La idea de mujer en la segunda mitad del siglo XIX y en la primera del XX

Director: David Haines MD

Teaching Faculty: Wai Shun Wong MD, James Stewart MD, K.

Ching Man DO, Brian Williamson MD, Ilana

Kutinsky MD, David Nori MD

A. OVERVIEW

The Clinical Cardiac Electrophysiology (CCEP) Services rotation is designed to provide the clinical fellows with an integrated experience and progressive responsibility. In order to accomplish that goal, the 3-month experience has been divided between Academic Heart and Vascular group (supervising faculty for first 6 months of the academic year), and Northpointe Cardiology (supervising faculty for the second 6 months of the academic year). Regardless of the supervising faculty, fellows will participate in inpatient activities (CCEP consult service and CCEP laboratory activities) and outpatient activities. These experiences will focus on developing cognitive and technical skills for the diagnosis and management of patients with arrhythmias, and those at risk of sudden cardiac death.

B. OBJECTIVES

Clinical Objectives

1. Evaluate and treat patients with cardiac arrhythmias with focus on VT, VF, sudden death risk assessment, atrial fibrillation, SVT, and device therapies (ICD/PPM).

2. Understand indications, limitations, and complications of temporary and permanent cardiac pacing. 3. Understand indications, limitations, and complications for EP studies and ablative treatment. 4. Understand ability of EPS to predict/detect clinical arrhythmias, and be able to interpret basic EP

Studies.

5. Understand anatomy/physiology of normal and diseased cardiac conduction system.

6. Understanding/interpret all scalar modalities including ECG, DCG’s (Holter monitors), and signal averaged ECG’s.

7. Understand the mechanism, use, and toxicology of antiarrhythmic drugs. 8. Understand the indication for and interpretation of tilt table testing. 9. Understand the indications, risks, and methods of cardioversion.

10. Understand the results and implications of major clinical arrhythmia and pacing trials. 11. Understand the interpretation of stress ECGs.

CCEP Laboratory Objectives

12. Learn the techniques of electrode catheter placement for EP testing. 13. Perform and interpret diagnostic EP studies.

C. TEACHING STRATEGIES

1. The CCEP teaching service consists of one or more CCEP teaching attendings, one advanced CCEP fellow, and one or more CCEP clinic fellows.

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2. Formal teaching activities are provided by the CCEP teaching faculty on a daily basis, as outlined in Section D below.

3. CCEP teaching strategies are focused on four general areas:

a. evaluation and treatment of inpatients with a variety of electrophysiological problems b. evaluation and treatment of outpatients with a variety of electrophysiological problems

c. performance and interpretation of noninvasive studies (ECG, DCG, SAECG), invasive studies (EPS), EP ablations, and device therapy (PPM, AICD).

d. Recognition, management and pharmacotherapy of cardiac dysrhythmias.

4. Inpatient and outpatient care, performance of noninvasive and invasive procedures with recognition and management of dysrhythmias directly supervised by the CCEP attending.

5. Other teaching strategies include required participation in weekly EP conference, and preparation of a formal didactic presentation on an EP topic.

6. Fellows are expected to utilize web-based services through the Beaumont Medical Libraries to access ACC/AHA Guidelines and other useful resources.

7. Several EP textbooks and manuals of ECG interpretation are available for self-study. D. ATTENDING RESPONSIBILITIES

Supervision of All Fellows

1. Conduct the Monday Noon Conference (Electrophysiology).

2. Provide formal ECG reading sessions on Monday, Thursday and Friday from 9:00 am to 10:30 am. These sessions will include formal interpretation of stress ECG.

3. Supervise a weekly outpatient teaching session in the Heart Rhythm Clinic (half-day). 4. Review and correct the fellows' ECG, DCG, and signal average ECG reports.

5. Review the results of diagnostic electrophysiology studies with the fellow. A variety of specific arrhythmia mechanisms will be discussed in this context.

6. The EP attending will meet with the EP fellow at the beginning of the rotation to verbally review the goals, objectives and responsibilities for the upcoming month. The fellowship coordinator will maintain a signature log confirming that this meeting has occurred.

7. The EP attending will meet with the EP fellow at the end of the monthly rotation to verbally review the fellow’s written evaluation and performance. The Fellowship Coordinator will maintain a signature log confirming that this meeting has occurred.

8. Supervise inpatient electrophysiology consultations. No more than 4 new patients will be assigned on a daily basis, and patients assigned to the fellow will be selected for their educational value. It is the responsibility of the EP attending physician to ensure that the fellow is exposed to a variety of EP consultations with high educational value, and eliminate fellow consults for “service”. Responsibilities to see inpatient consults will be superseded by responsibilities to attend required conferences and weekly outpatient continuity clinic.

Supervision of CCEP Laboratory Fellows

9. Supervise fellow activities during invasive electrophysiological studies. This will include gaining vascular access, positioning diagnostic electrode catheters in the heart, and pacing the heart through an

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external pacer. Fellows selecting a career pathway in Clinical Cardiac Electrophysiology may also gain experience in performing programmed electrical stimulation, catheter manipulation during catheter ablation procedures, intracardiac echocardiography and transseptal catheterization. Each fellow should participate in a minimum of 3 invasive studies per week.

10. Supervise fellow activities during pacemaker procedures. Unless fellows have committed to a full course of training in CCEP or pacemaker implantation, activities during device implantation will be limited to observation of the surgical technique and device testing through the external programmer/analyzer.

11. Review the tilt table tests with the fellow.

E. FELLOW RESPONSIBILITIES

All patients referred for electrophysiological consultation are eligible for evaluation by the fellows. Such patients include, but are not limited to, those with simple and complex cardiac dysrhythmia; syncope; and disorders requiring invasive EPS, pacemaker or ablation.