the egyptian fellowship board for cardiovascular medicine§لقلب.pdf · the egyptian fellowship...

Egyptian Fellowship Board

Cardiovascular Medicine Curriculum

The Egyptian Fellowship Board For Cardiovascular Medicine

1

CONTENTS

Preface………………………………………………………………………………………..….. 3

References ………………………………………………………………………………………. 5

Acknowledgement ………………………………………………………………………..…….. 7

Goal ………………………………………………………………………………………...…… 8

Aims……………………………………………………………………………………………. . 8

Entry Requirements For The Egyptian Fellowship Of Cardiovascular Medicine ……………… 8

Training rules and regulations ……………………………………………………………….…. 9

Curriculum

THEME 1. BASIC SCIENCE & BASIC CARDIOLOGY…………………….………………. 17

THEME 2. HEART FAILURE ………………………………………………….…….……….. 20

THEME 3. CARDIAC RHYTHM DISORDERS……………………………………………… 21

THEME 4. ISCHEMIC HEART DISEASE………………………………………….………… 25

THEME 5. SYSTEMIC AND PULMONARY HYPERTENSION………………..………….. 25

THEME 6. STRUCTURAL HEART DISEASE ……………………………….…..………….. 30

THEME 7. ANGIOLOGY AND TRAUMA OF THE ………………………………..……….. 35

THEME 8. THE HEART IN SPECIAL GROUPS……………………………….……………. 37

THEME 9. CARDIAC INVESTIGATIONS……………….…………………………….……. 40

THEME 10. COMMON COMPETENCIES…………………………………………………… 43

Blue print ………………………………………………………………………………..……… 51

MARKS & STANDARDS ……………………………………………………………..………. 51

Instructions for using Procedure Based Assessments (PBAs)……………………………..…… 53

Teaching plan……………………………………………………………………………..…….. 55


2

PREFACE

The Egyptian Fellowship Board and the Egyptian Fellowship of Cardiovascular medicine (EFOC)

scientific council worked collaboratively and closely to make this curriculum available for

trainees’ guidance and support.

Worldwide, postgraduate medical education is now governed by sets of academic standards that

describe the qualities and abilities of graduates. In addition, there are standards for the training

processes, trainers’ selection and methods of assessment to ensure transparency and clarify

expectations.

The Egyptian fellowship board has already defined and published its standards for the general and

professional competencies’ expected from our graduates in different specialties upon successful

completion of training. These expectations are clearly reflected in the Cardiovascular medicine

curriculum.

The curriculum describes what trainees should know and be able to do upon completion of

training. The curriculum also describes in details, expectations from trainees during their

rotations.

Methods of assessment and examination regulations are also available in the last section of the

curriculum.

All topics covered during clinical and theoretical studies are outlined. This will help trainees to

guide their readings and their choice of learning activities. In addition, all required procedures are

listed together with the expected performance.

To help our trainers, supervisors and maximize benefits, we provided a guide for required lectures

at various training stages.

Mandatory courses are also mentioned and the Egyptian Fellowship Board will work closely with

EFOC scientific council to ensure proper organization of courses at appropriate training stages.

We hope that all our trainees, trainers and educational supervisors will follow the guidelines

provided in the curriculum and cooperate with The Egyptian Fellowship Board and EFOC

Scientific Council to implement the curriculum in the best ways.

This curriculum will be revised and updated every 3 years.

Secretary General

Higher Committee of Medical Specialties


3


4

REFERENCES

The Committees consulted international curricula in cardiovascular medicine.

The external references for the development of this curriculum are:

Braunwald ‘s Heart Disease: A Textbook of Cardiovascular Medicine, 9th edition

Hurst's the Heart, 13th Edition

Topol Textbook of Cardiovascular Medicine 3rd edition

Agreed upon items between American and European Guidelines in the last three years and

National Guidelines.

http://www.amazon.com/Hursts-Heart-13th-Two-Set/dp/0071636463/ref=sr_1_1?s=books&ie=UTF8&qid=1344084431&sr=1-1&keywords=hurst%27s+the+heart

http://www.google.com.eg/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CGUQFjAA&url=http%3A%2F%2F1aim.net%2Ffourm%2Fshowthread.php%3F4909-%25DF%25CA%25C7%25C8-Topol-Textbook-of-Cardiovascular-Medicine&ei=QxwdUPCGOsjmtQbkh4HICg&usg=AFQjCNHIomFI_UK8yyM5F8ub_4C5AyWkxA


5


6

Acknowledgement

This curriculum has been created through collaboration between the head of EFOC Scientific

Council, the EFOC accreditation team and the Egyptian Fellowship Curriculum Committee. The

following members of the Cardiology experts have made substantial contribution to the

curriculum development as subject matter experts

Professor Dr Khairy Abdel Dayem, Professor of Cardiovascular Medicine,

Ain Shams University and head of the Cardiovascular Medicine scientific

council

Dr Ahmad Magdy, Consultant of Cardiology, National Heart Institute.

Professor Dr Amr Adel, Professor of Cardiovascular Medicine, Ain Shams

University

Professor Dr Gameela Nasr, Professor of Cardiovascular Medicine, Suez

Canal University

Professor Dr Yasser Al-Boghday, Professor of Cardiovascular Medicine,

Cairo University

Dr Ahmed Onsy, Assistant Professor of Cardiovascular Medicine, Ain Shams

University

Dr Bassem Zarif, Assistant consultant of Cardiovascular Medicine, National

Heart Institute.

Dr Muhamad Helmy, Assistant consultant of Cardiovascular Medicine,

National Heart Institute.

Dr Karim Saeed, Lecturer of Cardiovascular Medicine, Cairo University

The Egyptian Fellowship Curriculum Committee has made significant contribution to the curriculum

through Collaboration with the council in the design and formulation of the educational structure.

The member who participated in this work is Prof Dr Shereen Fawzy Hafez, Professor of Medical

Microbiology & Immunology, Ain Shams University, Medical education expert and technical

coordinator of the Egyptian Fellowship for international accreditation of Cardiolovascular

Medicine specialty.


7

Goal The goal of EFOC curriculum is to graduate a safe competent trained specialist in cardiovascular

medicine who will be able to work within the National Health Service and will have the knowledge,

skills and attitudes required to do this and to develop further subspecialty expertise if appropriate.

Aims The educational process in the fellowship of Cardiovascular Medicine aims to equip trainees with

the necessary knowledge, skills and attitude so that they will acquire competencies; at a level

consistent with practice in the specialty of cardiovascular medicine and at the level of

professionalism, that will include the following:

Patient care that is appropriate, effective and compassionate dealing with health problems

and health promotion.

Medical knowledge in the basic and clinical sciences, and medical ethics and application of

such knowledge in the diagnosis and management of patients with cardiovascular disorders.

Acting as safe independent specialists whilst recognizing the limitation of their own practice

and the obligation to seek assistance from colleagues where appropriate.

Interpersonal and communication skills that ensure effective information exchange with

individual patients and their families and teamwork with other health professionals.

Appraisal and utilization of new scientific knowledge to update and continuously improve

clinical practice.

The ability to function as a trainer and teacher in relation to colleagues and medical students.

Maintenance of standards appropriate in their professional field and able to respond

constructively to assessments and appraisals of professional competence and performance.

Entry requirements for the Egyptian Fellowship of

Cardiovascular Medicine

Any of the following is considered a satisfactory entry requirement for the Egyptian Fellowship of

Cardiovascular Medicine

1. Diploma in General Medicine

2. Master in General Medicine

3. M.D. in General Medicine

4. M.R.C.P.

5. Fellowship of Egyptian Board of General Medicine

6. Diploma in Cardiology (2 years study)

7. Master in Cardiology

Those admitted to the Fellowship training program with qualification in general medicine (number 1

to 5 above) will be exempted from the first 2 years in general medicine training..

Those admitted to the Fellowship training program with qualification in Cardiovascular Medicine

(number 6 &7 above) are exempted from stage 3 in Cardiovascular Medicine training (ST3) and first

part examination in basic science and basic Cardiovascular Medicine.


8

MANDATORY COURSES

Each trainee has to attend an internationally recognized Life support training course (BLS and ALS)

and provide a valid certificate as prerequisite for entry cardiology fellowship.

