Adult Cardiology Fellowship
The program aims to train and graduate competent, safe, skilled and knowledgeable cardiovascular specialists. This is a three year program of structured training in cardiology in accordance with ACGME-I (Accreditation Council for Graduate Medical Education International) accreditation program. At its completion, the trainee is expected to be a competent cardiology specialist capable of functioning independently in cardiology comparable to International Standards.
To provide safe, skilled and competent specialists in the field of cardiology who will be leaders in providing quality health care to patients all over Oman and also envision and implement National programs towards achieving excellence in cardiovascular health issues.
Patient Care (PC)
Medical knowledge (MK)
Practice-Based Learning and Improvement (PBLI)
Interpersonal and communication skills (ICS)
Professionalism (P)
Systems-based practice (SBP)
MEDICAL KNOWLEDGE:
Fellows should demonstrate knowledge of established, current and evolving knowledge in the field of cardiology and related sciences and apply this knowledge to patient care. Fellows must be able to:
Demonstrate an investigatory and analytic thinking approach to clinical situations. (MK,PBLI)
Demonstrate a sound understanding of the basic science background of cardiology and apply this knowledge to clinical problem solving, clinical decision making and critical thinking. (MK,PBLI,PC,SBP)
Demonstrate an understanding of the strengths and limitations of various research designs, and will during fellowship training, design and present the results of at least one prospective study which addresses an issue of relevance to the specialty. (MK,SBP,PBLI)
PATIENT CARE:
By the end of fellowship program, the fellows are expected to provide appropriate, compassionate and effective care for treatment of various problems relating to cardiology and promote cardiac patients health.
Demonstrate caring and respectful behavior when interacting with patients and their families (PC,P,ICS)
Gather essential information about patients by performing a complete and accurate medical history and physical examination. (PC,ICS,MK)
Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment. (PC,PBLI,MK)
Develop, negotiate and implement effective patient management plans. (PC,ICS,P,SBP)
Counsel and educate patients and their families. (PC,PBLI,ICS,P,MK)
Use information technology to support patient care decisions and patient education. (PC,PBLI,SBP)
Perform competently all medical and invasive procedures considered essential for specialist practice in the discipline of cardiology. (PC,MK)
Understands the differences between screening and diagnostic tests essential for specialist practice in cardiology. (PC,MK)
PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI):
Fellows should develop the ability to constantly self-evaluate their patient care with a view to improve their practice.
Fellows must be able to:
Identify areas for personal and practice improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care, as well as making a commitment to life-long learning. (MK,P,SBP,PBLI)
Analyze and evaluate personal practice experience and implement strategies to continually improve the quality of patient care. (PBLI, SBP,P,MK,PC)
Locate, appraise and assimilate evidence from scientific studies related to patients health problems (PBLI,MK,PC)
Obtain and use information about their population of patients (PBLI, SBP, PC)
Demonstrate receptiveness to instruction and feedback (PBLI, ICS,P)
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies. (PBLI,MK,PC)
Use information technology to manage information, access online medical information, and support their education (PBLI,P,MK)
Facilitate the learning of students and other health care professionals (PBLI, ICS, SBP,MK)
SYSTEMS-BASED PRACTICE (SBP):
Fellows should demonstrate an awareness and responsiveness to the larger context of the health care system and the ability to effectively call on system resources to provide optimal care.
Fellows should be able to:
Understand how their patient care and professional practices affect other health care professionals, their health care organization and society and how these in turn affect them and their practice. (SBP,PC,P,ICS)
Practice cost-effective health care and resource allocation that does not compromise quality of care. (SBP,PC,P)
Advocate for quality patient care and assist patients in dealing with system complexities (SBP,ICS,P)
Acknowledge that patient safety is always the first concern of the physician, demonstrate ability to discuss errors in management and learn from errors to improve patient care, participate in Quality improvement activities and patient safety initiatives, participate in disclosure and discussion of adverse events with patients (SBP,ICS,P,PBLI,PC,MK)
Partner with health care managers and providers to assess and improve health care (SBP,ICS,P,PBLI,PC)
Describe a systematic plan for minimizing the risk of professional liability claims in clinical practice and medico-legal concepts regarding professional liability. (P,SBP,PCandICS)
INTERPERSONAL AND COMMUNICATION SKILLS (ICS):
Fellows should demonstrate effective interpersonal and communication skills and achieve a high level of competence in communicating with patients and relatives. Fellows must also develop effective oral and written communication skills with other members of the health care team.
