In the tables below, the principal educational goals for all activities that are part of the Cardiac Electrophysiology Residency are indicated for each of the six ACGME competencies. The second column of the table indicates the most relevant principal teaching/learning activity for each goal, using the legend above(*).
Patient Care
Principal Educational Goals | Learning Activities* |
Interview and examine patients more skillfully | DPC-OP, DPC-H |
Interpret noninvasive data more skillfully | DPC-OP, DPC-H, EPC, CC, CCL |
Interpret invasive data more skillfully | DPC-EPL, EPC, CC, CCL |
Successfully evaluate and manage implanted devices | DPC-OP, DPC-H, DPC-EPL, EPC, CC, CCL |
Generate and prioritize differential diagnoses | DPC-OP, DPC-H, DPC-EPL, EPC, CC, CCL |
Develop rational, evidence-based management strategies | DPC-OP, DPC-H, DPC-EPL, EPC, CC, CCL |
Medical Knowledge
Principal Educational Goals | Learning Activities* |
Expand clinically applicable knowledge base of the basic and clinical sciences underlying the care of patients with cardiac arrhythmias in accordance with the syllabus below | DPC-OP, DPC-H, DPC-EPL, MGR, CGR, CDL, EPC, ECG, JC, CC, CCL |
Access and critically evaluate current medical information and scientific evidence relevant to care of the arrhythmia patient | EPC, ECG, JC, CC |
Practice-Based Learning and Improvement
Principal Educational Goals | Learning Activities* |
Identify and acknowledge gaps in personal knowledge and skills in the care of arrhythmia patients | DPC-OP, DPC-H, DPC-EPL, CC, EPC, ECG |
Develop and implement strategies for filling gaps in knowledge and skills | JC, CC, EPC, ECG, CCL, CDL, MGR, CGR |
Interpersonal Skills and Communication
Principal Educational Goals | Learning Activities* |
Communicate effectively with patients and families | DPC-H, DPC-OP, DPC-EPL |
Communicate effectively with physician colleagues at all levels | DPC-H, DPC-OP, DPC-EPL, CCL |
Communicate effectively with all non-physician members of the health care team to assure comprehensive and timely care of arrhythmia patients | DPC-H, DPC-OP, DPC-EPL |
Present patient information concisely and clearly, verbally and in writing | DPC-OP, DPC-H, DPC-EPL, EPC, CC, M&M |
Teach colleagues effectively | DPC-H, DPC-EPL, EPC, JC, CC |
Professionalism
Principal Educational Goals | Learning Activities* |
Behave professionally toward towards patients, families, colleagues, and all members of the health care team | All |
Recognize the substantial pressures in cardiac electrophysiology that create a potential for conflicts of interest and develop strategies for avoidance of impropriety | DPC-EPL, DPC-H, DPC-OP |
Systems-Based Practice
Principal Educational Goals | Learning Activities* |
Understand and utilize the multidisciplinary resources necessary to care optimally for patients with cardiac arrhythmias | DPC-H, CCL, M&M |
Collaborate with other members of the health care team to assure comprehensive patient care | DPC-H, DPC-OP |
Use evidence-based, cost-conscious strategies in the care of arrhythmia patients | DPC-H, DPC-OP, DPC-EPL, CCL, MGR, CGR, EPC, JC, CC, M&M |
Syllabus of Specific Topics
A. Clinical Experience
1. Techniques for evaluating patients with
a. sinus node dysfunction
b. atrioventricular (AV) and intraventricular block
c. supraventricular and ventricular tachyarrhythmias
d. unexplained syncope
e. aborted sudden cardiac death
f. palpitations
g. atrial fibrillation
h. Wolff-Parkinson-White (WPW) syndrome
i. long QT syndrome
2. Clinical experiences involving
a. consultation to physicians in other disciplines.
b. care of patients in the cardiac care unit, emergency room, or other intensive care settings.
c. care of the patient before and after an electrophysiologic procedure.
d. care of patients with postoperative arrhythmias.
e. outpatient follow-up of patients treated with drugs, devices, or surgery.
f. electrocardiography--proficiency in the interpretation of the standard 12-lead ECG, stress testing, ambulatory ECG recording, signal-averaged ECG, and telephone-transmitted ECGs.
g. care of patients with temporary and permanent pacemakers.
h. care of patients with ICDs and CRT devices.
B. Technical and Other Skills
1. Acquire skill in the interpretation of
a. activation sequence mapping recordings.
b. invasive intracardiac electrophysiologic studies, including endocardial electrogram recording.
c. relevant imaging studies, including X-rays and MRI scans.
d. tilt testing.
e. electrocardiograms and ambulatory ECG recordings.
f. continuous in-hospital ECG recording.
g. signal-averaged ECG recordings.
h. stress test ECG recordings.
i. transtelephonic ECG readings.
j. stored electrograms retrieved from implanted devices.
2. Acquire skill in the performance of clinical cardiac electrophysiologic studies, including:
a. Electrode catheter introduction
b. Electrode catheter positioning in atria, ventricles, coronary sinus, His bundle area, and pulmonary artery
c. Stimulating techniques to obtain conduction times and refractory periods and to initiate and terminate tachycardias
d. Recording techniques, including an understanding of amplifiers, filters, and signal processors
e. Measurement and interpretation of data
3. Acquire proficiency in catheter ablation procedures, including AV nodal reentrant tachycardia and accessory pathway modification, atrial tachycardia and atrial flutter, AV junctional ablation and modification, ventricular tachycardia ablation, and ablation procedures for atrial fibrillation including pulmonary vein isolation.
4. Acquire proficiency in device procedures, including pacemaker and ICD insertion and programming. This includes acquiring skill in:
a. Lead placement, including cardiac resynchronization leads
b. Fashioning device pockets
c. Device programming
d. Noninvasive programmed stimulation for arrhythmia induction through the device
e. Defibrillation threshold testing
f. Final prescription of anti-tachycardia pacing and defibrillation therapies
C. Core Curriculum Lecture Series
1. EP 101 – Procedures, vascular access, catheters, sheaths, basic measurements
2. Electrical Engineering for EP – Filters, amplifiers, noise, etc.
3. Complications in the EP Laboratory: What Are They and How Do You Avoid Them
4. Pacemakers – Physiology, timing cycles, programming, troubleshooting
5. ICDs – Devices, leads, waveforms, DFT, ULV, ATP, programming, troubleshooting
6. Lead extraction – Indications and techniques
7. Pharmacology and Proarrhythmia
8. Syncope – Mechanisms, differential diagnosis
9. SVT – Differential diagnosis, EP lab diagnostic maneuvers
10. Accessory pathways and AVNRT – Ablation strategies
11. Arrhythmia Mechanisms I – Automaticity and Triggered activity
12. Arrhythmia Mechanisms 2 - Reentry, entrainment, ablation strategies for reentrant VT
13. Cardiac anatomy for the electrophysiologist
14. 3D and electroanatomical mapping
15. Atrial flutter and Atrial tachycardia – Mechanisms, ablation strategies
16. Atrial fibrillation – Mechanisms, ablation strategies
17. Inherited Arrhythmias – ARVD, Sarcoid, HOCM, Long QT, Short QT, Brugada syndrome
18. Noninvasive Testing and Risk Stratification – Holters, Event monitors, SAECG, HRV, T wave alternans
19. Ablation modalities – RF, Cryo, Microwave, Focused ultrasound
20. Pediatric Arrhythmias
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