Preventive Cardiology
I. Rationale
Cardiovascular disease causes major morbidity and mortality in our society. The family physician should
be proficient in the diagnosis and management of a variety of cardiovascular disorders. Family physicians
should emphasize comprehensive and continuing care to individuals and their families. An interest in
prevention and the impact of medical, psychosocial and economic factors on patients and their families is
of utmost importance. The depth of experience for each resident depends on the expected practice
needs of the resident, especially in terms of practice location, available facilities and accessibility of
consultants. At times the family physician may find it appropriate to seek consultation from a cardiologist
to either manage or co- manage a patient for optimal care.
II. Goals
Residents will be evaluated on the following six competencies, eventually achieving the expected level of
a board certified family physician. Achievement of satisfactory performance levels for all six competencies
will be necessary for successful completion of the rotation.
III. Objectives
Medical Knowledge/Patient Care
A. Develop a broad knowledge base of symptoms, physical exam, and diagnoses, including:
1. Normal cardiovascular anatomy and physiology
2. Risk factors for coronary artery disease
-Hyperlipidemia
-Cigarette smoking
-Genetic predisposition
-Sedentary life style
-Hypertension
-Emotional stress
-Excess weight
-Nutrition and Lifestyle
-Hormonal status
-Diabetes
B. Obtain a pertinent cardiovascular history.
C. Perform a cardiac focused physical examination.
D. Develop a familiarity with noninvasive cardiovascular procedures:
-Electrocardiography interpretation
-Chest radiography interpretation
-Stress testing including a variety of techniques and protocols
-Radioisotope imaging
-ECG monitoring
-Vascular studies
E. Become familiar with the indications and contraindications of therapeutic interventions.
-Coronary artery bypass
-Angioplasty, including stent placement
-Valve replacement/repair
F. Be able to interpret relevant laboratory information including serum enzymes, isoenzymes and lipids.
Last Updated March 7, 2013
G. Learn incorporation of health promotion and disease prevention into patient care. The resident
should develop attitudes that encompass:
1. Awareness of the importance of physician and patient working as partners to promote optimal
cardiovascular health.
2. A compassionate approach to the care of patients with cardiac disease, especially those with
chronic disease.
3. Recognize the psychosocial and economic impact of cardiovascular disease on the individual and
family.
4. Support of the individual, and family through consultation, evaluation, treatment and
rehabilitation.
H. Learn comprehensive elements of the cardiac management, treatment and rehabilitation of:
1. Congestive Heart Failure
2. Diastolic dysfunction
3. Hypertension
4. Angina
I. Become familiar with the psychological issues of cardiovascular medicine including:
1. Sexual function/dysfunction
2. Depression
3. Family dynamics
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to
ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supersedes self-interest; accountability to patients, society, and the profession; and a
commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care,
confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at the rotation in a timely fashion.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
Last Updated March 7, 2013
G. Assist patients and their families in planning for future care needs and care decisions based
on prognosis for the disease.
H. Support the patient in their healthcare decisions.
I. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
J. Appear professionally dressed and well groomed.
K. Completes clinic notes in a timely fashion.
L. Attends required conferences.
M. Responds to pages in a timely fashion.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence, and improve their patient care practices. Residents are expected to:
A. Analyze practice experience and perform practice-based improvement activities using a systematic
methodology.
B. Locate, appraise, and assimilate evidence from scientific studies related to their patients' health
problems.
C. Obtain and use information about their own population of patients and the larger population from
which their patients are drawn.
D. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and
other information on diagnostic and therapeutic effectiveness.
E. Use information technology to manage information, access on-line medical information; and support
their own education.
G. Learn to incorporate health promotion and disease prevention into patient care.
H. Use evidence-based medicine, evaluation of available evidence, and use of best-available
evidence at morning report meetings and during routine clinical care.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Last Updated March 7, 2013
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
Procedures
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective
information exchange and teaming with patients, their patients families, and professional associates.
Residents are expected to:
A. Develop skills for interviewing patients that allow accurate, complete collection of information
regarding symptoms, and the community environment that affect the patients cardiovascular
health.