Fellows should be able to:
Sustain therapeutic and ethically sound relationships with patients, their relatives and colleagues. (ICS,P)
Provide effective and professional consultation to other physicians and health care professionals (ICS,P,SBP,MK,PBLI)
Elicit and provide information using effective listening, non-verbal, explanatory, questioning and writing skills. (ICS,P)
Communicate effectively and appropriately with patients keeping cultural and socioeconomic background in view. (ICS, P,PC)
Maintain comprehensive, timely and legible medical records (ICS,P,PC) Communicate effectively as a member or leader of a health care team or other professional group (ICS,SBP,P)
PROFESSIONALISM (P):
Fellows should demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse population.
Fellows should be able to:
Demonstrate respect, compassion, integrity and responsiveness to the needs of patients and society that supersedes self-interest (P,ICS)
Demonstrate accountability to patients, society and the profession – uncompromised honesty (P,ICS), punctuality and efficiency(P) good work ethics, positive attitude and high initiative levels (P)
Demonstrate a commitment to excellence and ongoing professional development (P,PBLI)
Demonstrate a commitment to ethical principles of clinical care (P,PC)
Describe basic ethical concepts like autonomy, beneficence, justice and non- malfeasance (P,ICS)
Describe the process of informed healthcare decision making including specific components of informed consent decisions (P,ICS,PC)
Discuss surrogate decision making for incapacitated patients, who can act as proxy decision makers in healthcare choices (P,PC,ICS)
Describe legal, ethical and emotional issues surrounding withholding and withdrawing medical therapies (P,MK,SBP,PC)
Discuss appropriateness of using or limiting all available technology to sustain life and when it is appropriate to limit treatment (P,ICS,SBP,PC)
Discuss ethical implications of commonly used technologies in cardiology (P,MK,SBP,PC)
Analyze an ethical conflict and develop a ethically defensible and medically reasonable course of action (P,PC,MK,ICS)
Discuss important issues regarding stress management, substance abuse and sleep deprivation (P,MK,ICS,PC)
Maintain confidentiality of patient information and understand sources of loss of privacy in the health care system (P,SBP,ICS)
Demonstrate sensitivity and responsiveness to culture, age, socioeconomic status, beliefs and disabilities of patients and colleagues (P,ICS)
OMSB ADMISSION CRITERIA
To be admitted to a Fellowship Program, the applicant must:
Be Board certified or equivalent recognized by OMSB in the core specialty.
Pass the interview for the particular sub-specialty and / or selection examination successfully (if applicable)
Provide written permission from the sponsoring employer of the applicant allowing him / her to join for the full duration of the fellowship program.
ADULT CARDIOLOGY ADMISSION CRITERIA
Be a holder of bachelor’s degree in Medicine and Surgery or equivalent and an OMSB Specialty Certificate in Internal Medicine or equivalent.
Be of good conduct and medically fit for specialty
Submit a letter of approval from the applicant's sponsor confirming permission to join the specialty-training program on full time basis for the entire period of training if applicable.
Pass the interview conducted by OMSB cardiology faculty.
The education committee may add other conditions or oral / written examinations or tests as approved by OMSB.
The trainees are selected as per the rules and regulations of OMSB.
* Note: 4 to 6 fellows per year will be recruited for the fellowship program.
CURRICULUM COMPONENTS AND ROTATION OUTLINE
DURATION OF THE PROGRAM
This is a three year program of structured training in clinical, non-invasive and invasive cardiology.
