Η εκπαίδευση στην ειδικότητα της Καρδιολογίας

Transcription

1 Η εκπαίδευση στην ειδικότητα της Καρδιολογίας Πώς γράφονται οι ερωτήσεις των εξετάσεων Γνωριμία με το EEGC exam ΚΑΤΕΡΙΝΑ Κ. ΝΑΚΑ MD, PhD, FESC Associate Professor of Cardiology University of Ioannina 2 nd Department of Cardiology Ioannina, 28 June 2018

2 DISCLOSURES SPEAKER: KATERINA K. NAKA MD, PhD, FESC None related to this lecture apart from MCQ writer since 2013 MCQ selector for the EEGC since 2015 Deputy Chair of the Selection Committee since 2018

3 European Examination in General Cardiology EEGC 1. Overview of what the exam aims for 2. How it fits into the cardiology training 3. What it looks like and how it is organized 4. How Multiple Choice Questions (MCQs) are written 5. How to best prepare for the exam

4 European Examination in General Cardiology EEGC A knowledge-based assessment to be used as part of a formal training program Designed to assess the application of knowledge in the core areas of cardiology set out in the ESC Curriculum for the General Cardiologist to a level appropriate for a newly appointed specialist in cardiology covering all aspects of cardiovascular medicine including basic aspects of the advanced curricular areas One element of the assessment of trainees in parallel with other types of assessment workplace-based techniques logbooks and other indications of professional development

5 EEGC aims To assess a trainee s understanding of the necessary knowledge components of the cardiology curriculum to a level appropriate for a newly appointed specialist will cover all aspects of cardiovascular medicine including basic aspects of the advanced curricular areas An assessment of the core cardiology knowledge expected of a newly qualified specialist in cardiology EEGC - is not an assessment of overall competence only 1 component of the assessment strategy for trainee specialists in cardiology

6 EEGC How it fits in with the cardiology training The training curriculum defines the necessary knowledge, skills and behaviors needed in order to become a specialist in general cardiology The examination is designed specifically to determine if a trainee has gained sufficient knowledge for specialist practice the score should not be used to rank candidates or to determine their suitability for advanced training A satisfactory performance in the EEGC is required before completion of training (exit exam) Trainees who fail to achieve this standard on the 1st sitting The EEGC is offered on an annual basis so that a trainee will, if necessary, have opportunities to re-sit the examination

7 EEGC The ESC core curriculum in cardiology training (I) Defines the necessary knowledge, skills and behaviors that need to be acquired in order to become a specialist in general cardiology The trained cardiologist with the knowledge, skills, behaviors, and attitudes to act independently as an expert in the diagnosis, assessment, and management of CV emergencies; diagnosis, assessment, and management of patients referred from primary care or other medical specialties with known or suspected disorders of the heart and circulation; and risk assessment and prevention of CVD in the community and their patients. ESC Core Curriculum for the General Cardiologist ESC Committee for Education, EHJ 2013

8 EEGC The ESC core curriculum (1) The Core Curriculum per topic 1. History taking and clinical examination 2. The electrocardiogram (standard ECG, ambulatory ECG, exercise ECG, CPX) 3. Non-invasive imaging 3.1. Non-invasive imaging in general 3.2. Echocardiography 3.3. Cardiac magnetic resonance 3.4. Cardiac X-ray computed tomography 3.5. Nuclear techniques 4. Invasive imaging: cardiac catheterization and angiography 5. Genetics 6. Clinical pharmacology 7. Cardiovascular prevention 7.1. Cardiovascular risk factors, assessment, and management 7.2. Arterial hypertension 8. Acute coronary syndromes 9. Chronic ischaemic heart disease 10. Myocardial diseases 11. Pericardial diseases 12. Oncology and the heart 13. Congenital heart disease in adult patients ESC Core Curriculum for the General Cardiologist ESC Committee for Education, EHJ 2013

