Welcome to the Cardiovascular Fellowship Program

Transcription

1 Welcme t the Cardivascular Fellwship Prgram HCMC Cardilgy Fellwship Manual TABLE OF CONTENTS Welcme t the Cardivascular Fellwship Prgram... 7 Missin Statement... 7 Prgram Descriptin... 7 Fellw Respnsibilities fr Patient Care... 7 Prgressive respnsibility fr patient management... 8 First year fellws:... 8 Secnd year fellws:... 8 Third year fellws:... 8 Key Cntacts... 9 HCMC... 9 Abbtt Nrthwestern Hspital (ANW)... 9 Rtatins Advanced Heart Failure ANW Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility Learning Objectives Advanced Imaging - ANW Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility

2 Case f the week Learning Objectives ADVANCED IMAGING - HCMC Cntacts Lcatin Hurs General descriptin Cnferences... Lines f Respnsibilty Learning bjectives Cardiac Catheterizatin ANW Cntacts Lcatin Hurs General descriptin Cnferences Lines f Respnsibilty Learning bjectives Cardiac Catheterizatin HCMC Cntacts Lcatin Hurs General descriptin Cnferences... Lines f Respnsibilty... Learning bjectives... CARDIAC MRI - ANW

3 CONTACTS LOCATION HOURS GENERAL DESCRIPTION CONFERENCES LINES OF RESPONSIBILTY LEARNING OBJECTIVES MILESTONES Cardivascular Preventin and Vascular Disease Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibilty Learning Objectives Cntinuity Clinic Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility Learning Objectives Echcardigraphy ANW Cntacts Lcatin

4 Hurs General Descriptin Cnferences Lines f Respnsibility Learning Objectives Echcardigraphy - HCMC Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility Learning Objectives Electrphysilgy- ANW Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility Learning Objectives Electrphysilgy - HCMC CONTACTS LOCATION HOURS GENERAL DESCRIPTION CONFERENCES

5 LINES OF RESPONSIBILITY LEARNING OBJECTIVES Inpatient Cardilgy Cnsultatins-ANW Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility Learning bjectives Inpatient Cardilgy Cnsultatins HCMC Cntacts Lcatin Hurs General descriptin Cnferences Lines f Respnsibility Learning Objectives Elective/Quality Rtatin Cntacts Lcatin Hurs General Descriptin Cnferences Lines f Respnsibility Learning Objectives Cnferences and research activities

6 Jurnal Club ECG review Cardiac Auscultatin Cardilgy Grand Runds Cardiac Catheterizatin Cnference Cnference schedule Research Evaluatins Perfrmance Imprvement Activity Ambulatry Patient Self Review Activity (APSRA) Key Prcedures and Dcumentatin Prgram Eceptins t Scheduled days ff and vacatin plicy Time ff Requests

7 WELCOME TO THE CARDIOVASCULAR FELLOWSHIP PROGRAM Welcme t the Hennepin Cunty Medical Center/Abbtt-Nrthwestern Hspital Fellwship Training Prgram in Cardivascular Disease. We are cnfident yu will have an utstanding experience in this prgram ver the next 3 years. Our faculty and staff are lking frward t wrking with yu as yu develp yur career as a cardilgist and pursue a life-lng passin fr learning and schlarly inquiry. This manual shuld answer many f the basic questins yu may have abut the general rganizatin f the training prgram. Hwever, please ask Cheryl Christensn, the Prgram Crdinatr, r Brad Bart, MD, the Prgram Directr if yu have any remaining questins after reviewing this manual. Yu are expected t understand and adhere t all the plicies and guidelines cntained in this manual. MISSION STATEMENT The missin f the Hennepin Cunty Medical Center/Abbtt-Nrthwestern Hspital Fellwship Training Prgram in Cardivascular Disease is t prvide utstanding clinical training in cardilgy. We aim t train cardivascular disease specialists with superb clinical skills, a life-lng cmmitment t learning, and the ability t functin as leaders in their lcal medical cmmunities. The educatinal gals are t prvide fellws with: 1. Cmprehensive knwledge in the area f general cardivascular disease 2. Technical expertise in perfrming and interpreting standard cardivascular diagnstic studies 3. A fundatin f evidence based best practices 4. An ability t critically appraise published reprts 5. A cmpassinate apprach t a diverse patient ppulatin 6. A lifelng desire t engage in schlarly activities PROGRAM DESCRIPTION FELLOW RESPONSIBILITIES FOR PATIENT CARE Fellws will be respnsible fr all aspects f patient care under the supervisin f a faculty member. These aspects f patient care include: Obtaining the histry f the present illness and perfrming a physical examinatin. Cllecting materials relevant t the patients past medical histry including prir test results. Frmulating a diagnstic and treatment plan. Crdinating an inter-prfessinal effrt t enact the diagnstic and treatment plan. 7

