OUTLINE FOR DESCRIPTION OF ROTATION

ROTATION: Cardiology Rotation

PRECEPTOR(S): Drs. Palmer, Saeian, Staudacher and Zarling

DURATION: One Block

1. GOALS/OBJECTIVES OF ROTATION:

--- To strengthen cardiac physical diagnosis skills

--- To develop diagnostic and management skills of primary care urgent cardiac problems (see list of Recommended Core Educational Guidelines for Family Practice Residents)

--- To understand the proper use of non-invasive testing (e.g.: stress testing, nuclear medicine, echocardiography.) and to develop proficiency in ECG interpretation skills

--- To develop proficiency in procedural skills such as placement of invasive lines (CVP, arterial line) and fluid and pressure management as well as to enhance skills in ACLS

--- To develop skills of timely consultation and referral as well as understanding the limitations of primary care physicians in this field

--- To understand and manage family psychosocial, emotional, and personal issues relevant to cardiac care

2. EXPECTATIONS OF ROTATION:

The resident will see patients and provide first response care to emergency situations relevant to cardiac care in the CCU/IMC and ER settings. After a history and physical is completed, the resident will discuss their impression and plan with the cardiologists and participate in the ongoing care of that patient to include procedures relevant to a family physician.

Residents are expected to demonstrate a high level of intellectual curiosity which will in turn stimulate interest in teaching by the preceptors. Residents should try to gain experience with non-invasive and invasive cardiac procedures being performed (e.g. should observe echocardiogram and catheterization, tilt table, etc. being performed)

Residents should moonlight very little if at all when on Cardiology rotation.

Response to codes - the resident on call should attend all codes unless another team member is designated during rounds.

Designating a resident coordinator - the team should select a resident coordinator who will interact with attendings to help schedule times when the team will meet with the attendings, do rounds with them, and designate which topics will be discussed during the didactic sessions noted below. The Residency scheduling coordinator will call the Cardiology scheduling coordinator (Barb Smith) to define who will be the primary cardiologist preceptor each day during the rotation. The Cardiology scheduling coordinator (Barb Smith) should notify attendings, prior to the rotation, who the resident coordinator is, and schedule an orientation session with the primary cardiologist and the residents for the first day.

When the service is slow - The list of didactic topics can be used to add additional teaching discussions. Participation in stress tests and ECG review should be done in the cardiovascular department. Residents could go to the attendings office to see outpatient consults.

Order writing - orders that may impact on the cardiac status of the patient must be discussed in advance with the attending prior to entering the order. Such cardiac orders must be written as “per Dr. _____”.

3. SUGGESTED PREPARATION/REFERENCES:

Basic ECG reading

ACC/AHA Guidelines for:

Myocardial Infarction

Congestive Heart Failure

4. TYPICAL WEEK:

Residents will alternate call from home on an every-fourth-day basis. Morning rounds should start as early as necessary for residents to see all patients they have worked-up, and patients the cardiologist has assigned based on educational benefit. Notes should be written, if possible, before the attendings see the patients (usually before 9:00 am.) Sign-out rounds between residents are expected by the attendings to complete the transfer of responsibility. Didactic rounds will be held with the assigned cardiology preceptor daily Monday through Friday. The residents will keep track of which lectures have been given, so as to avoid overlap.

Two residents should always be available until 6:00 PM for rounds and admissions with one resident being primary (on call) and the other acting as back up. The third resident will usually be in the office (WFPC) in the afternoon. The on call resident will be available overnight.

ECG INTERPRETATION: Regular sessions to be arranged by attendings and resident coordinator.

5. WORK-UPS/WRITE-UPS:

See above. After discussing new admissions with attendings, an H&P or consultation note should be written by the resident. No dictation is to be done. Some cardiac catheterization patients may come with a completed H&P; residents do not need to do complete evaluations or paperwork on these patients. It is important for residents to coordinate with the attendings which patients require resident documentation. Residents do not need to dictate on this rotation, unless they do a procedure.

6. PROCEDURES:

Available procedures include central and arterial lines, management of cardiac arrests, exercise stress testing, and insertion of Swan-Ganz catheters. When possible, these should be done by the residents. The resident must gain an understanding of hemodynamic monitoring. For those patients that residents have evaluated, participation during non-invasive and invasive studies is highly desirable to allow for a complete educational experience. Stress tests and catheterizations should be attended if possible.

Stress Testing - Residents must attend at least 10 stress tests during this rotation. The Cardiology rotation coordinator (Barb Smith) will designate a morning of each week for each resident to attend stress tests. The responsible resident should assure that this has been done before the rotation begins. The other residents should cover rounds during that time.

7. AVAILABLE EDUCATIONAL EXPERIENCES/CONFERENCES:

Standard program conferences including family practice morning teaching rounds (Monday/Thursday) and Wednesday afternoon conferences are mandatory. Hospital conferences should also be attended unless patient emergencies conflict.

8. IMPACT ON OFFICE SCHEDULE:

Second- and third-year residents will maintain two half days per week. Afternoon or evening sessions in the office should only be scheduled (in order to allow for morning rounds).

9. CALL:

Every fourth night from home including both weekdays and weekends. Residents on call must be immediately available when providing coverage.

10. WEEKEND REQUIREMENTS:

See above.

11. VACATION/TIME OFF: None

12. EVALUATION:

Meet with attendings at the beginning of the rotation to discuss logistics. Informal discussions of progress/ evaluation should occur throughout the block. Near the end of the rotation, meet with the attendings to discuss performance and areas for future development. Evaluation forms will be provided by Barb Smith during the last week of the rotation and should be reviewed with a cardiologist.

13. CRITERIA FOR SUCCESSFUL COMPLETION:

A. Completion of expected responsibilities and all call days.

B. Written final evaluation by preceptor indicating satisfactory performance of expected responsibilities and involvement in required activities.

C. Participation in at least 10 stress ECG tests.

D. Demonstration of an accurate cardiac H & P.

E. Reviewed minimum of 100 ECG tracings

14. SUPERVISION:

All resident activities will be supervised by rotation preceptors so that residents are able to call the attending in for support when needed for unstable patients. Cardiologists will comment on adequacy and accuracy of documentation.

Revised: 06/01/05 – LSL:lmc