracic and Transesophageal echocardiography.

6. Echocardiography: ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of

echocardiography (J Am Coll Cardiol 2003;42:954-70)



FY2014

Kansas City Veteran’s Administration Medical Center

Invasive Cardiology Rotation (Va Cath)

During this rotation the fellow gains expertise in understanding, interpreting, and performing invasive

catheterizations, including right heart catheterizations, transvenous and transcutaneous pacing, left

heart catheterizations including coronary arteriography, left ventriculography, pericardiocentesis, and

percutaneous transluminal coronary angioplasty.

The fellow is trained in all aspects of invasive hemodynamics including measurement of cardiac

output by thermodilution and the Fick method; measurement of intrapulmonary and intracardiac

pressures; evaluation of systemic and pulmonary vascular resistance; measurement of intracardiac

shunts; evaluation of stenotic and regurgitant valvular lesions including aortic and mitral stenosis and

regurgitation. Also, the fellow learns about constrictive and restrictive physiology.

The indications and complications of diagnostic coronary angiography and ventriculography will be

reviewed in detail during this rotation and the morning report.

The fellow works daily in the catheterization laboratory directly with a staff attending performing

procedures. The fellow attends the morning report on a daily basis.

The fellow is involved in the invasive and interventional treatment of patients with acute coronary

syndromes including emergency angioplasty. There are in-depth discussions on the pathogenesis of

coronary artery disease and altered coronary physiology. Thus, the fellows obtain a detailed

review in coronary artery anatomy and physiology as well as cardiovascular metabolism. These

subjects are also discussed during the daily morning lecture at 7:00 am at the University of Kansas

Medical Center. At the end of the rotation an evaluation is performed by the staff attending and

discussed with the program director.

Fellow duties include:

• Stay scrubbed during interventions at the discretion of the staff cardiologist to help as needed,

but is an operator during the cardiac catheterization, pacemaker, and ICD implantations.

He/she is not required to write the procedure related notes unless they have directly

participated in the procedure.

• Pre-reading is expected. The invasive fellow will enter all procedures in the computer once

complete and reviewed by the staff cardiologist.

• The invasive fellow sends alerts about the procedural results to the requesting providers, for the

cases they are involved.

• The invasive fellow calls all necessary parties of critical findings and document in chart, for the

cases they are involved.

• May aide residents and primary team on admissions. The invasive fellow follows-up on all

CTS or other consults he/she has placed. He/she is responsible for contacting a mid-level

provider and notifying the staff, which supervised the procedure, of results or of results that need to

be followed up should they be off-site, on vacation, or otherwise away from the VA for an

extended period of time. It is optimal for fellow to assign a staff cardiologist and/or a NP as

additional report signer to facilitate this continuity of care.



FY2014

Duration : PGY 4 fellows spend approximately 1-2 months on this rotation.


rotation.

PGY6 Elective - one month rotation


with faculty):

Fellows are always supervised by faculty.

Rotation Facility: KCVA

Required




12:00pm Noninvasive Imaging Conference, Thursday twice a

month















below in the first column. The second column of the table lists the most relevant learning activities for

that goal, and the third column indicates the correlating evaluation methods for that goal. Specific

issues that will be discussed by the attending during the CCU rotation include and are not limited to

those listed below.



FY2014

PGY 4 KCVA Invasive/Cath Lab




Activities

Evaluation

Methods

Pre-procedural patient evaluation, post procedural follow-up protocols.

CAC, CCON, FS, DSP

AE, PL


AE, PL

Experience and expertise in the performance of coronary angiography and left ventriculography.

CAC, CCON, FS, DSP

AE, PL


CAC, CCON, FS, DSP

AE, PL



AE, PL


CAC, CCON, FS, DSP

AE, PL

Experience and expertise in placement utilization and indications for intra-aortic balloon counterpulsation placement.

CAC, CCON, FS, DSP

AE, PL




Activities

Evaluation

Methods

Expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of patients with chest pain and acute cardiac disease.

(CAC), DPC, FS

AE

Access and critically evaluate current medical information and scientific evidence relevant to acute cardiac care.

(CAC), DPC, FS

AE

Understand indications for aggressive anticoagulant and antiplatelet therapy as well as the mechanisms of action of the various agents.

(CAC), DPC, FS

AE

Understand the physiologic and pathophysiologic principles of invasive hemodynamic monitoring including indications.


AE

Develop and demonstrate in-depth knowledge of the principles of diagnosis and management of ischemic heart disease including unstable angina pectoris and myocardial infarction; congestive heart failure; rheumatic heart disease, and congenital heart disease.

(CAC), DPC, FS

AE



FY2014

Develop and demonstrate in-depth knowledge of the indications for, principles, complications, and interpretation of right and left heart catheterization, coronary angiography, ventriculography and percutaneous interventions.

(CAC), DPC, FS

AE




Activities

Evaluation

Methods


DPC, FS AE


DPC, FS AE


DPC, FS AE




Activities

Evaluation

Methods


DPC AE





Activities

Evaluation

Methods

Identify and acknowledge gaps in personal knowledge and skills in care of acute cardiac patients.

DPC, (CAC) AE


DPC, ( JC), (CAC)

AE



FY2014




Activities

Evaluation

Methods


DPC, (CAC) AE


DPC, ( JC), (CAC)

AE


DPC, (CAC) AE

PGY 5 KCVA Invasive/Cath Lab




Activities

Evaluation

Methods


CAC, CCON, FS, DSP

AE, PL


AE, PL


CAC, CCON, FS, DSP

AE, PL


CAC, CCON, FS, DSP

AE, PL



AE, PL


CAC, CCON, FS, DSP

AE, PL


CAC, CCON, FS, DSP

AE, PL





FY2014


Activities

Evaluation

Methods


(CAC), DPC, FS

AE


(CAC), DPC, FS

AE


(CAC), DPC, FS

AE



AE


(CAC), DPC, FS

AE


(CAC), DPC, FS

AE




Activities

Evaluation

Methods


DPC, FS AE


DPC, FS AE

Communicate effectively with colleagues when discussing results of various cardiac catheterization and interventions and further management

DPC, FS AE





FY2014


Activities

Evaluation

Methods


DPC AE





Activities

Evaluation

Methods


DPC, (CAC) AE


DPC, ( JC), (CAC)

AE




Activities

Evaluation

Methods


DPC, (CAC) AE


DPC, ( JC), (CAC)

AE


DPC, (CAC) AE





Activities

Evaluation

Methods


CAC, CCON, FS, DSP

AE, PL



FY2014


AE, PL


CAC, CCON, FS, DSP

AE, PL


CAC, CCON, FS, DSP

AE, PL



AE, PL


CAC, CCON, FS, DSP

AE, PL


CAC, CCON, FS, DSP

AE, PL




Activities

Evaluation

Methods


(CAC), DPC, FS

AE


(CAC), DPC, FS

AE


(CAC), DPC, FS

AE



AE


(CAC), DPC, FS

AE


(CAC), DPC, FS

AE





FY2014


Activities

Evaluation

Methods


DPC, FS AE


DPC, FS AE


DPC, FS AE




Activities

Evaluation

Methods


DPC AE





Activities

Evaluation

Methods


DPC, (CAC) AE


DPC, ( JC) (CAC)

AE




Activities

Evaluation

Methods


DPC, (CAC) AE



FY2014


DPC, ( JC), (CAC)

AE


DPC, (CAC) AE

Suggested Reading:

1. Baim DS, Grossman W: Grossman’s Cardiac Catheterization, Angioplasty, and Intervention.

Seventh Edition. Philadelphia, Lippincott Williams & Wilkins, 2006.

2. Topol EJ: Textbook of Interventional Cardiology. 5th Edition. Philadelphia, W.B. Saunders

Company, 2007.



FY2014

The VA Medical Center

Consultative Rotation (VA Cons)

The educational purpose of this rotation is to acquire expertise in consultative management of a wide

variety of clinical disorders in cardiology in a tertiary care medical center. This includes patients

with cardiology problems on the medical services as well as pre-operative evaluation and post-

operative management of patients undergoing non cardiac surgery. They will see patients on other

services such as neurology, psychiatry and obstetrics/gynecology.

The fellow will function under the supervision of the assigned V A staff cardiologist while

supervising medical residents and medical students assigned to this rotation. The assigned staff

cardiologist will make daily rounds with team members. The fellow will develop skills in providing

patient management as a consultant and enhance their communication skills with non- cardiology

physicians and medical professionals. The VA staff cardiologist reviews cardiac testing results on

cardiology consult patients with all team members on daily rounds.



writes notes on all new consults that are not seen by the cardiology consult resident.