8 Cmmunicating with patients, families, and ther health prfessinals t facilitate patient care. Dcumenting all activities in the patient chart cmpletely and in a timely fashin Teaching patients, families, ther trainees and health prfessinals abut cardivascular disease, diagnsis and treatment. Using infrmatin technlgy t access relevant infrmatin regarding a patient s medical cnditin including published trials, basic science, epidemilgy, and guidelines. Cnducting neself in a prfessinal, humane and ethical manner. PROGRESSIVE RESPONSIBILITY FOR PATIENT MANAGEMENT FIRST YEAR FELLOWS: Will be able t btain a cmplete histry and perfrm a cmprehensive physical examinatin Will be able t quickly identify critically ill patients with cardivascular disease Will be able t develp a plan fr evaluatin and management f cmmn cardivascular cnditins Will begin t understand the risks, benefits, indicatins fr and clinical implicatins f cmmnly rdered cardivascular invasive and nninvasive studies Will begin t understand the imprtance f preventive cardivascular medicine SECOND YEAR FELLOWS: Will be able t btain a fcused histry and perfrm a fcused cardivascular physical examinatin Will be able t frmulate a lgical and schlarly treatment and evaluatin plan fr critically ill patients Will be able t develp and implement the evaluatin and management f cmmn cardivascular cnditins Will have a detailed understanding f the risks, benefits, indicatins fr and clinical implicatins f cmmnly rdered cardivascular invasive and nninvasive studies. Will be able t perfrm cmmnly rdered cardivascular invasive and nninvasive studies cmpetently Will be able t apply preventive strategies directly t individual patient care THIRD YEAR FELLOWS: Will demnstrate mastery f taking a detailed and fcused histry and perfrming a fcused cardivascular physical examinatin Will be able t frmulate and implement a lgical and schlarly treatment and evaluatin plan fr critically ill patients 8

9 Will be demnstrate mastery in the evaluatin and management f cmmn cardivascular cnditins Will have expert understanding f the risks, benefits, indicatins fr and clinical implicatins f cmmnly rdered cardivascular invasive and nninvasive studies. Will be able t perfrm cmmnly rdered cardivascular invasive and nninvasive studies with expertise Will cntinue t apply preventive strategies directly t patients and understand hw these strategies can be applied t larger ppulatins KEY CONTACTS HCMC Prgram Directr Brad Bart, MD Prgram Crdinatr Cheryl Christensn Echcardigraphy Rtatin Directr Charles Herzg, MD Cardiac Catheterizatin Rtatin Directr Fuad Bachur, MD Inpatient Cnsultatins Rtatin Directr Steve Gldsmith, MD Cardivascular Disease/Preventin Rtatin Directr Wubeshet Ayenew, MD HCMC Cntinuity Clinic Crdinatr - Wubeshet Ayenew, MD Hspital Main Operatr Ech lab Cath lab Nuclear lab ECG lab Emergency Department (STAB Rm) (ED backline) Radilgy EPIC help line Cardilgy Clinic New Innvatins Kelly Naplitan Amin.cm ABBOTT NORTHWESTERN HOSPITAL (ANW) Site Directr Dr. Kevin Harris

10 Site Crdinatr Meghan Hver Inpatient Cnsultatins Rtatin Directr Dr. Rin Orlandi Ech Lab Rtatin Directr Dr. Kevin Harris Advanced Heart Failure Rtatin Directr Dr. Kasia Hryniewicz Cardivascular Disease/Preventin Rtatin Directr Dr. Tm Knickelbine Hspital Main Operatr Ech lab Cath lab Nuclear lab ECG lab Emergency Department Radilgy EPIC help line ROTATIONS Advanced Heart Failure Abbtt Nrthwestern Hspital Advanced Imaging Abbtt Nrthwestern Hspital Advanced Imaging Hennepin Cunty Medical Center Cardiac Catheterizatin HCMC Cardiac Catheterizatin Abbtt Nrthwestern Hspital Cardivascular Preventin and Vascular Disease Cntinuity Clinic Echcardigraphy HCMC Echcardigraphy - Abbtt Nrthwestern Hspital Elective Rtatin Electrphysilgy Inpatient Cardilgy Cnsultatins HCMC Inpatient Cardilgy Cnsultatin Abbtt Nrthwestern Hspital Research Elective Rtatin 10

11 ADVANCED HEART FAILURE ANW CONTACTS Rtatin Directr Kasia Hryniewicz, M.D p ANW - Site Crdinatr Meghan Hver Imprtant Phne Numbers Special Diagnstics LOCATION Minneaplis Heart Institute Building, 3 rd Flr, Suite 300 HOURS Hurs: Mn Fri 8:00am t 6:00pm GENERAL DESCRIPTION Fellws will rund five days a week n the inpatient Advanced Heart Failure service. Wrking directly with a faculty member, the fellw will be expsed t patients with severe heart failure and the multidisciplinary team apprach needed t manage these cmplex patients. Fellws will participate in team runds each mrning. They will be respnsible fr 4-6 patients n the inpatient service and will wrk directly with faculty n the management f these patients. The fellw will be expected t attend Mnday mrning Cardilgy Grand Runds cnference, a weekly Heart Failure cnference, and weekly cre curriculum cnferences. Fellws will als attend Transplant and VAD (Ventricular Assist Device) Clinics. CONFERENCES General Required Cnferences Mnday Minneaplis Heart Institute Fundatin Grand Runds 7:00-8:00 AM, ANW Educatin Building, Watsn Rm Tuesday HCMC Cardiac Catheterizatin Labratry Cnference 7:30-8:30 AM, HCMC, R5.252 Thursday Cre Curriculum Cnference 3:00-5:00 PM, HCMC r ANW as scheduled Rtatin Specific Cnferences Heart Failure cnference (time and lcatin t be annunced) LINES OF RESPONSIBILITY Supervising Physician: The faculty physician will assign specific fellw duties based n the individual fellw s level f training and expertise. The faculty physician will verbally review the rtatin expectatins at the beginning f the mnth. The faculty physician will prvide verbal feedback and a written evaluatin at the end f the mnth. The faculty physician will prvide cncise fcused teaching sessins during weekly cnferences r during perfrmance and interpretatin f labratry studies. 11

