مااللها نا م 1
Shahid Beheshti University of Medical Sciences CARDIOLOGY DEPARTMENT Log Book Clinical skill report booklet for residents of cardiology 2
The Name of Allah This collection is designed at Shahid Beheshti University of Medical Sciences with the aim of advancing scientific and practical capabilities of Cardiology residents. I trust that we will achieve the main objective, promotion of the quality of training of residents, by application of its contents, proper use of it, and implementation of all programs set forth herein. Obviously, success will be guaranteed only by preservance and stamina, and by continually carrying out the instructions laid down in the booklet. Dr.Mohammad Asadpour Piranfar Head of Cardiology Department Shahid Beheshti University of Medical Sciences Tehran-Iran 3
Preface This collection which will be called Logbook is actually a clinical skill report booklet designed to record practical and scientific activities of cardiology residents of Shahid Beheshti University of Medical Sciences. It is used to either evaluate these activities by faculty or self evaluate by residents. This log book has been designed based on similar material used in well known medical universities and will help in dealing with the educational pitfalls during the residency program. We wish this will facilitate better educational outcomes among our residents. Dr. Mersedeh Karvandi Cardiologist-Echocardiologist Assistant of Cardiology Shahid Beheshti University of Medical Sciences 4
Faculty Members Department of Cardiology Name & Surname Academic Degree Name & Surname Academic Degree Mohammad Abazari MD Assistant professor Mersedeh Karvandi MD Assistant professor Shapour Alidaei MD Assistant professor Mohammad Khani MD Associate professor Saeed AliPour Parsa MD Assistant professor Homayoun Koohi Kamali MD Assistant professor Mohammad Assadpour Piranfar MD Associate professor Reza Miri MD Associate professor Manouchehr Behnia MD Assistant professor Mohammad Hassan Namazi MD Associate professor Mohammad Reza Beyranvand MD Associate professor Mohammad Parsa Mahjoob Assistant professor Neda Behzadnia MD Assistant professor Habibollah Saadat MD Associate professor Seyed Masoud Ghavam MD Assistant professor Roxana Sadeghi MD Assistant professor Mohammad Esmaeil Gheidari MD Associate professor Morteza Safi MD Associate professor Mohammad Yousof Heidari MD Assistant professor Babak Sharif Kashani MD Associate professor Mohammad Haji Aghajani MD Assistant professor Maryam Taherkhani MD Assistant professor Farhad Hajsheikholeslami MD Assistant professor Hossein Vakili MD Associate professor Head of Department of Cardiology Dr. Mohammad Asadpour Piranfar 5
Contents Preface.. 4 Peripheral angiography.42 CV line- Arterial line-swan-ganz..154 Faculty members...5 Fluoroscopy. 45 EPS-RF-ICD.. 156 Content table..6 PCI...49 Cardiovascular surgery...160 Objectives 7 Holter monitoring 53 Pericardial diseases...164 T 7 61 166 7 UTT 74 168 8 T 77 170 z 9 80 G 172 fi 10 83 174 fi 11 TT 89 177 T 12 T 13 15 G 31 z 34 T 135 138 142 146 T 148 T 150 153 6
Objectives The assistant will record his scientific experiments accurately and completely in the Logbook that led him to document his experiences, clear his shortages and help him to resolve them. The Logbook will help the professors to assess the educational process of each assistant. The Logbook will assist relevant authorities in assessing the success of the educational sector to create professional experiences for the residents. The Logbook will help estimating the ability of an educational department to provide scientific grounds for their assistants. Terms and conditions All cardiology residents should record their academic experiences in their Log Book. Each assistant should fill its own Logbook. All written data should be approved by the respective observing professors. Assistants should complete their logbook from the beginning of the training course, or from the beginning of the school year. The Department can any time demand the logbook for review or coping. Contents of the logbook is personal and confidential and only can be checked by the faculty, director, education officials of the university, staff and members of the examination center and the relevant educational authorities of the Ministry of Health and Medical Education. The observing professor should approve the procedures reported in the tables even if the assistant perform a procedure independently but with permission. The reports written in the logbook can be cited as abilities and experiences of its owner. A copy of the logbook should be provided to the department office at the end of the training course. 7