Each trainee has to attend an echocardiography training course provided by a centers accredited by

the medical council

TRAINING RULES & REGULTIONS

STRUCTURE OF THE TRAINING PROGRAM The structure of the training program of EFOC Board requires five years supervised training that

must be conducted in an accredited hospital before sitting for the final examination.

A list of accredited hospitals will be announced yearly by the Board.

The Cardiovascular Medicine training program follows at least two years residency (or equivalent

training) in general medicine (ST1-2) and consists of three years residency in Cardiovascular

Medicine (ST3-ST5).

During the entire training program the candidate must be dedicated full time and must be fully

responsible for patient care. Holidays and on call duties are according to Ministry of health

regulation.

GENERAL RULES For Evaluation OF TRAINEE PERFORMANCE

Workplace Based Assessment (WPBA) Performance of the trainee shall be evaluated on regular and continuous basis. The evaluation

process should involve all aspects of the training including clinical and procedural skills, review of

the logbook as well as review of attendance and participation and the audit project. This is

performed on monthly bases and through the annual assessment review process (ARP) for the

trainees.

Workplace based assessment will be performed for both clinical and procedural skills by using Mini-

clinical evaluation exercise (Mini-CEX) and procedure based assessment (PBA) respectively. It is

mandatory that each trainee achieve a satisfactory level in history taking and clinical examination by

the end of ST4. In addition there is WPBA for selected 5 procedures (Exercise stress testing, adult

transthoracic echocardiography, central venous catheter insertion, temporary pacemaker insertion

and basic coronary angiography) that trainees must pass to sit for the second part examination.

THE LOGBOOK It is the responsibility of the trainee to record activities into the logbook at least on weekly

basis.

These entries should be signed by the trainer directly supervising the trainee during the

procedure and countersigned by his assigned trainer.

Educational activities should also be recorded and signed by person in charge of the activity

and countersigned by the assigned trainer.

Logbooks should be ready for inspection by the education supervisor at all times.

It is the responsibility of each trainee to fill the logbook statistics in the trainee assessment

form (attached). This form should be counter signed by his assigned trainer.


9

Logbooks and trainee assessment forms will form part of the evidence submitted for the

annual assessment meeting by review committee.

Mini Clinical Evaluation Exercise (Mini-CEX)

The mini-Clinical Evaluation Exercise (mini-CEX) is a structured assessment of an observed clinical

encounter. Mini-CEX will be used to assess a range of core competencies that a trainee uses

during day-to-day encounters with patients and to provide feedback on these essential skills for the

provision of good clinical care.

The mini-CEX will be used as a formative assessment tool in ST3 and ST4 to help trainees review

their performance on-the-job and to aid the learning process during their training. Through being

observed undertaking a number of cases, over a period of time, with a number of different

assessors, these individual brief encounters add up to provide a reliable measure of a trainee's

performance. Who is a mini-CEX assessor? Trained trainers in assessment and feedback methodology and educational supervisors are the responsible assessors. They must be able to competently perform the interaction themselves. If possible, a different assessor should be used for each mini-CEX. The number of assessments required

During a period of ST3 and ST4, trainees will be observed multiple times carrying out different

domains of the procedure until reaching the satisfactory standard and their overall rating is

good/Excellent. Trainees are encouraged to perform as many as possible and not all question areas

need be assessed on each occasion. However, at least one assessment in any six month period should

be undertaken completely. How does it work?

The process is typically led by the trainee. The trainee chooses the clinical encounter, which should

be representative of his workload. However, trainers should also carry out unscheduled assessments.

The observed process typically takes around 20 minutes and immediate feedback around 5 minutes.

It may be necessary to allocate more time. What specific competences does the mini-CEX assess?

Mini-CEX includes six areas; History taking, Physical examination skills, Professionalism &

Communication skills, Critical judgment, Organization & efficiency and Counseling skills. Mini-CEX validation sheet

It includes the six areas to be assessed and provides free-text space for trainer to identify strengths,

areas for development and an action plan.

Rating

Rating the question areas


11

A series of competencies within the six core domains are rated as follows:

N = Not observed U = Unsatisfactory S = Satisfactory

Overall rating

An overall global assessment divided into three levels rated as follows:

Unsatisfactory - Gaps in knowledge or skills that you would not expect at this level of training. Some

concerns about professionalism or patient safety.

Satisfactory - Generally clinically competent and with satisfactory communication skills and professionalism.

Excellent - Performing well above the level they are at. No concerns about their clinical method,

professionalism, organisation, communication etc.

Feedback

In order to maximize the educational impact of using mini-CEX, both trainer and trainee need to identify

strengths, areas for development, and an action plan. This should be done sensitively and in a suitable

environment.

Tips for using Mini-CEX by trainers

Clinical setting: Select the most appropriate setting; if none apply select other and specify.

Clinical problem category: These are based on the clinical areas described in the Curriculum.

New or Follow-up: Select whether this is a new patient encounter for the trainee or a follow-up.

Focus of the clinical encounter: Select the most appropriate focus. Diagnosis should include an

assessment of the trainees, examination skills and their abilities to reach a provisional diagnosis.

Complexity of case: Score the difficulty of the clinical encounter for a ST3 or ST4 trainees.

Procedure Based Assessments (PBAs) The PBA is a formative method (without marks allocated in the exit exam) for assessing a range

of competencies involved in performing certain procedures during routine training. It enables

trainees to build on assessor feedback and follow their own progress. Although PBA is

formative, the summary evidence will be used to inform the ARP and will contribute to the

decision made as to how well the trainee is progressing and his illegibility to sit for exam. The

tool has two principal components:

1- A series of competencies within four core domains (consent, preprocedure, procedural

and post-procedural that are scored as follows:

N = Not observed U = Unsatisfactory S = Satisfactory


11

2- An overall global assessment divided into four levels rated as follows:

Level 0: Insufficient evidence observed to support a judgment

Level 1: Unable to perform the procedure under supervision

Level 2: Able to perform the procedure under supervision

Level 3: Able to perform the procedure with minimal supervision (occasional help)

Level 4: Competent to perform procedure unsupervised (and deal with

complications)

WHO SHOULD DO AN ASSESSMENT? 1- The trainee’s assigned trainer for temporary pacemaker, stress test and central venous

catheter insertion.

2- In addition to the assessment by the trainee’s assigned trainer; at the end of the training

program the educational supervisor will assess the trainee in echo and angiography.

THE NUMBER OF ASSESSMENTS REQUIRED: During a period of training, trainees will be observed multiple times carrying out different

domains of the procedure until reaching the satisfactory standard and their overall rating is 4.

Trainees are encouraged to perform as many as possible.

HOW SHOULD IT WORK? The trainee’s learning agreement should indicate which PBAs are selected. It is the trainee’s

responsibility to ensure the required number of PBAs is performed to a satisfactory standard by

the specified timescale. The trainee generally chooses the timing and makes the arrangement

with the assessor. Trainees should carry out the procedure, explaining what they intend to do

throughout. The assessor should observe the trainee undertaking the agreed sections of the PBA

in the normal course of workplace activity. Given the priority of patient care, the assessor

should choose the appropriate level of supervision depending on the trainee’s stage of training.

If the trainee is in danger of harming the patient at any point, he must be warned or stopped by

the assessor immediately. Trainees and assessors will find the assessment criteria in the next 2

pages of the validation worksheet. This will help them define each phase in the procedure and

the required satisfactory level.

WHAT DOES A COMPLETED PBA MEAN? A completed set of PBAs provides evidence that a trainee has learned to perform competently a

number of procedures in supervised settings.

FEEDBACK When a PBA is completed, the assessor should provide immediate feedback to the trainee in a

debriefing session. The assessor should identify areas of achievement and opportunities for

improvement. This should be done sensitively and in a suitable environment.

AFTER THE ASSESSMENT AND FEEDBACK The corresponding PBA table should be filled and signed by both the assessor (assigned trainer

or other consultant) and trainee.


12

TIPS FOR USING PROCEDURE-BASED ASSESSMENTS (PBAS) Perform an assessment as many as possible an index procedure is carried out; this

helps to make assessment and feedback ‘routine’ and aids learning.

Focus on one particular domain of a procedure this can reduce stress.

Review of the PBA checklist before the start of the procedure can help with briefing.

The trainee can write up the procedure note whilst the assessor completes the

assessment table (not forgetting to assess the procedure note as well).

A suitable place is chosen for the assessor and trainee to review the completed PBA

table, and for the assessor to provide constructive feedback.