OUTLINE OF ROTATIONS
YEAR ONE (FY I)
Fellows will be introduced to general cardiology along with training in non-invasive cardiology rotations. Each block comprises 4 weeks.
Fellows will undergo rotations in different training centers as follows:
|
Clinical Cardiology Coronary Care Unit (CCU) Consult Service(Clinic + Referrals + Preventive) Electrophysiology (EP.) Cardiothoracic/PCICU/Vascular Surgery |
6 Blocks total 2 Blocks 2 Blocks 1 Block 1 Block |
|
Non-Invasive Cardiology Echocardiography (Echo.) Holter and Stress Test Cardiac Imaging (Nuclear) |
5 Blocks total 2 Blocks Block Block |
|
Selective (Cath lab/EP./ Echo./Cardiac Imaging/CCU) |
1 Block |
|
Annual leave |
1 Block |
Selective options: (Cardiac Catheterization Laboratory / Electrophysiology / Echocardiography / Cardiac Imaging / Coronary Care Unit)
YEAR TWO (FY II)
Fellows will undergo rotations in different training centers as follows:
|
Clinical Cardiology Coronary Care Unit (CCU) Adult Congenital Heart Disease (ACHD) Consult Service (Clinic + Referrals + Preventive) Research |
6 Blocks total 2 Blocks 2 Blocks 1 Block 1 Block |
|
Non-Invasive Cardiology |
3 Blocks total |
|
Echocardiography (Echo.) |
1 Block |
|
Cardiac Imaging (CT) |
1 Block |
|
Electrophysiology (EP.) |
1 Block |
|
Invasive-Cardiology Cardiac Catheterization Laboratory (Cath. Lab.) |
2 Blocks |
|
Selective (Cath lab/EP./ Echo./Cardiac Imaging/CCU) |
1 Block |
|
Annual leave |
1 Block |
|
Clinical Cardiology Coronary Care Unit (CCU) Consult Service (Clinic + Referrals + Preventive) Research |
4 Blocks total 2 Blocks 1 Block 1 Block |
|
Non-Invasive Cardiology Echocardiography (Echo.) Cardiac Imaging (MRI) |
2 Blocks total 1 Block 1 Block |
|
Invasive-Cardiology Cardiac Catheterization Laboratory (Cath. Lab.) |
2 blocks |
|
Selective (Cath lab/EP./ Echo./Cardiac Imaging/CCU) |
4 Blocks |
|
Annual leave |
1 Block |
Selective options: (Cardiac Catheterization Laboratory / Electrophysiology / Echocardiography / Cardiac Imaging / Coronary Care Unit)
BLOCK DIAGRAM OF ADULT CARDIOLOGY FELLOWSHIP PROGRAM
|
FY I |
|||||||||||||
|
Blocks |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Sites |
NHC/ SQUH |
NHC/ SQUH |
NHC |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
Annual leave |
||||
|
Rotations |
Coronary l Care Unit |
Consult Service |
Electrophysiology |
Cardiothoracic/PCI CU/ Vascular |
Echocardiography |
Holter and Stress Test |
Cardiac Imaging (Nuclear) |
Selective |
|||||
|
FY II |
|||||||||||||
|
Blocks |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Sites |
NHC/ SQUH |
NHC |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
Annual leave |
|||
|
Rotations |
Coronary Care Unit |
Adult Congenital Heart Disease |
Consult Service |
Research |
Echocardiography |
Cardiac Imaging (CT) |
Electrophysiology |
Cardiac Catheterization Laboratory |
Selective |
||||
|
FY III |
|||||||||||||
|
Blocks |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Sites |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
NHC/ SQUH |
Annual leave |
|||||
|
Rotations |
Coronary Care Unit |
Consult Service |
Research |
Echocardiography |
Cardiac Imaging |
Cardiac Catheterization Laboratory |
Selective |
||||||
Selective
options: (Cardiac Catheterization Laboratory / Electrophysiology / Echocardiography
/ Cardiac Imaging / Coronary Care Unit)
GRADED RESPONSIBILITIES FOR EACH YEAR OF FELLOWSHIP
YEAR 1
The fellow is expected to know the basic anatomy, physiology, and embryology of the heart as well as pathophysiology of cardiovascular disorders and cardiac pharmacology (MK ,PC)
By the end of Year 1 he/she should be able to:
Take cardiac history and perform cardiac clinical examination (PC, ICS)
Request and interpret appropriate investigations and reach a provisional diagnosis of common cardiac disorders (PC, MK)
Effectively communicate with patients and relatives and counsel accordingly under supervision (MK,ICS, P)
Perform pre-cardiac procedure evaluation of common elective / emergency cardiac procedures and manage them post-procedure. (MK, PC)