12 The faculty physician and/r the fellw will discuss testing results with the patient and the patient s family and prvide apprpriate dcumentatin. Fellw: The fellw will perfrm all required pre-prcedure duties (ensure apprpriate cnsent btained, review labs, write preprcedure rders, etc). The faculty physician and/r the fellw will discuss testing results with the patient and the patient s family and prvide apprpriate dcumentatin. LEARNING OBJECTIVES Year 1 Patient Care Be able t recgnize the signs and symptms f heart failure and be able t perfrm a thrugh differential diagnsis and physical examinatin aimed at bth alternative diagnses and the varius etilgies f heart failure. Knw hw t emply apprpriate invasive and nninvasive studies in the evaluatin and treatment f patients with heart failure. Be able t initiate and versee, with apprpriate supervisin, the basic management f heart failure patients in bth the acute and chrnic settings. Medical Knwledge Becme familiar with the basic pathphysilgic prcesses underlying cngestive heart failure, including mycellular structure and functin, hemdynamics, disturbances f neurhrmnal regulatin and renal functin. Becme knwledgeable abut the cre studies n which the evidence base fr treating heart failure is funded, including bth pharmaclgic and device therapy. Understand the mechanisms by which pharmaclgic therapies prvide benefit. Understand the limitatins f current evidence as it is applied t patient with a brader spectrum f disease. Knw the indicatins fr placement f implanted defibrillatrs and resynchrnizatin therapy. Systems-based practice Understand the imprtance f incrprating apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Understand the imprtance f wrking effectively with supprt staff and cwrkers Understand the imprtance f identifying and addressing financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Understand the imprtance f lcating, appraising, and assimilating infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment Understand the imprtance f develping familiarity with research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Understand the imprtance f cmmunicating well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Understand the imprtance f practicing within the scpe f persnal technical skills r expertise Understand the imprtance f exhibiting sensitivity t patient preference and end-f-life issues Interpersnal and cmmunicatin skills 12

13 Understand the imprtance f cmmunicating well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Understand the imprtance f cmmunicating diagnstic test results in a timely manner t primary and referring physicians Understand the imprtance f engaging in shared decisin-making with patients abut their heart cnditin and the ptins fr diagnsis and treatment Year 2 Year 3 Patient Care Be able t independently manage bth hspitalized and clinic patients with heart failure ther than thse with Stage D disease, recgnizing the limits f pharmaclgic, antiarrhythmic and resynchrnizatin therapy. Becme familiar with the indicatins fr referral fr advanced therapies such as ventricular assist devices and transplant. Medical Knwledge Becme familiar with the literature supprting the use f ventricular device therapy and transplantatin in the management f patients with advanced heart failure. Knw the indicatins fr bth ventricular device therapy and transplant. Becme familiar with the majr limitatins f each therapy. Systems-based practice Demnstrate an ability t access and incrprate apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Demnstrate an ability t wrk effectively with supprt staff and cwrkers Demnstrate an ability t identify and address financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Demnstrate an ability t lcate, appraise, and assimilate infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment Demnstrate a familiarity with research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Demnstrate an ability t cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Demnstrate an ability t practice within the scpe f persnal technical skills r expertise Demnstrate an ability t exhibit sensitivity t patient preference and end-f-life issues Interpersnal and cmmunicatin skills Demnstrate an ability t cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Demnstrate an ability t cmmunicate diagnstic test results in a timely manner t primary and referring physicians Demnstrate an ability t engage in shared decisin-making with patients abut their heart cnditin and the ptins fr diagnsis and treatment 13

14 Patient Care Be able t independently manage the Stage D patient, and t evaluate patients fr advanced therapies such as ventricular assist devices and transplant. Be able t carry ut evaluatin and management f patients with ventricular assist devices, and thse with transplants, including the perfrmance f endmycardial bipsy. Medical Knwledge Becme aware f and knwledgeable abut nging clinical research aimed at the develpment f new therapies fr heart failure, including advances in bth device and transplant medicine. Cntinue t refine basic knwledge relating t evlving cncepts f pathphysilgy, evaluatin and treatment. Becme knwledgeable cncerning key principles f the evlving sci- ecnmic aspects f heart failure as they affect bth patients and prviders. Systems-based practice Cnsistently apply apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Cnsistently wrk effectively with supprt staff and cwrkers Cnsistently identify and address financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Cnsistently lcate, appraise, and assimilate infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment Cnsistently apply research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Cnsistently cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Cnsistently practice within the scpe f persnal technical skills r expertise Cnsistently exhibit sensitivity t patient preference and end-f-life issues Interpersnal and cmmunicatin skills Cnsistently cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Cnsistently cmmunicate diagnstic test results in a timely manner t primary and referring physicians Cnsistently engage in shared decisin-making with patients abut their heart cnditin and the ptins fr diagnsis and treatment Milestnes Medical Knwledge Knw the pathphysilgy, differential diagnsis, stages, and natural histries f heart failure 2. Knw the indicatins and clinical pharmaclgy f intravenus vasactive and intrpic drugs used fr circulatry supprt and advanced/refractry heart failure 3. Knw the types f and indicatins fr mechanical circulatry supprt 4. Knw the indicatins fr referral fr cardiac transplantatin r assist devices 14

