Objective Teaching Methods Assessment

Transcription

1 Rotation: Vascular Medicine Director: Mark Robbins, M.D. Learning Objectives Patient Care Obtain and document complete medical histories, including review of patient medical records, and perform accurate examinations with an emphasis on the arterial, venous and lymphatic systems Demonstrate appropriate decision making based on clinical assessment, interpretation of tests, patient preferences and current standards of evidence based medicine. Communicate effectively and compassionately information to patients and family members. Provide patient education. Discuss prognosis, and when appropriate, end of life issues. Clinical Experiences Shadowing Review pertinent literature, Didactics Clinical teaching Clinical experiences Consultative services Attending 360 evaluations As above As above Medical Knowledge The cardiologist must be able to evaluate and manage common vascular disorders (see topic outline below) and refer patients appropriately to vascular surgeons, interventional cardiologists, hematologists, rheumatologists and other subspecialists where appropriate. Didactics, Shadowing Attending, 360 evaluations,, In training examination

2 Professionalism Demonstrate accountability and professional behavior towards patients, family members, and members of the health care team and adherence to ethical principles Demonstrate compassion and respect for others, including patients from a diverse cultural, social, and religious backgrounds Attending, 360 evaluations, Attending, 360 evaluations, Interpersonal and Communication Skills Communicate effectively with patients, families, and members of the health care team, including findings and diagnoses when appropriate to both patients and consulting physicians Maintain timely and comprehensive medical records Attending, 360 evaluations, Administrative Monitoring, Attending Program Director Practice Based Learning and Improvement Identify both strengths and gaps in knowledge and expertise and set appropriate learning goals Utilize information technology to effectively locate, appraise, and utilize evidence based medicine with in current literature to improve patient care Review rotation curriculum, Review pertinent literature, Role models Utilize on line resources such as Knowledge Map, Vanderbilt Library, supervising attending supervising attending

3 Utilize quality improvement methods to implement changes within the practice environment Cardiosource, Up to Date Literature Review Division and Institutional Resources and Committees supervising attending Systems Based Practice Work effectively as a member of the health care team, including coordination of patient care Demonstrate understanding of cost effectiveness and risk benefit analysis and incorporate these into patient care Advocate for and work towards patient safety and improved quality of care Identify system errors and implement systems solutions Clinical Teaching Literature Review Division and Institutional Resources and Committees Literature Review Division and Institutional Resources and Committees Literature Review Division and Institutional Resources and Committees supervising attending supervising attending and division QI committees supervising attending and division QI committees supervising attending and division QI committees Rotation Format and Responsibilities: Fellows have the opportunity to rotate on the Vascular Medicine Service. On this service, the fellow provides inpatient consultative services with one of our cardiologists who specializes in vascular and interventional vascular medicine. The fellow also sees patients with vascular disease in the outpatient vascular surgery and general cardiology clinics and has the opportunity to interpret noninvasive vascular studies. An opportunity to participate in specialty clinics other than cardiovascular medicine

4 during this rotation are also available including pulmonary hypertension, hematology and vasculitis clinics. Second and third year fellows also have the option to have a half day clinic a week in the vascular surgery clinic as part of their sub-specialty outpatient clinical training. Curriculum Outline: A. Arterial Disease 1. Normal: anatomy and physiology of the cerebrovascular, renal, and peripheral vascular beds 2. Atherosclerosis: a. Pathogenesis b. Risk factors: recognition, life style modifications and interventions 3. Peripheral Arterial Disease: a. epidemiology and natural history i. claudication vs pseudoclaudication b. clinical examination and role of vascular testing c. life style and risk factor modifications d. novel risk factors: hyperhomocysteinemia, lipoprotein (a), etc. e. Treatment: i. antithrombotic and other pharmacologic therapy ii. exercise therapy iii. percutaneous and surgical indications and therapies f. Complications of PAD

5 i. atheroembolism ii. amputation 4. Extracranial Cerebrovascular Disease a. Normal anatomy and physiology b. Pathophysiology of CV disease c. Clinical Presentations d. Physical examination e. Diagnostic testing and imaging modalities f. Treatment: i. Medical therapy ii. Percutaneous and surgical indications and therapies 5. Renovascular Disease a. atherosclerotic and non atherosclerotic b. renovascular hypertension: diagnostic work up and treatment 6. Aortic Dissection, Penetrating Aortic Ulcer, Incomplete Aortic Rupture a. definition and classification b. etiology, natural history and clinical manifestations c. Diagnosis: imaging modalities d. Medical and surgical treatment 7. Aneurysmal Disease: a. definition and classification b. etiology, natural history and clinical manifestations c. Abdominal Aortic aneurysms: infrarenal i. risk factors, presentation, and natural history

6 ii. diagnosis iii. pre operative assessment iv. endovascular and surgical repair d. Thoracic and suprarenal abdominal aneurysms i. risk factors, presentation, and natural history ii. diagnosis iii. indications for repair iv. endovascular and surgical repair B. Venous Disease 1. anatomy and physiology of upper and lower extremity veins 2. venous thromboembolism 1. acute DVT of lower extremities 2. upper extremity DVT 3. pulmonary embolism 4. catheter/device related thrombosis 3. thrombophilias (hereditary and acquired) 4. post thrombotic syndrome 5. chronic venous insufficiency and venous stasis disease 6. varicose veins C. Lymphedema 1. anatomy and physiology of the lymphatic system 2. causes, diagnosis and management D. Miscellaneous Arterial Disease 1. thoracic outlet syndrome

7 2. popliteal artery entrapment 3. thromboangitis obliterans (Beuger's Disease) 4. vasculitis E. Vasospastic Disorders 1. Raynaud's Phenomenon 2. Livedo Reticularis 3. Chronic Pernio 4. Erythromelalgia F. Hypercoagulable Disorders 1. Antiphospholipid syndrome 2. Factor V Leiden Mutation 3. Heparin Induced Thrombocytopenia 4. Protein C/S Deficiency 5. Anti thrombin III deficiency 6. Hyperhomocystinemia Recommended Reading: Guideline on Management of Patients with Extracranial Carotid and VertebralArtery Disease. J Am Coll Cardiol. 2011;57(8): ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease. J Am Coll Cardiol. 2005;47(6): Renal Atery Stenosis. NEJM. 2009;361(20): Guidelines on the diagnosis and management of acute pulmonary embolism. European Heart Journal. 2008;29: Focus on Vascular Disease Text on PVD. Evaluation and Feedback:

8 Fellows are evaluated at the end of the rotation with a competency based evaluation system Fellows are directly observed and given real time feedback on their performance Fellows participate in structured case discussions (ie, catheterization or interventional conference)