Recommendations It is recommended that assistants have the logbook with them in all conditions while they are present in the ward and to fill the tables immediately after performing any procedure. It is recommended that the data written in relevant tables be approved by the observing professor as soon as possible. Clinical components Cardiology specialty training course During the training course the assistants should have the possibility to visit outpatients consistently and independently and made diagnosis and treatment plan for them, while having a direct or indirect supervision of Academic Staff. Due to the importance of providing proper outpatient care, assistants should have the possibility to track their patients and evaluate their therapeutic actions. These measures should be under supervision of the faculty. During the training course the assistants should have the opportunity to provide emergency cardiac cares to the patients. These measures should be supervised directly or indirectly by the faculty. The training program should provide enough time and condition for the assistant to learn electrocardiography, echocardiography, exercise test, Holter monitoring, Tilt test, pacemaker, cardiac catheterization, invasive interventions, cardiac MRI interpretation, and interpretation of cardiac CT angiography and Thallium scan in the field of cardiology. 8
In order to gain the mentioned skills by an assistant it is needed to ensure the following conditions. Conducting at least 150 exercise testing and its analysis. Reporting and interpreting at least 100 Holter monitoring for electrocardiographic and cardiac rhythm changes. Performing and reporting at least 20 Tilt test. Performing at least 500 echocardiography and interpreting them. 20 of them should be recorded to be assessed by the faculty. Performing at least 50 cases of right and left catheterization and at least 200 cases of coronary angiography as first operator and interpreting the results and management of possible side effects. Participating in at least 25 invasive intervention like PCI. Temporary pacing for at least 25 cases. Participating in at least 25 PPM. Interpretation of at least 25 cardiac MRI, CTA, and Thallium scam. Participating in at least 25 EPS, RF ablation and ICD and interpretation of the results. Specialized Skills Assistant should know the applications, contra indications and side effects of the following techniques and skills and have the ability to perform them and interpret their results. Electrocardiography, chest radiography, echocardiography, exercise test, cardiac nuclear imaging, holter monitoring, cardiac imaging techniques, Head up tilt test and diagnostic and therapeutic invasive procedures such as catheterization, angiography, (percutaneous coronary intervention) PCI and... Echocardiography, including knowledge of cardiac anatomy, physiology and hemodynamic, principles of physics of echo and Doppler phenomenon, to be familiar enough with the echocardiography devices. 9
Assistant should be familiar with Transesophaheal Echocardiography and stress echocardiography, but to achieve the full skills it is needed to pass complementary courses. Invasive cardiology including ability to perform coronary angiography and left and right catheterization, and management of their side effects. Electrical cardioversion, cardiovascular resuscitation, pericardiocentesis, placing an arterial line and Swan-Ganz catheter, electrophysiology study, temporary pacing (pace maker) Applications, specifications and properties of different types of pacemakers and monitoring and programming them. It is necessary to participate in pacemaker clinic. Assistant should be familiar with PCI and PPM insertion and EPS procedures, but to achieve the full skills it is needed to pass complementary courses. Certification Each assistant is required to perform a research project as a thesis during the residency program under the supervision of one of the faculty members. Each assistant is required to participate in all examinations and tests conducted by the cardiology department during his academic course. Assistants are required to participate in the annual promotion examination and national board examination conducted every year by the Council Secretariat of Specialized Medical Training based on the approved regulations. 10
Resident Profile: Name and Surname: Birthplace: of pass on residency: University of MD: Father's Name: Birthday: Residency program start date: Year of Graduation: Address: Phone/Fax: Cell Phone: email: 11
About the Thesis Title in Persian: Title in English: Type of Research: Advisor: Supervisor: Approved Number: About thesis defense and score: Advisor Signature: Meeting time for defense: Score: Thesis accepted for publication in an approved journal: Yes NO Journal name: Advisor Signature: 12
Tables 13
Cath-Lab 14
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 15
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 16
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 17
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 18
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 19
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 20
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 21
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 22
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 23