9 EEGC The ESC core curriculum (2) The Core Curriculum per topic 14. Pregnancy and heart disease ESC Core Curriculum for the General Cardiologist 15. Valvular heart disease ESC Committee for Education, EHJ Infective endocarditis 17. Heart failure 18. Pulmonary arterial hypertension 19. Physical activity and sport in primary and secondary prevention Sports cardiology Cardiac rehabilitation 20. Arrhythmias 21. Atrial fibrillation and flutter 22. Syncope 23. Sudden cardiac death and resuscitation 24. Diseases of the aorta and trauma to the aorta and heart 25. Peripheral artery diseases 26. Thrombo-embolic venous disease 27. Acute cardiovascular care 28. The cardiac consult The patient undergoing non-cardiac surgery The patient with neurological symptoms The patient with conditions not presenting primarily as CVD

10 EEGC The ESC core curriculum in cardiology training The general cardiologist may decide, after completion of training, to develop additional knowledge and skills. The areas of specialized experience currently include: (a) interventional cardiology; (b) electrophysiology and device therapy; (c) cardiovascular imaging (echocardiography, cardiac X-ray CT, CMR, nuclear and PET scan); (d) cardiovascular intensive care; (e) advanced heart failure and transplantation; (f) cardiac rehabilitation and prevention; (g) grown-up congenital heart disease (GUCH) ESC Core Curriculum for the General Cardiologist ESC Committee for Education, EHJ 2013

11 EEGC The ESC core curriculum in cardiology training (I) Defines the necessary knowledge, skills and behaviors that need to be acquired in order to become a specialist in general cardiology The trained cardiologist with the knowledge, skills, behaviors, and attitudes to act independently as an expert in the diagnosis, assessment, and management of CV emergencies; diagnosis, assessment, and management of patients referred from primary care or other medical specialties with known or suspected disorders of the heart and circulation; and risk assessment and prevention of CVD in the community and their patients. ESC Core Curriculum for the General Cardiologist ESC Committee for Education, EHJ 2013

12 EEGC What does it look like? A single paper with 120 multiple choice questions (MCQs) to be answered in 3 hours = 1,5 min/mcq The questions consist of a clinical stem possibly including reference to an image or video loop followed by a single question and and then a series of 5 choices of answer The candidate must choose the BEST of the 5 options. There is no negative marking.

13 EEGC What does it look like as a whole? Around 25% of questions will have an image or video i.e. the ratio of image/video questions to non-image questions will be approximately 1:3 Approximately the distribution in topics is as follows: 20% : Valvular and Myocardial Disease 20% : Ischaemic Heart Disease 20% : Rhythm Disorders 14% : Non-invasive Investigations 6% : Adult Congenital Heart Disease 20% : Other General Cardiology

14 EEGC What does it look like? 20% : Valvular and Myocardial Disease Valvular disease Infective endocarditis Myocardial Disease Heart Failure 20% : Ischaemic Heart Disease Invasive cardiac imaging CVD Protection and Risk Factors (dyslipidaemia, diabetes) Acute coronary syndromes Chronic IHD Rehabilitation and exercise physiology 20% : Rhythm Disorders Basic Investigations ECG, ambulatory ECG, exercise testing Arrhythmias including atrial fibrillation Syncope Sudden cardiac death and resuscitation

15 EEGC What does it look like? 14% : Non-invasive Investigations Non-invasive imaging incl. echocardiography (TTE, TOE, stress echo) Nuclear cardiology Cardiac MR Cardiac CT 6% : Adult Congenital Heart Disease Adult congenital heart disease Heart disease in pregnancy 20% Other General Cardiology Clinical skills, history and examination Diseases of the aorta and trauma Peripheral vascular disease Pericardial disease Oncology and the heart Pulmonary hypertension Clinical genetics Clinical pharmacology - Hypertension - Venous thrombo-embolism - The cardiac consult (Non-cardiac disease and the heart)