In addition to the duties listed above the Fellow will be responsible for covering three half days in

the VA outpatient clinic.

Duration : PGY4 fellows spend approximately 1 month on this rotation.


rotation.



with faculty):



Required





a month





FY2014











EVAL Educational Committee Review

(every 6 months)






PGY 4 VA Consult Rotation




Activities

Evaluation

Methods

Understand the pharmacology of cardiovascular drugs CCON (CORE), AR

AE



AE



AE



AE



AE



FY2014



AE




Activities

Evaluation

Methods


CCON, AR AE



AE



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, Eval


DPC, AR AE, Eval





FY2014


Activities

Evaluation

Methods



AE




Activities

Evaluation

Methods


DPC, CCON AE





Activities

Evaluation

Methods


CCON (EP), IMNC

AE


AE


AE


AE


NIC, (CAC), IMNC

AE


AE


AE


CCON, NIC AE


AE


AE



FY2014


AE


CCON (EP), AR

AE


AE




Activities

Evaluation

Methods



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, Eval




Activities

Evaluation

Methods



AE



FY2014




Activities

Evaluation

Methods


DPC, CCON AE





Activities

Evaluation

Methods


AE, DSP


AE


AE


CCON (CORE), AR

AE


AE


CCON, AR, IMGR

AE


CCON, NIC, IMNC

AE




Activities

Evaluation

Methods


CCON, AR AE



AE



FY2014



AE



AE




Activities

Evaluation

Methods


DPC, AR, NCC AE


DPC, AR AE, SE


DPC, AR AE, EVAL




Activities

Evaluation

Methods


DPC, AR AE, EVAL


DPC, AR AE, EVALl




Activities

Evaluation

Methods


DPC, CCON, (JC)

AE





FY2014


Activities

Evaluation

Methods


DPC, CCON AE


DPC, CCON AE

Suggested Reading:




edition

3. Rochester, MN, Mayo Clinic Scientific Press, 2006

4. Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities:

Bethesda Conference 36 (Revision if BC 16 &26), April 19, 2005, J Am Coll Cardiol

2005;45:1318-73

5. Atrial Fibrillation: Performance Measures for Management of Patients with Nonvalvular Atrial

Fibrillation or Atrial Flutter, January 01, 2008, J Am Coll Cardiol 2008;51:865-906

6. Atrial Fibrillation, Key Data Elements and Definitions for Measuring the Clinical Management

and Outcomes of Patients With, January 01, 2004, J Am Coll Cardiol. 2004;44:475-95

7. 6. Guide to Warfarin Therapy, January 1, 2003, J Am Coll of Cardiol 2003;41:1633-52

8. 7. Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Guidelines on,

November 02, 2009, J Am Coll Cardiol 2009;54:e13-118

9. 8. Coronary Artery Bypass Graft Surgery: Guideline Update for, January 01, 2004, J Am Coll

Cardiol 2004;44:e213-e310

10. 9. Peripheral Artery Disease: Adults With, November 29, 2010, J Am Coll Cardiol.

2010;56:2147-81

11. 10. Thoracic Aortic Disease: Guidelines for the Diagnosis and Management of Patients With,

January 01, 2010, J Am Coll Cardiol; 55:e27-130

12. 11. Vascular Imaging with Computed Tomography and Magnetic Resonance, August 31, 2007, J

Am Coll Cardiol 2007;50:1097-114

13. 12. Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic):

Guidelines for the Management of Patients with, January 01, 2005, J Am Coll Cardiol

2006;47:1239-312


November 02, 2009;54:e13-118

In case a Fellow is absent the charts below will be used to maintain the necessary rotation coverage.



FY2014

OUTPATIENT CONTINUITY CLINIC The University of Kansas Medical Center


Outpatient Continuity Clinic at the University of Kansas Medical Center Kansas City Veteran’s Administration Medical Center, and the Mid America Cardiology (MAC) Clinic in

Overland Park, KS, State Ave., KS, and the University of Kansas Medical Center.

The ambulatory clinics for the cardiovascular fellows at KU Medical Center and the Kansas City

Veterans Administration Medical Center have been restructured. An ambulatory cardiovascular clinic

was developed for fellows at the MAC Clinics in Overland Park, KS, State Ave., KS, and at KU

Medical Center. Each cardiovascular fellow has a one-half day clinic per week. The clinic is in

the same location each week, and the fellow follows the same cadre of patients throughout their

cardiovascular fellowship experience. There is always a faculty member who is readily available to

supervise the cardiovascular fellow in this outpatient experience. Clinical skills, especially as

pertains to obtaining a pertinent history, performing a comprehensive examination, developing a

problem list, and determining when additional diagnostic and therapeutic interventions are necessary,

are addressed with the cardiovascular fellow in this outpatient ambulatory setting.

The cardiovascular fellow outpatient continuing care clinics are structured such that the fellow has

a wide variety of patients to follow. These include patients with coronary disease, valvular heart

disease, cardiac arrhythmias, and patients with permanent cardiac pacemakers and cardiac

defibrillators, patients with congestive heart failure, pericarditis, as well as cardiovascular

abnormalities associated with other medical illnesses such as rheumatoid arthritis and systemic lupus.

The cardiovascular fellows’ outpatient experience is evaluated every quarter. Generally, the

cardiovascular fellows see one to two new patients per half-day clinic along with two to four return

patients. Some patients remain in the ambulatory care clinic for extended periods of time and may be

followed by a fellow for as long as two to three years. This may include patients with frequent

angina pectoris or patients receiving continued permanent pacemaker surveillance. Other patients,

however, may be seen back in ambulatory clinic only once or twice following an angioplasty and

then return to their primary care physician. Some patients may be seen in the ambulatory clinic on

a one time only basis for consultation and then are immediately referred back to the primary care

physician.

The University of Kansas Medical Center and the Kansas City Veterans Administration Medical

Center have ambulatory care facilities located on site. Therefore, when noninvasive and invasive

cardiovascular procedures are required, they are performed within the laboratories maintained by

these respective institutions. The ambulatory care facilities are equipped with examination

rooms, receptionists, nurses, and general office equipment such as sphygmometers, ophthalmoscopes,

and otoscopes. Specimens for culture and blood work are analyzed by laboratories maintained by

their respective institutions. Similarly, MAC Liberty and MAC Overland Park clinics have on site

non-invasive cardiology facilities and ambulatory care facilities.

Generally, an entire database is completed on each new patient. This will include a description of

the chief complaint, a description of the history of present illness, a description of review of systems,

past medical history and surgical history, family history, social history, risk factor profile,

medications, allergies, a comprehensive physical examination, and review of laboratory, chest x-ray,

ECG, and stress testing along with any other noninvasive and invasive examinations. A problem list is

generated along with recommendations for diagnostic and therapeutic interventions. Generally, on



return patients, an updated present history and pertinent physical examination are obtained and an

assessment, in the form of a problem list, is generated with recommendations for diagnostic and

therapeutic interventions. The cardiovascular fellow presents each case to the faculty cardiologist and

is responsible for synthesizing their own assessment and plans for the patients they see in the

ambulatory care setting.

Duration : PGY 4 fellows spend one ½ day per week though the year.

PGY 5 fellows spend one ½ day per week though the year.

PGY 6 fellows spend one ½ day per week though the year.


with faculty):

Fellows are supervised by their attendings.


Required




12:00 pm Non-Invasive Imaging Conference, Thursday twice

a month





CPC Internal Medicine Clinicopathologic Conference






AE End of Rotation Attending Evaluation

PL Procedure Logs








Specific issues that will be discussed by the attending during the Outpatient Continuity Clinic

include and are not limited to those listed below.

PGY 4 Outpatient Continuity Clinic


Goal: Demonstrate competency in approach and management of patient cases.


Activities

Evaluation

Methods

Take complete medical history. Perform a careful and accurate examination with cardiology focus.

DPC, AR AE, SE


Goal: To evaluate chest discomfort in an outpatient setting.


Activities

Evaluation

Methods

Expand knowledge base to care for patients with chest pain and acute coronary syndromes.

CCON, (CAC), IMGR, IMNC, AR, FS

AR, SE




Activities

Evaluation

Methods

Communicate effectively with patients and families in an outpatient setting.

DPC, AR, AE, EVAL

Interact with patients and family in a professional, appropriate manner.

DPC, AR, AE, EVAL

Communicate effectively with referring physicians when performing consults.

DPC, AR, AE, EVAL




Activities

Evaluation

Methods

Interact professionally towards patients, families, and members of the health care team.