Completion of the assessment without providing feedback is much less useful for the

trainee.

Items rated as “0, 1, 2” should be expected the first time that a trainee performs a

procedure. This simply means that they need more practice and more assessments.

PROCEDURES SELECTED FOR ASSESSMENT (INDEX PROCEDURES)

Procedures

1 Echocardiography

2 Stress ECG

3 Coronary angiography

4 Central venous catheter insertion

5 Temporary pacemaker insertion

AUDIT PROJECT The trainee will undertake an audit project during the training program (ST4/ST5) under the

guidance and supervision of his/her trainer. Such project should be appropriately written (not

necessarily published) and accepted by the ARP committee for the trainee to sit for the second part

examination.

ANNUAL REVIEW PROCESS (ARP) The chairman of the scientific council sets the date for the ARP, selects the members of the

review board and sends the invitations.

Minimum 4 out of the following review board members (Chairman of scientific council +

program director + council member + educational supervisor + specialty coordinator +

representative of trainers) should attend this meeting.

Trainees will be notified one month ahead of the meeting date.

Learning agreements, logbooks (including Mini-CEX and PBAs), trainer monthly reports,

educational supervisor reports, trainee assessment forms and training post assessment forms

should be submitted by the specialty coordinator at least 3 weeks before the date of the

meeting (all these forms are attached)

The specialty coordinator will forward the above documents to the review board members at

least 2 weeks before meeting date.

The following items will be assessed in the meeting:

Verification of signatures


13

Attendance of activities

Trainees' performance during previous placement

The level of competence achieved by the trainee

Based on the above evidence and following discussion with trainees one of the following

outcomes will be decided:

ARP 1: Satisfactory to progress to the following stage

ARP 2: Can proceed but with targeted training (closer than usual monitoring and

supervision, to address particular needs & provide feedback). The recommended

improvements will be reassessed in the following ARP meeting.

ARP 3: An official warning of discontinuation of the training program will be

issued if the previous recommendations have not been rectified, subject to review

in a follow up meeting.

ARP 4: Unsatisfactory and should be dismissed from the training program.

ARP 5: Satisfactory completion for training program, legible to sit for a final

exam.


14

LEARNING AGREEMENT Soon after start of each post the trainee and trainer should arrange a formal meeting to

discuss trainee needs and career plans.

An agreed plan should be documented in the learning agreement form detailing objectives,

procedures and other activities to be achieved during the placement.

This form should be filled no later than one month after the start of the post and the form

should be forward to the EFOC offices to be retained in the candidates file.

Dates of future meetings to review the progress of the trainee and the training process should

be agreed on during the initial meeting and documented on the form.

In each of the above meetings the trainee and the trainer should discuss the achieved

objectives and plan further actions.

At the end of the post the completed learning agreement should be forward to the Egyptian

board offices together with trainee and training post assessment forms to document the

progress of such objectives in respective post. These forms together with other evidence will

form the basis of the Annual Review Process (ARP) meeting.

JOB DESCRIPTION OF THE TRAINEE ST3& ST4 In Emergency room

1- Observes primary assessment and suggests management of patients in ER

2- Suggests admission of patients

3- Assists in various emergency procedures performed in ER

In wards and CCU

1- Clerking of all admissions (history, general and local clinical examination) and suggests basic

investigations and plan of management

2- Perform daily rounds

3- Write detailed daily progress notes

4- Arrange discharge, home medication, counseling and follow up appointments of inpatients

5- Assists performing various bedside procedures and emergency procedures (pericardiocentesis,

TPM)

6- Rapid decision making in the CCU

7- Administration of emergency drugs after consultation.

8- Follow and obtains various results of investigations and reports abnormal results to seniors

9- Follow up referral of patients to other specialties

10- Observes seniors explaining to patients the methods of management and their illness and

discusses this process with seniors

11- Observes the approaches taken by the seniors when talking to patients about prognosis of their

illness

12- Checks completeness of medical reports of patients

13- Participates in the interdepartmental consultation.

In OPD

1- Attends the general cardiology clinic with other senior staff

2- Participate in patients management under appropriate supervision

3- Completes various hospital forms


15

JOB DESCRIPTION FOR TRAINEE AT ST5 In Emergency room

1- Conducts assessment and management of patients in ER

2- Admission of patients

3- Performs various emergency procedures performed in ER

In wards and CCU

1- Revise and supervises clerking of all admissions, requests advanced investigations with

consultation of seniors and draws plan of management

2- Supervises daily rounds

3- Comments on daily progress notes

4- Arrange discharge, home medication, counseling and follow up appointments of inpatients

5- Assists and teaches to perform various bedside procedures and emergency procedures

(pericardiocentesis, TPM)

6- Rapid decision making in the CCU

7- Administration of emergency drugs.

8- Follow and obtains various results of investigations and reports abnormal results to seniors

9- Follow up referral of patients to other specialties

10- Observes seniors explaining to patients the methods of management and their illness and

discusses this process with seniors

11- Observes the approaches taken by the seniors when talking to patients about prognosis of

their illness

12- Checks completeness of medical reports of patients

13- Participates in the interdepartmental consultation.

In OPD

1- Attends the general cardiology clinic with other senior staff

2- Manage patients with the availability of appropriate supervision.

3- Completes various hospital forms

Educational activities

1- Presents cases in rounds

2- Participates in grand rounds and journal clubs

3- Attends all educational activities of the residency program

4- Attends local education courses

5- Learns to prepare audiovisual materials for presentations

TRAINEE WEEKLY ACTIVITIES IN ST3 It is expected that the trainees are attached to basic training hospitals for 6 days / week & are freed

from any hospital duties 2 days per month to participate in the Central Teaching Days.

The weekly timetable of clinical & scientific activities held in the training hospitals should be

drafted at the beginning of each location & documented in the Learning Agreement Form. This form

is sent to the Egyptian Fellowship Boards & copies are kept by the trainee/s. This form is made

available to the Educational Supervisor/s, & shall form the basis of their visits to the hospitals.

It is the duty of the trainers to ensure that trainees are freed from hospital duties at least for an

additional half day per week which is dedicated for self directed learning.


16

Activities held in the training hospital shall cover the following items:

6 days per week (12 sessions) in the training hospital:

2 sessions outpatient clinics

4 sessions group ward round

1 session ER (day), 1 session ER (night)

1 session CCU (day), 1 session CCU (night)

2 Sessions educational activities:

a) Grand rounds

b) Lectures

c) Journal club

d) Meetings: Morbidity- Mortality, Clinical meetings

Out of hour duties including ER cover and on call Rota follow the hospital policy.

Central Scientific Day

All Trainees are expected to have protected teaching time at a specific day every 2 weeks. The

teaching program of these days is drafted centrally at the Egyptian Fellowship Boards.

The Specialty Coordinator should notify training centers by the agenda of these days.

TRAINEE WEEKLY ACTIVITIES IN ST4&5 It is expected that the trainees are attached to an advanced training hospital for 6 days per week &

are freed from any hospital duties 2 days per month to participate in the Central Teaching Days.

The weekly timetable of clinical & scientific activities held in the training hospitals should be

drafted at the beginning of each location & documented in the Learning Agreement Form. This form

is sent to the Egyptian Fellowship Boards & copies are kept by the trainee/s. This form is made

available to the Educational Supervisor/s, & shall form the basis of their visits to the hospitals.

It is the duty of the trainers to ensure that trainees are freed from hospital duties at least for an

additional half day per week which is dedicated for self directed learning.

Activities held in the training hospital shall cover the following items:

6 days per week (12 sessions) in the training hospital:

2 sessions outpatient clinics

2 sessions group ward round

2 sessions for procedural training

1 session ER (day), 1 session ER (night)

1 session CCU (day), 1 session CCU (night)

2 Sessions educational activities:

a) Grand rounds

b) Lectures

c) Journal club

d) Meetings: Morbidity- Mortality, Clinical meetings

Out of hour duties including ER cover, and on call rota follow the hospital policy.

Central Scientific Day

All Trainees are expected to have protected teaching time at a specific day every 2 weeks. The

teaching program of these days is drafted centrally at the Egyptian Fellowship Boards.

The Specialty Coordinator should notify training centers by the agenda of these days.


