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Principal Educational Goals by Competency

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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