16 EEGC how it is prepared MCQ writers (5 groups of at least 6-8 people each time) write MCQs at home all year round interact in groups for 2-day meetings 1) at the ESC Heart House (January) and 2) during the annual ESC meeting (August) review old MCQs (in the light of changes in guidelines) MCQ selectors review the MCQs they have been allocated from various areas of interest from January to February each year interact in a 1.5-days selection meeting that takes place mid-late February each year MCQ setters setup the final exam on the basis of the selected MCQ and the level of perceived difficulty during a 1.5-days meeting that takes place in April each year

17 EEGC Beyond the questions Instructions that are given to MCQ writers write benign questions i.e. non trap always based on a clinical scenario not just theoretical knowledge choose a clinically important topic and an important piece of knowledge to test ideally do not try to test 2 points of knowledge within the same MCQ write positive answers; negative answers / exceptions are discouraged (i.e. never used) Ισχύουν όλα τα παρακάτω εκτός από : ΑΚΑΤΑΛΛΗΛΗ ΕΡΩΤΗΣΗ allocate the MCQ in the most appropriate topic to facilitate the selection process try to write as short as possible questions avoiding unnecessary information (misleading); the length (and difficulty) of the MCQ is also taken into account in the selection process choose media as clear and unambiguous as possible (and simple) MCQs with medications not used in all countries sitting the exam are discouraged

18 EEGC example question (1a) Clinical stem A 52-year-old man attended the out-patient clinic for review having been lost to follow-up for several years. He had a past history of aortic valve endocarditis 10 years earlier which had been successfully treated with antibiotics. He was asymptomatic but his family doctor had noted a murmur on routine examination. On examination his pulse was 60 beats per minute and his blood pressure was 155/55mmHg. Auscultation revealed systolic and diastolic murmurs at the left sternal border. There was no clinical evidence of heart failure. An echocardiogram revealed a left ventricular end-systolic dimension of 48mm, an end-diastolic dimension of 66mm, a left ventricular ejection fraction of 53% and an aortic root diameter 46mm. The aortic valve was bicuspid with severe regurgitation and a peak trans-valvular pressure gradient of 30 mmhg.

19 EEGC example question (1b) Question What is the most appropriate treatment at this stage? This is a Valvular Heart Disease question. Answers (always provided in alphabetical order) A. aortic valve and root replacement B. aortic valve replacement C. bisoprolol D. no intervention required E. ramipril asymptomatic severe AR with BAV BP 155/55mmHg LVESD 48mm, LVEDD 66mm LVEF 53% Aortic root diameter 46mm Correct answer: E

20 EEGC example question (2a) Clinical stem (and media if included in the MCQ) A 57-year-old man was seen in the outpatient clinic with a 6 month history of progressive breathlessness. There was no significant past medical history. On examination he was obese and had mild ankle oedema but no other abnormal physical signs were identified. An ECG showed sinus rhythm with left bundle branch block. A chest X-ray revealed borderline cardiomegaly. Transthoracic echocardiographic images were nondiagnostic due to poor windows. A cardiac MR scan was performed (see image). Media/Image

21 EEGC example question (2b) Question What is the most likely diagnosis? This is a Non-Invasive Imaging question. Answers (always provided in alphabetical order) A. amyloid heart disease B. dilated cardiomyopathy C. haemochromatosis D. ischaemic heart disease E. sarcoidosis Correct answer: D

22 EEGC How the test is ran The examination software runs on individual PCs. A short (15 minute) explanation of the software will be provided before beginning the exam. The screen has a timer showing how much time has elapsed. The question stem and the options appear on one screen. Images or video loops will run in a separate window. It is possible to mark questions as unanswered or uncertain to allow you to return to them later. No personal items allowed in test centers (no water, no food, no mobile phones )

23 EEGC How to prepare for the exam There is no limited or exclusive list of appropriate sources of reading. Trainees are encouraged to read extensively and use the wide variety of available resources. Examples of good knowledge resources include: Textbooks e.g. ESC Textbook of Cardiovascular Medicine Guidelines e.g. from ESC, AHA/ACC On-line educational material e.g. ESCeL; ESC webinars and cases Educational articles e.g. Education in Heart On-line reviews e.g. theheart.org; Cardiosource Academic journals e.g. EHJ; Heart; NEJM; Lancet; Circulation; JACC The question bank for the EEGC is still relatively small in size and thus it is not feasible to share past examination papers.