DPC AE

Understand the social context of illness. DPC AE

Understand the importance of utilization of end of life

cardiac care

CCON, DPC,IMNC, IMGR

AE






Activities

Evaluation

Methods

Learn to identify and acknowledge gaps in personal knowledge and skills in care of chronic cardiac patients.

DPC, CCON AE, EVAL



Objective: Learning

Activities

Evaluation

Methods

Effective professional collaboration with other parts of health care team.

DPC, NCC AE



Goal: Demonstrate competency in approach and management of patient cases.


Activities

Evaluation

Methods

Recognize the physical findings of chronic congestive heart failure, acute pulmonary edema, mitral regurgitation, mitral stenosis, and aortic stenosis.

DPC, FS, AR AE

Formulate comprehensive and accurate problem list, concise diagnosis and plans of managing patients with acute and chronic cardiovascular illnesses.

DPC, CCON, AR AE, SE

Evaluate and manage patients with chronic cardiac illnesses, particularly atherosclerosis, congestive heart failure, arrhythmias and valvular heart disease.

DPC, CCON, FS, AR, IMNC

AE, SE, EVAL

Effectively manage patients with undiagnosed chest pain including appropriate use of diagnostic testing, including appropriate admission.

DPC, (CAC) AE, SE

Perform review and recognize results of cardiac stress testing, cardiac sonography and coriangiography.

DPC, (CAC), FS, DSP, EKG, NIC

AE, DSP

Interpret complex EKG and complex surface EKG findings and Holter monitor and event recorder findings.

DPC, CCON, EKG

AE

Manage patients who have undergone interventional procedures including focusing on secondary prevention.

DPC, CCON, CAC

AE

Counsel patients on primary risk factor prevention. DPC, CCON, IMGR, IMNC

AE






Activities

Evaluation

Methods

Understand mechanisms of action and indications for anticoagulation and antiplatelet agent.

CCON, AR, (CAC), IMNC, IMGR

AR




Activities

Evaluation

Methods


DPC, AR, AE, EVAL


DPC, AR, AE, EVAL


DPC, AR, AE, EVAL




Activities

Evaluation

Methods

Interact professionally towards patients, families, and members of the health care team.

DPC AE

Appreciate the social context of illness. DPC AE


Goal: Investigate and evaluate personal patient care practices, appraise and assimilate scientific evidence related to Cardiology, and improve personal patient care practices.


Activities

Evaluation

Methods

Identify and acknowledge gaps in personal knowledge

and skills in care of chronic cardiac patients.

DPC, CCON AE, EVAL





Objective: Learning

Activities

Evaluation

Methods

Consideration of cost effectiveness of diagnostic and therapeutic strategies.

CCON, DPC AE



Goal: Demonstrate competency in approach and management of patient care.


Activities

Evaluation

Methods

Provide concise, accurate, informative history, physical examination, clinic notes with a cardiology focus.

DPC, AR, FS AE, SE

Manage cardiovascular risk factors such as hypertension, diabetes, hyperlipidemia from hyperhomocysteinemia and smoking.

DPC, IMGR, CCON, IMNC, IMGR

AE




Activities

Evaluation

Methods

Develop knowledge of principles and treatment of hypertension, ischemic heart disease, congestive heart failure, cardiac arrhythmias, especially atrial fibrillation, valvular and congestive heart disease.

CCON, AR, (CAC), IMGR, IMNC, EP

AR

Develop knowledge of indications for principles and interpretation of ECG, Holter Monitoring, Stress testing, both treadmill and pharmacologic, transthoracic and Tranesophageal echocardiography, and nuclear cardiac imaging.

CCON, DPC, AR

AR

Understand principles and implementation of primary and secondary risk factor modification.

CCON, DPC, AR

AE




Activities

Evaluation

Methods


DPC, AR, AE, EVAL


DPC, AR, AE, EVAL




DPC, AR, AE, EVAL




Activities

Evaluation

Methods

Appreciate the social context of illness. DPC AE

Effect utilization of end of life cardiac care CCON, DPC, IMNC, IMGR

AE




Activities

Evaluation

Methods

Develop professional scholarship with emphasis on integration of basic science and clinical medicine with principles of evidence based medicine.

CCON, JC AE



Objective: Learning

Activities

Evaluation

Methods

Understand and utilize multidisciplinary resources to optimally care for chronic cardiac patients.

CCON, DPC, NCC

AE


Cardiovascular Diseases Fellowship Department Rules/Understandings

E. CONFERENCES Fellows are expected to attend conferences throughout their training. Fellows attend CV Morning

Conference, Research Conference, Non-Invasive Conference, Grand Rounds, and Core Curriculum Conferences, CPC, and Patient Safety Conferences. Fellows will receive a weekly conference schedule

and the monthly conference schedule is available at all times.

The CV Morning Conference is held every day, except Wednesdays, at 7am in the Dunn Conference

Room, Room 1001 Delp. It is mandatory that all fellows attend the morning conference. However, if a

Fellow is doing a KU CCU rotation they may be excused from attending Morning Conference.

Fellows must maintain an cumulative average of 80% attendance. There are a variety of topics which

include EKGs, Journal Club, CCU M&M, Cath Conferences, etc.

The Research Conference is held the third Wednesday of the month at 7am with the Cardiovascular

Research Institute (CVRI). Attendance is mandatory.

Non-Invasive Imaging Conference is held every other Thursday at noon. Every effort should be

made to attend.

F. SCHOLARLY ACTIVITY

Fellows are required to conduct a research project during their fellowship. An oral presentation at a national conference is strongly encouraged by the Division. Other acceptable scholarly activities

include peer-reviewed publications, poster presentations, or other similar activity approved by a Program Director.

Each fellow is expected to make several presentations during their fellowship. These may take the

form of conducting a journal club, CCU M&M, preparing a presentation (a topic of interest or

assigned by the chief fellow) or various other short presentations as directed by the attending

physician. While such presentations are an invaluable component of fellowship training, they do not

qualify as the needed research project.

G. ELECTIVES The Division enthusiastically supports fellows who wish to engage in research projects during their

training or explore electives outside of the traditional fellowship program.

Fellows can take up to six months (two months per PGY level) during their training to conduct

research, as long as the fellow is deemed in good standing by the Program Director. Elective

rotations are present at each year with increasing duration based on level of training. Electives are

approved by the Program Director.

H. DEFICIENCY AND REMEDIATION

Please refer to the GME Policies and Procedures Manual section 4, for a comprehensive section on deficiency and remediation policies.



Definitions and Policies of Remediation and Probation

Remediation is the process in which the faculty of a Program and a fellow judged to be performing

at a less than satisfactory level work together to identify, understand, and correct the cause(s) for the

fellow’s deficiencies.

Probation identifies a fellow as requiring more intensive levels of supervision, counseling and/or

direction than is required of other fellows at the same training level in the same program.

Disciplinary Actions

Should fellow be found to be deficient in any of the criteria or parameters of performance and not meet advancement or promotion specifics, he/she will meet with the Program Director, wherein 1) The expectations and deficiencies will be stated, 2) What the individual can do to improve will be explored

and planned, and 3) An attempt will be made to determine if there are outside factors which may explain why a problem has developed. At this point a determination will be made of whether the fellow

is in good standing or is in a Performance Warning Status (PWS).

The PWS will involve a period of 3 months, where the performance of the fellow can be monitored

more closely. PWS is designed to identify weaknesses that, if not remedied, may lead to probation or

dismissal. The Program Director will be responsible for determining the process for remediation.

This meeting will be documented, given to the fellow for his/her agreement of the meeting content,

and a final copy will go into the fellow’s personal file. Unless otherwise stated, a fellow in

Performance Warning Status is still considered to be in good standing and does not have to report

this action on future professional applications. Should, however, the fellow be placed in Performance

Warning Status again after the initial 3 month period, he/she is eligible to be placed on probation.

Should the fellow continue to be deficient despite appropriate counseling, professional assessment

and input (if indicated), and faculty efforts, a period of probation (usually 3 months) is indicated.

Before being placed on probation, the fellow will appear before a committee of one CV fellow, 2 CV

faculty members and the Program Director wherein his/her case will be discussed. The fellow in

question will have the right to rebuke the claims made against him/her. If his/her performance is

deemed to warrant probation then formal written communication of probation will be drafted.

Written communication of probation should:

1) State deficiencies that the individual has been counseled for and document that

insufficient improvement has been made,

2) State explicitly that because of this the individual is being put on probation,

3) State period of probation,

4) State what is expected during this period,

5) State what will be done to assist the individual in meeting these expectations,

6) State what the mechanism(s) will be to determine improvement and

7) State what the consequences or options are to be if expectations are not met.

