Family Medicine Residency Program

Curriculum for

CARDIOLOGY

Introduction:

This is a one block (4 week) mandatory rotation in the 2nd year of the residency program under the supervision of the Hospital Cardiologist. The resident will have an opportunity to evaluate patients with cardiac issues in both the In-patient and Outpatient settings. Further training will be provided by the Family Medicine/Internal Medicine Faculty during the resident’s regular Family Medicine Clinics and In-patient Rotations. 

Goals:

1. To provide the resident with cardiology training under the supervision of a Board Certified Cardiologist.
    
2. To become competent in managing common cardiac problems seen in both the ambulatory and hospital setting.
    
3. To gain knowledge in utilization of appropriate cardiac testing in a clinical practice environment. Current cardiac testing available in SJGH testing and their appropriate use will be stressed.

Objectives for PGY2

1. The resident is to perform initial evaluation of patients with cardiac concerns, referred by the Internal Medicine/Family Medicine team in both the In-Patient and Outpatient setting. The resident is to obtain a proper cardiac history and a physical Examination including a review of current medications, pertinent past and social history, and prior cardiac testing.
    
2. The resident is to organize a rational diagnostic plan for further evaluation and management of the common cardiac referrals in the Cardiology Clinic and in the hospital setting.
    
3. The resident is to interpret all Electrocardiograms available and further is able to list and discuss the indications/contraindications of various cardiac testing at SJGH.
   
   This includes but not limited to the following:
    
   1. Echocardiograms
   2. Persantine Thallium
   3. Dobutamine Stress Test
   4. Dobutamine Stress Echocardiograms
   5. Cardiac Angiography. 
       
4. The resident is to diagnose and manage common cardiac conditions. This includes but not limited to the following:
    
   1. Acute Coronary Syndromes
   2. Arrhythmias (Atrial Fibrillation, Supraventricular Tachycardia, A-V Blocks and Ventricular Fibrillation)
   3. Congenital/Acquired Valvular Disorders
   4. Infective Endocarditis (acute and sub acute)
   5. EKG changes associated with Electrolyte Imbalances
   6. Acute and Chronic Congestive Heart Failure
   7. Hypertension (Essential, Secondary, Hypertensive Urgency and Emergency)
   8. Cor Pulmonale
       
5. The resident is responsible for writing daily progress notes and discussing the formulated management plan with the Cardiologist. The resident is to communicate with the referring Attending and family members in a clear and timely manner, with the appropriate assistance of interpreters, social services and ethical committee when needed.

Implementation:

The Cardiology rotation is a one-month required rotation during the second year of the Family Medicine Residency. The resident will work with the hospital cardiologist, performing consultations, daily in-patient rounds, clinical presentations, and attending the cardiac clinic. The resident will also attend cardiac testing and observe cardiac catheterization when available. Further instructions will be given through cardiology lectures and reading assignments. 

Evaluation:

The resident is evaluated on the basis of competency in the following six areas:

1. Patient Care that is compassionate, appropriate, and effective for the treatment and promotion of health. (Objective 1-5)
    
2. Medical knowledge about established and evolving testing of various cardiac ailments with proper management. (Objective 1-5)
    
3. Practice-Based Learning and improvement that involves investigation and evaluation of referred cardiac patients under the supervision of a Board Certified Cardiologist. (Objective 1-4)
    
4. Interpersonal and Communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals. (Objective 5)
    
5. Professionalism, as manifested through a commitment to carry out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse population. (Objective 5)
    
6. System-Based Practice, as manifested by actions that 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 that is optimal. (Objective 3 & 5) 

Methods of Evaluation:

Multiple ways of evaluation of the competency of the resident will be utilized including but not limited to the following:

1. Formative Evaluation:
    
   1. The Cardiologist during the rotation will provide continuous and helpful feedback to the resident. This includes the evaluation of the consultation and progress notes of the resident, his interpretation of EKG’s, the management plan and recommendation for further cardiac testing (specific patient, oral exam and chart review).
       
   2. The resident is to keep a log of all the patients upon whom he/she encountered during the whole rotation (medical record number, gender, age, and diagnosis).
      
      He/she will need to keep a log of the interpretation of the EKG’s. This log will be kept in the resident’s folder for future credentialing.
       
2. Summative evaluation:
    
   1. The Cardiologist will complete a formal evaluation form of the performance of the resident at the end of the rotation.

Each resident will evaluate the teaching/supervising Attending at the end of all rotations as well as evaluate the curriculum of the rotation. The Attending evaluation is done anonymously.

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