General Cardiology

Purpose:

The purpose of this rotation is to provide senior Cardiovascular Disease fellows in training at the University of Iowa with graduate medical educational experiences in general cardiology in a private practice and community hospital setting. The cardiology fellow is expected to acquire skills related to the clinical management of community cardiology problems.

Responsibiliies/Specific Duties:

The clinical activities will be assigned by the cardiology teaching staff and may include:

  1. Evaluation of new patients and follow up of established patients in the office which may include diagnostic testing and interpretation.
  2. Evaluation and treatment of patients in the hospital setting which may include the Emergency Room, Chest Pain Center, Hospital Wards, Cardiac Catheterization Lab, Noninvasive Laboratory including stress testing, and echocardiography.
  3. Evaluation of patients in established outreach clinics in surrounding communities.

Supervision:

The fellow will work under the direction and supervision of the education coordinator and teaching staff of Cardiologists LC.

  1. All cardiac consultations are reviewed in detail with the attending cardiologist with attention to patient and diagnosis based teaching of the fellow.
  2. In addition to clinical review, the attending cardiologist reviews the progress of the fellow in providing appropriate communication and collaboration with the requesting service.
  3. The attending cardiologist provides teaching of electrocardiographic interpretation.
  4. The fellow’s teaching and learning skills are reviewed on rounds and constructive suggestions are made.
  5. The attending cardiologist reviews cardiac invasive and non-invasive tests on cardiac consult patients with the fellow and other team members on attending rounds.

Learning Objectives:

  1. Provide exposure to the practice of cardiology in a community setting.
  2. Enhancing the training in non-invasive and invasive cardiology.
  3. Developing an understanding of the role of outreach clinical activities in improving access to cardiology services.
  4. Providing exposure to cardiology practice management.

Level Specific Goals and Objectives:

Junior Fellows (first year fellows)

Not applicable

Senior Fellows (second year fellows and above)

This is an elective rotation for senior level fellows only

Patient Characteristics/Mix of Diseases/Types of Clinical Encounters:

Training occurs at the private office of Cardiologists, LC, and St Luke’s Hospital, and Mercy Medical Center, all in Cedar Rapids, Iowa. The patient population includes men and women of all adult ages and of varied ethnic and socioeconomic background. The population includes patients from a primary care base and emergency room patients. Special populations include surgical patients, and patients in intensive care units. Clinical encounters consist of inpatient cardiac consultations. Consultations often are for diagnosis and management of chest pain, unexplained dyspnea, dysrhythmias or syncope, and for preoperative cardiac risk evaluation or perioperative cardiac management. Initial consultation and inpatient follow-up are included.

Teaching Methods:

Teaching by the attending cardiologist occurs in the office and on attending rounds. The attending physician reviews the detailed presentations prepared by the fellow. The attending cardiologist provides constructive suggestions for acquisition of additional relevant clinical information, alternate interpretations of the data presented, recommendations for additional diagnostic considerations, and additional treatment considerations. The attending cardiologist reviews noninvasive and invasive studies with the fellow. The attending physician reviews electrocardiograms interpreted by the fellow and provides appropriate feedback for the accurate interpretation of ECG. The attending cardiologist provides bedside teaching of clinical history and cardiac examination skills.

Evaluation:

  1. The goals and objectives for the rotation will be verbally communicated at the beginning of the rotation.
  2. The fellow’s progress will be reviewed verbally at mid-rotation.
  3. A standard electronic fellow evaluation form will be completed by the attending cardiologist at the end of the rotation.
  4. The attending cardiologist’s final evaluation will be based on the fulfillment of the rotation objectives as determined by:
    1. Personal observation during interaction with the fellow.
    2. Evidence of literature review related to the individual patient.
    3. Evidence of a thorough and accurate patient history and physical examination for each consult.
    4. Accuracy in interpretation of invasive and non-invasive tests for the patient, with good insight into the role of those test results in arriving at an appropriate differential diagnosis and treatment plan.
    5. Performance of the fellow in arrival at a broad, appropriate differential diagnosis, with focus on a most likely diagnosis.
    6. Use of literature and guidelines to develop appropriate treatment plans.
    7. Improved accuracy in interpretation of electrocardiograms.
    8. Evidence of effective written and oral communication with referring physicians.

Resources:

  • Heart Disease: A Textbook of Cardiovascular Medicine (9th edition) Eugene Braunwald, editor
  • Otto’s Textbook of Clinical Echocardiography (4th edition)
  • Baim and Grossman’s Cardiac Catheterization, Angiography, and Intervention (7th edition)
  • Chou’s Electrocardiography in Clinical Practice (6th edition) Surawicz B and Knilans T
  • www.cardiosource.com

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