GCRMC Cardiology

Cardiology Eval

Faculty Chair:

Leandrita Ortega, MD

Contacts:

Required Experiences:

Gerald Champion Regional Medical Center

Optional Experience:

Elective rotations

Weekly Schedule PGY 2 or 3:

Sunday Monday Tuesday Wed Thursday Friday Saturday
Clinic Cards-AM Cards-AM Clinic Cards-AM
Clinic Cards-PM Didactics Clinic Clinic

Requirements:

AOA

Internal Medicine

The program must provide at least thirty-two weeks of clinical training in internal medicine disciplines, including at least eight weeks of general internal medicine experiences during the OGME-1 year. This requirement can be met by either inpatient internal medicine or inpatient family medicine service.

At a minimum internal medicine training must include:

  • Twenty-four weeks of inpatient experience.
  • Four weeks of training in critical care medicine.
  • Didactic and clinical training.

Internal medicine training shall include exposure to the following disciplines, in either inpatient or outpatient settings:

  • Allergy and immunology.
  • Cardiology.
  • Dermatology.
  • Endocrinology.
  • Gastroenterology.
  • Hematology.
  • Infectious diseases.
  • Nephrology.
  • Neurology.
  • Oncology.
  • Pulmonology.
  • Rheumatology.

ACGME

There must be specific subspecialty curricula to address the breadth of patients seen in family medicine. (Core)

The program must ensure that every resident has exposure to a variety of medical and surgical subspecialties throughout the educational program. (Detail)

Description of Rotation or Educational Experience:

Cardiovascular disease is a major cause of morbidity and mortality in our society. The family physician should be proficient in the diagnosis and management of a variety of cardiovascular disorders. Family physicians provide comprehensive and continuing care to individuals and families, with particular attention to behavioral and lifestyle factors.

The depth of experience for each resident depends on the expected practice needs of the resident, especially in terms of practice location, available facilities, and accessibility of consultants. At times the family physician may find it appropriate to seek consultation from a cardiologist to either manage or co-manage a patient for optimal care.

Expectations:

Residents

Residents are expected to arrive to Cardiology and continuity clinics on time and to dress and act in a professional manner. They are expected to contact the Cardiology preceptors’ office prior to their first day on the rotation in order to arrange the initial meeting time and location of the rotation. It is expected that while at the preceptors’ office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty:

Family medicine faculty will provide precepting of Cardiology cases and procedures as seen in resident continuity clinics. Dr. Leon, Colato, Canon, and possibly other physicians, will provide precepting during the focused Cardiology rotation. The faculty and preceptors are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of cardiac conditions and their treatments.

Call:

There is no call specific to this rotation.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

    • Perform an appropriate cardiac history and physical examination, document findings, develop an appropriate differential diagnosis, and plan for further evaluation and management. (Patient Care, Medical Knowledge, Interpersonal and Communication Skills)
    • Use evidence based knowledge regarding primary and secondary prevention of cardiovascular disease. (Medical Knowledge, Patient Care)
    • Review current practices regarding the care of patients with cardiovascular disease and develop plans to improve the care. (Patient Care, Medical Knowledge, Practice- based Learning and Improvement, Professionalism)
    • Work with physicians, nurses, pharmacists, dieticians, and other health care professionals who care for patients with common cardiovascular diseases. (Patient Care, Medical Knowledge, Professionalism, Systems-based Practice)

Objectives

In the appropriate setting, the resident should demonstrate the ability to perform or appropriately refer:

  1. Diagnostic procedures:
    1. Performance of history taking and physical examination
      1. Mechanics and interpretation ofECG
      2. Interpretation of chest radiographs
      3. Treadmill/bicycle stress test monitoring and interpretation
      4. Ambulatory ECG monitoring and interpretation
    2. Therapeutic procedures
      1. Riskmanagement
      2. Cardiopulmonary resuscitation (CPR), both basic life support (BLS) and advanced cardiac life support (ACLS)
      3. Treating dysrhythmias and conduction disturbances
      4. Use of external temporary pacemakers
      5. Management of acute myocardial infarction, postinfarction care, and complications
      6. Congestive heart failure
      7. Hypertensive emergencies
      8. Supervision and management of cardiovascular rehabilitation
      9. Psychosocial issues
        1. Sexual functioning
        2. Depression
        3. Family dynamics
      10. Management of patients after an intervention
        1. Lifestyle adjustments
        2. Coronary artery bypass surgery
        3. Valve surgery
        4. Congenital heart disease surgery
        5. Catheter-related interventional procedures

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

  • Be able to understand normal cardiovascular development, anatomy and physiology.

Objective:

In the appropriate setting, the resident should demonstrate the ability to apply knowledge of:

    1. Normal cardiovascular anatomy and physiology
  2. Changes in cardiovascular physiology with age and pregnancy
  3. Risk factors
    1. Coronary artery disease
      1. Hyperlipidemia
      2. Cigarette smoking
      3. Genetic predisposition
      4. Sedentary life style
      5. Hypertension
      6. Diabetes mellitus
      7. Obesity
      8. Nutrition
      9. Hormonal status
      10. Emotional stress
    2. Valvular heart disease
  4. Cardiovascular history
  5. Cardiovascular physical examination
  6. Noninvasive examinations
    1. Electrocardiography
    2. Chest radiography
    3. Stress testing, including treadmill/bicycle or pharmacologic techniques
    4. Echocardiography/Doppler imaging, both rest and stress, using treadmill/bicycle or pharmacologic techniques
    5. Radioisotope imaging, both rest and stress, using treadmill/bicycle or pharmacologic techniques
    6. ECG monitoring, in-hospital and ambulatory
    7. Vascular Doppler and ultra sound examinations
    8. Computerized tomography (CT)
    9. Magnetic resonance imaging (MRI) and Magnetic resonance angiogram (MRA)
  7. Invasive examinations
    1. Diagnostic cardiac catheterization and angiography
    2. Diagnostic carotid and peripheral vascular angiography
    3. Intracoronary and peripheral vascular intervention using appropriate devices
    4. Internal monitoring devices
      1. Central venous and peripheral arterial catheter
    5. Electrophysiologic studies
    6. Indications and contraindications of therapeutic interventions
      1. Coronary artery bypass
      2. Angioplasty techniques and stent placement
      3. Pacemaker insertion
      4. Implantable cardioverter-defibrillator
      5. Valve replacement/repair, percutaneous balloon valvotomy
      6. Electrophysiologic ablation
  8. Relevant laboratory interpretation, including serum enzymes, isoenzymes, lipids, and b-type natriuretic peptide (BNP) or pro-BNP.
  9. Specific diseases/condition
    1. Coronary artery disease
      1. Stable and unstable angina
      2. Myocardial infarction, with and without complications
        1. Cardiogenic shock
        2. Dysrhythmias
        3. Papillary muscle dysfunction and rupture
        4. Ventricular rupture
        5. Aneurysm
      3. Sudden death
    2. Syncope, cardiogenicandnon-cardiogenic
    3. Dysrhythmias
      1. Tachyarrhythmia
        1. Supraventricular
        2. Ventricular
        3. Reentrant
      2. Bradyarrhythmia
      3. Ectopy
        1. Atrial
        2. Ventricular
    4. Hypertension
      1. Essential
      2. Secondary
      3. Pulmonary
    5. Pulmonary heart disease
      1. Cor pulmonale
    6. Heart failure
      1. Systolic dysfunction
      2. Diastolic dysfunction
    7. VenousThromboembolic disease (VTE)
    8. Valvular heart disease
      1. Rheumatic
      2. Congenital
      3. Degenerative
      4. Mitral valve prolapse syndrome
    9. Congenital heart disease
      1. Common left to right shunts (acyanotic)
      2. Common right to left shunts (cyanotic)
      3. Common obstructive problems
    10. Dissecting aneurysm
    11. Innocent heart murmurs
    12. Peripheral vascular disease
      1. Aneurysm
      2. Carotid atherosclerosis
      3. Arterial disease
      4. Arteriosclerosis obliterans
    13. Cardiomyopathies
      1. Congestive (dilated)
      2. Restrictive
      3. Hypertrophic cardiomyopathy
      4. Postpartum
      5. Infection-related
      6. Viral myocarditis
      7. Subacute bacterial endocarditis
      8. Kawasaki’s disease
    14. Other cardiac disorders
      1. Immunologic
        1. Acute rheumatic fever
        2. Autoimmune disorders
      2. Psychogenic
      3. Traumatic
      4. Nutritional
      5. Myxoma
      6. Thyroid dysfunction
      7. Marfan syndrome
      8. Drug-related such as cocaine, steroids and chemotherapeutic agents
    15. Evaluation of cardiac patient for noncardiac surgery
      1. Cardiac risk including preoperative assessment tools
      2. Preoperative and postoperative management
    16. Antibiotic prophylaxis for valvular disease
  10. Cardiovascular pharmacology

Practice Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

  • Be able to recognize his or her own practice limitations and seek consultation with other health care providers to provide optimal care.

Objectives

  • Complete assigned reading topics and apply learned material in the clinical setting
  • Demonstrate ability to identify limitations in own knowledge and take steps to fill these gaps.

System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

  • Be able to optimize treatment plans based on knowledge of local resources that include local, state and federal agencies.
  • Coordinate ambulatory, in-patient and institutional care across health care providers, institutions and governmental agencies.

Objectives

  • Make appropriate referrals to and coordinate care with neurologists for those conditions that fall out of the scope of family medicine or do not respond to that treatment which family physicians can provide
  • Demonstrate cost effective care and diagnostic testing

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

The list below reflects competencies that fall under Professionalism. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

  • Compassion, integrity, and respect for others
  • Responsiveness to patient needs that supersedes self-interest
  • Respect for patient privacy and autonomy

Objectives

  • Display sensitivity for patient privacy and autonomy during exams and procedures
  • Engage in interviewing techniques which demonstrate cultural and social sensitivity

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

The list below reflects competencies that fall under Interpersonal and Communication Skills. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

  • Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
  • Act in a consultative role to other physicians and health professionals

Objectives

Communicate with patients and their families in a respectful, and concise manner that facilitates understanding with minimal jargon.

Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed. They will participate in weekly conferences. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

Direct observation with a ongoing global assessment based on the REDI system. All procedures will be recorded on New Innovations and independence for each procedure assessed using the REDI system. Evaluation from each of the community preceptors to be completed at the end of the rotation. Review of documentation by family medicine preceptors as part of continuity clinic supervision.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.

Educational Resources

Readings:

Week 1

Week 2

Week 3

Week 4

Text Books

Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders; 2008.

Wagner GS, Marriott HJ. Marriott’s Practical Electrocardiography. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008.

Web Sites

American Academy of Family Physicians. Board review questions, including cardiology groupings. http://www.aafp.org/online/en/home/cme/boardrev/questions.html.

American Academy of Family Physicians, American Family Physician. Topics in cardiology. http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId= 4. Updated June 14, 2011.

American College of Cardiology. http://www.acc.org. American College of Chest Physicians Evidence Based

Guidelines. http://www.chestnet.org/education/hsp/guidelinesProducts.php. Centers for Disease Control and Prevention. http://www.cdc.gov/HeartDisease/.

Updated July 7, 2011.

National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/guidelines/.

Location 2450 S. Telshor Blvd. Phone 575-521-5378 E-mail john.andazola@lpnt.net
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