Manage common cardiac disorders under direct supervision (MK,PC,ICS)
Perform common critical care procedures under supervision. (PC,MK)
Achieve competency in basic cardiac skills e.g. echocardiography, Femoral Venous and Arterial puncture, temporary wire insertion, bedside pericardiocentesis, electrical cardioversion. (PC, MK)
Have a research project underway. (MK,PBLI,ICS)
First year fellows will start with first on call Registrar level duty and, by the end of 1st year, the fellow should be able to perform second on call Registrar level duty.
Complete the relevant courses assigned for FY I.
YEAR 2
By the end of the fellow year 2, the fellow should be able to:
Have a sound knowledge of all common cardiac disorders. (MK)
Manage common cardiac disorders independently (MK,PC,ICS)
Perform common critical care procedures independently. (PC,MK)
Consolidate cardiac skills learned in year 1 and progress to performing simple echocardiography independently. (PC,MK)
Perform diagnostic coronary angiogram under supervision. (PC,MK)
Have a research project underway. (MK,PBLI,ICS)
Continue to perform second on call Registrar duty.
Complete the relevant courses assigned for FY II.
YEAR 3
By the end of this academic year the fellow should:
Have acquired detailed knowledge of all cardiac disorders including complex
cases. (MK,PC,SBP)
Perform and interpret complex echocardiogram (MK,PC)
Perform and interpret coronary angiogram independently. (MK,PC)
Effectively communicate with patients and relatives and counsel independently (ICS,PC,MK,P)
Have the ability to supervise and teach junior colleagues and medical students. (MK,P,ICS)
Take part in administrative responsibilities. (SBP,P,ICS)
Complete the research project and publish in national journal. (MK,PBLI,ICS)
Complete selective in any cardiology subspecialty. (MK,PC)
Perform 3rd on call Senior Registrar level or Junior on call attending role independently.
Complete the relevant courses assigned for FY III.
Pass OMSB exit examination.
All procedures, evaluations and assessment tools are logged electronically through the Trainees Management System (New Innovations). Fellows are assessed by faculty members during and at the end of each assigned rotation as in the log-book specifically clinical cases/procedural skills/academic activities and overall ACGME competences.
These evaluations will be based on the objectives for that assignment and appropriate to the level of the fellow. Appropriate feedback is given throughout the rotation as needed and the assessment is discussed with the fellow at the end of the rotation. Completed assessments are forwarded to the program director to be used in the semi-annual evaluation meeting.
The fellow’s admission notes, progress notes, outpatient notes and discharge summaries will be reviewed randomly by faculty. Feedback can be given to the fellow with regard to the quality of their written notes and faculty has a direct opportunity to continuously evaluate fellow performance.
The communication skills of a fellow in cardiology must be both verbal and written. Verbal communication skills and clinical skills of the fellows are evaluated on a daily basis when residents discuss cases with faculty in outpatient department or in ward and suggestions made when appropriate.
ASSESSMENT BY ROTATION SUPERVISOR (DIRECT OBSERVATION)
The assessment will be carried out by a rotation supervisor. One Rotation Supervisor will be identified at each site and they will endeavor to solicit feedback from all the consultants and specialists a trainee worked with. A verbal mid-rotation evaluation will be provided. This will aim to identify certain issues that the trainee may have and allow him/her, the rest of rotation to rectify any short-comings or deficiencies. A final, formal, evaluation will be completed by the respective rotation supervisors. After completion of the rotation, the final evaluation of the rotation supervisor will be based on the fulfillment of the rotation objectives as determined by:
Personal observation during interaction with the fellow.
