Rotation: Vascular Medicine
Director: Mark Robbins, M.D.
Learning Objectives
Patient Care
Objective
Teaching Methods Assessment
Obtain and document complete medical histories,
including review of patient medical records, and
perform accurate examinations with an emphasis on
the arterial, venous and lymphatic systems
Clinical Teaching,
Clinical Experiences
Shadowing
Demonstrate appropriate decision making based on
clinical assessment, interpretation of tests, patient
preferences and current standards of evidence based
medicine.
Clinical Teaching,
Clinical Experiences,
Review pertinent
literature,
Didactics
As above
Communicate effectively and compassionately
information to patients and family members. Provide
patient education. Discuss prognosis, and when
appropriate, end of life issues.
Clinical teaching
Clinical experiences
Consultative services
As above
Objective
Teaching Methods
Assessment
The cardiologist must be able to evaluate and manage
common vascular disorders (see topic outline below)
and refer patients appropriately to vascular surgeons,
interventional cardiologists, hematologists,
rheumatologists and other subspecialists where
appropriate.
Clinical Teaching,
Clinical Experiences,
Didactics,
Shadowing
Supervising
Attending,
360 evaluations,
Self-assessment,
In-training
examination
Supervising Attending
360 evaluations
Self-assessment
Medical Knowledge
Professionalism
Objective
Teaching Methods
Assessment
Demonstrate accountability and professional
behavior towards patients, family members, and
members of the health care team and adherence to
ethical principles
Clinical Teaching,
Clinical Experiences,
Role Models
Supervising
Attending,
360 evaluations,
Self-assessment
Demonstrate compassion and respect for others,
including patients from a diverse cultural, social, and
religious backgrounds
Clinical Teaching,
Clinical Experiences,
Role Models
Supervising
Attending,
360 evaluations,
Self-assessment
Objective
Teaching Methods
Assessment
Communicate effectively with patients, families, and
members of the health care team, including findings
and diagnoses when appropriate to both patients and
consulting physicians
Clinical Teaching,
Clinical Experiences,
Role Models
Supervising
Attending,
360 evaluations,
Self-assessment
Maintain timely and comprehensive medical records
Clinical Teaching,
Role Models
Administrative
Monitoring,
Supervising
Attending
Program Director
Interpersonal and Communication Skills
Practice Based Learning and Improvement
Objective
Teaching Methods
Assessment
Identify both strengths and gaps in knowledge and
expertise and set appropriate learning goals
Review rotation
curriculum,
Review pertinent
literature,
Role models
Utilize on-line
resources such as
Knowledge Map,
Vanderbilt Library,
Self-assessment
Feedback from
supervising attending
Utilize information technology to effectively locate,
appraise, and utilize evidence based medicine with in
current literature to improve patient care
Self-assessment
Feedback from
supervising attending
Utilize quality improvement methods to implement
changes within the practice environment
Cardiosource,
Up-to-Date
Literature Review
Division and
Institutional
Resources and
Committees
Self-assessment
Feedback from
supervising attending
Systems Based Practice
Objective
Teaching Methods
Assessment
Work effectively as a member of the health care team,
including coordination of patient care
Role Models
Clinical Teaching
Self-assessment
Feedback from
supervising
attending
Demonstrate understanding of cost-effectiveness and
risk-benefit analysis and incorporate these into
patient care
Literature Review
Division and Institutional
Resources and
Committees
Feedback from
supervising
attending and
division QI
committees
Advocate for and work towards patient safety and
improved quality of care
Literature Review
Division and Institutional
Resources and
Committees
Feedback from
supervising
attending and
division QI
committees
Identify system errors and implement systems
solutions
Literature Review
Division and Institutional
Resources and
Committees
Feedback from
supervising
attending and
division QI
committees
Rotation Format and Responsibilities:
Fellows have the opportunity to rotate on the Vascular Medicine Service. On this service, the fellow
provides inpatient consultative services with one of our cardiologists who specializes in vascular and
interventional vascular medicine. The fellow also sees patients with vascular disease in the outpatient
vascular surgery and general cardiology clinics and has the opportunity to interpret noninvasive
vascular studies. An opportunity to participate in specialty clinics other than cardiovascular medicine
during this rotation are also available including pulmonary hypertension, hematology and vasculitis
clinics.
