In-Training Examination in a Cardiovascular Disease Fellowship Program Curriculum: Success Towards Board Certification
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1 In-Training Examination in a Cardiovascular Disease Fellowship Program Curriculum: Success Towards Board Certification Eva Meunier, BS, C-TAGME Education Program Manager Division of Cardiovascular Health and Disease University of Cincinnati College of Medicine
2 No Disclosures
3 Objective ACC ITE Overview Does the ITE results correlate to ABIM Cardiovascular Disease board scores? Program utilization of ITE for individual fellows and program education.
4 Fellows Division of Cardiovascular Health and Disease Program Structure 19 General Cardiology fellows 2 Interventional Fellows 1 Cardiac Imaging Fellow 1 Heart Failure Fellow
5 History 2011 First ACC Organized In-Training Exam Organization Committee: Cardiology Training and Workforce Committee Prior to 2011 A National Exam Was Not Available Most programs developed their own in-service examination
6 History 210 programs participated in the ACC-ITE examination ( ) 288 ACGME Cardiology Fellowship Programs (2017 ACGME Report) ACC-ITE has become the primary Cardiology FIT testing tool during training in the U.S.
7 In-Training Exam Benefits your fellows by helping them to identify knowledge gaps and prepare for the ABIM certification examination. Helps your training program adapt to the needs of your fellows and assess for deficiencies in medical knowledge
8 Preparation for In-Training Exam ACC Identifies Dates in the Winter/Spring Year Prior Usually held the 3 rd Tuesday/Wednesday October October 23-24, 2018 October 22-23, 2019
9 Preparation for In-Training Exam Fellow Preparation No detailed material to review. A web link will be provided for fellows to view an example question. Plenty of rest the night before the exam.
10 The Big Day Total Session Time 6 hours 15 minutes Tutorial Exam Section 1 (30 items) Break * Exam Section 2 (30 items) Break * Exam Section 3 (30 items) Break * Exam Section 4 (30 items) Break * Exam Section 5 (30 items) Survey 15 minutes 60 minutes 10 minutes 60 minutes 10 minutes 60 minutes 30 minutes 60 minutes 10 minutes 60 minutes (untimed)
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12 Results
13 Program Use of Scores Review of Scores w/fellow During Semi-Annual Evaluation PGY Program Comparison PGY National Comparison
14 Name: ID #: Program: University of Cincinnati College of Medicine This report shows your performance on this examination. Information to assist you in interpreting your scores is provided in the accompanying Performance Interpretation Guidelines document. Your Scale Score 826 Your Percent Correct Score 87 Percent Correct Score Your Score Third Year Fellows Mean (SD) Content Area Arrhythmias (15) Coronary Artery Disease (13)
15 Program Use of Scores Review of Scores w/fellow During Semi-Annual Evaluation Program Director Compares to Peers in Program and National Fellows ITE 2 and 3 year report
16 Program Use of Scores In-ServiceExam ReportHistory Fellow Name, MD 2014 Natl Natl Natl 2016 Percent Correct Arrhythmias Cororonary Artery Disease Acute Coronary Syndromes/Acute MI Valvular Disorders Congenital Disorders Aorta/Peripheral Vascular Disease Hypertension/Pulmonary Disorders Congestive Heart Failure
17 Program Use of Scores Clinical Competency Committee Reviews Scores Milestone Reporting Medical Knowledge. Program Evaluation Committee Development of annual curriculum Identify clinical education focus within rotations ACGME WebAds/GME Annual Program Evaluation Faculty recruitment needs of program/division/department Development of Self-Study Program AIMS Environment Context: Opportunities/Threats
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21 Program Use of Scores Clinical Competency Committee Reviews Scores Milestone Reporting Medical Knowledge.
22 Program Use of Scores Remediation Fellows who fall below national average 1 st / 2 nd year fellows Review for improvement 3 rd year fellows Prepare for ABIM subspecialty exam Focused remediation w/mentors 1:1 Sessions
23 Program Use of Scores Remediation Additional Board Review Sessions Sessions for fellows who fell below national average or dropped in scores from previous year Restructure Board Review for 2 nd Half of Academic Year Annual review of program outcomes Program compared to National
24 Program Use of Scores Evaluation of Program Survey recent graduates Board review topics based on recent board examination Evaluate conferences/board topics Review program data Common themes Other than structured board reviews, what other conferences or topics need covered Opportunities for grand round presentations ACC program directors toolbox Subspecialty resources available for cath, EP, etc. HRS SCAI SCMR
25 Does the In-Training Exam Predict ABIM Cardiovascular Disease Board Outcomes?
26 What can we tell you about the Bearcat Fellows
27 Example: ITE Arrhythmia Fellows Completing In-Service Exam Score Program National Year
28 Example: ITE Coronary Artery Disease 75 Fellows Completing In-Service Exam Score Program National Year
29 Example: ITE Arrhythmia Fellows Completing In-Service Exam Score Program National Year
30 Example: ITE Coronary Artery Disease 80 Fellows Completing In-Service Exam Score Program National Year
31 Example: ITE Arrhythmia Fellows Completing In-Service Exam Score Program National Year
32 Example: ITE Coronary Artery Disease 70 Fellows Completing In-Service Exam Score Program National Year
33 5 Year Review ITE/Board Scores R² = Board Average Scores ITE Average Scores
34 Indik, et al JACC 69: , 2017
35 Resources
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37 Individual Board Prep Study Plan Developed by Chief Fellow
38 Resources Mayo Cardiovascular Disease Board Review Curriculum DVDs Question/Answer Sets O Keefe: Complete Guide to ECCGs ECG Source
39 Resources Fellows want to know the why, not just the right answer to a question A 53-year-old man with multiple atherosclerotic risk factors, including HTN, hyperlipidemia, and tobacco use, presents with a 6-month history of DOE and exertional chest tightness. He has orthopnea and paroxysmal nocturnal dyspnea. Echocardiography reveals a severely dilated LV with an EF of 20% and global ventricular hypokinesis. The ECG is normal. The next step in diagnostic evaluation should be: A. Holter monitor B. Stress test with measurement of maximal oxygen consumption C. Coronary angiography D. Heart transplant evaluation Answer: C This patient is at high risk for CAD since he has multiple CV risk factors, cardiomyopathy, and apparent angina. Thus, coronary angiography should be preferred and noninvasive stress bypassed. A Holter monitor and transplant evaluation are not clinically warranted at this time. Reference: Mayo Clinic Cardiology Board Review Question/Answers Lloyd and Murphy
40 What Have We Learned Structure Board Review Review annually with in-training exam breakdown and ABIM score reports Include in Annual Program Review Weekly board review w/detailed schedule Preparation by fellows Assign material to review Encourage Q/A before and after session Include faculty focus on their expertise Junior Faculty Are Huge Benefit.Recent Experience/Study Preparation Structure Board Review by the Program Better Results in In-Training Exam and ABIM Boards Independent Study Sounds Great, but Scores Not Reflected
41 Thank You! University of Cincinnati, Division of Cardiovascular Health and Disease David Harris, MD (Program Director) and Robin Vandivier-Pletsch, MD (Assoc. Program Director) Regina Kayse, MD (Chief Fellow) Caroline Meunier (Graphing)
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