B. Develop skills in communicating results, educating patients and their families, and dealing with
sensitive issues for patients and families, and negotiating a plan of treatment with the patient
and family.
C. Residents will understand the need for a multidisciplinary, integrated approach to cardiac
prevention and rehabilitation including: nutritionists, behavioral scientists, exercise physiologists,
educators, cardiologists, and family physicians.
D. Develop patient sensitive skills for interviewing that allow accurate, and complete collection of
information regarding symptoms, the family and the community that affect the patient's health
and care.
E. Develop skills in communicating results to patients, their families, other health care
providers.
F. Develop skills in educating patients and their families, in dealing with sensitive issues for
patients and families, and in negotiating a plan of investigation and treatment with the patient
and family.
G. Develop professional relationships with co-workers, consultants, ancillary staff and other
Professionals to enable assembling of health care teams and mobilization of community resources
to optimize care of the patient.
H. Develop an understanding of the role of the family medicine consultant, and is able to
support the patient through the process of consultation, medical evaluation, treatment,
rehabilitation and long-term care.
J. Use professional language and demeanor when communicating with other residents, with
Family Medicine attending physicians, with physicians from other services, with nonphysician clinical staff, with non-physician non-clinical staff, and with patients and their
families.
K. Create and sustain a therapeutic and ethically sound relationship with patients.
L. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills.
M. Work effectively with others as a member or leader of a health care team or other
professional group.
N. Improve skills for providing patient education regarding prevention of cardiovascular
disease associated with other medical conditions.
Last Updated March 7, 2013
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on system resources to provide care that is of optimal value.
Residents are expected to:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of the
system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including methods
of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality of care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
E. Know how to partner with health care managers and health care providers to assess, coordinate, and
improve health care and know how these activities can affect system performance.
F. Learn the appropriate documentation, coding, and billing for cardiology consults, procedures, and
patient education.
G. Thoroughly document the plan for patient care management in the medical record.
H. Learn what constitutes an appropriate cardiology consult, including the formulation of a specific
clinical question for the consultant.
I. Become knowledgeable about prevention strategies for preventing cardiovascular sequelae.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Last Updated March 7, 2013
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Directly Supervised Procedures
In-Training Exam
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
X
Morning Report
Faculty Supervision
Review
360 ᵒ evaluation
Other
IV.
Videotape Review
X
and Feedback
Quarterly Review
Instructional Strategies (see above)
This is a four-week rotation and should be attended by the resident for a minimum of 5-6 half days per
week. The other 4-5 half days per week will be spent in the resident’s continuity clinic and in didactics.
Readings can be obtained from Section VI and should also be solicited from the Preventive Cardiology
attending and team. The resident should assess and manage patients on the service and should actively
participate in case discussions. Outpatient care of cardiac conditions will occur longitudinally in the
resident’s continuity clinic.
V.
Evaluation Strategies (see above)
A.
B.
C.
Observation of the resident by the Preventive Cardiology attending.
Procedure/diagnosis documentation by the resident.
End of rotation evaluation.
VI.
Implementation Methods
This medical subspecialty consists of 6 ½ day sessions per week of preventive cardiology in a clinical
setting at Emory University School of Medicine, for a total of 4 weeks. This Medical Subspecialty will be
under the supervision of Dr. Larry Sperling, Department of Cardiology, Emory University School of
Medicine.
Location:
Laurence Sperling, MD
The Emory Clinic
1525 Clifton Road, Suite 208
Atlanta, GA 30322
Contact:
404-778-2898 ofc
404-778-2835 fax
Family Practice Center: 5 ½ days per week in the Family Medicine Clinic, 4 ½ days in the Preventive
Cardiology Clinic.
Call/Vacation: Call will be with the FMS @ Emory Midtown Hospital. Vacation is permitted.
Supervision: Residents will be supervised by a cardiology attending. Residents should document all
procedures in their residency passport.
Conferences: The resident is expected to attend Family Medicine Didactics Conferences.
VII.
Suggested Readings/Resources
AFP Monographs
Coronary Artery Disease (Dec 2007) #343
Heart Failure Update
(Aug 2009) #363
Hypertension in Special Populations (May 2009) #360
Last Updated March 7, 2013