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Clinical Cardiac Electrophysiology Training Education

In This Section:

Principal Teaching and Learning Activities

group photo of CCE program participants

The curriculum is reviewed at least semi-annually in a curriculum committee meeting that includes the program director, key faculty, and the fellows. The following activities within the fellowship program provide learning and teaching opportunities for the trainee in clinical cardiac electrophysiology:

Direct Patient Care

The collaborative relationship between attending physician and trainee in the delivery of patient care is at the core of this Program; the provision of high-quality patient care is the fundamental vehicle for teaching and learning of all the required competencies. In the development of educational objectives direct patient care is broadly and somewhat arbitrarily divided into those three loci of care where the particular skills required of the successful sub-specialist in cardiac electrophysiology differ:

  • Out-Patient clinic including implantable device follow up clinic (DPC-OP*)
  • Hospital, including coronary, medical and surgical intensive care units and the emergency department (DPC-H*)
  • Electrophysiology Laboratory (DPC-EPL*)

Conferences

Teaching conferences are convened at the institutional, departmental and section level and all contribute to the educational experience of the cardiac electrophysiology trainee.

  • Electrophysiology Core Curriculum Lecture Series (CCL*)
  • Department of Medicine Grand Rounds (MGR*)
  • Division of Cardiology Grand Rounds (CGR*)
  • Division of Cardiology Didactic Lecture Series (CDL*)
  • Electrophysiology Morbidity and Mortality Conference (M&M*)
  • Electrophysiology weekly Conference (EPC*)
  • Division of Cardiology ECG teaching conferences (ECG*)
  • Arrhythmia Service Journal Club (JC*)
  • Arrhythmia Service Case Conference (CC*)

 

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 GoalsLearning Activities
Interview and examine patients more skillfullyDPC-OP, DPC-H
Interpret noninvasive data more skillfullyDPC-OP, DPC-H, EPC, CC, CCL
Interpret invasive data more skillfullyDPC-EPL, EPC, CC, CCL
Successfully evaluate and manage implanted devicesDPC-OP, DPC-H, DPC-EPL, EPC, CC, CCL
Generate and prioritize differential diagnosesDPC-OP, DPC-H, DPC-EPL, EPC, CC, CCL
Develop rational, evidence-based management strategiesDPC-OP, DPC-H, DPC-EPL, EPC, CC, CCL
 

Medical Knowledge

Principal Educational GoalsLearning 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 belowDPC-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 patientEPC, ECG, JC, CC
 

Practice-Based Learning and Improvement

Principal Educational GoalsLearning Activities
Identify and acknowledge gaps in personal knowledge and skills in the care of arrhythmia patientsDPC-OP, DPC-H, DPC-EPL, CC, EPC, ECG
Develop and implement strategies for filling gaps in knowledge and skillsJC, CC, EPC, ECG, CCL, CDL, MGR, CGR
 

Interpersonal Skills and Communication

Principal Educational GoalsLearning Activities
Communicate effectively with patients and familiesDPC-H, DPC-OP, DPC-EPL
Communicate effectively with physician colleagues at all levelsDPC-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 patientsDPC-H, DPC-OP, DPC-EPL
Present patient information concisely and clearly, verbally and in writingDPC-OP, DPC-H, DPC-EPL, EPC, CC, M&M
Teach colleagues effectivelyDPC-H, DPC-EPL, EPC, JC, CC
 

Professionalism

Principal Educational GoalsLearning Activities
Behave professionally toward towards patients, families, colleagues, and all members of the health care teamAll
Recognize the substantial pressures in cardiac electrophysiology that create a potential for conflicts of interest and develop strategies for avoidance of improprietyDPC-EPL, DPC-H, DPC-OP
 

Systems-Based Practice

Principal Educational GoalsLearning Activities
Understand and utilize the multidisciplinary resources necessary to care optimally for patients with cardiac arrhythmiasDPC-H, CCL, M&M
Collaborate with other members of the health care team to assure comprehensive patient careDPC-H, DPC-OP
Use evidence-based, cost-conscious strategies in the care of arrhythmia patientsDPC-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: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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