Evidence of extensive literature reviews appropriate for the individual patient
Ability to construct a logical management plan.
Inclusion of appropriate physical examination.
Appropriateness of use of diagnostic tests.
Correct interpretation of diagnostic tests.
Appropriate selection of pharmacologic and non-pharmacologic therapies.
Competent performance of cardiac procedures relative to the fellow’s level of
training.
Appropriate follow-up.
Feedback from other team members, other healthcare providers, and patients.
A successful completion of all rotations is mandatory for the successful completion of the cardiology fellowship program. A trainee who fails the rotation will be expected to complete a remedial rotation(s). The site of the remedial rotation will be at the discretion of the program director.
LOG BOOK/PORTFOLIO
The logbook is an essential method for assessing the fellow’s progress and graded responsibilities during their training years. The decision to allow the trainee to perform procedures independently will depend on the supervisor’s assessment of the individual’s skills and not necessarily on the number of procedures observed / assisted.
It is not necessary to document every case seen or encountered. The fellows are required to document interesting/complicated cases encountered, academic activities and all procedures participated in and the level of contribution based on following four point scale: O: Observed A: Assisted S: Supervised I: Independently. The faculty will document ACGME-I competencies for each fellow.
All procedures, evaluations and assessment tools must be used or logged electronically through the Trainees Management System (New Innovations). Fellows will be evaluated by appropriate faculty members during and at the end of each assigned rotation as in the log- book specifically clinical cases/procedural skills/academic activities and overall ACGME competences.
ASSESSMENT AND FEEDBACK METHODS BASED ON THE ACGME –I COMPETENCES
Fellow’s performance will be assessed throughout her/his tenure in the training program to ensure appropriate development of skills and competencies. Methods used will provide assessment of competencies in patient care, medical knowledge, and Practice-Based Learning and Improvement, interpersonal and communication skills, professionalism, and systems- based practice. The fellows are specifically evaluated on the ACGME-I competencies every rotation by the rotation supervisor.
All fellows are expected to get signatures of their supervisors same time/day of case seen or procedure done and at the end of their rotation from the rotation supervisor. In addition, semi-annual logbook has to be signed by the program director and then countersigned by the chairperson of the education committee.
Assessment is marked as 3 grades –Unsatisfactory (below expectations)/ Satisfactory (meets expectations) /Good (exceeds expectation). 1. Unsatisfactory-Poor competency judgment, Requires continuous supervision. 2. Satisfactory- Meets Expectations, Effective competency judgment. Supervision needed for complex/difficulty situations.3. Good- Exceeds Expectations, Exemplary competency judgment including in complex/difficult situations. Can practice independently.
A trainee who fails the rotation will be expected to complete a remedial rotation(s). The site of the remedial rotation will be at the discretion of the program Director.
The following are the utilized Assessment forms:
In – Training Assessment Report (ITAR):
This form is used by the supervisor of the rotation to evaluate the fellow competence on multiple criteria including Medical Knowledge, Patient Care, Professionalism, Practice-Based Learning and Improvement, Interpersonal and Communication Skills and SYSTEMS-BASED PRACTICE.
Mini - clinical Assessment (MINI-CEX):
This form is used to evaluate a quick clinical competence of a fellow by the in charge consultant of the team.
Rotation Evaluation Form:
This form is used by the supervisor, to evaluate the fellow for the complete rotation, including the number of patients seen by the fellow, presentations done, patient management and ward rounds.
Final In-Training Assessment Report (FITAR):
This form is used to assess in depth the fellow on the six different ACGME competencies as an overall performance. It is done at the end of the program by the Program Director.