The deficient fellow will receive this written communication and a copy will go into his/her



personal file. Fellows placed on probation may have difficulty with licensure in some

jurisdictions. The probationary period is intended to emphasize to the fellow the importance of

satisfactorily meeting the fellowship training requirements. The fellow should clearly appreciate

the meaning of expected remediation, appreciate the defined time in which this must be

accomplished, and alert his/her attending faculty during this period of probation to the

importance of helping the fellow with defined problems. The faculty should provide an honest

evaluation, should there be any possibility of personal problems, learning disability, or outside

factors that may be contributory to the fellow’s performance.

Fellows on probation must achieve a satisfactory evaluation from their attending faculty on

assigned clinical service rotations during their probationary period. Probationary actions will

only be shared with those needing to know, and will not be disclosed to other fellows or students.

Should the fellow fail the above probationary period, then at the discretion of the Department, written

communication extending the probation may be issued, or written communication dismissing the

fellow from the program on a designated date will be issued, assuming that dismissal was a

consequence of probationary failure as stated above. Accompanying this written communication

must be a statement of the fellow’s right of appeal.

A fellow who may or may not have been on probation (and successfully accomplished remediation

in the probationary period), but who has received intermittent low satisfactory or isolated

unsatisfactory marks during the 8 to 12 months of the academic year (and particularly following a

probationary period), may be asked to repeat the year.

The Program extends many professional courtesies to its’ fellows and asks that fellows be

professional and alert the Program Director well in advance of his/her intended date of

departure. Similarly, the Program reserves the right not to renew a contract for any fellow it

deems as performing in an unsatisfactory manner.

I. EVALUATIONS Please refer to the GME Policies and Procedures Manual section 9 for more information.

Utilizing an electronic evaluation format, each fellow is evaluated monthly in the six aforementioned

competencies by their attending physician. Additionally, the fellow is required to evaluate their

attending, themselves, and receives an evaluation from peers, clinic preceptors, nursing personnel

and patients. The goal is to achieve a multi-source evaluation of the fellow’s work and

communication skills.

Evaluations are intended to be drafted with an emphasis on constructive assistance with particular

suggestions for improvement. However, if the fellow feels that the evaluation is unfair, inaccurate

or unwarranted, then, it is his/her right to refute the legitimacy of the evaluation with a written

response. This will be reviewed by the Program Director, and further action will be taken as needed

to clarify the discrepancy. The fellow’s written response will become part of the fellow’s

permanent file.



All of the evaluations are reviewed by the Program Director and are placed in the fellow’s file,

which is available to the fellow for review at any time. It is encouraged that the attending and

fellow speak directly about their evaluation at the completion of each rotation. Evaluations play a

key role in deciding whether or not to advance a fellow to the next level of training. Fellows

receive direct feedback on a semiannual basis by way of a documented meeting with the Fellowship

Director and faculty to discuss content of these evaluations amongst other performance measures.

The criteria for advancement and final matriculation from the fellowship program are based upon the

satisfactory achievement of the following core competencies as outlined by the American College of

Graduate Medical Education (ACGME). The six core competencies are as follows (Patient Care,

Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication

Skills, Professionalism, and Systems-Based Practice.

A summary of who receives and can view data regarding all evaluations in the e-value system is as

follows:

Who can see what?

0 = can see nothing

1 = can see data, but not who said it, nor can they see the full evaluation

2 = can see the data but not who said it. They can see the full evaluation

3 = can see the data and who said it but not the full evaluation

4 = can see everything

Program

Faculty

of

Resident

Resident

of

Faculty

Faculty

of

Program

Resident

of

Program

Peer Nurse of Resident

Program Director CARD 4 2 4 2 2 2

Program

Coordinator CARD 4 2 4 2 2 2

Resident CARD 4 1 N/A 1 1 1

Faculty CARD 1 1 1 N/A N/A 1

• FACULTY OF FELLOW- The faculty evaluates the fellow at the end of every

monthly rotation through E-Value. Each evaluation is specific to the rotation with

numeric scale questions and comments.

• FELLOW OF FACULTY- The fellow evaluates the faculty at the end of their

monthly rotation through E-Value which includes both numeric scale questions and

comments. The fellow’s evaluation of faculty is anonymous; these evaluations are

batched and un-identified when shared with faculty.

• FELLOW OF PROGRAM- The fellow evaluates the program at the end of the year

through E-Value. The ACGME also has an annual evaluation which fellows are

expected to participate.

• SEMI-ANNUAL- Twice a year the fellow will meet with the program director and

evaluation committee to discuss their performance, based on information from faculty,

evaluations, in service training exam and procedure numbers. The purpose of these



sessions is to review the fellow’s portfolio for completion, provide feedback, counseling,

assistance, and listen to suggestions.

• FINAL SUMMATIVE- The final summative evaluation is held at the end of the

academic year for graduating fellows. This evaluation summarizes the fellow’s

performance for the duration of their fellowship.

• 360°- The primary goal of the 360 evaluation is to allow fellows to get different

perspectives on their performance. a) Nurse- a nurse will evaluate the fellow twice a year through E-Value.

b) Lab tech- A Lab Tech will evaluate the fellow twice a year through E-Value.

c) Peer- A peer will evaluate the fellow twice a year through E-Value.

d) Self-evaluation- you will evaluate yourself twice a year through E-Value.

e) Staff- Administration will evaluate the fellow twice a year through E-Value.

f) Patient- Program Director or staff member will have a patient fill out the paper

evaluation twice a year.

J. GRIEVENCE

Please refer to the GME Policies and Procedures Manual section 13 for more information.

A grievance procedure is available to fellows for resolution of problems relating to their

appointments or responsibilities, including differences with the School, Program, or any

representative thereof. The School ensures the availability of procedures for redress of grievances,

including complaints of discrimination and sexual harassment, in a manner consistent with the law

and with the general policies and procedures of the University of Kansas and the School. The

grievance process is available to all fellows in the programs sponsored by the School of Medicine.

K. PROFESSIONALISM

1. Adhere to basic ethical principles a. Document and report clinical information truthfully

i. Follow formal policies

b. Accept personal errors and honestly acknowledge them

c. Uphold ethical expectations of research and scholarly activity

2. Demonstrate compassion and respect to patients

a. Demonstrate empathy and compassion to all patients

b. Demonstrate a commitment to relieve pain and suffering

c. Provide support (physical, psychological, social and spiritual) for dying

patients and their families

d. Provide leadership for a team that respects patient dignity and autonomy

3. Provide timely, constructive feedback to colleagues

a. Communicate constructive feedback to other members of the health care team\

b. Recognize, respond to and report impairment in colleagues or substandard care

via peer review process

4. Maintain Accessibility

a. Responsibilities including but not limited to calls and pages

b. Carry out timely interactions with colleagues, patients and their designated

caregivers



5. Recognize conflicts of interest

a. Recognize and manage obvious conflicts of interest, such as caring for family

members and professional associates as patients

b. Maintain ethical relationships with industry

c. Recognize and manage subtler conflicts of interest

6. Demonstrate personal accountability

a. Dress and behave appropriately

b. Maintain appropriate professional relationships with patients, families and staff

c. Ensure prompt completion of clinical, administrative, and curricular tasks

d. Recognize and address personal, psychological, and physical limitations that may

affect professional performance

e. Recognize the scope of his/her abilities and ask for supervision and assistance

appropriately

f. Serve as a professional role model for more junior colleagues (e.g., medical

students, interns)

g. Recognize the need to assist colleagues in the provision of duties

h. Must be responsible for finding coverage for certain rotations

7. Practice individual patient advocacy

a. Recognize when it is necessary to advocate for individual patient needs

i. Effectively advocate for individual patient needs

8. Comply with public health policies

a. Recognize and take responsibility for situations where public health

supersedes individual health (e.g. reportable infectious diseases)

9. Respect the dignity, culture, beliefs, values and opinions or the patient

a. Treat patients with dignity, civility and respect, regardless of race, culture,

gender, ethnicity, age or socioeconomic status

b. Recognize and manage conflict when patient values differ from their own

10. Confidentiality

a. Maintain patient confidentiality

b. Educate and hold others accountable for patient confidentiality

11. Recognize and address disparities in health care

a. Recognize that disparities exist in health care among populations and that they may

impact care of the patient

b. Embrace physicians’ role in assisting the public and policy makers in

understanding and addressing causes of disparity in disease and suffering

c. Advocates for appropriate allocation of limited health care resources.

