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Cardiovascular Fellowship Curriculum University of Pittsburgh Medical Center UPMC Presbyterian UPMC Shadyside Veterans Administration Medical Center Outpatient Services Goals and Objectives Educational purpose and rationale or value as part of training of a cardiovascular specialist The rotation of the cardiovascular fellow as a consultant in outpatient cardiology is a critical aspect of the fellows training in that the average non laboratory based adult cardiologist spends approximately 30 40 percent of his her time in the outpatient department evaluating both new referrals as well as established patients At the present time all of our second and third year fellows are board certified in internal medicine and all of our first year fellows are board eligible in internal medicine As such they have had considerable experience in their medical residency training in general consultative services They are all already competent in obtaining a general history and performing a general physical examination During the three years of one half day per week continuity clinic they will become skilled in obtaining a detailed cardiovascular history and performing a complete cardiovascular physical examination By having continuity of care for a patient throughout the three year period they will become familiar with the role of aging and psychogenic factors in the production of symptoms and emotional and physical responses of the patient with cardiovascular disease They will also become familiar with the importance of preventive care and rehabilitative aspects of the management of patients with known or potential cardiovascular disease All fellows will develop the interpersonal and communication skills that result in effective information exchange with patients their families and other health professionals particularly referring physicians They must demonstrate that their patient care is compassionate appropriate and effective for the long term management of their patients During the three years they will encounter a wide spectrum of cardiovascular disease and it is expected that each trainee will increase their cardiology knowledge base by studying the many available texts of cardiology as well as reviewing the pertinent literature relative to their patient s problem available both on the web as well as the many journals available on cardiovascular disease in the library Practice based learning and improvement that involves investigation and evaluation of their own patient care will be emphasized by their preceptor throughout this three year period System based practice will be emphasized by the faculty mentor such that the trainee will demonstrate an awareness and the responsiveness of the overall system of health care for the patient as well as the ability to effectively call on system resources to provide optimal care to the patient with cardiovascular disease Methodology of Teaching Principle teaching method throughout the three years of cardiovascular fellowship 36 months Each cardiac fellow spends one half a day a week in the outpatient department Throughout the three years Each trainee rotates on a weekly basis between the VA outpatient cardiology center and the Presbyterian and Shadyside outpatient offices At the VA Medical Center half day clinics are assigned throughout the week and during this four to five hour period approximately 5 8 patients are seen by each fellow and every patient is precepted by a faculty member These include both new as well as established patients and it is the responsibility of the cardiac trainee to follow his or her own patients throughout the three year period Each cardiac trainee is expected to perform a complete history and physical examination as well as order and interpret the appropriate routine and specialized cardiovascular tests It is expected that when his her patient is admitted to the hospital they will be involved with the inpatient management particularly when admitted for specialized tests such as cardiac catheterization or transesophageal echocardiography It is also anticipated that patients that have been catheterized previously by the trainee will be followed up in the outpatient clinic 4 At the University of Pittsburgh Medical Center UPMC Presbyterian and UPMC Shadyside each trainee is assigned at the onset of the fellowship training to a specific faculty member for one half day during one of the 10 morning or afternoon sessions during the week Because of the strict new Medicare laws all the patients evaluated will be on the faculty attendee s service It is the responsibility of the trainee to work closely with his assigned faculty mentor both in terms of initial evaluation and follow up of the outpatient clinic patients Every attempt is made to have follow up patients see the faculty attendee on a day when the cardiac trainee is available and in clinic It is the responsibility of the trainee to document in writing the initial history and physical as well as further evaluation and long term management plan Every patient is seen and discussed in detail by the attending physician and the official outpatient report to the referring physician is the responsibility of the faculty member Educational Content Mix of Disease VA Medical Center 75 80 percent of patients have coronary artery disease The remainder is a mix of valvular and primary myopathic disease as well as arrhythmia problems At UPMC a broad spectrum of cardiovascular disease is seen Approximately 50 60 percent coronary disease 15 20 percent valvular disease 10 15 percent myopathic disease and the remainder adult congenital heart disease Patient Characteristics VA Medical Center 90 percent male UPMC 50 50 Environment of Teaching At the VA Medical Center there are excellent facilities in the common outpatient department with individual rooms for patients and physicians At UPMC Presbyterian there is a new state of the art 15 room outpatient department Included in this area are exercise testing facilities as well as adjacent echocardiographic facilities Nuclear cardiology facilities are available 1 floor below the outpatient department Similar facilities are available at UPMC Shadyside Procedures and Services The cardiology trainees are expected to interpret the electrocardiograms on all new and return patients and to retrieve prior electrocardiograms for comparison When these tracings are not available by the computerized system it will be the responsibility of the trainee to have


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