17

ROTATION PLAN OF TRAINEES 1- ST3 basic training in basic training center (during this year the trainee should rotate between

trainers at least once every six months)

2- ST4/5 advanced training in advanced training center, the candidate should rotate according to the

below rotation map and each rotation comprises 6 months this is ongoing with their regular work

on ward, outpatients clinics and cath lab. N.B At the entry of ST4 candidates can start at any point in the rotation map except pediatrics & EPS

INTERRUPTION OF TRAINING It is not permissible to interrupt such a structural training program except in major unavoidable

circumstances. Such circumstances should be convincing and approved by the Secretary General of

The higher committee of Medical Specialties. The interruption once approved should not be for

more than one year. Interruption of the training program for more than one year shall result in

dismissal from the program and cancellation of the preceding training period

JOB DESCRIPTION OF THE TRAINER DURING THE TRAINING

PROGRAM 1. Provides training and teaching for the trainees according to the provided curriculum and intended

learning outcomes and sign a learning agreement with each trainee.

2. Supervises the various activities of the trainees and their logbooks.

3. Ensures and help trainees for fulfillment of the logbook activities according to year of training

and the required level of competence and signing them.

4. Ensuring patient safety in relation to trainee performance by the early recognition and

management of those trainees in distress or difficulty.

5. Evaluates the trainees through WPBA and routine training activities with feedback to the trainee,

to the educational supervisor and centrally in the trainer monthly report.

6. Perform individual appraisal for trainees at the end of their rotation (after 3 or 6 months) and

submit their reports (trainee assessment form) to the Egyptian Board

7. Participate as attendant in the annual review process and in exit examination as nominated or

requested by the scientific board

Echo-cardiography

Imaging, thalium, stress

CCU

Paediatrics

EPS


18

JOB DESCRIPTION OF THE EDUCATIONAL SUPERVISOR DURING THE

TRAINING PROGRAM

1- Checks and evaluates the progress of the training program

2- Evaluates the trainers periodical reports and propose remedial actions for any deficiencies

3- Ensures that all training activities are running according the curriculum

4- Checks the availability of the requirements for training.

5- Checks that each trainee is involved in an audit process

6- Assesses the logbook activities of each trainee & provide needed remarks for both trainer &

trainees.

7- Ensures the adherence to rotation plan for each trainee

8- Reports to the EFOC accreditation committee and scientific board and discuss with them the

performance of trainees and their legibility to sit for the exam

9- Discuss with hospital authorities the administrative affairs of the trainees and propose solutions.

10- Participate in the annual review process and in exit exams as nominated or required by the

cardiology scientific board.

JOB DESCRIPTION OF THE TRAINING PROGRAM DIRECTOR DURING

THE TRAINING PROGRAM 1. Advise trainees on all aspects of EFOC

2. Ensure that trainees notify the specialty coordinator of their entry into training program at ST3,

ST4 and ST5.

3. Follow implementation of the curriculum and the planned program of education

4. Supervise the organization of the training sequence

5. Ensure that each post delivers the education and training expected for that period and to feed

back to the trainers involved any unsatisfactory reports from trainees

6. In conjunction with the scientific council and the Egyptian board, may withdraw a placement

which is considered unsuitable to the needs of the trainee

7. Ensure that the cycle of academic lectures is in place

8. Monitor logbook entries by regular inspection with the specialty coordinator through the ARP

9. Arrange the ARP meeting with the head of scientific council.

10. Ensure that trainees carry out audit

11. Arrange for completion of the training post-assessment form by each trainee after the end of each

rotation. The training post assessment form is confidential and should only be retained by the

specialty coordinator with access rights to the head of the scientific council and Program

Director. The Program Director is to give anonymous feedback to training units and ensure any

problems highlighted are investigated

12. Advise the scientific council on: the facilities needed for training; and the minimum learning

requirements necessary to complete training

JOB DESCRIPTION OF SPECIALTY COORDINATOR

1- Training management across hospitals and hospital networks

2- Keep records of trainees' progression in trainees’ files


19

3- Collection and follow up of all forms related to the training process. These forms should be

organized and summarized in a suitable spreadsheet reflecting each activities corresponding to

trainees, trainers, supervisors and training post.

4- Organization of the training sequence to meet the needs of the trainee

5- Management of rotations

6- Recruitment of trainers under scientific board supervision

7- Recruitment of trainees in collaboration the Egyptian Board administration and according to the

approved scientific board requirements.

8- Follow up and facilitation of trainers and supervisors activities

9- Liaise with training hospitals’ management teams to successfully manage the training program in

each training center

10- Coordination of annual review meetings

11- Preparation for and participation in visits for accreditation of training hospitals

12- Follow up on regular Audit of training centers performance which is based on:

a. Reports from trainers

b. Reports from educational supervisors

c. Trainee post assessment forms

d. Feedback from program director

e. Reports from the monitoring and evaluation office of the Egyptian Boards.

The specialty coordinator should identify any issues arising from previously mentioned monitoring

approaches or as a direct complain from trainees and liaise appropriately with relevant personal to

resolve it.


21

THEME 1. BASIC SCIENCE &

BASIC CARDIOLOGY

All trainees must be able to competently apply the knowledge of basic science when interpreting

clinical investigations and in the practice of cardiology.

1.1. ANATOMY & HISTOLOGY OBJECTIVE All trainees must be able to describe the anatomy, developmental basis and histology of cardiac and

vascular structures with special emphasis on applied anatomy relevant to clinical methods of

assessment and management in cardiology practice.

KNOWLEDGE (K.1.1) All trainees should be able to describe:

K.1.1.1 Embryology of heart and aortic arch

K.1.1.2 Surface anatomy of the heart, aorta, great vessels and peripheral arteries

K.1.1.3 Anatomy of the heart, great vessels, and peripheral arteries.

K.1.1.4 Anatomy of coronary vessels

K.1.1.5 Histological structure of the heart and blood vessels

INTELLECTUAL & CLINICAL SKILLS (ICS.1.1) All trainees should be able to:

ICS.1.1.1 Identify anatomic landmarks clinically.

ICS.1.1.2 Identify cardiac chambers and vascular structures in non-invasive & invasive

imaging.

1.2. PHYSIOLOGY OBJECTIVE All trainees must be able to discuss physiological basis of cardiac action and that of systemic and

pulmonary circulation. They must apply this knowledge when interpreting clinical symptoms, signs

and investigations in the practice of cardiology.

KNOWLEDGE (K.1.2) All trainees should be able to:

K.1.2.1 Explain hemostasis, coagulation, & fibrinolysis processes.

K.1.2.2 Identify the basis of acid – Base Balance, water and electrolyte regulation

K.1.2.3 Discuss cardiac Performance (Pump Function & Heart Failure).

K.1.2.4 Describe the mechanism of capillary Circulation, body fluids formation & oedema.

K1.2.5 Differentiate between different types of shock

K.1.2.6 Explain the autonomic regulation of cardiovascular system.

K.1.2.7 Explain the physiology of Cardiac Muscles.

K.1.2.8 Discuss cardiac cycle, pressure/volume loop.

K.1.2.9 Discuss arterial & venous circulations, microcirculation & Tissue Blood Flow.

K.1.2.10 Discuss pulmonary, coronary and cerebral Circulation.


21


ICS.1.2.1 Interpret JVP and arterial pulse and differentiate between heart sounds

ICS.1.2.2 Measure blood pressure in different clinical settings

ICS.1.2.3 Interpret results of physiologic tests such as blood gas analysis, blood pictures and

electrolyte analysis.

ICS.1.2.4 Interpret normal intra-cardiac pressure tracings.

ICS.1.2.5 Calculate cardiac output

ICS.1.2.6 Interpret normal ECG.

1.3. BIOCHEMISTRY OBJECTIVE All trainees must be able to discuss various metabolic processes affecting circulation. They must

apply this knowledge when interpreting clinical symptoms, signs and investigations and

management in the practice of cardiology.

KNOWLEDGE (K.1.3) All trainees should be able to describe:

k.1.3.1 Metabolism (carbohydrate, lipids, lipoproteins, cholesterol & minerals)

K.1.3.2 Basis of molecular biology and genetic engineering

K.1.3.3 Diagnostic cardiac enzymes and other related enzymes.

K.1.3.4 Inflammatory biomarkers, acute phase reactants and free radicals.