These forms and others are used in the fellowship evaluation according to the following description:
|
|
Form |
Frequency |
Assessor |
Remarks |
|
1 |
In-Training Assessment Form (Clinical) |
Once per block |
Trainer/Supervisor |
Assess the performance of the Fellow in the specified block |
|
2 |
Rotation Evaluation |
Once per block |
Fellow |
Evaluate the rotation objectives |
|
3 |
Six-monthly/Annual Assessment |
Two per year |
Program Director |
Face to face Assessment |
|
4 |
Final In-Training Assessment Report (FITAR) |
Towards the end of training |
Program Director |
Done 3 months before graduation. Summative assessment of the Residents performance |
|
5 |
Mini-CEX |
Once per block |
Trainer |
As described earlier in the text |
|
10 |
Research Assessment Form |
2 times |
Research mentor |
Assess the Performance of the Fellow on research |
|
11 |
Research mentor Assessment Form |
2 times |
Fellows |
Evaluate the effectiveness of the research mentor |
|
12 |
Trainer Evaluation |
Once per block |
Fellow |
Evaluate the trainer |
|
13 |
Trainer Evaluation Form by program |
Three times |
Education Committee/ PD/APD |
Evaluate the trainers |
|
15 |
Program Evaluation Form by trainers |
At the end of the year |
Trainers |
Evaluate the entire program |
|
16 |
Program Evaluation Form by fellows |
At the end of the year |
Fellows |
Evaluate the entire program |
EXAMINATION REQUIREMENTS
The cardiology fellowship certificate examination will be designed to test the cardiology knowledge, skills and behavior of fellows in training. The fellowship examination will be a knowledge-based and practical skill based assessment for core cardiology training in Oman.
a.Fellows should sit for OMSB Exam after they finished 3 years training successfully.
b.The number of attempts allowed for examination are as per OMSB regulations.
c.After three years of successful training in Cardiology and passing the scheduled exams, the trainee will be granted the OMSB Fellowship Certificate in Adult Cardiology.
It will have two parts:
Part 1 Written: The exam will consist of 100 multiple choice questions that includes all the disciplines in cardiology.
Part 2 Clinical:
a.OSCE 20 -25 slides
b.2 short cases
YEAR 3
RULES AND REGULATIONS OF FELLOWSHIP EXAMINATION
Candidates who do not achieve satisfactory final In-training Assessment report are not eligible to sit for the OMSB Adult Cardiology examination.
Candidates who pass both the written exam and the clinical will be awarded the Certificate of OMSB Fellowship in Adult Cardiology.
Candidates who failed all or part of the Fellowship Exam will be allowed a second attempt to sit for the Fellowship Exam on the following year for the parts they failed.
Candidates who wish not to reappear for the Fellowship Exam for the second time will be given a Certificate of Completion of the Fellowship Training in Adult Cardiology.
Candidates who failed to pass all part of the end of year exams by the end of second attempt will be given a Certificate of Completion of the Fellowship Training in Adult Cardiology.
EXIT QUALIFICATIONS
Before applying for the final certifying examination, the Fellow must:
Be certified by the general specialty;
a.Have successfully completed the Fellowship Training Program.
b.Complete the Final In-Training Assessment Report (FITAR)
c.Upon completion of the training requirements and passing of the exit examination, the Fellowship Certificate will be conferred upon the Fellow. The title of the certificate will be “OMSB Fellowship Certificate in Adult Cardiology”
ACADEMIC ACTIVITIES/ TEACHING METHODS
OVERVIEW:
The Cardiology fellowship program will conduct various educational activities as part of the educational process to achieve the objectives of the fellowship program. These activities are conducted at the OMSB facilities and at each training site, daily, weekly, monthly or annually. Attendance of fellows at these activities is strictly monitored.