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 24
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 25
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 26
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 27
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 28
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 29
Coronary Angiography Patient s Name Proposed Treatment Possible Complications Tasks for Complications 30
Coronary Angiography in CABG Patients Patient s Name Proposed Treatment Possible Complications Tasks for Complications Superscriptio n 31
Coronary Angiography in CABG Patients Patient s Name Proposed Treatment Possible Complications Tasks for Complications 32
Coronary Angiography in CABG Patients Patient s Name Proposed Treatment Possible Complications Tasks for Complications 33
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 34
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 35
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 36
Catheterization in Valvular and Congenital Heart Diseases No. Patient s Name Proposed Treatment Possible Complications Tasks for Complications 37
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 38
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 39
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 40
Catheterization in Valvular and Congenital Heart Diseases Patient s Name Proposed Treatment Possible Complications Tasks for Complications 41
Peripheral Angiography Patient s Name Proposed Treatment Complications 42
Peripheral Angiography Patient s Name Proposed Treatment Complications 43
Peripheral Angiography Patient s Name Proposed Treatment Complications 44
Fluoroscopy Patient s Name Proposed treatment score 45
Fluoroscopy Patient s Name Proposed treatment score 46
Fluoroscopy Patient s Name Proposed treatment score 47
Fluoroscopy Patient s Name Proposed treatment score 48
PCI Patient s Name Procedure 49
PCI Patient s Name Procedure 50
PCI Patient s Name Procedure 51
Holter Monitoring Exercise Testing HUTT 52
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 53
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 54
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 55
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 56
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 57
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 58
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 59
Holter Monitoring NO. Patient s Name Patient s complaint QTc Holter findings Abnormal holter results HRV Commentary 60
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 61
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 62
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 63
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 64
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 65
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 66
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 67
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 68
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 69
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 70
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 71
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 72
Exercise Testing Patient s Name Indication for Testing Result of Testing Possible Complications Proposed Treatment 73
HUTT Patient s Name ECG findings&(qtc) Result of Test & Complications Proposed Treatment 74
HUTT Patient s Name ECG findings&(qtc) Result of Test & Complications Proposed Treatment 75
Temporary pacemaker Permanent pacemaker Pace maker clinic 76
Temporary Pacemaker (TPM) NO. Patient s Name Complications Over Time Remaining TPM Tasks for Complications 77
Temporary Pacemaker (TPM) NO. Patient s Name Complications Over Time Remaining TPM Tasks for Complications 78
Temporary Pacemaker (TPM) NO. Patient s Name Complications Over Time Remaining TPM Tasks for Complications 79
Permanent pacemaker NO. Patient s Name 80
Permanent pacemaker NO. Patient s Name 81
Permanent pacemaker NO. Patient s Name 82
Pacemaker clinic Patient s Name Primary diagnosis Analysis results Proposition Obsrving professor 83
Pacemaker clinic Patient s Name Primary diagnosis Analysis results Proposition Obsrving professor 84
Pacemaker clinic Patient s Name Primary diagnosis Analysis results Proposition Obsrving professor 85
Pacemaker clinic Patient s Name Primary diagnosis Analysis results Proposition Obsrving professor 86
Pacemaker clinic Patient s Name Primary diagnosis Analysis results Proposition Obsrving professor 87
Echocardiography 88
TTE Patient s Name Proposed Treatment 89
TTE Patient s Name Proposed Treatment 90
TTE Patient s Name Proposed Treatment 91
TTE Patient s Name Proposed Treatment 92
TTE Patient s Name Proposed Treatment 93
TTE Patient s Name Proposed Treatment 94
TTE Patient s Name Proposed Treatment 95
TTE Patient s Name Proposed Treatment 96
TTE Patient s Name Proposed Treatment 97
TTE Patient s Name Proposed Treatment 98
TTE Patient s Name Proposed Treatment 99
TTE Patient s Name Proposed Treatment 100