K1.3.5 Food chemistry and principle of dietetics


ICS.1.3.1 Interpret results of biochemical tests such as cardiac & liver enzymes &

biomarkers analysis

ICS.1.1.2 Prescribe diet for different cardiac conditions based on patient’s requirement and

food chemistry

1.4. PATHOLOGY OBJECTIVE All trainees should be able to discuss the pathological basis of different forms of CV diseases.

KNOWLEDGE (K.1.4) All trainees should be able to discuss the pathogenesis of:

K.1.4.1 Inflammatory heart diseases

K.1.4.2 Rheumatic heart disease

K.1.4.3 Degenerative diseases, diabetes mellitus, glycogen storage disease, malnutrition &

vitamin deficiencies.

K.1.4.4 Atherothrombosis and myocardial infarction.

K.1.4.5 Cardiovascular infection.

K.1.4.6 Myocardial diseases & Cardiomyopathy.

K.1.4.7 Vascular diseases (arteriosclerosis, vasculitis, aneurysms).

INTELLECTUAL & CLINICAL SKILLS (ICS.1.4) ICS.1.4.1 Correlate pathological changes in cardiovascular structures and it with

non invasive & invasive imaging.


22

1.5. PHARMACOLOGY OBJECTIVE All trainees should demonstrate deep understanding of the classification, pharmacokinetics and

pharmacodynamics of drugs used in the field of cardiology.


K.1.5.1 Describe drugs pharmacokinetics.

K.1.5.2 Explain mode of action, indications, contraindications, interactions and adverse

reactions of cardiovascular drugs.

K.1.5.3 Recognize the effects of age, body size, organ dysfunction and concurrent illness

on drug distribution and metabolism.

K.1.5.4 Describe principals of drug trials.


ICS.1.5.1 Take a relevant history of a patient’s medication regimen and its side effects.

ICS.1.5.2 Adjust the dose of the prescribed drug for a given cardiovascular condition.

ICS.1.5.3 Monitoring different drugs used in cardiovascular medicine (e.g. anticoagulants).

ICS.1.5.4 Recognize and manage possible drug interactions (including treatments of

concomitant diseases).

ICS.1.5.5 Select the appropriate drugs used in cardiovascular emergencies & acute

situations.

1.6. RESUSCITATION, BASIC & ADVANCED LIFE SUPPORT OBJECTIVE By the end of the training all trainees should describe the current guidelines on Resuscitation & the

principles of cardiopulmonary resuscitation (CPR) and carry out and supervise resuscitation of

patients suffering from cardiac arrest.


K.1.6.1 Define cardiac arrest

K.1.6.2 Discuss different drugs used in CPR

K.1.6.3 Describe current guidelines of CPR

K.1.6.4 Discuss CPR in specific groups (pediatrics, pregnant females & elderly).

INTELLECTUAL & CLINICAL SKILLS (ICS.1.9) ICS.1.6.1 Perform efficiently and supervise resuscitation of patients suffering from cardiac

arrest in hospital and in field.

ICS.1.6.2 Supervise pre hospital care of critically ill patients.

ICS.1.6.3 Differentiate between cases legible for resuscitation versus illegible

ICS.1.6.4 Decide when to stop resuscitation

ATTITUDE & BEHAVIOR (AB.1.6) All trainees should:

AB.1.6.1 Support relatives in critical situations.

AB.1.6.2 Break bad news in an empathetic manner.

AB.1.6.3 Appreciate legal and ethical considerations of resuscitation.


23

THEME 2. HEART FAILURE

2.1. ACUTE DECOMPENSATED HEART FAILURE (ADHF) OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with acute decompensated heart failure and

management of critically ill patients

KNOWLEDGE (K.2.1) All trainees should be able to

K.2.1.1 Define ADHF

K.2.1.2 Describe epidemiology and precipitating factors of ADHF

K.2.1.3 Outline the causes, pathogenesis, and pathophysiology of ADHF

K.2.1.4 Discuss pharmacological and non-pharmacologic management of ADHF

K.2.1.5 Recognize the complications and prognosis of ADHF

K.2.1.6 Explain risk assessment in secondary prevention including drug therapy.


ICS.2.1. 1 Take a history and perform clinical examination for patients with ADHF with

emphasis on signs of congestion and hypoperfusion.

ICS.2.1.2 Select appropriate investigations.

ICS.2.1.3 Manage patients who are critically ill with hemodynamic disturbances.

ICS.2.1.4 Monitor hemodynamic parameters, interpret the results & take appropriate actions.

ICS.2.1.5 Perform central venous catheterization & CVP measurement.

ICS.2.1.6 Use appropriately inotropic drugs while recognizing their indications and

limitations.


A.B.2.1.1 Appreciate the importance of consulting & cooperating with other specialists.

A.B.2.1.2 Appreciate the importance of patient education, lifestyle modification upon

discharge.

A.B. 2.1.3 Consider the cost effectiveness of the prescribed treatment regimen.

A.B. 2.1.4 Be aware of legal and ethical issues of surrounding care, nutrition and ventilation

of the unconscious patient.

A.B. 2.1.5 Be able to break bad news & communicate sensitively and support.

2.2. CHRONIC HEART FAILURE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with chronic heart failure.

KNOWLEDGE (K.2.2) Define and classify chronic heart failure K.2.2.1

Describe the epidemiology, causes, pathophysiology, prognosis and complications of

chronic HF. K.2.2.2

Explain the natural history and clinical presentation of patients with chronic HF K.2.2.3


24

Outline the diagnostic procedures in the patient with known or suspected chronic HF K.2.2.4

Describe the medical management of chronic HF. K.2.2.5

Describe when and whom to refer for device therapies for chronic heart failure (CRT

and ICDs) K.2.2.6

Outline the indications for referral for surgical interventions K.2.2.7

Discuss strategies for 1ry & 2ry prevention of chronic HF K.2.2.8

Discuss the management of special entities of HF: diastolic HF, high cardiac output

failure, HF in elderly & refractory HF. K.2.2.9


ICS.2.2.1 Take a relevant history and perform an appropriate examination


ICS.2.2.3 Select appropriate drug and device therapy for individual patients with heart failure

ICS.2.2.4 Evaluate chronic HF patients during follow-up, appropriately and continuously adjust

the treatment plan.

ICS.2.2.5 Manage risk factors appropriately


A.B. 2.2.1 Appreciate the importance of lifestyle modification & rehabilitation.

A.B.2.2.2 Develop supportive relationships with patients with chronic heart failure.

A.B.2.2.3 Recognize the importance of multidisciplinary care including home-based

management.

A.B.2.2.4 Offer advice and support to family members

A.B.2.2.5 Consider the cost effectiveness of the prescribed treatment regimen.

THEME 3. CARDIAC RHYTHM DISORDERS

3.1. SYNCOPE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with syncope.

KNOWLEDGE (K.3.1) Define syncope. K.3.1.1

Describe the epidemiology and pathophysiology of different causes of syncope. K.3.1.2

Classify causes of loss of consciousness e.g. neural mediated reflex syncope, Adams -

Stokes attack, orthostatic hypotension. K.3.1.3

Outline strategy of diagnostic evaluation. K.3.1.4

Emphasize the indications, limitations, risks and predictive value of non-invasive and

invasive investigations. K.3.1.5

Identify the prognosis of different causes of syncope. K.3.1.6

Discuss different treatment modalities; device based or pharmacological. K.3.1.7


25


ICS.3.1.1 Take a relevant history and perform an appropriate examination including carotid

sinus massage.

ICS.3.1.2 Differentiate syncope from the other causes of loss of consciousness.

ICS.3.1.3 Select and interpret the investigations that pertain patient with syncope.

ICS.3.1.4 Perform risk stratification to patients with syncope.

ICS.3.1.5 Develop a management plan for patients with syncope.


A.B. 3.1.1 Appreciate the impact of syncope on the patient’s lifestyle.

A.B. 3.1.2 Assure the patient that syncope is a transient symptom and not a disease.

A.B.3.1.3 Appreciate when patients with syncope should be hospitalized.

A.B.3.1.4 Appreciate that observations during the event are of key importance.

A.B.3.1.5 Appreciate that the diagnostic yield of tests depends on the appropriateness of their

selection (per-test probability).