15 Patient care Skill t: 1. Apprpriately select and incrprate data frm diagnstic and labratry testing in the evaluatin and management f heart failure 2. Identify candidates fr palliative care and hspice, heart transplantatin and ventricular assist devices 3. Participate in the management f patients with heart transplantatin and mechanical circulatry assist devices System based practice 1. Utilize a multidisciplinary crdinated apprach fr patient management, including transfer f care and emplyment related issues Practice-based learning and imprvement 1. Utilize decisin supprt tls fr accessing guidelines and pharmaclgic infrmatin at the pint f care fr patients with heart failure Prfessinalism 1. Exhibit sensitivity t patient preference and end-f-life issues 2. Prmte adherence t heart failure guidelines Interpersnal and cmmunicatin skills 1. Engage in shared decisin-making with patients abut their advanced heart failure and the ptins fr diagnsis and treatment ADVANCED IMAGING - ANW CONTACTS Rtatin Directr Marc Newell, M.D marc.newell@allina.cm p ANW - Site Crdinatr Meghan Hver meghan.hver@allina.cm Imprtant Phne Numbers David Caye LOCATION Abbtt Nrthwestern Heart Hspital, 2nd Flr, Rm H

16 HOURS Fellws are expected t help with patient preparatin questins, which can be answered frm hme/en rute via text r page after 6:30 AM (d/w David Caye n starting rtatin). Fellws are expected t be in the lab frm 8 am until review f the last scan. Call will be per fellwship prtcl fr MHI. GENERAL DESCRIPTION Cardiac cmputer tmgraphy (CT) and MRI Fellws in Cardivascular Disease have the pprtunity t learn the fundamentals and clinical applicatins f cardiac cmputed tmgraphy (CT) and cardiac magnetic resnance imaging (MRI). They gain experience in the interpretatin f cardiac CT and MRI by wrking with faculty experienced in the use and interpretatin f these imaging mdalities. Fr cardiac CT and MRI, fellws will be invlved in: 1) Patient Preparatin a. Patients require clse bservatin befre, during, and after their scan. A nurse is in charge f these aspects, but ften will require the input f the fellw b. Fellws may be asked t call in metprll dsing fr inpatients prir t their scan c. Please review the bard with the patient infrmatin in the scanner rm upn arrival in the mrning. Please review any ptential questins r cncerns frm the technicians r nurses regarding upcming patients. 2) Scan interpretatin a. It is highly recmmended t spend the first few days f the rtatin in the scanner rm learning EKG gating, scan prtcls, and pitfalls. b. The attending physician will teach ften while reviewing, please be attentive and feel free t ask questins. c. When there are n active scans t review, please use this time t becme mre familiar with the sftware and manipulatin f images. Als, interesting past cases will be laded and available fr review 3) Cmmunicatin/Dcumentatin a. Any abnrmal CT angigram shuld be discussed with the rdering physician b. Any inpatient scan shuld als have dcumentatin in the chart c. All inpatient scan results shuld be prmptly cmmunicated t the rdering physician 4) Case Dcumentatin a. It is the fellw s respnsibility t keep track f their cases thrugh the mnth (David Caye can help tabulate at the end f the mnth if questins arise). b. Please keep track f the cardiac/crnary cases and peripheral cases separately, especially if yu desire certificatin in bth areas. c. A frmal letter will be cmpsed at the end f the rtatin, signed by Dr Newell. 5) Recmmended Reading: At the start f yur rtatin, please ask abut btaining a cpy f the chapter n CT imaging written by Dr Newell, Schwartz, and Lesser (n the desktp next t the reading statin). Many fellws have liked the textbk by Budff et al, as well as his handbk. Many articles are f imprtance in cardiac CT. Dr Newell is planning n placing a Fellws Flder n the desktp in the back f the reading rm with these articles in place. Yur feedback will be vital in helping shape the rtatin ging frward. Please make sure yu speak with any attending, but ideally Dr Newell r Dr Lesser regarding feedback prir t the end f yur mnth. We hpe yu have a psitive experience. Mycardial perfusin imaging 16