TTE Patient s Name Proposed Treatment 101
TTE Patient s Name Proposed Treatment 102
TTE Patient s Name Proposed Treatment 103
TTE Patient s Name Proposed Treatment 104
TTE Patient s Name Proposed Treatment 105
TTE Patient s Name Proposed Treatment 106
TTE Patient s Name Proposed Treatment 107
TTE Patient s Name Proposed Treatment 108
TTE Patient s Name Proposed Treatment 109
TTE Patient s Name Proposed Treatment 110
TTE Patient s Name Proposed Treatment 111
TTE Patient s Name Proposed Treatment 112
TTE Patient s Name Proposed Treatment 113
TTE Patient s Name Proposed Treatment 114
TTE Patient s Name Proposed Treatment 115
TTE Patient s Name Proposed Treatment 116
TTE Patient s Name Proposed Treatment 117
TTE Patient s Name Proposed Treatment 118
TTE Patient s Name Proposed Treatment 119
TTE Patient s Name Proposed Treatment 120
TTE Patient s Name Proposed Treatment 121
TTE Patient s Name Proposed Treatment 122
TTE Patient s Name Proposed Treatment 123
TTE Patient s Name Proposed Treatment 124
TTE Patient s Name Proposed Treatment 125
TTE Patient s Name Proposed Treatment 126
TTE Patient s Name Proposed Treatment 127
TTE Patient s Name Proposed Treatment 128
TTE Patient s Name Proposed Treatment 129
TTE Patient s Name Proposed Treatment 130
TTE Patient s Name Proposed Treatment 131
TTE Patient s Name Proposed Treatment 132
TTE Patient s Name Proposed Treatment 133
TTE Patient s Name Proposed Treatment 134
TEE Patient s Name Proposed Treatment Complication During TEE 135
TEE Patient s Name Proposed Treatment Complication During TEE 136
TEE Patient s Name Proposed Treatment Complication During TEE 137
Stress Echocardiography Patient s Name Proposed Treatment Complication During SE 138
Stress Echocardiography Patient s Name Proposed Treatment Complication During SE 139
Stress Echocardiography Patient s Name Proposed Treatment Complication During SE 140
Cardiopulmonary resuscitation 141
Cardiopulmonary Resuscitation Patient s Name Treatment CPR Length Result 142
Cardiopulmonary Resuscitation Patient s Name Treatment CPR Length Result 143
Cardiopulmonary Resuscitation Patient s Name Treatment CPR Length Result 144
Cardiac Imaging 145
Cardiac MRI interpretation Patient s Name Indication Interpretation 146
Cardiac MRI interpretation Patient s Name Indication Interpretation 147
Cardiac CT Angiography Patient s Name Indication Interpretation 148
Cardiac CT Angiography Patient s Name Indication Interpretation 149
Thallium scan Patient s Name Indication Interpretation 150
Thallium scan Patient s Name Indication Interpretation 151
Pericardiocentesis CV line pericardiocentesis Arterial line Swan-Ganz 152
Pericardiocentesis Patient s Name Possible cause of tamponade Echocardiography Result Possible Complications Tasks for Complications * Score from A to D by the observer 153
CV Line- Arterial line- Swan-Ganz Patient s Name File Indication Possible Complications Tasks for Complications * Score from A to D by the observer 154
EPS RF Ablation ICD 155
EPS-RF Ablation- ICD Patient s Name Indication Interpretation & diagnosis * Score from A to D by the observer 156
EPS-RF Ablation- ICD Patient s Name Indication Interpretation & diagnosis * Score from A to D by the observer 157
EPS-RF Ablation- ICD Patient s Name Indication Interpretation & diagnosis * Score from A to D by the observer 158
Cardiovascular Surgery 159
Cardiovascular Surgery Patient s Name Indication for surgery Type of Surgery Cardiac Surgeon 160
Cardiovascular Surgery Patient s Name Indication for surgery Type of Surgery Cardiac Surgeon 161
Cardiovascular Surgery Patient s Name Indication for surgery Type of Surgery Cardiac Surgeon 162
Inpatient and outpatient management 163
Pericardial diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 164
Pericardial diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 165
Myocardial diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 166
Myocardial diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 167
Valvular diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis Score * 168
Valvular diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis Score * 169
Coronary diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 170
Coronary diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 171
Great vessels diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 172
Great vessels diseases Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 173
Congenital heart disease Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 174
Congenital heart disease Patient s Name Primary diagnosis Diagnostic plan& results Final diagnosis 175
Scientific activities 176
Scientific Conferences and Activities Title Activity Venue and Organizer Director name and approval 177
Scientific Conferences and Activities Title Activity Venue and Organizer Director name and approval 178
Scientific Conferences and Activities Title Activity Venue and Organizer Director name and approval 179
Scientific Conferences and Activities Title Activity Venue and Organizer Director name and approval 180