3.2. DYSRHYTHMIAS OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with dysrhythmias.


Describe the genetics, epidemiology, pathogenesis, natural history and prognosis of

dysrhythmias. K. 3.2.1

Classify different types of dysrhythmias K.3.2.2

Describe the forms of presentation of dysrhythmias, their etiology, recognition and

management. K.3.2.3

Describe the normal electrophysiology of the heart and the mechanisms of

dysrhythmias. K.3.2.4

Categorize the pharmacology of drugs currently used in the treatment of

dysrhythmias including thromboprophylaxis. K.3.2.5

Identify the indications for temporary and permanent pacemakers. K.3.2.6

Summarize the indications for electrophysiological studies and the use of

radiofrequency ablation. K.3.2.7

Outline the indications of implantable cardioverter defibrillators (ICD) and cardiac

resynchronization therapy. K.3.2.8

Recognize the limitations and potential risks of antiarrhythmic drug therapy. K.3.2.9


Take a relevant history, including family history, and perform an appropriate

examination. ICS.3.2.1

Select and interpret investigations appropriately. ICS.3.2.2

Classify dysrhythmias by standard electrocardiogram. ICS.3.2.3


26

Perform emergency management for dysrhythmias with drugs or cardioversion. ICS.3.2.4

Prescribe appropriate preventive pharmacological therapy. ICS.3.2.5

Interpret electrophysiological studies (EPS). ICS.3.2.6

Assess patient for pacing. ICS.3.2.7

Insert temporary pacing electrodes. ICS.3.2.8

Manage the follow up of patients with pacemakers including interrogation and

programming of the device. ICS.3.2.9

Interpret Holter’s monitoring studies. ICS.3.2.10

Observe EPS and ablation procedures. ICS.3.2.11

Observe permanent pacemaker implantation. ICS.3.2.12


A.B. 3.2.1 Appreciate the anxiety suffered by patients with dysrhythmias as related to the

disease and some of its methods of management e.g. catheter ablation pacing and

ICD.

A.B.3.2.2 Appreciate the importance of co-existing structural heart disease, in relation to the

outcome & management of dysrhythmias.

A.B.3.2.3 Discuss with the patient the risk of his dysrhythmia and reassure him.

3.3. ATRIAL FIBRILLATION OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with atrial fibrillation.

KNOWLEDGE (K.3.3) Describe the epidemiology, prognosis and pathophysiology of AF. K.3.3.1

Classify atrial fibrillation. K.3.3.2

Describe the diagnosis, clinical features of AF and its impact on quality of life. K.3.3.3

Describe the risk of thromboembolic complications according to CHA2D-VASc

scoring system. K.3.3.4

Discuss AF management K.3.3.5


Take a relevant history and perform an appropriate clinical examination for patients

with suspected AF (as an isolated dysrhythmias or in the context of other heart

diseases).

ICS.3.3.1

Perform ECG, transthoracic echocardiogram, prolonged ECG monitoring and

exercise testing. ICS.3.3.2

Interpret: ECG, transthoracic echocardiogram, transesophageal echocardiogram,

prolonged ECG monitoring and exercise testing. ICS.3.3.3

Stratify the risk of thrombembolism versus bleeding risk using different scoring

systems and manage accordingly. ICS.3.3.4

Select the type of cardioversion appropriate for each patient. ICS.3.3.5

Perform electrical and pharmacological cardioversion ICS.3.3.6

Select patients for EPS and atrial catheter ablation or surgical ablation. ICS.3.3.7


27

ATTITUDE & BEHAVIOR (AB.3.3) All trainees should appreciate:

A.B. 3.3.1 The anxiety of patients suffering from AF and methods of management.

A.B.3.3.2 The importance of coexisting structural heart diseases for the outcome and

management of AF.

A.B. 3.3.3 The limitations and risks of anti-arrhythmic drug therapy.

A.B.3.3.4 The importance of anticoagulant therapy and its adverse effects.

A.B. 3.3.5 Refer patients for specialist treatment when appropriate.

A.B.3.3.6 The importance of patient education as regards thromboembolic and bleeding risks

3.4. SUDDEN CARDIAC DEATH (SCD) OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with sudden cardiac death.

KNOWLEDGE (K.3.4) Define SCD K.3.4.1

Describe the epidemiology, etiology, pathology, pathophysiology and clinical

presentation of the different conditions which may lead to SCD. K.3.4.2

Describe the principles of acute management of patients with SCD. K.3.4.3

Describe the principles of diagnostic work-up and risk stratification of survivors. K.3.4.4


Interpret prodromal symptoms underlying causes and prognosis of SCD survivor. ICS.3.4.1

Perform risk stratification methods: surface ECG, long-term ECG monitoring,

echocardiography. ICS.3.4.2

Interpret risk stratification methods: surface ECG, long-term ECG monitoring,

echocardiography, catheterization, electrophysiological studies. ICS.3.4.3

Follow-up SCD survivors & select appropriate long-term therapeutic options. ICS.3.4.4

Risk-stratify and manage individuals at elevated risk including family members of

SCD patients. ICS.3.4.5


A.B. 3.4.1 Recognize the urgency of the management of cardiac arrest.

A.B.3.4.2 Recognize the importance of prodromal symptoms.

A.B. 3.4.3 Appreciate patient and family anxieties.

A.B.3.4.4 Appreciate the importance of patient education & secondary prevention.


28

THEME 4. ISCHEMIC HEART DISEASE

4.1 CHEST PAIN OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with chest pain.


Categorize the causes of chest pain. K.4.1.1

Describe the indications, limitations, risks and predictive value of noninvasive and

invasive investigations. K.4.1.2


ICS.4.1.1 Take a relevant history and perform an appropriate examination for patients with

chest pain


ICS.4.1.3 Plan for management of patients with acute chest pain

Attitude & Behavior (AB.4.1) All trainees should appreciate:

A.B. 4.1.1 The importance of the history in evaluating chest pain.

A.B.4.1.2 The anxiety and concerns of patients and relatives with chest pain.

A.B.4.1.3 The contribution of non-medical and non-cardiology disciplines in the treatment of

patients with chest pain.

4.2. ACUTE CORONARY SYNDROMES (ACS) OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients presenting with acute coronary syndromes.


Classify ACS K.4.2.1

Discuss the epidemiology, etiology, and pathophysiology of ACS K.4.2.2

Describe the dominant clinical features of ACS K.4.2.3

Describe the diagnostic process in ACS K.4.2.4

Describe the prognosis and management of potential complications of ACS. K.4.2.5

Discuss management strategies for patients with ACS. K.4.2.6


ICS.4.2.1 Take a relevant history, analyze symptoms and clinical differential diagnosis and

perform an appropriate examination

ICS.4.2.2 Interpret biochemical markers of myocardial damage.

ICS.4.2.3 Interpret ECG & imaging techniques to detect & locate ischemia & / or infarction.

ICS.4.2.4 Monitor effectively patients with ACS.

ICS.4.2.5 Risk stratify ACS patients


29

ICS.4.2.6 Select appropriate pharmacological treatment including analgesic, antiplatelet,

antithrombotic and anti-ischaemic therapy.

ICS.4.2.7 Select the appropriate reperfusion therapy.

ICS.4.2.8 Identify patients who need cardiac catheterization in the context of ACS.

ICS.4.2.9 Treat patients with ACS complications.

ICS.4.2.10 Observe PCI procedures including primary PCIs


A.B. 4.2.1 Recognize the importance of organized teamwork required for optimal management

of patients with ACS.

A.B.4.2.2 Recognize the importance of making rapid decisions regarding patients with ACS,

from the time of their arrival in the ER until definitive therapy is established.

A.B.4.2.3 Appreciate the concerns and the anxiety of patients and relatives.

A.B.4.2.4 Advise patients regarding life style and long-term risk factor management.

A.B.4.2.5 Appreciate referral of the patient to another hospital for interventional or surgical

revascularization.

4.3. CHRONIC ISCHEMIC HEART DISEASE (IHD) OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients presenting with chronic ischemic heart

diseases.


Describe the epidemiology of chronic IHD and their risk factors. K.4.3.1

Explain the pathology, pathophysiology of IHD K.4.3.2

Describe events that precipitate a clinical angina attack. K.4.3.3

Outline the prognosis of chronic IHD. K.4.3.4

Discuss different methods of assessment of chronic IHD. K.4.3.5

Discuss the management of chronic IHD including lifestyle measures,

pharmacological management and interventional management. K.4.3.6

Explain the role and relative merits of medical therapy and revascularization

(percutaneous coronary intervention of coronary artery bypass surgery) in the

patient with IHD.

