Core
Required
Rotation:
Block Rotation
CARDIOLOGY
1) Location: Outpatient and inpatient practice of a staff cardiologist at North Colorado Medical Center.
2) Duration: Four weeks.
3) Goals and Objectives. By graduation, each resident is expected to demonstrate the following level of
general and specific competence (categories based on the ACGME Competencies).
a) Medical Knowledge.
i) Demonstates good knowledge of basic and clinical sciences, uses textbooks and evidencebased resources to supplement knowledge; demonstrates good understanding of complex
relationships and disease processes.
ii) Medical Knowledge Competencies specific to this rotation include demonstrated knowledge
(and application of knowledge to patient care) in the following areas:
(1) Coronary artery disease
(2) Congestive heart failure
(3) Cardiac dysrhythmias
(4) Hypertension and hypertensive emergencies
(5) Acute myocardial infarction
(6) Angina syndromes
(7) Thromboembolic disease
(8) Valvular heart disease
(9) Congenital heart disease
(10) Peripheral vascular disease
(11) Cardiomyopathies
(12) Pericardial disease including acute pericarditis, effusion, and constrictive disease
b) Patient Care.
i) Consistently develops an effective therapeutic relationship with patients and families that
includes sensitivity to culture, age, gender and disability; gathers essential and accurate
information from the patient and other sources (labs, xray, old records, family); develops a
detailed differential and is able to prioritize that differential based on urgency and likelihood;
develop a comprehensive treatment plan that incorporates patient preferences and health care
maintenance/disease prevention (when appropriate); appropriately involves consultations in
the care of patients.
ii) Performs accurate and complete physical exams; demonstrated competence to perform simple
procedures and more complex procedures that the resident plans to include in his/her future
practice (including knowledge of indications, contra-indications, appropriate consent,
complications (and how to address them), and follow up).
iii) Patient Care competencies specific to this rotation include:
(1) To increase the knowledge in the gathering of information relevant to the care of the
cardiovascular system, including:
(a) Appropriate cardiovascular history taking
(b) Principles and practice of cardiovascular physical exam
(c) The resident is expected to become proficient in several non-invasive cardiac
examinations, including
(i) interpretation of the chest X-ray
(ii) interpretation of EKG’s
(iii) performance and interpretation of stress EKG and ambulatory EKG monitoring.
(d) The resident is expected to know the indications and limitations of non-invasive
examinations including the above; and also to include echocardiography and
radioisotope imaging.
(e) Residents are to become proficient in the indications, limitations, and risks associated
with cardiac catheterization and coronary angiography, as well as electrophysiologic
studies.
(f) Residents will become proficient in the interpretation of internal monitoring devices
including central venous pressure monitors and Swan Ganz catheter readings.
(2) To gain expertise in the therapeutic skills necessary in cardiovascular medicine in a rural
area, including:
(a) Basic and advanced cardiopulmonary resuscitation.
(b) Pharmacologic and mechanical treatment of arrhythmias and conduction
disturbances.
(c) Use of internal and external temporary cardiac pacemaker.
(d) Elective cardioversion.
(3) To gain expertise in the evaluation and management of outpatient cardiovascular diseases,
including:
(a) Angina
(b) Hypertension
(c) Peripheral vascular disease
(d) Evaluation and intervention in risk factors for atherosclerotic disease
(e) Congestive heart failure
c) Practice-Based Learning and Improvement. Investigates and evaluates his/her own patient care,
appraises and assimilates scientific evidence, and uses this information to work toward
improvements in patient care.
d) Interpersonal and Communication Skills. Written documentation/communication is legible, timed
and dated, complete (but with appropriate conciseness), accurate and using appropriate language
and abbreviations. Verbal communication with patients, families, and members of the healthcare
team are respectful and effective (including effective presentation skills). Keeps supervising
physicians up to date on patients.
e) Professionalism. Consistently on-time, works hard, able to identify required tasks and complete
them in a timely and efficient manner; team-oriented and willing to assist with work load as needed
to optimize team function; able to identify need for help and request it; demonstrates a positive
attitude and interactions with team members; adheres to ethical principles in the course of his/her
practice; identifies and progresses toward personal educational goals; is receptive to, seeks, and
incorporates feedback.
f) Systems-Based Practice.
i) Demonstrates an awareness of the larger healthcare system, assists patients in dealing with
system complexities through the effective use of hospital and community resources;
participates in some system improvement through identification of errors and system problems
and initial discussion of potential system improvements; acts as an effective teacher of junior
residents and other members of the healthcare team.
ii) Systems-Based Practice competencies specific to this rotation include:
(1) Demonstrate knowledge of appropriate referrals to cardiology
(2) Demonstrate knowledge of appropriate use of community resources such as:
(a) CHF clinic
(b) Cardiac rehabilitation
4) Methods:
a) Required four week block rotation.
b) This rotation is arranged with a member of the cardiology section, department of internal medicine
at North Colorado Medical Center. This attending is responsible for the direct supervision of the
resident.
c) In order to better facilitate the learning of outpatient diseases, at least one session per week is to be
spent in the outpatient environment of the attending physician’s office.
d) The resident on cardiology is assigned primary responsibility for reading all of the cardiologist’s
EKG’s with confirmation of interpretation by the attending cardiologist.
e) Other caridiology experience:
i)
ii)
iii)
iv)
v)
To increase proficiency in the techniques of basic and advanced cardiovascular life support,
all residents will be current in their ACLS certification. The resident who is on medicine call
at North Colorado Medical Center (NCMC) is the first responder for all codes at NCMC and
runs the cardiopulmonary resuscitation effort until the patient’s attending physician can be
notified.
During the R1 year, the resident on medicine has primary responsibility for reading all EKG’s
done on patients on the medicine service with confirmation of the EKG interpretation by the
family medicine or cardiology attending.
Interpretation of EKG’s done on the resident’s continuity patients and on the patients on the
adult medicine service is performed by the resident with supervision of the family medicine
attending.
ETT’s done on the resident’s continuity patients are performed by the resident with
supervision of the family practice attending, and residents may obtain further experience
performing ETT’s on their procedures elective.
Cardiology topics are included in the core didactic curriculum and the didactic schedule for
the adult medicine service.
5) Evaluation: This curricular area is evaluated as outlined in the policy “Evaluation of Residents”.
SG
Reviewed and Approved:
H. Daniel Fahrenholtz, MD, MBA, Program Director