L. IMPAIR MENT

Satisfactory performance includes the absence of significant impairment (impaired function of a fellow to a degree that it is causing less than satisfactory performance, and/or the impaired function, if not

corrected or is uncorrectable, is likely to lead to future unsatisfactory performance) due to physical, mental, or emotional illness, personality disorder, or substance abuse. Every effort will be made to

reasonably accommodate those individuals with conditions or impairments that qualify as a disability under applicable law, provided that the accommodation does not present an undue hardship for the

Department, the Medical School, or venues of training. Fellows will nevertheless be required to satisfactorily meet the Division’s performance criteria, requirements, and expectations of the



Cardiovascular Diseases Fellowship Program. Please refer to Kansas University Medical Center’s Graduate Medical Education Policy Manual for the details of institutional policy regarding

identification of impairment, reintegration into training, and ongoing monitoring of affected fellows.

III. DEPARTMENT RULES/UNDERSTANDINGS

A. DUTY HOURS

Limitations on Resident Duty Hours

The School policy is that resident duty hours will be in compliance with the guidelines established by the

Accreditation Council for Graduate Medical Education (ACGME). Each ACGME RRC may impose stricter duty

hour restrictions in their program requirements. Each program’s leadership should be familiar and fully comply with these requirements.

Exceptions to Duty Hour Policy

The GME Leadership and the GMEC will carefully evaluate the duty hour exception request through the GMEC

Major Program Change Application. The GMEC’s criteria for application approval depends upon the specific

Major Program Change being requested, but generally relate to the application’s merit with regards to how the proposed change;

1. Enhances the education of the Program residents (i.e., improvement in education/service ratio, introduction of unique educational experience),

2. Does not detract from the education of surrounding ACGME-accredited core and affiliated residency

programs, 3. Substantially improves compliance of a program with ACGME Program or Institutional

requirements,

4. Improves resident safety and well-being (i.e., improvement in work environment) and

5. Maintains or improves the quality of patient care.

The GMEC will review the application according to the written procedures and criteria for endorsing requests for

an exception to the duty hour limits delineated in the ACGME Manual on Policies and Procedures. If allowed by the program’s ACGME Residency Review Committee, exceptions for up to 10% or a maximum of 88 hours may

be considered. The duty hour exception application will be reviewed by the GMEC prior to submission to the

ACGME. Approved applications will also be monitored during the Program’s Internal Review, Site Visit

Preparation process and at other intervals dependent on program and GME duty hour monitoring. Review will also be considered if other interval accreditation issues arise. The overall Review Criteria are described on the

Application Tracking Form, but duty hour exception applications also include, but are not limited to;

1. Allowances specified in the ACGME Program Requirements,

2. Magnitude and PGY-level of duty hour exception requested,

3. Educational rationale for exception in terms of service/education ratio and rotations, 4. Anticipated effects on patient safety,

5. Program’s current moonlighting policy and level of moonlighting,

6. ACGME accreditation history with special regard to duty hour rule compliance,

7. Appropriateness and anticipated effectiveness of enhanced duty hour monitoring process, and 8. Program outcomes (i.e., first-attempt Board certification pass rate, disciplinary issues, scholarly

activity level).



Duty hours are defined as all clinical and academic activities related to the residency program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient

care, time spent in-house during call activities, and scheduled activities such as conferences. Duty hours do not

include reading and preparation time spent away from the duty site.

a) Duty hours must be limited to 80 hours per week, averaged over a four week period, inclusive of all in-house

call activities and all moonlighting.

b) Duty periods of PGY-1 residents must not exceed 16 hours in duration.

c) Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as 1 continuous 24-hour period free from all clinical,

educational, and administrative duties.

d) Adequate time for rest and personal activities must be provided. This should consist of a 10-hour time and MUST have an 8-hour time period provided between all daily duty periods for PGY-1 and intermediate-level

residents. Intermediate-level residents must have 14 hours free of duty after 24 hours of in-house duty.

e) Senior-level residents will be defined by each ACGME RRC, but generally includes residents in their final

years of education. It is desirable that senior-level residents have 8 hours free of duty between scheduled duty

periods. Each ACGME RRC will define specific circumstances when senior-level residents may stay on duty to care for their patients or return to the hospital with fewer than 8 hours free of duty. Circumstances of return-to-

hospital activities with fewer than 8 hours away from the hospital by the senior-level residents must be

monitored by the Program Director.

The resident is expected to be rested and alert during duty hours, and the resident and resident’s attending

medical staff are collectively responsible for determining whether the resident is able to safely and effectively

perform his/her duties.

If a scheduled duty assignment is inconsistent with the Resident Agreement or the Institutional Duty Hours and

Call Policies, the involved resident shall bring that inconsistency first to the attention of the Program Director for

reconciliation or correction. If the Program Director does not reconcile or correct the inconsistency, it shall be

the obligation of the resident to notify the Department Chair or Associate Dean for Graduate Medical Education,

who shall take the necessary steps to reconcile or correct the raised inconsistency The School policy is that fellow duty hours will be in compliance with the guidelines established by the Accreditation Council

for Graduate Medical Education (ACGME) for Cardiovascular Diseases. Please reference the GME Policies and Procedures Manual section 15.

Duty hours are defined as all clinical and academic activities related to the fellowship program; i.e.,

patient care (both inpatient and outpatient), administrative duties relative to patient care, the

provision for transfer of patient care, time spent in-house during call activities, and scheduled

activities such as conferences. Duty hours do not include reading and preparation time spent away

from the duty site.

Duty Hour Rules and Regulations

a. Duty hours must be limited to 80 hours per week, averaged over a four-week period,

inclusive of all in-house call activities.



b. Fellows must be provided with one day in seven free from all educational and clinical

responsibilities, averaged over a four-week period, inclusive of call.

c. Adequate time for rest and personal activities must be provided. This should consist of a 10-

hour time period provided between all daily duty periods and after in-house call.

The fellow is expected to be rested and alert during duty hours, and the fellow and fellow’s attending

medical staff are collectively responsible for determining whether the fellow is able to safely and

effectively perform his/her duties.

Call Schedules

The objective of on-call activities is to provide fellows with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day,

when fellows are required to be immediately available in the assigned institution.

In-house call must occur no more frequently than every third night, averaged over a 4-week

period.

Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Fellows may

remain on duty for up to six additional hours to participate in didactic activities, transfer care of

patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.

No new patients may be accepted after 24 hours of continuous duty.

a. The frequency of at-home call is not subject to the every third-night, or 24+6 limitation.

However at home-call must not be so frequent as to preclude rest and reasonable personal time

for each fellow.

b. Fellows taking at-home call must be provided with one day in day completely free from all

educational and clinical responsibilities, averaged over a four-week period.

c. When fellows are called into the hospital from home, the hours fellows spend in-house are

counted toward the 80-hour limit.

B. ELIGIBILITY AND SELECTION

Please reference the GME Policies and Procedures Manual Section 4 for more information.

1. Graduation from an acceptable medical school, as outlined by the University of Kansas, School of

Medicine and the Kansas State Board of Healing Arts (KSBHA):

a. Graduation from a medical school in the United States or Canada accredited by the

Liaison Committee on Medical Education (LCME), or

b. Graduation from a college of osteopathic medicine in the United States accredited by

the American Osteopathic Association (AOA), or



c. Graduation from an acceptable medical school outside the United States or Canada with

one of the following:

d. Successful completion of a Fifth Pathway program provided by an LCME accredited

medical school, or

1. A current, valid certificate from the Educational Commission for Foreign Medical

Graduates (ECFMG) prior to appointment, or

2. All Canadian citizens and eligible Canadian Landed Immigrants who are NOT

graduates of a foreign medical school must hold a status, which allows

employment as a medical resident, and maintain an appropriate status throughout

the length of the graduate medical training program. Possession of valid

immigration documents which verify the status must be presented, or

3. A full, unrestricted license to practice medicine in the State of Kansas.

e. Foreign medical schools are deemed acceptable as defined by the KSBHA (K.S.A.

652873).This is the minimum standard for graduates of foreign medical schools, however

individual programs may have more stringent requirements for foreign medical school

graduates:

f. Inclusion in the list of “approved” medical schools on the KSBHA’s website

(http://ksbha.org/medicalschoolsapprovedunapproved.html),

g. The school must not appear on the list of “disapproved” schools, also on the KSBHA

website,

h. If the school has not been specifically approved by the Board, an applicant may still

be eligible for a license if the school has not been disapproved and has been in

operation (date instruction started) for not less than 15 years,

i. Medical schools that are established less than 15 years ago are not immediately

approved and will need to be approved by the KSBHA on a case by case basis.