K.4.3.7


ICS.4.3.1 Take a relevant history and perform an appropriate clinical examination

ICS.4.3.2 Risk-stratify patients and select an appropriate management strategy.

ICS.4.3.3 Select and interpret non-invasive, and invasive diagnostic tools for the evaluation of

ischemia, viability, left ventricular structure and function and coronary anatomy.

ICS.4.3.4 Identify and treat risk factors for chronic IHD.


31


A.B. 4.3.1 Recognize the importance of risk factor management and secondary prevention.

A.B.4.3.2 Consult with specialists such as interventional cardiologists, cardiac surgeons,

dieticians and diabetologists to devise an appropriate management plan for individual

patients.

4.4. REHABILITATION and EXERCISE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

provide rehabilitation to patients with cardiovascular diseases.

KNOWLEDGE (K.4.4) All trainees should:

Describe rehabilitation. K.4.4.1

Discuss different components of rehabilitation program. K.4.4.2

Explain the use of rehabilitation for secondary prevention. K.4.4.3


ICS.4.4.1 Identify target population and risk stratify individual patients.

ICS.4.4.2 Plan appropriate program for specific populations in appropriate settings.


A.B.4.4.1 Anticipate and address patient concerns regarding work, exercise and sex.

A.B.4.4.2 Demonstrate involvement as an active member of a multidisciplinary rehabilitation

team.

A.B.4.4.3 Recognize specific population challenges: ageing, gender, socioeconomic status and

culture.

4.5. LIPID DISORDERS OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with lipid abnormalities.

KNOWLEDGE (K.4.5) All trainees should

K.4.5.1 Identify types of dyslipidemias and possible genetic transmission

K.4.5.2 Discuss the management of patients with lipid disorders.

K.4.5.3 Describe the pharmacology of drugs currently used in the treatment of lipid

disorders.

K.4.5.5 Explain the current evidence for pharmacological and non- pharmacologic

intervention in both primary and secondary prevention.


31


Select the proper investigations required for diagnosing patients with lipid disorders. ICS.4.5.1

Evaluate lipid results relevant to individual patients for primary and secondary

prevention of cardiovascular diseases. ICS.4.5.2


Encourage patients to adopt a healthier lifestyle with specific emphasis on risk

factors. A.B. 4.5.1

Appreciate importance of continuous active implementation of lipid control and

continuous monitoring of possible drug treatment side effects and interactions. A.B.4.5.2

Appreciate the importance of screening for lipid disorders in general population A.B.4.5.3

Appreciate the importance of other specialists such as dieticians diabetologists and

nurse specialists. A.B.4.5.4

THEME 5. SYSTEMIC AND PULMONARY

HYPERTENSION

5.1. SYSTEMIC HYPERTENSION OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients presenting with systemic hypertension.

KNOWLEDGE (K.5.1) All trainees should be able to

Explain the epidemiology, pathophysiology and prevention of essential hypertension. K.5.1.1

Describe the complications and consequences of essential hypertension. K.5.1.2

Describe the diagnosis and assessment of essential hypertension K.5.1.3

Discuss management of essential hypertension and related complications. K.5.1.4

Explain secondary hypertension and its various causes & their management. K.5.1.5

Explain the management of patients with resistant hypertension. K.5.1.6


ICS.5.1.1 Take a relevant history and perform an appropriate clinical examination

ICS. 5.1.2 Measure blood pressure using the correct method for diagnosis

ICS. 5.1.3 Monitor treatment of hypertension including ambulatory blood pressure.

ICS. 5.1.4 Assess the global cardiovascular risk of individuals and patients.

ICS. 5.1.5 Plan for life style modification and pharmacological management of hypertension.

ICS. 5.1.6 Identify patients who require further investigations for secondary hypertension.

ICS. 5.1.7 Select proper treatment for hypertension in different patient groups.

ICS. 5.1.8 Manage patients with hypertensive emergencies and urgencies.


32


A.B. 5.1.1 Appreciate the economic burden of hypertension.

A.B. 5.1.2 Recognize that the diagnosis and treatment of hypertension may need a

multidisciplinary approach.

A.B. 5.1.3 Motivate the patient to maintain long term compliance with life style modification

and antihypertensive therapy.

A.B. 5.1.4 Consider the cost while prescribing antihypertensive medications.

AB. 5.1.5 Appreciate of the racial variation in hypertension and the varying response to

pharmacological treatment

AB. 5.1.6 Counsel patients regarding need & method for measuring their own blood pressure.

5.2. PULMONARY HYPERTENSION OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

diagnose & provide optimal management of patients with pulmonary hypertension.GMP


Define pulmonary hypertension and describe its clinical classification. K.5.2.1

Describe the epidemiology of pulmonary hypertension K. 5.2.2

Describe the pathology, genetic basis and pathophysiology of different classes of

pulmonary hypertension. K. 5.2.3

Describe the clinical features of pulmonary hypertension. K. 5.2.4

Discuss non-invasive and invasive work up for the diagnosis and prognosis

assessment of pulmonary hypertension K. 5.2.5

Discuss pharmacological, interventional and surgical modalities in treatment of

pulmonary hypertension. K. 5.2.6


Take a relevant history, perform an appropriate clinical examination & recognise

clinical signs consistent with pulmonary hypertension. ICS. 5.2.1

Diagnose pulmonary hypertension and distinguish between different types. ICS. 5.2.2

Select and Interpret related investigations. ICS. 5.2.3

Prescribe appropriate medical/invasive (surgical or interventional) management. ICS. 5.2.4


A.B. 5.2.1 Appreciate the need for patient counselling and family screening for patients with

pulmonary hypertension.


33

THEME 6. STRUCTURAL HEART DISEASE

6.1. VALVULAR HEART DISEASE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients presenting with valvular heart diseases.

KNOWLEDGE (K.6.1) Explain the epidemiolgy and etiology of valvular heart disease & rheumatic fever. K.6.1.1

Explain the natural history and progression of valvular heart diseases. K. 6.1.2

Explain strengths & limitations of invasive & non-invasive diagnostic techniques. K. 6.1.3

Discuss the main aspects of surgical and percutaneous interventions. K. 6.1.4

Identify the different types of prosthetic valves available for clinical use. K. 6.1.5

Discuss common and uncommon presentations of prosthetic valves malfunction and

its management K. 6.1.6


ICS.6.1.1 Analyze patient clinical picture and manage accordingly after making a relevant

history and performing appropriate clinical examination.

ICS.6.1.2 Compare between the different cardiac investigations for valvular heart diseases and

determine the most the appropriate method for each clinical situation.

ICS.6.1.3 Decide whether to indicate surgery or intervention in appropriate timing.

ICS.6.1.4 Recognize and manage the complications which may occur in patients with

prosthetic valves.

ICS.6.1.5 Select the anticoagulation regimes appropriate for patients with valve disease and

valve prostheses and its follow-up.

ICS.6.1.6 Observe different methods of valvular intervention


A.B.6.1.1 Adopt a management strategy which reflects a multifactorial approach including

clinical evaluation, results of diagnostic procedures and the risk/benefit ratio of

intervention.

A.B. 6.1.2 Cooperate with cardiovascular surgeons, interventional cardiologists & radiologists.

A.B.6.1.3 Recognize the importance of patient education with respect to the natural history of

valvular heart disease, management of anticoagulation,.

6.2. INFECTIVE ENDOCARDITIS OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with endocarditis or who are at risk of

endocarditis.


34

KNOWLEDGE (K.6.2) Describe the epidemiology, the pathology, pathogenesis and microbiology of

endocarditis. K.6.2.1

Discuss its clinical features, laboratory investigations including microbiological

results. K.6.2.2

Summarize the indications and limitations of echocardiography and other

investigations in the diagnosis and management of endocarditis. K.6.2.3

Explain the selection and management of antibiotic therapy. K.6.2.4

Describe the role of surgery in patients with endocarditis. K.6.2.5

Describe the possible complications of endocarditis & their management. K.6.2.6

Outline the current guidelines for endocarditis prophylaxis K.6.2.7


ICS.6.2.1 Assess, diagnose & treat patients with infective endocarditis (native & prosthetic

valves).

ICS.6.2.2 Select and perform the appropriate laboratory investigations and diagnostic

procedures (blood culture transthoracic and transosephageal echocardiography).

ICS.6.2.3 Compile information from different disciplines to establish a diagnosis

ICS.6.2.4 Select an appropriate antibiotic regimen.