17 This rtatin is designed t fulfill ACGME and COCATS level I training requirements by the end f the third year f fellwship training. Level II training in nuclear cardiac imaging will require advanced planning and shuld be discussed with the prgram directr by the middle f the secnd year t insure that all the requirements can be met. Fr thse fellws interested in level II training, 2 additinal imaging will be required in the third year alng with a structured, self-directed curriculum in nuclear cardiac imaging. Fellws will actively participate in nuclear cardilgy study interpretatin during the rtatin. Self study invlving the basic aspects f nuclear cardilgy, radiatin safety, reading, and viewing case files is required. Lectures n mycardial perfusin imaging will take place at imaging cnferences and during the curse curriculum. Fellws shuld actively participate in nuclear cardilgy study interpretatin (minimum f 100 cases ver 3 years f fellwship training). Live cases and a teaching file can be used t ensure experience with varius imaging mdalities and prtcls. Fellw shuld perfrm 35 cmplete nuclear cardilgy studies alng with the technlgists and ther labratry persnnel. Under supervisin, they shuld bserve and participate in standard prcedures and have experience in the practical aspects f radiatin safety assciated with perfrming clinical patient studies. Images will be interpreted with the nuclear cardilgy staff assigned t that duty fr the day and all attempts shuld be made t crrelate scan findings with ther diagnstic testing such as ECGs, crnary angigrams, CT, MRI, and echcardigrams. Fellws are expected t becme familiar with reprting standards and t assist in cmmunicating the results f abnrmal tests t the referring prvider. CONFERENCES General Required Cnferences Mnday Minneaplis Heart Institute Fundatin Grand Runds 7:00-8:00 AM, ANW Educatin Building, Watsn Rm Tuesday HCMC Cardiac Catheterizatin Labratry Cnference 7:30-8:30 AM, HCMC, R5.252 Thursday Cre Curriculum Cnference 3:00-5:00 PM, HCMC r ANW as scheduled Rtatin Specific Cnferences Thursday Valve/TAVR cnference 7:00-8:00 AM, ANW, Rm E1220 LINES OF RESPONSIBILITY Supervising Physician: The faculty physician is respnsible fr the supervisin f all prcedures perfrmed in the cardilgy labratries. The faculty physician will assign specific fellw duties based n the individual fellw s level f training and expertise. The faculty physician will verbally review the rtatin expectatins at the beginning f the mnth. The faculty physician will prvide verbal feedback and a written evaluatin at the end f the mnth. The faculty physician will mnitr the fellw s perfrmance f prcedures and review the fellw s interpretatin f all diagnstic tests. The faculty physician will prvide cncise fcused teaching sessins during weekly cnferences r during perfrmance and interpretatin f labratry studies. The faculty physician and/r the fellw will discuss testing results with the patient and the patient s family and prvide apprpriate dcumentatin. 17

18 Fellw: The fellw will perfrm all required pre-prcedure duties (ensure apprpriate cnsent btained, review labs, write pre-prcedure rders, etc). Fellws will perfrm invasive prcedures under the supervisin f the faculty physician in accrdance with their level f training and expertise. The fellw is respnsible fr any necessary pst-prcedure care. The faculty physician and/r the fellw will discuss testing results with the patient and the patient s family and prvide apprpriate dcumentatin. CASE OF THE WEEK Fellws are expected t help cmpse case summaries Case f the Week with Dr Schwartz while n rtatin. Ideally ne case per week will be cmpsed, mre than that will be welcme. If a case is f particular interest, it may be mre frmally written up fr publicatin r presentatin n the SCCT website. The Advanced Imaging Lab perfrms active research. Please ask abut nging prjects if yu have an interest. LEARNING OBJECTIVES Year 1 Patient Care Understand cmmn indicatins fr advanced imaging mdalities (mycardial perfusin scan, CT crnary angigram, cardiac MRI) and applicability in the care f patients with established r suspected cardivascular disease Understand factrs invlved in the decisin making t determine which test is apprpriate fr varius clinical indicatins in individual patients. Medical Knwledge Understand cmmn indicatins fr advanced imaging mdalities (mycardial perfusin scan, CT crnary angigram, cardiac MRI) and applicability in the care f patients with established r suspected cardivascular disease Observe advanced imaging mdalities being perfrmed t understand nuances and principles invlved. Systems-based practice Understand the imprtance f incrprating apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Understand the imprtance f wrking effectively with supprt staff and cwrkers Understand the imprtance f identifying and addressing financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Understand the imprtance f lcating, appraising, and assimilating infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment Understand the imprtance f develping familiarity with research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Understand the imprtance f cmmunicating well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Understand the imprtance f practicing within the scpe f persnal technical skills r expertise 18

