UC San Diego Jacobs Medical Center Consult Service
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:
- Consultative inpatient cardiology
- Emergency room evaluation of patients with cardiac disease
- Outpatient continuity clinic
- Cost-effective management of hospitalized patients with cardiac disease
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These include daily clinical teaching rounds with attending staff and direct faculty supervision of any procedures. The fellow will attend daily echocardiography reading sessions at the CVC when possible, as well as regularly scheduled didactic sessions.
Part of the population seen at the Thornton Pavilion is similar to that of a community hospital, while other patients are referred for specialized care. Patients tend to be middle-aged to elderly, and genders are approximately equally represented.
ER evaluations and inpatient cardiology consultations are generally seen first by the fellow and then together with the faculty attending. Fellows are strongly encouraged to assist with procedures such as DC cardioversions and transesophageal echocardiograms.
Fellows are expected to attend daily echocardiography teaching rounds at the CVC noninvasive lab whenever possible.
Independent analysis of patient information by the fellow is encouraged, but all inpatients and consultations are seen by the faculty and reviewed with the fellow. All major clinical decisions are discussed by the fellow and faculty. Faculty directly supervise all invasive procedures.
- Braunwald's "Heart Disease"
- Hurst's "The Heart"
- Feigenbaum's "Echocardiography"
Teaching files of interesting echocardiograms, angiograms, and stress tests are available on-line on the CVC’s digital cardiac imaging system.
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 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.
Second-year fellows are expected to:
- Hone their skills in consultative management of acute coronary syndromes, acute CHF, and valvular disease
- Perform right heart catheterizations with attending supervision, when necessary.
Third- year fellows are expected to:
- Show continued clinical maturation: they should act with increased levels of independence in patient care activities, and should act as the leader of the consult service.
- Serve as primary operators for invasive procedures with minimal attending input.
All fellows are expected to show empathy with patients and their families, and to communicate well with patients, their families, and ancillary staff.
Specific activities during this rotation that will enhance the fellows’ skills in the 6 core competencies:
- Patient Care: Fellows will encounter a large group of patients a wide variety of acute and chronic cardiovascular illnesses. They will round on the consult service daily and dictate/write notes to be cosigned by the attending.
- Medical Knowledge: Fellows will learn from the attending faculty during patient rounds and teaching rounds, and also from self- directed review of the literature.
- Interpersonal and Communication Skills: Fellows will interact with medical staff, nurses, pharmacists, and other ancillary personnel. They will communicate with patients’ families. There are no internal medicine residents working with the fellow during this rotation, so fellows are the main cardiovascular contact person for family members, ancillary personnel, etc. Fellows are expected to keep accurate, timely-signed medical records.
- Professionalism: Fellows will gain experience in the respectful treatment of all the above-mentioned groups, and will also maintain accurate procedure reports and logs.
- Practice-Based Learning: Fellows are expected to gain knowledge from self-directed literature review. Fellows will present cases from the CVC and Thornton Pavilion during weekly catheterization conference and discuss pertinent literature.
- Systems-Based Practice: Fellows will work within a team of health care professionals and participate in consultative management, facilitation of cardiac procedures, and discharge planning. They will be exposed to patient concerns such as cost of medication, ambulatory follow-up, and end-of-life issues.