The adult cardiology fellowship program will allow for protected, didactic teaching activities that are projected to run regularly during the academic year. These will be interrupted during the summer holidays, public holidays and also during the holy month of Ramadhan. The overall proposed layout of the academic activities is as follows:
Teaching activities which fellows will take part include:
|
No |
Academic Activity |
Frequency |
|
1 |
Departmental meeting discussing previous day admissions including ECG and Angiograms. |
Every week day morning 7.30 to 8.00 am |
|
2 |
Echo/Cath meeting with CTVS Surgeons. |
Every weekday Wednesday 7.30 to 8.30 am |
|
3 |
Journal Club every 1st week |
Every Thursday 7.30 am to 8.30 am |
|
4 |
Statistics Meeting/Clinical audit /Intervention topic every 2nd week |
|
|
5 |
Mortality and Morbidity Meetings every 3rd week |
|
|
6 |
Imaging presentation/Nuclear/CT combined meeting every 4th week |
|
|
7 Academic Half-Day Fellows Only |
Fellows will have protected teaching hours- Grand rounds presentation by Fellows Case presentations by Fellows Scenario Based Simulation Simulation Learning by Fellows |
Every Monday afternoon 2:00 – 4:00 pm |
Journal club: the rotating fellow is expected to present an article pre-chosen with a local faculty member. Journal clubs will be held once per month.
Academic half-day [Every Monday afternoon 2:00 – 4:00 pm]: These will be coordinated with the faculty at each of the two training sites alternatively, the Sultan Qaboos University
Hospital (SQUH) and the National Heart Center (NHC) and will be conducted Every Monday afternoon 2:00 – 5:00 pm. ALL fellows will be expected to attend a half day of didactic sessions (either at the OMSB or NHC/SQUH auditorium). During this time, fellows will be excused from clinical duties. On call fellows will be covered by non-OMSB registrar. Post-call fellows are also expected to attend. The potential themes covered in these 180 minute sessions will include:
a. Grand rounds presentation: Interesting case discussion involving multispecialty Discussion of interesting cases, posing a challenging clinical question guided by available evidence and guidelines recommendations
b. Case presentations: Detailed history, bedside clinical examination and differential diagnosis discussion
c. Core-curriculum presentations: Two, 45-60 minute sessions will be conducted by local faculty. When possible, sessions will also be given by visiting professors and experts. The topics covered will be from the core cardiology curriculum. Lecturers will be expected, where appropriate, to provide 10-15 multiple choice or case-based questions on their respective topics. These will be used to construct a local cardiology question bank with the prospect of assisting local faculty in independently assembling validated exist-examination templates in the near future.
The following content areas of basic science:
1-Cardiovascular anatomy
2-Cardiovascular physiology
3-Cardiovascular metabolism
4-Cardiovascular pathology
5-Cardiovascular pharmacology, including drug metabolism, adverse effects, indications, the effects on aging, relative costs of therapy, and the effects of non- cardiovascular drugs on cardiovascular function
6-Genetic causes/ Molecular biology of cardiovascular system/disease
Scenario Based Simulation includes the following topics:
Evaluation, and Management of:
1-Coronary artery disease, including Acute coronary syndromes/ST-evaluation Myocardial Infarction (STEMI) and Stable CAD
2-Hypertension and Hypertensive heart disease
3-Cardiomyopathy
4-Pericardial disease
5-Valvular heart disease
6-Adult congenital heart disease
7-Heart failure- acute and chronic/Cardiogenic shock
8-Arrhythmias
9-Diseases of the aorta
10-Pulmonary hypertension/Pulmonary embolism/ Thromboembolic disorders
11-Lipid disorders and metabolic syndrome
12-Heart disease in pregnancy
13-Cardiovascular evaluation of patients undergoing non-cardiac surgery
14-Infectious and inflammatory heart disease
15-Cardiac trauma/tumors
16-Peripheral vascular disease
17-Cerebrovascular disease
18-Geriatric cardiology
19-Need for end-of-life (palliative) care
20-Diagnostic techniques, including: Challenging ECG/Echo/CT/MRI/EP /Cath hemodynamic and angiographic tracings.