24 EEGC How the test is organized (I) The EEGC is a complex and close collaboration of the European Society of Cardiology, UEMS-Cardiac Section and the national societies. There are testing centers across Europe. There is a single sitting each year. The pass-mark is criterion referenced by a standard setting group which includes trainee representatives and is usually around 60% correct answers. The pass-rate is usually between 85-95% of candidates. Those who fail can re-sit the following year.

25 EEGC How the test is organized (II) Registration usually starts in September with city selection and closes early April. The exam is open only to cardiology trainees in recognised training programs in their 3rd year of specialty training. The candidates are responsible to provide their national societies with the necessary information for the registration. The current fee for taking the exam is determined by each national society. In the event of illness, HCS should be informed as soon as possible.

26 EEGC How the test is organized (II) The EEGC is overseen by the Examination Performance Review Group (EPRG). Candidates are asked to fill in an online feedback form. This information is used by the Performance Review Group to improve the exam and has proved, in the past, to be very helpful. MCQs are continuously being monitored for their performance; MCQs that perform poorly (0% or 100% of the candidates get the correct answer are discarded from the bank and discussed among the writers and selectors).

27 EEGC National Cardiac Societies Appoint are committed to 3 to 5 MCQ writers to the MCQ group (2 meetings/year) 1 question selector (1 meeting/year) 1 standard setter (1 meeting/year) 1 representative at the EEGC board (1 meeting/year) 1 exam coordinator (Permanent staff in charge of registrations) Define testing centers cities Recruit candidates (approaching their 3 rd year of training) Handle registrations Disseminate the information on how to prepare for the exam Communicate results to candidates

28 EEGC Financial rules Entry fee: 500 / National Cardiac Society Candidates fee: 105 /candidates free registration is NOT encouraged because it may indicate limited motivation by the candidates Cancellations: Invoiced when done after the closing of the registration window No show candidates: Invoiced Name and surname provided for registrations must be exactly the same as on identity documents; Valid identity document is needed to access testing centers

29 EEGC Feedback on the test With the results, each NCS receives a summary of their candidates performances (% of success) classified in 5 topics: Arrhythmia Heart Failure and Clinical Pharmacology Ischaemic Heart Disease Non-invasive imaging Valvular and Congenital Heart Disease

30 EEGC How to implement in our Greek cardiology career structure? UK/Ireland approach: EEGC is the exit theoretical exam (prerequisite but more is needed on top of that) Other countries: extra exam added to their exams Greece: 2 pathways of professional career with probably distinct expectations consultant cardiologists working in hospitals ambulatory / private cardiologists working in their offices Is an exam appropriate for all?

31 How to implement EEGC in our Greek cardiology career structure A single theory exam in greekfor all Greek candidates close to the concept of the EEGC is ideal its proper application is complex: MCQ writing concept, databank keeping and cleaning, MCQ selection, continuous feedback and improvement once a year? Log books of procedures and practical training in all aspects of cardiology are needed monitor trainees on a yearly basis homogenise training among training centers by candidate rotation (to provide adequate and complete clinical training and also provide good clinical services at the same time)

32 HF Unit 2 nd Department of Cardiology University Hospital of Ioannina Tel heartfailure.uhi@gmail.com Thank you for your attention and GOOD LUCK to candidates! University Campus & University Hospital, Ioannina