1. The established date for any foreign school not specifically excluded should be

determined using the FAIMER tool at http://imed.ecfmg.org/search.asp. A

school appearing on the FAIMER website, but without an established date may

still be eligible and must be approved by the KSBHA. Please use the “Foreign

School Verification Request Form” on the KSBHA website under the

“FORMS” heading.

j. To be eligible for appointment, all Canadian citizens and eligible Canadian Landed

Immigrants who ARE graduates of a foreign medical school must seek and maintain

sponsorship through ECFMG for J1nonimmigrantvisa status.

2. The Office of Graduate Medical Education reserves the right to reject any candidate at the

point it is determined that they have matriculated from an unacceptable medical school.

http://ksbha.org/medicalschoolsapprovedunapproved.html)

http://imed.ecfmg.org/search.asp



3. Some ACGME program requirements stipulate further qualifications that must be met for

eligibility to an ACGME accredited program at the University of Kansas. Additionally, some

program may have more stringent qualifications requirements as specified in their individual

program manuals.

4. To be eligible, applicant must meet with or without reasonable accommodation, all duties and

responsibilities as described in our policy and procedure manual 20

http://www.kumc.edu/eoo/forms.html.

C. SUPERVISION

Levels of fellow supervision must be in compliance with these RRC program requirements. Please reference the GME Policies and Procedures Manual Section 23 for more information.

The University of Kansas, School of Medicine gives fellows significant but appropriately, well-

supervised latitude in the management of all patients and provides a comprehensive experience in

Cardiovascular Diseases in order for them to become independent and knowledgeable clinicians

with a commitment to the life-long learning process that is critical for maintaining professional

growth and competency.

During a fellow’s training, all patient care and educational activities are to be under Program

Faculty supervision. Each patient must have an identifiable, appropriately-credentialed and

privileged attending physician or RRC-approved licensed independent practitioner who is ultimately

responsible for their care. A patient’s responsible supervising attending physician or licensed

practitioner should be identified to fellows, faculty members and patients. Fellows and faculty

members should inform patients of their respective roles in each patient’s care.

The appropriate level of supervision depends on the individual fellow’s level of competency as

determined by their knowledge, skill and attitudes. The appropriate level of Program Faculty

supervision for each fellow is determined by the responsible Program Faculty, Program Director,

Division Chair, and Department Chair.

Levels of fellow supervision must be in compliance with these RRC program requirements

Classification Levels of Supervision:

a. Direct Supervision: the supervision physician is physically present with the fellow

and patient

b. Indirect Supervision with direct supervision immediately available: the supervising

physician is physically within the hospital or other site of patient care, and is

immediately available to provide Direct Supervision

c. Indirect Supervision with direct supervision available: the supervising physician is

not physically present within the hospital or other site of patient care, but is

immediately available by means of telephonic and/or electronic modalities, and is

available to provide Direct Supervision

http://www.kumc.edu/eoo/forms.html



d. Oversight: the supervising physician is available to provide review of

procedures/encounters with feedback provided after care is delivered

There are multiple layers of supervision of fellow educational and patient care activities, including

supervision by an advanced-level fellow. Advanced-level fellow supervision is recognition of

progress toward independence and demonstration of graded authority and responsibility. The final

level of supervision is the responsibility of the responsible Program Faculty and Program Director.

Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of

each fellow and delegate to him/her the appropriate level of patient care authority and responsibility.

The privilege of progressive authority and responsibility, conditional independence, and a

supervisory role in patient care delegated to each fellow must be assigned by the program director

and faculty members. The program director must evaluate each fellow’s abilities based on specific

criteria. When available, evaluation should be guided by specific national standards- based criteria.

Faculty members functioning as supervising physicians should delegate portions of care to fellows

based on the needs of the patient and the skills of the fellows. Each fellow must know the limits of

his/her scope of authority, and the circumstances under which he/she is permitted to act with

conditional independence.

D. WORK ENVIRONMENT

The University of Kansas Medical Center will:

a. provide a stipend and benefits to the fellow as stipulated in the applicable Resident

Agreement;

b. use its best efforts, within the limits of available resources, to provide an educational

training program that meets the ACGME's accreditation standards;

c. use its best efforts, within the limits of available resources, to provide the fellow with

adequate and appropriate support staff and facilities in accordance with federal, state,

local, and ACGME requirements;

d. orient the fellow to the facilities, philosophies, rules, regulations, procedures and

policies of the Medical Center, School, Department and Program and to the

ACGME’s and RRC’s Institutional and Program Requirements;

e. provide the fellow with appropriate and adequate faculty and Medical Staff supervision

and guidance for all educational and clinical activities commensurate with an individual

fellow’s level of advancement and responsibility;

f. allow the fellow to participate fully in the educational and scholarly activities of the

Program and Medical Center and in any appropriate institutional medical staff

activities, councils and committees, particularly those that affect Graduate Medical

Education and the role of the staff in patient care subject to these policies and

procedures;



g. through the officers of the program and the attending medical staff, clearly

communicate to the fellow any expectations, instructions and directions regarding

patient management and the fellow’s participation therein;

h. maintain an environment conducive to the health and well-being of the fellow;

i. within limits of available resources, provide:

j. adequate and appropriate food service and sleeping quarters to the fellow while on-call

or otherwise engaged in clinical activities requiring the fellow to remain in the Medical

Center overnight;

i. personal protective equipment including gloves, face/mouth/eye protection in

the form of masks and eye shields, and gowns. The Occupational Safety and

Health Administration (OSHA) and the Centers for Disease Control (CDC)

assume that all direct contacts with a patient’s blood or other body substances

are infectious. Therefore, the use of protective equipment to prevent parenteral,

mucous membrane and non-intact skin exposures to a healthcare provider is

recommended;

ii. patient and information support services;

iii. security; and

iv. uniform items, limited to scrub suits and white clinical jacket;

k. through the Program Director and Program faculty, evaluate the educational and

professional progress and achievement of the fellow on a regular and periodic basis.

The Program Director shall present to and discuss with the fellow a written summary of

the evaluations at least semi-annually;

l. provide a fair and consistent method for review of the fellow’s concerns and/or

grievances, without the fear of reprisal;

m. provide fellows with an educational and work environment in which may raise and

resolve issues without fear of intimidation or retaliation including the following

mechanisms:

n. The GME office ensures that all programs provide their fellows with regular, protected

opportunities to communicate and exchange information on their educational and work

environment, their programs, and other fellow issues, with/without the involvement of

faculty or attending. Such opportunities include, but are not limited to, confidential

discussion with the chief residents, program director, program chair, core program

director, and/or core program chair. Other intradepartmental avenues to confidentially

discuss any fellow concern or issue occur during the Annual Program Evaluations

completed by each fellow and/or through discussion with the fellow representative



during the required Annual Program Review (Annual Program Outcomes Assessment

and Action Plan Report);

i. ii) The internal review process, during which fellows in each program are

afforded the opportunity to discuss their concerns about their programs with

a fellow from another program and have them presented confidentially to the

GMEC;

ii. iii) An ombudsman, the Assistant Dean for GME Administration, or any other

member of the GME staff, including the Executive Vice Chancellor, Senior

Associate Dean and the Associate Dean, who are available for the fellows to

bring any issues raised in these protected fellow meetings, or any other issues a

fellow may need to address;

iii. iv) Peer leadership and membership of the University of Kansas, School of

Medicine Resident’s Council, who are available to confidentially receive

any fellow concern and present their concerns to the Graduate Medical

Education Committee and GME Staff;

iv. v) E*Value “On-The-Fly” praise and concern comments can be sent through

E*Value directly and confidentially to those program directors that offer this

service. In addition, “On-The-Fly” comments can be confidentially sent to

the DIO. This can be accessed through any fellow’s E*Value user menu.

v. vi) ACGME Resident Survey, administered directly to all residents/ fellows in

ACGME-accredited Programs. This survey provides summary and anonymous

feedback to Program and GME Leadership. For programs with less than four

residents/fellows the GME Resident Survey, which is a confidential,

anonymous survey organized by the GME office, is administered annually;

vi. vii) a grievance process, as outlined in section 13 of this Manual, which

provides the fellow with a formal mechanism for addressing serious concerns

within their programs;

vii. viii) ACGME Department of Resident Services at [email protected]

or by phone (312) 755-7498 is available if the above described avenues have not

satisfactorily addressed a specific resident issue. The ACGME Resident Services

representative will work with the DIO to resolve issues surrounding concerns.