Second and third year fellows also have the option to have a half day clinic a week in the vascular
surgery clinic as part of their sub-specialty outpatient clinical training.
Curriculum Outline:
A. Arterial Disease
1. Normal: anatomy and physiology of the cerebrovascular, renal, and peripheral
vascular beds
2. Atherosclerosis:
a. Pathogenesis
b. Risk factors: recognition, life-style modifications and interventions
3. Peripheral Arterial Disease:
a. epidemiology and natural history
i. claudication vs pseudoclaudication
b. clinical examination and role of vascular testing
c. life-style and risk factor modifications
d. novel risk factors: hyperhomocysteinemia, lipoprotein (a), etc.
e. Treatment:
i. antithrombotic and other pharmacologic therapy
ii. exercise therapy
iii. percutaneous and surgical indications and therapies
f. Complications of PAD
i. atheroembolism
ii. amputation
4. Extracranial Cerebrovascular Disease
a. Normal anatomy and physiology
b. Pathophysiology of CV disease
c. Clinical Presentations
d. Physical examination
e. Diagnostic testing and imaging modalities
f. Treatment:
i. Medical therapy
ii. Percutaneous and surgical indications and therapies
5. Renovascular Disease
a. atherosclerotic and non-atherosclerotic
b. renovascular hypertension: diagnostic work-up and treatment
6. Aortic Dissection, Penetrating Aortic Ulcer, Incomplete Aortic Rupture
a. definition and classification
b. etiology, natural history and clinical manifestations
c. Diagnosis: imaging modalities
d. Medical and surgical treatment
7. Aneurysmal Disease:
a. definition and classification
b. etiology, natural history and clinical manifestations
c. Abdominal Aortic aneurysms: infrarenal
i. risk factors, presentation, and natural history
ii. diagnosis
iii. pre-operative assessment
iv. endovascular and surgical repair
d. Thoracic and suprarenal abdominal aneurysms
i. risk factors, presentation, and natural history
ii. diagnosis
iii. indications for repair
iv. endovascular and surgical repair
B. Venous Disease
1. anatomy and physiology of upper and lower extremity veins
2. venous thromboembolism
1. acute DVT of lower extremities
2. upper extremity DVT
3. pulmonary embolism
4. catheter/device related thrombosis
3. thrombophilias (hereditary and acquired)
4. post-thrombotic syndrome
5. chronic venous insufficiency and venous stasis disease
6. varicose veins
C. Lymphedema
1. anatomy and physiology of the lymphatic system
2. causes, diagnosis and management
D. Miscellaneous Arterial Disease
1. thoracic outlet syndrome
2. popliteal artery entrapment
3. thromboangitis obliterans (Beuger's Disease)
4. vasculitis
E. Vasospastic Disorders
1. Raynaud's Phenomenon
2. Livedo Reticularis
3. Chronic Pernio
4. Erythromelalgia
F. Hypercoagulable Disorders
1. Antiphospholipid syndrome
2. Factor V Leiden Mutation
3. Heparin Induced Thrombocytopenia
4. Protein C/S Deficiency
5. Anti-thrombin III deficiency
6. Hyperhomocystinemia
Recommended Reading:
1. 2011 Guideline on Management of Patients with Extracranial Carotid and
VertebralArtery Disease. J Am Coll Cardiol. 2011;57(8):1002-1044.
2. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial
Disease. J Am Coll Cardiol. 2005;47(6):1239-1312.
3. Renal-Atery Stenosis. NEJM. 2009;361(20):1972-8.
4. Guidelines on the diagnosis and management of acute pulmonary embolism.
European Heart Journal. 2008;29:2276-2315.
5. Focus on Vascular Disease Text on PVD. www.cardiosource.com.
Evaluation and Feedback:
-
Fellows are evaluated at the end of the rotation with a competency based evaluation
system
-
Fellows are directly observed and given real time feedback on their performance
-
Fellows participate in structured case discussions (ie, catheterization or interventional
conference)