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Keck Hospital Internal Medicine Cardiology Service

RESIDENT ORIENTATION

First Day of Rotation:

Report to Keck Hospital 2nd floor Cardiology labs Page Fellow day before rotation for more information

Faculty in Charge of Rotation: Dr. David Shavelle

323-442-5604 David.Shavelle@med.usc.edu

Dr. Vivian Mo 323-442-6130

Vivian.Mo@med.usc.edu

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Educational Purpose The primary goal of this rotation is to provide and educational opportunity for the resident to acquire experience in the management of a broad range of acute and chronic cardiovascular diseases, including myocardial infarction, unstable angina, chronic coronary artery disease, evaluation of chest discomfort, use and limitations of noninvasive and invasive cardiac testing, congestive heart failure, arrhythmias, lipid disorders, hypertension, peripheral vascular disease, valvular heart disease, cardiomyopathy and pulmonary heart disease, as well as preoperative evaluation of patients with known or suspected cardiac disease. There will also be a focus on electrocardiogram interpretation, echocardiography interpretation with emphasis on basic cardiac anatomy, physiology and pathophysiological correlation. Description of Rotation The resident will work in conjunction with a cardiology attending, a cardiovascular disease fellow, one medicine resident, and one nurse practitioner; this team will take care of patients at Keck Hospital and Norris Cancer Center. Internal medicine residents will be an active part of the team and participate in all aspects of patient care. The team provides consults including complex tertiary academic center patients, post-cardiac surgery patients and pre-op evaluations for non-cardiac surgery. Competency Based Learning Objectives: The curriculum is designed to promote six broad goals based on the six ACGME core competencies: Patient Care: Accurate history and physical examination in the including selection of diagnostic testing based on the patient’s clinical presentation. The resident will perform a history and examination, formulate and carry out effective management plans, clearly and succinctly document patient management in the medical record, and competently perform procedures such as read EKGs, read stress tests, read echocardiograms, interpret pulmonary artery tracings. The resident will also arrange for the continued outpatient follow-up, and will participate in follow-up in those settings where this is possible. Medical Knowledge: This rotation will provide exposure to a broad range of cardiovascular problems through direct patient management of acute and chronic cardiovascular problems. Informal and formal didactic teaching sessions are used as well.

1. The resident will determine whether non-invasive or invasive testing is appropriate and whether an urgent pharmacologic or procedural intervention should be initiated.

2. The resident must study and understand the indications, contraindications, risks, and limitations of studies and interventions.

3. The resident must study and understand the sensitivity, specificity, positive and negative predictive accuracy of studies recommended or performed.

4. The resident must review and understand relevant diagnostic and imaging findings as well as discuss therapeutic medical or procedural interventions.

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Professionalism: The resident will have the opportunity to work and collaborate on a multidisciplinary team. Respectful treatment of, and communication with patients, families and staff is expected. Interpersonal and Communications Skills: Effective, mutually satisfying communication with patients, families and other physicians and allied health care personnel. Practice Based Learning and Improvement: Using information technology, the web, literature sources and other available resources to practice evidence based medicine based on sound medical principles, guidelines, and best practices. These sources will be used to individualize treatment plans for each patient’s condition. Systems Based Practice: The resident will have to coordinate the timing of diagnostic testing for the individual patient and will be encouraged to interact with other commonly called subspecialists (nephrologists, interventional cardiologists, cardiac and vascular surgeons, endocrinologists, radiologists) to learn about optimal treatment strategies and how to interpret the results of the diagnostic tests accurately.

Educational Objectives for the Resident: At the completion of the Cardiology rotation, the resident will be able to:

1. Diagnose and manage chest pain. 2. Understand the use and limitations of noninvasive and invasive testing. 3. Diagnose and manage acute coronary syndromes. 4. Diagnose and manage congestive heart failure. 5. Diagnose and manage atrial and ventricular arrhythmias. 6. Diagnose and manage congestive heart failure. 7. Diagnose and manage valvular disease. 8. Diagnose and manage cardiomyopathy. 9. Diagnose and manage dyslipidemia 10. Perform preoperative evaluations of patient with known or suspected cardiac disease.

At the completion of the Cardiology rotation the resident will also have a working knowledge of:

1. The diagnostic tests which are important in evaluating patients with acute cardiac disease. 2. The indications for cardiac stress testing. 3. The pre-operative management of the patient with coronary artery disease who are awaiting

surgery or have post-operative cardia complications. 4. Acute and chronic management of patients with heart failure and commonly occurring

arrhythmias. At the end of the rotation, the resident will be evaluated on milestones such as knowledge, skills, attitudes, and other attributes for each of the ACGME competencies, ranging from critical deficiencies to aspirational behavior Teaching Methods The principle teaching method of the KH cardiology service is direct teaching from the faculty assigned to this service. The faculty reviews the history, physical exam, laboratory tests, cardiac noninvasive and invasive tests, and treatment plan with the resident and provides direct feedback about the resident's

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performance in these assessments. The experience is complemented by conferences, lectures, and supplementary reading. Educational Materials and Resources The main educational material during the inpatient rotation consists of individual cases which are used as template to discuss differential diagnosis, invasive and non-invasive data and therapeutic modalities for a variety of cardiovascular pathology. Patient management conferences and morbidity-mortality conferences also provide the resident with the opportunity to learn and review current cardiovascular literature. The resident is expected to read appropriate materials to supplement the learning experience. Reading List American College of Cardiology/American Heart Association Guidelines Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine Mayo Clinic Board Review Journal of the American College of Cardiology Circulation Journal New England Journal of Medicine Expectations of Residents: The resident assigned to the cardiology rotation will round on the cardiology primary inpatient and consult service. The resident on the rotation will be present during reasonable working hours from Monday – Friday and one weekend day per week during the rotation month that will be assigned by the cardiology scheduler which may be the attending, fellow, or nurse practitioner. Changes to the weekend call schedule must be approved by the attending on service at least 3 days prior to the anticipated weekend of change and submitted to Tiffany Andalon (Tiffany.Andalon@med.usc.edu) who will distribute changes to the three call schedule entities. Please note that if a holiday or holiday weekend falls within the rotation month, the resident may be assigned to work during that period. If the resident needs to be excused from their responsibilities during the normal workweek for a personal or professional matter, a form requesting an excused absence is available through the rotation coordinator and should be submitted one (1) month prior to the start of the rotation. If there is any scheduling conflict, it is the resident’s responsibility to find coverage for him/herself. The resident will participate in all activities of the program including the following:

1. New Patient Evaluations: The resident will be responsible for obtaining the initial history and physical on new patients evaluated in the hospital as the primary service or as a consultant. The resident will begin discussion for the evaluation and treatment course of the patient’s disease and determine in conjunction with team appropriate testing and management.

2. Inpatient Experience: The resident will follow the patients admitted to the inpatient cardiology primary or consult service and provide timely and written notes that outline management decisions as well as facilitate treatment of cardiac disease.

Milestones: Residents will be assessed by the ACGME Milestones at the end of the rotation (see Appendix). Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competences described above that assess the development of the competence from an early subspecialty learner up to and beyond that expected for unsupervised practice.

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Residents will receive written feedback of their performance through myevaluations.com and verbal feedback from the attending. The evaluations will then be sent to the Internal Medicine Program Director who will review them and place them in the internal medicine resident’s file.

Appendix: ACGME Milestones

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