19 Understand the imprtance f exhibiting sensitivity t patient preference and end-f-life issues Interpersnal and cmmunicatin skills Understand the imprtance f cmmunicating well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Understand the imprtance f cmmunicating diagnstic test results in a timely manner t primary and referring physicians Understand the imprtance f engaging in shared decisin-making with patients abut their heart cnditin and the ptins fr diagnsis and treatment Year 2 Patient Care Participate in the actual perfrmance f advanced imaging mdalities (mycardial perfusin scan, CT crnary angigram, cardiac MRI) t understand patient related factrs and nuances invlved fr each mdality. Understand the apprpriateness criteria fr individual advanced imaging mdalities (mycardial perfusin scan, CT crnary angigram, cardiac MRI) and applicability in practice. Medical Knwledge Wrk with the technicians t understand the technical factrs invlved in btaining a CT crnary angigram with special emphasis n gating/radiatin dse expsure and pst prcessing. Wrk with the radiatin technicians t understand the best use f raditracers fr mycardial perfusin imaging. Specifically related t handling f raditracers, time f injectin, factrs related t best imaging techniques. Wrk with cardiac MRI technicians t understand safety mechanisms, rming f the individual patient, and varius sequences invlved in btaining a cmplete cardiac MRI. Systems-based practice Demnstrate an ability t access and incrprate apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Demnstrate an ability t wrk effectively with supprt staff and cwrkers Demnstrate an ability t identify and address financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Demnstrate an ability t lcate, appraise, and assimilate infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment Demnstrate a familiarity with research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Demnstrate an ability t cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Demnstrate an ability t practice within the scpe f persnal technical skills r expertise Demnstrate an ability t exhibit sensitivity t patient preference and end-f-life issues Interpersnal and cmmunicatin skills 19

20 Demnstrate an ability t cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Demnstrate an ability t cmmunicate diagnstic test results in a timely manner t primary and referring physicians Demnstrate an ability t engage in shared decisin-making with patients abut their heart cnditin and the ptins fr diagnsis and treatment Year 3 Patient Care Understand the translatin f abnrmal findings n CT crnary angigram t patient care, need fr further invasive r nn-invasive evaluatin. Understand the rle f abnrmal calcium scre in the realm f preventive management f patients withut established crnary artery disease Understand the interpretatin f abnrmal findings n mycardial perfusin imaging, t determine need fr further patient care, including invasive evaluatin. Medical Knwledge Understand radiatin physics and determine applicability pertaining t patient safety and practical applicatin t nuclear medicine and crnary CTA. Understand principles f magnetic resnance imaging, and determine applicability in practical applicatins t cardiac MRI. Cnsistently demnstrate ability t accurately interpret CT crnary angigrams fr structural and functinal abnrmalities Cnsistently demnstrate ability t accurately interpret cardiac MRI fr structural and functinal abnrmalities. Cnsistently demnstrate ability t accurately interpret mycardial perfusin scans and applicability t practical use Understand the artifacts invlved that can affect interpretatin using advanced imaging mdalities (mycardial perfusin scan, CT crnary angigram, cardiac MRI) Systems-based practice Cnsistently apply apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Cnsistently wrk effectively with supprt staff and cwrkers Cnsistently identify and address financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Cnsistently lcate, appraise, and assimilate infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment Cnsistently apply research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Cnsistently cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Cnsistently practice within the scpe f persnal technical skills r expertise 20

21 Cnsistently exhibit sensitivity t patient preference and end-f-life issues Interpersnal and cmmunicatin skills Cnsistently cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Cnsistently cmmunicate diagnstic test results in a timely manner t primary and referring physicians Cnsistently engage in shared decisin-making with patients abut their heart cnditin and the ptins fr diagnsis and treatment Milestnes Medical Knwledge Knw the indicatins fr mycardial perfusin imaging and the apprpriate selectin f exercise versus pharmaclgic stress testing 2. Knw the prperties and use f standard mycardial perfusin tracers 3. Knw the principles f radiatin safety and hw t minimize radiatin expsure 4. Knw the principles behind the perfrmance f gated crnary CT angigraphy Patient care and prcedural skills Select the apprpriate stress imaging study 2. Identify results n stress imaging studies that indicate a high risk state 3. Identify basic crnary anatmy and cmmn anmalies seen during crnary CT angigraphy 4. Recgnize the rle f crnary CT angigraphy in the evaluatin f chest pain Systems-based practice Wrk effectively with the imaging labratry staff 2. Incrprate apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in the use f radinuclide techniques 21

22 Practice-based learning and imprvement Identify cmpetency gaps and engage in pprtunities t achieve fcused educatin and perfrmance imprvement in the clear and CT imaging Prfessinalism Prmte adherence t guidelines and apprpriate use criteria Interpersnal and cmmunicatin skills Cmmunicate imaging test results in a timely manner t primary and referring physicians ADVANCED IMAGING - HCMC CONTACTS Rtatin Directr Bradley Bart, M.D bartx006@umn.edu HCMC - Site Crdinatr Cheryl Christensn Cheryl.christensn@hcmed.rg Imprtant Phne Numbers Ech lab Nuclear reading Rm Nuclear Medicine LOCATION HCMC Stress labratry, Orange building, 5 th flr HOURS Fellws are expected t help with patient preparatin questins, which can be answered frm hme/en rute via text r page after 7:00 AM Fellws are expected t be in the lab frm 8 am until 4 pm Mnday thrugh Friday except fr the Thursday afternn cre curriculum, ther mandatry cnferences and/r meetings, and cntinuity clinic. 22