Valid complaints are processed by Resident Services and will require a response

from the program director and attestation to the response by the DIO, and review

by the relevant review committee.

o. upon satisfactory completion of the Program and satisfaction of the Program's

requirements and the fellow’s responsibilities delineated herein, furnish to the fellow

a Certificate of Completion of the Program;

mailto:[email protected]

mailto:[email protected]



p. annually review and approve the number of fellows and funding sources for each

program and discuss these quotas and sources of funding with the chair and Program

Directors in a timely fashion so as to facilitate the recruitment and retention of

residents;

q. provide the agreed upon levels of financial support, subject to the terms of the fellow

contract; and

r. exercise all rights and responsibilities expressed and implied by the “Institutional

Requirements” of the ACGME.

E. MOONLIGHTING

Moonlighting must not interfere with the ability of the fellow to achieve the goals and objectives of

the educational program.

** First years are not allowed to moonlight during the first six-months of their program.

Moonlighting must be considered part of the 80-hour weekly limit on duty hours.

The ability to moonlight with departmental sanction is regulated by the Program Director. There are

only a few approved sites for moonlighting; currently these include the Topeka VA, the Kansas City

VA, the University of Kansas Medical Center and the Leavenworth VA. Additional site requests

must be submitted in writing to the Program Director for approval.

Moonlighting is not a right, it is a privilege. Cardiovascular fellows must be in good standing and

progressing steadily through the Department to be sanctioned to moonlight.

Moonlighting is not permitted on certain rotations (CCU and supervisory services), and must not

conflict with training assignment, call schedule, or patient responsibilities. In order to participate in

moonlighting, cardiovascular fellows must read and sign the policy sheet provided by the department.

All moonlighting hours are counted toward weekly work hours, which must not exceed 80 hours total.

In addition, all duty hour requirements regarding residency may apply to moonlighting as well, and

must not be violated. Cardiovascular fellows cannot moonlight if doing so brings them into conflict

with duty hour requirements while performing their normal duties. Cardiovascular fellows with J-1

or H-1B visas are not eligible to moonlight.

Please reference the GME Policies and Procedures Manual section 7 for more information.

IV. BENEFITS

Refer to GME Policies and Procedures Manual section 5.5 for more information.

A. VACATION DAYS The University will provide up to maximum of three weeks (15 workdays) of vacation, per year, which



is covered by the fellow stipend. Vacation cannot be accumulated from year to year. Vacation must be requested from and approved by the Program Director or a designee in advance in the manner

prescribed by the program. Denial of a specific request for vacation is a management decision on the part of the officers of the program..

Fellows need to submit their vacation request 30 days in advance, or 45 days if rotating at the VA.

Also, if rotating at the VA, CCU, or Night Float you must have another fellow provide coverage

which is documented by both parties by signing the vacation request form. Only one fellow is

allowed to be on vacation while at the VA.

Once the vacation request form is filled out appropriately the request for time off has to be approved

by a chief fellow and the program director (by signing the vacation request form). If rotating at the

VA, the site director must approve time off. Administrative staff will notify you if your vacation

request has been approved or denied. Your vacation request has not been approved until you receive

an email from administrative staff.

B. SICK DAYS The University will provide up to 10 workdays of sick leave per year to cover personal illness or illness

in the fellow’s immediate family (spouse, parents or children). Sick leave cannot be accumulated from year to year. The use of sick leave must be approved by the Program Director or Department Chair. At

the discretion of the Chair or Program Director, a physician’s written statement may be required as a condition of approval for sick leave.

C. PROFESSIONAL DAYS

The University of Kansas will provide all fellows with paid professional leave at the discretion of the Program Director for the following reasons:

a) While in the due process phase of a fair hearing or if relieved of clinical and patient care

duties for reasons of suspension or probation.

b) Scholarly presentations at national or regional conferences

c) Conference attendance in a community away from the University of Kansas Medical

Center

d) Studying for medical board examinations e)

Taking medical board examinations

f) Interviews for jobs or fellowships

Fellows need to submit their professional development request 30 days in advance, or 45 days if

rotating at the VA. It will need to be signed off by both a chief fellow and program director.

D. MATERNITY LEAVE It is important to inform the Chief Fellows and the Program Director promptly upon knowledge of

pregnancy. This permits necessary adjustments in the schedule. Obstetrical appointments are handled as any other medical appointment; a fellow should inform the rest of his/her team.

Any unused sick leave/vacation time can be used to cover maternity leave. Should a leave of

absence exceed accrued time, stipend payments will be interrupted. However, family health

insurance benefits will continue as long as the fellow pays the individual premium. (See the



University House Staff Policies & Procedures Manual, Section 15.2). In addition, fellows are

required to make up time at the end of residency should they exceed their accumulated time for

leave. This is subject to departmental approval, as the Department of Medicine becomes financially

responsible for a fellow’s salary if training is completed “off-cycle,” or after June 30 of the third year

of training.

For a maximum of 8 weeks of maternity leave, the following schedule is recommended:

• 1 week of sick leave (no outpatient clinical duties)

• 3 weeks of vacation (no outpatient clinical duties, and no other vacation used the

rest of the year)

• 4 weeks of reading elective (one ½ day of outpatient continuity clinic per

week)

E. PATERNITY LEAVE/ADOPTION

It is important to inform the Chief Fellows and the Program Director as soon as paternity

leave/adoption is anticipated. This may permit assignment to a service less likely to be adversely

affected by an unexpected absence.

Any unused sick leave/vacation time can be used to cover leave. Should a leave of absence exceed

accrued time, stipend payments will be interrupted and time will need to be made up at the end of

fellowship training. However, family health insurance benefits will continue as long as the fellow

pays the individual premium. (See the University’s House Staff Policies and Procedures Manual for

more information).

F. PAY

Fellows get paid every two weeks, starting two weeks after the fellow completes the first pay period.

G. MEDICAL INSURANCE Medical insurance is paid by the University but fellows do have a choice regarding particular

plans. This is the same choice offered to University employees. Detailed information on the various coverage plans will be made available during the new fellow’s orientation.

H. LIFE INSURANCE

The Department purchases a group term life insurance policy for all of its fellows without the necessity of prior examination. This includes accidental death and dismemberment protection in the

amount of $50, 000. This policy is convertible to permanent life insurance within 31 days of leaving the group. This benefit should be kept firmly in mind as the training program finishes.

I. MALPRACTICE INSURANCE

While practicing medicine at the KU Medical Center and its affiliated hospital training sites, fellows are covered by a self-insurance plan administered by the State of Kansas. This policy

provides standard coverage for all activities typical to internal medicine. There is tail coverage for any suits filed after a fellow has left the Department for a period of 3 years.

This policy covers fellows only while practicing under approved circumstances in the KU Medical

Center and its affiliated hospitals. In general, this is not confining. However, when considering



issues related to moonlighting, there may not be coverage provided for non-affiliated hospitals.

Fellows moonlighting or doing locum tenens without the benefit of prior approval by the Programs

Directors cannot be guaranteed malpractice coverage. Fellows must be most acutely aware of

this when moonlighting in a non-affiliated institution. Neither malpractice nor disability insurance

applies to these sites. It is the fellow’s responsibility to know if they have coverage during

moonlighting time.

J . DISABILITY INSURANCE

The Department insures fellows should they become disabled and cannot work. The policy pays

$1000/month if benefits begin 181 days after the disability. This policy takes effect without the necessity of a qualifying physical examination.

This policy may be converted to private use, again without requiring an examination, if one decides

to do so within 31 days of the termination of with the Department. This is potentially a very valuable

benefit which should be considered as one approaches the end of training. There are multiple

supplemental policies which will be covered in one of the orientation lectures.

K. PARKING

Parking is provided by the Department in the Bluff Parking Garage at KU at the beginning of the academic year. If Bluff Parking is not available, the fellow will receive Red Parking. Parking at the Kansas City VA Hospital is also provided (by the VA). Parking stickers must be obtained from the Medicine office at the VA and fellows should park only in designated areas.

L. WHITE COATS

The hospital provides each fellow with three white coats. Fellows should be aware that it is

official medical school policy that white coats with name and hospital ID be worn at all times. This same policy states that no other buttons, stickers, pictures, appliqués, statements, political comments etc. adorn the white coats.

M. ACCESS TO MEDICAL LITERATURE AND BOARD PREP MATERIALS

The Archie Dykes Library for the Health Sciences is located across 39th Street north of the hospital. The library stocks the vast majority of commonly desired periodicals by the clinical and basic science staff. Books and manuals are also readily available. Access to the library’s electronic

journals and databases are available online through the KUMC website, both on and off campus. Any library fines are the responsibility of the fellow and it is possible that a graduating diploma

could be withheld until library fines are paid in full. All the University and KCVA hospital computers have Up To Date on them and internet access to the Dykes library is available. There are books

available in the educational offices located in 1001 Eaton that are to be used like the library; they are loaned by the month. Books have been provided by the Department, faculty or drug companies.