Primary And Secondary Prevention Of Cardiovascular Disease, Including:
1-Current and emerging risk factors
2-Cardiac rehabilitation
3-Biostatistics/Clinical epidemiology
SIMULATION LEARNING
The simulation sessions constitute a valuable educational tool that allow the program to focus on certain skills that the fellow is expected to master by the end of his specialty fellowship program in adult cardiovascular medicine. These skills can be taught in a systematic and controlled environment mimicking real-life situations with the use of audio-visual aids and mannequins, when appropriate. The sessions will be conducted by the faculty members of the cardiology fellowship program at the simulation center of OMSB with the help of the simulation center staff and other OMSB faculty experienced in simulation activities.
It is expected that the sessions will be conducted once every 6 months, allowing each fellow in the program to be exposed to the same theme twice during their fellowship. The following are some themes proposed for the simulation sessions:
ACLS Refresher Course (Mock):
this will be coordinated with the local AHA representative at SQUH .The activity will allow the fellow to keep abreast of resuscitation guidelines and required practical skills essential for their day-to-day practice. The activity will also offer an opportunity to re-certify all fellows as ACLS providers at the start of their fellowship and also as they exit their training as qualified cardiologists. The specific stations include:
1.Pulseless electrical activity/Asystole
2.Pulseless ventricular tachycardia/Ventricular fibrillation
3.Unstable tachy-arrhythmias; ventricular and supraventricular
4.Unstable brady-arrhythmias
5.ABC of airway management during cardiopulmonary resuscitation
Communication skills:
effective and clear communication with patients is a vital component of the daily patient care. The practice of cardiology tests this skill in various settings; such as the ambulatory clinic, inpatient wards, intensive care unit and before procedures. This particular simulation activity aims to provide the candidate to practice these skills in a simulated environment under direct supervision. Some proposed themes include:
1.Obtaining consent for elective and emergency procedures
2.Counselling patients about a serious diagnosis or serious abnormal finding on a cardiac investigation
3.Counselling a pregnant patient and spouse about a serious cardiac diagnosis addressing maternal and fetal risks on the discussion (severe LV dysfunction, severe mitral stenosis, severe pulmonary hypertension)
4.Counsel family members about the deteriorating condition of a relative in the critical care unit
5.Counsel a patient about the side effects of a new medication
6.Counsel the patient about treatment options (e.g. patient needing valve replacement mechanical vs. bioprosthetic valve)
Essential procedures in the CCU:
This activity will educate the fellow on the basic theory in terms of indications, contraindications and required preparations for common cardiac procedures. These form a basic competency skill for any practicing cardiologist. These include:
1.Conscious sedation
2.Pericardiocentesis
3.Placement and management of temporary pacemakers, including trans venous and transcutaneous
4.Intra-aortic balloon counter pulsation
5.Basics of interrogation of pacemakers and implantable defibrillators
Observed Simulated Clinical Exam (OSCE) Stations:
The simulation sessions will be used in preparing the candidates for local and international exit examinations, specifically for the OSCE and clinical short-case component. These MOCK exam sessions will include bedside focused cardiac examination, interpretation of echocardiographic, angiographic and hemodynamic data.
The themes suggested above are only suggestions and are going to be a moving target for modification based on training requirements. The activity will allow for a rich medium for discussion and interaction between faculty, invited faculty and fellows. The faculty conducting the sessions is expected, where appropriate, to generate 10-15 multiple choice or case-based questions on their respective stations. These will be used to construct a local cardiology question bank with the prospect of assisting local faculty in independently assembling validated exist-examination templates in the near future.
Educational Activities arranged by the Oman Heart Association (OHA):
the OHA with its active scientific committee, conducts a series of high-quality educational activities delivered by local, regional and international experts in cardiology. Fellows will be encouraged to attend and participate in these activities to further enrich their training experience.
Regional and International Cardiology Conferences/Workshops:
The program will strive to allow its senior (2nd and 3rd year) fellows to attend, and more importantly actively participate in regional and international conferences with case presentations, presentation of their research work … etc. This activity is subject to availability of funding source and agreement of members of the education committee evaluating performance of the potential candidate.