23 There is n call duty assciated with this rtatin. Hwever, the general call schedule will be maintained. Vacatins and time away must be apprved prir t the rtatin by the curse directr and with the knwledge f the fellwship prgram directr. GENERAL DESCRIPTION Mycardial perfusin imaging general verview This rtatin is designed t fulfill ACGME and COCATS level I training requirements by the end f the third year f fellwship fr basic training in nuclear cardilgy. Level II training in nuclear cardiac imaging will require advanced planning and shuld be discussed with the prgram directr by the middle f the secnd year t insure that all the requirements can be met. Fr thse fellws interested in level II training, 2 additinal dedicated t nuclear cardilgy will be required in the third year alng with a structured, self-directed curriculum in nuclear cardiac imaging. Fellws will actively participate in nuclear cardilgy study interpretatin during the rtatin. Self study invlving the basic aspects f nuclear cardilgy, radiatin safety, reading, and viewing case files is required. Lectures n mycardial perfusin imaging will take place at imaging cnferences and during the curse curriculum. Fellws shuld participate in nuclear cardilgy study interpretatin (minimum f 100 cases ver 3 years f fellwship training). Live cases and a teaching file can be used t ensure experience with varius imaging mdalities and prtcls. Fellw shuld perfrm 35 cmplete nuclear cardilgy studies alng with the technlgists and ther labratry persnnel. Under supervisin, they shuld bserve and participate in standard prcedures and have experience in the practical aspects f radiatin safety assciated with perfrming clinical patient studies. Images will be interpreted with the nuclear cardilgy staff assigned t that duty fr the day and all attempts shuld be made t crrelate scan findings with ther diagnstic testing such as ECGs, crnary angigrams, CT, MRI, and echcardigrams. Fellws are expected t becme familiar with reprting standards and t assist in cmmunicating the results f abnrmal tests t the referring prvider. Specific expectatins 1. Interview and btain a brief histry fr every patient scheduled fr mycardial perfusin imaging 2. Understand the indicatin fr the test 3. Be physically present in the rm during all stress tests-assist the nurse as needed 4. Independently interpret the stress ECG and the SPECT, gated SPECT, and MUGA studies 5. Review yur interpretatin with the staff member assigned t read nuclear cardiac imaging studies fr the day 6. Cmmunicate the results f all inpatient studies t the respnsible physician 7. Cmmunicate results f all studies shwing the presence f ischemia with the respnsible physician fr bth inpatient and utpatient studies 8. Dcument all cases perfrmed in RMS 9. Understand the functining f the high lab, dsimetry, and quality cntrl prcedures - spend ne week reviewing these prcedures in nuclear medicine-yu will need t cme t wrk early during this week and accmpany the nuclear medicine technlgist 10. Wrk with the technlgists n image acquisitin and prcessing f at least 10 mycardial perfusin imaging studies and dcument this experience 23

24 11. Establish/maintain a teaching database f mycardial perfusin imaging studies with pertinent histry and additinal imaging mdalities as apprpriate 12. Pursue independent study a. Textbks and CDs b. Internet resurces i. American Sciety f nuclear cardilgy ii. Certificatin bard f nuclear cardilgy c. Jurnals such as the Jurnal f nuclear cardilgy 13. Prepare an assigned tpic fr a 30 minute lecture t be presented during cre curriculum as part f a rtating didactic curriculum a. Radipharmaceuticals/tracer kinetics b. Instrumentatin i. SPECT t prcessing, quantificatin and display ii. Artifacts and crrectin iii. PET imaging c. Gated SPECT and ventricular functin d. Gated bld pl imaging e. Perfusin imaging i. Exercise stress this etilgy and prtcls ii. Pharmaclgic stress physilgy and prtcls iii. Diagnses f CAD and prgnsis f. Specific issues i. Imaging in wmen ii. Preperative risk assessment iii. Diabetes iv. Heart failure/cardimypathy is v. Imaging after revascularizatin g. Acute crnary syndrmes i. Use in ED/chest pain units ii. Pst-STEMI risk stratificatin iii. Unstable angina/nn-st elevatin MI risk stratificatin h. Viability testing CONFERENCES General Required Cnferences Mnday Minneaplis Heart Institute Fundatin Grand Runds 7:00-8:00 AM, ANW Educatin Building, Watsn Rm Tuesday HCMC Cardiac Catheterizatin Labratry Cnference 7:30-8:30 AM, HCMC, R5.252 Thursday Cre Curriculum Cnference 3:00-5:00 PM, HCMC r ANW as scheduled

