Focus and Content of Training
Focus of Training:
All cardiac electrophysiologists, independent of eventual career choice, must have extensive training and experience in the care of patients with cardiac arrhythmias in both the outpatient and inpatient settings, and must demonstrate competency in dealing with health concerns and problems of these patients and their families. This basic core of educational content is required of all cardiac electrophysiologists, and is in accordance with the Accreditation Council for Graduate Medical Education requirements, and qualifies one to take the American Board of Internal Medicine Certifying Examination in Clinical Cardiac Electrophysiology. The curriculum for an individual trainee will contain the above requisites, but may be modified for the trainee’s specific career goals.
Flexibility in rotational scheduling is emphasized for all trainees so as to permit optimal tailoring of an individual curriculum to the specifics of a trainee’s eventual career.
Content of Training:
In order to accomplish the above, training is a process of patient care in a variety of settings, in and out of the hospital and with a variety of encounters from the brief and superficial to the long and in depth, with a variety of patients with different backgrounds, ages and problems. The educational basis of these patient encounters follows a philosophy of “crawl-walk-run,” and consists of a gradual increase in independence (and decrease in supervision), a system of evaluations, feedback and encouragements to adhere to the above knowledge, skills, attitudes and habits, and the provision of role models worthy of emulation. These activities are then supplemented by a curriculum of clinical and case-oriented conferences and a core reading program throughout the training period.
Training experiences are rotated on a monthly basis, except for the Continuity Clinic schedule that is ongoing throughout the entire training period. Rotations are of the following types.
Preceptor model with 1 or 2 fellows assigned to a supervising cardiac electrophysiologist. Focused training experience in all aspects of cardiac electrophysiological intervention and device implantation. Fellows are expected to complete 300 interventions during this rotation, including 90 catheter ablations and 75 implantable cardioverter defibrillators (ICD) implants, including biventricular implants.
Longitudinal Outpatient Clinic
Preceptor model, with fellows assigned to a full or part-time electrophysiology teaching faculty, seeing scheduled new and return patients, and urgent care patients, in Continuity Clinic. Experience in the methodology and interpretation of noninvasive procedures such as tilt table testing, event recorder monitoring, Holter monitoring and pacemaker and implantable defibrillator testing and programming are obtained during this rotation.
A supervised curriculum on research with a self-directed program to establish, carry out, and report the results of an individual or group investigation. All fellows will be expected to submit an abstract to a national meeting and prepare a manuscript for publication.
Inpatient Consultative Service
Preceptor model, with fellows performing initial workup of patient with presumed or proven arrhythmic problem and reviewing the diagnostic and therapeutic plan with a supervising cardiac electrophysiologist.