Kaiser San Diego Medicine Center Cardiovascular Medicine

Educational purpose and learning objectives

The educational purpose of this rotation is to give the fellow the experience and varied responsibilities of a practicing clinical cardiologist. Specific learning objectives include gaining expertise in the following areas:

  • Echocardiography
    • ESE, DSE, TEE, TTE
  • Cardiology graphics interpretation
    • ETT, ECG
  • Inpatient invasive procedures
    • Transvenous pacemaker placement, right heart catheterization, pericardiocentesis, etc.
  • Adult congenital heart disease

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Teaching methods

These include teaching rounds with attending staff and direct faculty supervision of procedures such as transesophageal echocardiography and stress echocardiography. The fellows will also attend regularly scheduled conferences.

Disease mix/patient characteristics

The patient population at Kaiser Permanente is typical of a community hospital in Southern California, with a diverse representation of ethnicities, ages, and a fairly equal gender representation.

Type of clinical encounters/procedures/services

Fellows are strongly encouraged to assist with transesophageal echos, elective cardioversions, right heart catheterizations, pacemaker placements, and other inpatient procedures.

Fellows are expected to interpret echocardiograms, stress echos, & graphics. Staff cardiologists will interpret echocardiograms each afternoon, and the fellow is expected to participate whenever possible.

Level of fellow supervision by faculty

Independent analysis of patient information by the fellow is encouraged, but all inpatient consultations are seen by the attending and reviewed with the fellow. All major clinical decisions are discussed by the fellow and attending. Staff cardiologists will directly supervise all inpatient procedures.

Reading list

  • Braunwald E. “Heart Disease”
  • Oh J. “The Echo Manual”

Pathological material and other educational resources

Teaching files of interesting cases are available through the fellowship director & individual staff.

Method of resident evaluation

ACGME core competencies are evaluated monthly by the attending faculty. These evaluations are discussed with the fellows and forwarded to the program director.

First-year fellows are expected to have a mean evaluation score of 5 or greater on the standard 1-9 scale of the 6 ACGME core competencies. Second-year fellows are expected to have a mean score of 6 or above; third-year fellows are expected to have a mean score of 7 or above. Expectations of fellow performance vary by year of training.

First-year fellows do not rotate at Kaiser.

Second-year fellows are expected to:

  • Perform an adequate history and physical examination
  • Understand the basic concepts of consultative cardiology, including (but not limited to) preoperative assessment and “cardiac clearance,” as well as evaluation for heart failure, coronary disease, arrhythmia, and valvular heart disease
  • Hone their skills in echocardiography, including transthoracic, stress, and transesophageal echo
  • Show empathy with patients and their families, and to communicate well with patients, their families, and ancillary staff

Third-year fellows are expected to:

  • Show continued clinical maturation: They should act with increased levels of independence in patient care activities
  • Serve as primary operators for cardiac catheterization and TEE procedures, with minimal attending input and guidance
  • Show empathy with patients and their families, and to communicate well with patients, their families, and ancillary staff

Educational purposes and ACGME Core Competencies

Specific activities during this rotation that will enhance the fellows’ skills in the 6 core competencies:

  1. Patient Care: Fellows will encounter a large group of patients, a wide variety of acute and chronic cardiovascular illnesses, and assist in all procedures performed.
  2. Medical Knowledge: Fellows will learn from the attending faculty during patient rounds and teaching rounds, and also from self-directed review of the literature.
  3. Interpersonal and Communication Skills: Fellows will interact with medical staff, nurses, pharmacists, and other ancillary personnel. They will communicate with patients’ families. Fellows are expected to keep accurate, timely-signed medical records.
  4. Professionalism: Fellows will gain experience in the respectful treatment of all the above-mentioned groups, and will also maintain accurate procedure reports and logs.
  5. Practice-Based Learning: Fellows are expected to gain knowledge from self-directed literature review. They will present cases during weekly catheterization conference and discuss pertinent literature.
  6. Systems-Based Practice: Fellows will work within a team of health care professionals and participate in consultative inpatient management and facilitation of procedures. Fellows will be exposed to patient concerns, such as conscious sedation during procedures, ambulatory follow-up, and satisfactory explanation of test results and their implications.