The Division of Cardiovascular Diseases pays for a membership of CardioSource Plus through the

American College of Cardiology.

N. FITNESS CENTER

The Kirmeyer Fitness Center, located on the corner of Rainbow and Olathe across from the Med Center, is open to all employees of the Med Center. The center has exercise equipment, aerobics



rooms, a basketball court, racquetball courts, a circular track and a lap pool. Some of the facilities are unavailable during the day since these are used by Rehab Med and the Sports Medicine

program. However, the Center opens at 6 AM and remains open in the evening and weekends for participant use. Fees are reasonable but not covered by the Department.

O. MEETINGS

Fellows are encouraged to attend and present at the 5 major national meetings which include AHA, ACC, American Society of Echo, Heart Failure Society of America, and Heart Rhythm. The

fellowship will pay up to $900.00 for attending one of these conferences (the fellow needs permission from Program Director and Chair if it is a different conference). If after you attend a conference, but

are planning on presenting the program will pay up to $600.00.

Second and third year fellows are urged to attend the Mayo Board Review Course. The division will

pay up to $995.00 for the conference (the fellow may be taxed through Endowment).

P. MEAL CARDS

Meal cards are given to fellows at the start of their fellowship. The fellow will receive $16.00 per day

for each night they are on Night Float. Also, fellows working on holidays will receive the daily allowance. The meal card balance will not carry over from month to month or converted into cash or

any other device (such as a gift card).

Q. RESIDENT ASSISTANCE AND ACCESS TO COUNSELING

The University of Kansas Medical Center is interested in the health and wellbeing of its residents. At

some time, members of the resident staff may be faced with a variety of personal problems that may

affect their wellness and job The PWS will involve a period of 3 months, where the performance of the

fellow can be monitored more closely. PWS is designed to identify weaknesses that, if not remedied,

may lead to probation or dismissal. The Program Director will be responsible for determining the

process for remediation. This meeting will be documented, given to the fellow for his/her agreement of

the meeting content, and a final copy will go into the fellow’s personal file. Unless otherwise stated, a

fellow in Performance Warning Status is still considered to be in good standing and does not have to

report this action on future professional applications. Should, however, the fellow be placed in

Performance Warning Status again after the initial 3 month period, he/she is eligible to be placed on

probation.

Should the fellow continue to be deficient despite appropriate counseling, professional assessment and

input (if indicated), and faculty efforts, a period of probation (usually 3 months) is indicated. Before

being placed on probation, the fellow will appear before a committee of one CV fellow, 2 CV faculty

members and the Program Director wherein his/her case will be discussed. The fellow in question will

have the right to rebuke the claims made against him/her. If his/her performance is deemed to warrant

probation then formal written communication of probation will be drafted. Written communication of

probation should:

1) State deficiencies that the individual has been counseled for and document that insufficient

improvement has been made,



2) State explicitly that because of this the individual is being put on probation,

3) State period of probation,

4) State what is expected during this period,

5) State what will be done to assist the individual in meeting these expectations,

6) State what the mechanism(s) will be to determine improvement and

7) State what the consequences or options are to be if expectations are not met.

The deficient fellow will receive this written communication and a copy will go into his/her personal

file. Fellows placed on probation may have difficulty with licensure in some jurisdictions. The

probationary period is intended to emphasize to the fellow the importance of satisfactorily meeting the

fellowship training requirements. The fellow should clearly appreciate the meaning of expected

remediation, appreciate the defined time in which this must be accomplished, and alert his/her

attending faculty during this period of probation to the importance of helping the fellow with defined

problems. The faculty should provide an honest evaluation, should there be any possibility of personal

problems, learning disability, or outside factors that may be contributory to the fellow’s performance.

Fellows on probation must achieve a satisfactory evaluation from their attending faculty on assigned

clinical service rotations during their probationary period. Probationary actions will only be shared

with those needing to know, and will not be disclosed to other fellows or students. Should the fellow

fail the above probationary period, then at the discretion of the Department, written communication

extending the probation may be issued, or written communication dismissing the fellow from the

program on a designated date will be issued, assuming that dismissal was a consequence of

probationary failure as stated above. Accompanying this written communication must be a statement of

the fellow’s right of appeal.

A fellow who may or may not have been on probation (and successfully accomplished remediation in

the probationary period), but who has received intermittent low satisfactory or performance. While

some individuals attempt to deal with such problems on their own, there are times when professional

assistance can be helpful.

It is in the best interests of the University, and its residents to provide assistance to those with personal

problems involving alcohol, drugs, family, marriage, finances, emotions, or other conditions which

may interfere with work attendance, productivity, and the ability to get along with co-workers. The

University believes that an effective Assistance Program encourages wellness and promotes efficiency

of its residents.

The University has a policy to maintain a drug-free workplace because drug abuse in the workplace

may cause serious harm to any resident's health, work performance and social interactions. To avoid

these adverse situations, the University encourages its residents to seek counseling and assistance from

on-campus and community resources.

The School’s Employee and Student Assistance Program is designed to provide information,



assessment and referral services to help faculty, staff, residents and students identify problems and

develop lifestyles that are physically and emotionally healthy. The University wants to encourage

identification of problems at the earliest possible stage to motivate the residents or their families to

seek assistance.

There are a number of resources available to residents experiencing personal problems:

18.1 The Department of Psychiatry

18.1.1 Offers a full range of inpatient, outpatient, and emergency services for the diagnosis and

treatment of personal problems, including chemical dependency. The department is professionally

staffed by psychiatrists, psychologists, and social workers and appointments may be made through the

Psychiatry Clinic or individually through the private practices of these faculty members. Information

about these services can be obtained by calling the Department of Psychiatry at 588-6400.

18.2 Kansas State Medical Advocacy Program

18.2.1 A Kansas medical license may be revoked, suspended or limited if a health care provider

becomes unable to practice with reasonable skill and safety due to physical or mental disabilities,

including deterioration through the aging process, loss of motor skills or abuse of drugs or alcohol.

Kansas law does provide a Medical Advocacy Program which providers can contact in lieu of

contacting the Kansas State Board of Healing Arts. The goal of the Medical Advocacy Program of the

Kansas Medical Society is to confidentially rehabilitate and support the provider whenever possible.

Under the Impaired Practice provisions of the program, confidential assistance is offered to residents

who suffer from chemical dependency or other forms of impairment. The phone number of the Medical

Advocacy Program is 1-800-332-0156 or 1-913-235-2383. Informational brochures about these

programs can be obtained from the Graduate Medical Education Office, the Student Center or the

Dean's Office of School of Medicine. You may also contact the Risk Manager in the Office of General

Counsel for further information.

18.3 University Counseling Center and the Psychological Clinic

18.3.1 Also available to KUMC residents is the counseling and educational support center located in

the Student Center G116. The counseling center’s contact number is (913)588-6580. Residents may

find help with the following:

• Training Exam coaching

• USMLE Step 3 Preparation

• Specialty Board Exam Assistance

• Educational & Performance Excellence Coaching

• Manage Stress/Time

• Residency Demands

• Personal Life Demands

• Relationships / Marital / Family Concerns

• Personal Counseling

• Psychiatric Counseling

• Consultation and Referrals

• Crisis Intervention

• Lending Library- in training & board exams



Counseling may be provided without cost or on a sliding-fee basis depending on the facility used.

These facilities are staffed by professional-level or practicum counselors. All services are provided in

the strictest of confidence.

18.4 State of Kansas HealthQuest

18.4.1 An additional source of assistance for residents needing confidential counseling, medical, and

psychological support services is the State of Kansas HealthQuest, 24-hour, toll-free assistance line (1-

800-284-7575); if referred through the HealthQuest, the first counseling session is paid by the State.

All contacts are kept in strict confidence.

Residents may also contact or be referred to off-campus resources as appropriate. Counseling costs are

often covered by health insurance with proper referral from the resident’s primary health care provider.

Ideally, the decision to seek counseling will be made by the affected resident, however, there may be

situations where referral is recommended or required by the Medical Center, the School of Medicine,

the Hospital Medical Staff, or the Officers of a resident’s program. Such situations generally arise

when performance or behavior problems are observed in the course of supervision of the resident’s

training. In these cases, the individual making the recommendation or imposing the requirement should

not attempt to diagnose the problem(s). Rather, the resident should be encouraged to seek professional

assistance.

cardiovascular fellowshandbook (pdf) - university of kansas

Documents