Diccionarios más relevantes utilizados para determinar y fundamentar la variación

1. Each fellow is to be evaluated on a monthly basis at the end of the CT/MR rotation as follows (360° Evaluation):

a. A formal evaluation will be completed by the CT/MR attending(s) in New Innovations, and the content of the evaluation will be reviewed verbally with the fellow. Deficiencies must be forwarded to the Program Director. Fellows will also be evaluated by Ralph Gentry at the end of each rotation. Fellows will also evaluate his/her performance in the context of the goals and responsibilities for this rotation. b. Dr. Raff must sign the procedure-credentialing log at the end of the month, and a copy of the form must

be filed with the Fellowship Coordinator.

2. The CT/MR fellow(s) will complete a formal evaluation of the CT/MR attending(s) each month, using New Innovations. This evaluation will be reviewed on an annual basis with the Program Director and Chief of Cardiology.

C. CREDENTIALING

1. Fellows MUST maintain a log of all CT/MR studies performed. Dr. Raff must sign this log at the end of the month, and a copy placed in the Fellow’ file. Routine certification is not provided.

2. ACC/AHA Competency Requirements: a. Onsite attendance

i. CT: 8 weeks ii. MRI: 3 months

b. didactic instruction: 20 hours

c. live acquisitions and interpretations: 50 cases d. additional cases from teaching library: 100 cases e. all activities require written documentation

3. Fellows are expected to complete the ACC/AHA requirements for didactic education. Part of this consists of the CT and MRI Registry Review manuals including test questions that are supplied at the beginning of the rotation. When answers to a chapter are turned in to Dr. Raff’s secretary, fellows receive the correct answers and a study guide explaining each. Fellows are expected to complete both manuals over 3 months, except for the chapters on anatomy. The CT manual must be completed during the first month, and the MRI manual must be completed over 3 months (1/3 during each).

G. SUGGESTED READING MATERIALS

a. Cardiovascular Magnetic Resonance, WJ Manning, DJ Pennell ed., Churchill Livingston, 2002 b. Cardiovascular MRI and MRA, CB Higgins, A De Roos, ed., Lippincott Williams and Wilkins, 2003 c. Case study filed, CMR department

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Modality Competency Level Cumulative Duration of Training No. of Examinations (present for acquisition)

No. of Examinations (interpretation) Cardiac CT Level 1 Level 2 Level 3 1 month 2 months 6 months 25 35 100 50 150 300

Cardiac MRI Level 1 Level 2 Level 3 1 month 3 months 12 months 25 50 100 50 150 300

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CARDIAC REHABILITATION/PREVENTIVE CARDIOLOGY (ELECTIVE)

Directors: Barry Franklin PhD

Teaching Faculty: J. Yanez MD

OBJECTIVES

1. To understand exercise principles, exercise prescription, stress testing, secondary prevention, metabolic calculations, risk factor modification, and nutrition.

2. To learn how to monitor and interpret graded exercise stress tests with specific emphasis on indications, contraindications, choosing appropriate protocols (e.g., treadmill, cycle ergometer, arm ergometer), normal and abnormal physiologic responses, test endpoints, cool-down procedures, and emergency measures. Fellows also gain exposure to pharmacologic stress testing (e.g., persantine, dobutamine), that are covered in greater depth in other rotations (i.e. nuclear medicine, echocardiography).

3. To learn the services, procedures and logistics for processing patients through inpatient and outpatient cardiac rehabilitation. This includes the history, lipid profiling, body composition testing, exercise evaluation, metabolic assessment (measurement of oxygen consumption), and formulation of the exercise prescription.

4. To learn the referral process (e.g., risk factor forms, exercise prescription data sheets) associated with outpatient programming.

5. To gain exposure to Phase II (telemetry-monitored exercise therapy) and Phase III rehab.

6. To identify patients at high risk for cardiovascular disease and to recommend specific primary preventive measures.

7. To implement cardiovascular risk reduction through diagnosis and treatment of hypertension, dyslipidemia, thrombosis, diabetes and obesity.

8. To understand the importance of smoking cessation, nutrition and its effects on the cardiovascular system, and psychosocial and behavioral aspects of cardiovascular disease.

9. To understand external counterpulsation (EECP) and its role in the treatment of CAD. TEACHING STRATEGIES

1. The Cardiac Rehab/Preventative Cardiology teaching service consists of several attending physicians and one cardiology fellow.

2. Direct hands on experience in the performance of exercise tests, cardiac rehabilitation classes, and EECP. 3. One-to-one instruction with the teaching faculty to discuss selected topics in exercise physiology, exercise

testing, cardiovascular rehabilitation, nutrition, and risk factor modification. 4. Active participation in the Preventative Cardiology Clinic.

5. Formal instruction in the interpretation of stress ECG. FACULTY RESPONSIBILITIES

1. Rehabilitation faculty meet regularly with the fellows during their rotation to discuss selected topics including: ECG’s, resting and exercise physiology, exercise prescription, cardiac rehabilitation, metabolic assessment (e.g., measurement of oxygen consumption, anaerobic threshold), chronotropic incompetence, recovery heart rate, Duke treadmill score, exertional hypotension, coronary risk factor modification, and related rehabilitation topics.

2. Guidance in formulating proposals is provided for fellows interested in conducting independent research in this area.

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3. At the beginning of the rotation, the Medical Director will verbally review the goals, objectives, and responsibilities with the fellow. The Fellowship Coordinator will maintain a signature log confirming that this meeting has occurred.

4. At the end of each rotation, the Medical Director will meet with the fellow and verbally review the written evaluation and performance. The Fellowship Coordinator will maintain a signature log confirming that this meeting has occurred.

5. Provide formal instruction in 2-5 stress ECGs per day. D. FELLOW RESPONSIBILITIES:

PATIENT CARE

1. Monitor patients undergoing exercise tests and rehabilitation classes.

2. Participate in the preventive cardiology clinic under the direction of Dr. Peter McCullough and staff. 3. Identify patients at high risk for cardiovascular disease, and recommend appropriate measures for primary

and secondary prevention.

4. Attend and observe at least one “patient planning session” with a behavioral psychologist for a prospective weight reduction patient.

5. Attend and observe at least one “group patient session” led by a behavioral psychologist for weight reduction patients.

6. Attend and observe at least one “instructions session” led by a nurse-clinician on how to initiate a meal replacement diet for significant weight reduction.

7. Attend and observe at least one “nutrition class” led by a registered dietician for weight reduction patients. 8. Attend and observe at least one “personal consultation for exercise therapy” led by an exercise physiologist

for a weight reduction patient.

9. Formal reading and interpretation of 2-5 stress ECGs per day. MEDICAL KNOWLEDGE

1. Become familiar with cardiovascular risk reduction, lipid subfractionation, novel risk factors, obesity management, nutrition, psychological and exercise counseling, meal replacement approaches, indications for bariatric surgery, and risk and assessment.

2. Understand principles of exercise physiology, normal and abnormal physiological responses, and use of pharmacologic stress tests.

3. Learn how to screen young athletes for risk of sudden cardiac death, and how to prevent it. PRACTICE-BASED LEARNING

1. Participate in all required Cardiology conferences.

2. Participate in regular didactic sessions with Cardiac Rehab/Preventative Cardiology faculty. INTERPERSONAL & COMMUNICATION SKILLS

1. Interact with the attendings, nursing staff, and technical staff to ensure a “team” approach, and identify and resolve any issues that arise.

2. Communicate with the patient and family to provide thoughtful recommendations about risk factor modification and primary/secondary prevention.

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