25 LINES OF RESPONSIBILTY Supervising Physician: The faculty physician is respnsible fr the supervisin f all prcedures perfrmed in the cardilgy labratries. The faculty physician will assign specific fellw duties based n the individual fellw s level f training and expertise. The faculty physician will verbally review the rtatin expectatins at the beginning f the mnth. The faculty physician will prvide verbal feedback and a written evaluatin at the end f the mnth. The faculty physician will mnitr the fellw s perfrmance f prcedures and review the fellw s interpretatin f all diagnstic tests. The faculty physician will prvide cncise fcused teaching sessins during weekly cnferences r during perfrmance and interpretatin f labratry studies. The faculty physician and/r the fellw will discuss testing results with the patient and the patient s family and prvide apprpriate dcumentatin. Fellw: The fellw will perfrm all required pre-prcedure duties (ensure apprpriate cnsent btained, review labs, write pre-prcedure rders, etc). The fellw will cmplete all the listed expectatins fr the rtatin as described abve. LEARNING OBJECTIVES Year 1 Nt applicable as this is a rtatin fr 2 nd and 3 rd year fellws Year 2 Patient Care Directly participate in the perfrmance f mycardial perfusin imaging t understand patient related factrs and nuances invlved Understand and be familiar with apprpriateness criteria as they applied t mycardial perfusin imaging Recgnize the rle f mycardial perfusin imaging in the evaluatin f chest pain Medical Knwledge Be familiar with the cmmn indicatins fr mycardial perfusin imaging and their applicability in the care f patients with established r suspected cardivascular disease Knw the indicatins fr mycardial perfusin imaging and the apprpriate selectin f exercise versus pharmaclgic stress testing Knw the standard display fr mycardial perfusin imaging and which segments crrespnd t standard crnary anatmy Knw the prperties and use f thallium and technetium 99 based mycardial perfusin tracers Identify results n stress imaging studies that indicate a high risk state Systems-based practice demnstrate an ability t access and incrprate apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making demnstrate an ability t wrk effectively with supprt staff and cwrkers demnstrate an ability t identify and address financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement 25

26 demnstrate an ability t lcate, appraise, and assimilate infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment demnstrate a familiarity with research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism demnstrate an ability t cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner demnstrate an ability t practice within the scpe f persnal technical skills r expertise Interpersnal and cmmunicatin skills demnstrate an ability t cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner demnstrate an ability t cmmunicate diagnstic test results in a timely manner t primary and referring physicians Year 3 Patient Care Understand and be able t prcess raw images Cnsistently apply apprpriateness criteria as they relate t mycardial perfusin imaging Recgnize the advantages and disadvantages f different imaging prtcls including dual istpe perfusin imaging Medical Knwledge Recgnize imaging artifacts that can adversely affect the accuracy f interpreting mycardial perfusin studies Frmulate an evidence-based treatment plan incrprating patient features and study results Cnsistently demnstrate an ability t accurately interpret mycardial perfusin scans Systems-based practice cnsistently apply apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in clinical decisin-making Cnsistently wrk effectively with supprt staff and cwrkers Cnsistently identify and address financial, cultural, and scial barriers t diagnstic and treatment recmmendatins Practice-based learning and imprvement Cnsistently lcate, appraise, and assimilate infrmatin frm scientific studies, guidelines, and registries in rder t identify knwledge and perfrmance gaps related t patients referred fr diagnstic evaluatin and/r treatment cnsistently apply research methdlgy in cardivascular disease including relevant clinical trials, utcmes research, and statistical methds Prfessinalism Cnsistently cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Cnsistently practice within the scpe f persnal technical skills r expertise Interpersnal and cmmunicatin skills 26

27 Cnsistently cmmunicate well with ther members f the health care team, families and patients acrss a brad range f cultural, ethnic, and sciecnmic backgrunds in a prfessinal and cmpassinate manner Cnsistently cmmunicate diagnstic test results in a timely manner t primary and referring physicians. Milestnes Medical Knwledge Knw the indicatins fr mycardial perfusin imaging and the apprpriate selectin f exercise versus pharmaclgic stress testing 2. Knw the prperties and use f standard mycardial perfusin tracers 3. Knw the principles f radiatin safety and hw t minimize radiatin expsure Patient care and prcedural skills Select the apprpriate stress imaging study 2. Identify results n stress imaging studies that indicate a high risk state Systems-based practice Wrk effectively with the imaging labratry staff 2. Incrprate apprpriate use criteria, risk-benefit, safety, and cst cntainment cnsideratins in the use f radinuclide techniques Practice-based learning and imprvement Identify cmpetency gaps and engage in pprtunities t achieve fcused educatin and perfrmance imprvement in mycardial perfusin imaging Prfessinalism 12 27

28 1. Prmte adherence t guidelines and apprpriate use criteria Interpersnal and cmmunicatin skills Cmmunicate imaging test results in a timely manner t primary and referring physicians CARDIAC CATHETERIZATION ANW CONTACTS Rtatin Directr Ivan Chavez, M.D p ANW - Site Crdinatr Meghan Hver Meghan.hver@allina.cm Imprtant Phne Numbers CV Operatins LOCATION 3rd Flr Heart Hspital Cardivascular Operatins HOURS Mn Fri: 730am-5pm. Sat Sun and majr hlidays: per n call schedule. GENERAL DESCRIPTION Fellws will be directly invlved in diagnstic cases in the cardiac catheterizatin at HCMC including crnary angigraphy, left ventriculgraphy, right heart catheterizatin, invasive hemdynamic mnitring, assessment f valvular heart disease and pericardicentesis. There is an pprtunity fr sme expsure t peripheral arterial angigraphy. The rtatin is divided int three parts: Pre-cath, Cath- the Prcedure, and Pst cath. I. Pre cath: A. Reading it is expected that fellws will read frm a basic textbk n crnary angigraphy as well as lk up pertinent articles related t interesting cases that ccur thrugh the curse f the mnth. B. All start with ne questin: Why am I ding this prcedure? The answer t this questin is the indicatin fr the prcedure this is perhaps the mst imprtant learning bjective f the entire rtatin. The ACC/AHA task frce guidelines fr 28