ICS.6.2.5 Determine the need for and timing of surgery.

ICS.6.2.6 Prescribe appropriate antibiotic agents for prophylaxis.

ATTITUDE & BEHAVIOR (AB6.2) All trainees should:

6.3. MYOCARDIAL DISEASE (CARDIOMYOPATHY &

MYOCARDITIS OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with cardiomyopathy & myocarditis.

KNOWLEDGE (K.6.3) Cardiomyopathy

K. 6.3.1 Describe the different types of cardiomyopathy.

K. 6.3.2 Describe the epidemiology, pathophysiology including genetics, clinical features &

diagnostic criteria of cardiomyopathies.

K6.3.3 Explain in depth the mechanisms of diseases of the myocardium

K.6.3.4 Explain the role of medical therapy, implantable cardioverter defibrillators, CRT,

catheter based and surgical based treatments of the cardiomyopathies

A.B.6.2.1 Develop a multidisciplinary approach with cardiac surgeons and bacteriologists for

diagnosis and management.

A.B.6.2.2 Recognize the importance of patient and physician education on prophylaxis.

A.B.6.2.3 Make efforts to encourage patients to prevent endocarditis with special emphasis

upon drug abusers.


35

Myocarditis

K. 6.3.5 Describe myocarditis and its etiology.

K. 6.3.6 Describe the clinical features, pathology and diagnostic criteria of infective and non-

infective myocarditis.

K. 6.3.7 Compare different treatment modalities for patients with myocarditis and its

complications.

K. 6.3.8 Identify prognostic indicators for myocarditis.


Take a relevant history and perform an appropriate clinical examination for patients

with suspected myocardial diseases or myocarditis. ICS. 6.3.1

Analyze patient clinical picture common and complicated diseases of the

myocardium ICS. 6.3.2

Select and interpret diagnostic data (ECG, ambulatory ECG. Echocardiography,

exercise testing, chest X-ray, cardiac catheterization coronary angiography,

magnetic resonance & radionuclide imaging, endomyocardial biopsy, genetic

assessment).

ICS. 6.3.3

Perform the cardiovascular procedures needed for the patient with diseases of the

myocardium (ECG, ambulatory ECG. Echocardiography, exercise testing, cardiac

catheterization coronary angiography)

ICS. 6.3.4

Manage cardiovascular presentations in both emergency, outpatient settings and

surgeries (cardiac and non-cardiac) ICS. 6.3.5

Plan and implement an effective prevention campaign for diseases of the

myocardium and pericardium ICS. 6.3.6


A.B. 6.3.1 Establish cooperative atmosphere with medical professionals in other specialties

(immunology, bacteriology, genetics, cardiac surgery, interventional cardiology,

imaging) for timely differential diagnosis of myocardial disease & further treatment.

A.B. 6.3.2 Counsel patient with cardiomyopathies & their relatives about associated risks.

6.4. PERICARDIAL DISEASE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with pericardial disease.

KNOWLEDGE (K.6.4) Describe the epidemiology, etiology and pathophysiology of:

Acute pericarditis (infective, idiopathic or malignant)

Chronic pericarditis.

Constrictive pericarditis.

K. 6.4.1

Describe relevant investigation: non-invasive and invasive. K. 6.4.2

Differentiate constrictive pericarditis from restrictive cardiomyopathy. K. 6.4.3

Describe the management of pericarditis. K. 6.4.4

Explain related complications like pericardial effusion, cardiac tamponade and

constriction. K6.4.5


36


ICS. 6.4.1 Manage patients with pericardial diseases.

ICS. 6.4.2 Select and interpret results of different non-invasive and invasive studies to diagnose

pericardial disease and the abnormalities

ICS. 6.4.3 Perform echocardiographic and invasive assessment for different pericardial disease

and the abnormalities

ICS. 6.4.4 Manage cardiovascular presentations in both emergency and outpatient settings to

reach diagnosis or differential diagnosis in patients with diseases of the pericardium

ICS. 6.4.5 Perform pericardiocentesis when indicated on appropriately selected patients.


A.B. 6.4.1 Co-operate efficiently in a multi-professional team working in diseases of the

pericardium

A.B. 6.4.2 Appreciate the severity of symptoms of patients with pericarditis and pericardial

effusion.

6.5. CONGENITAL HEART DISEASE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of adult patients with congenital heart diseases.


Outline the classification of congenital heart diseases K. 6.5.1

Describe the epidemiology, etiology, pathophysiology, and prevention of congenital

heart diseases. K. 6.5.2

Describe the genetic basis of inherited and non-inherited congenital heart diseases. K. 6.5.3

Describe different clinical presentations of cynotic and acyanotic ongenital heart

disease K. 6.5.4

Describe relevant investigations: non-invasive and invasive. K. 6.5. 5

Outline principles of management of congenital heart diseases K. 6.5.6

Recognize recent advances in the technologies (occluders, stents, balloon

valvuloplasty, etc) in the field of congenital heart disease K. 6.5.7


ICS. 6.5.1 Manage patients with congenital heart disease including patients undergoing

surgeries (cardiac and non cardiac).

ICS. 6.5.2 Interpret different investigations in congenital heart diseases

ICS. 6.5.3 Provide long-term follow up including patient monitoring and lifestyle advice.

ICS. 6.5.4 Observe cardiac catheterization and intervention procedures for congenital heart

disease


37


A.B. 6.5.1 Recognize the importance of referring patients for a specialist opinion.

A.B. 6.5.2 Appreciate the importance of genetic counselling.

A.B. 6.5.3

Appreciate the social and emotional difficulties encountered by adult patients with

congenital heart disease

A.B. 6.5.4 Work as a team member and be a leader when needs arise for better management of

patients with congenital heart disease.

6.6. CARDIAC TUMOURS OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

diagnose & provide optimal management of patients with cardiac tumours.

KNOWLEDGE (K.6.6) Classify and describe the epidemiology of cardiac tumours. K. 6.6.1

Describe the pathology, presentation and natural history of cardiac tumours. K. 6.6.2

Describe the indications, limitations and benefits of investigations used in the

assessment of cardiac tumours. K. 6.6.3

Describe the management of cardiac tumours in outpatient and emergency settings. K. 6.6.4


Take a relevant history and perform appropriate clinical examination of patients

with suspected cardiac tumours. ICS. 6.6.1

Select and interpret the appropriate cardiac investigations in patients with suspected

cardiac tumors ICS. 6.6.2

Differentiate between cardiac tumours and other cardiac masses. ICS. 6.6.3


A.B. 6.6.1 Collaborate effectively with cardiovascular surgeons and with other specialists

dealing with neoplastic disease.

A.B. 6.6.2 Appreciate the importance of support & counselling for the patient and family.

A.B. 6.6.3 Co-operate efficiently in a multi-professional team working


38

THEME 7. ANGIOLOGY AND TRAUMA OF THE

HEART

7.1 DISEASES OF AORTA OBJECTIVES All trainees should be able to assess diseases of the aorta and implement the appropriate medical

treatment regime and referral to surgery.

KNOWLEDGE (K7.1) All trainees should be able to:

K.7.1.1 Describe the pathogenesis, epidemiology, genetics, presentation and natural history

of aortic dissection and aortic aneurysms

K.7.1.2 Discuss the indications, limitations and benefits of non-invasive and invasive

investigations used in the assessment of aortic diseases

K.7.1.3 Describe the medical and surgical therapy of diseases of the aorta

INTELLECTUAL & CLINICAL SKILLS (ICS.7.1) All trainees should demonstrate the ability to:


ICS. 7.1.2 Select appropriately non-invasive imaging

ICS. 7.1.3 Manage patients with acute aortic syndromes

ICS. 7.1.4 Organise appropriate family screening and long term follow up

ATTITUDE & BEHAVIOR (AB.7.1) All trainee should:

A.B. 7.1.1 Appreciate the importance of cooperation with cardiac surgeons

A.B. 7.1.2 Recognise the urgency of management required of patients with acute aortic

syndromes

7.2 TRAUMA TO HEART AND GREAT VESSELS OBJECTIVES All trainees should be able to assess and to implement appropriate medical management for patients

with heart trauma and referral to surgery.

KNOWLEDGE (K7.2) All trainee should be able to:

K.7.2.1 Describe the causes and natural history of trauma to the heart and aorta

K.7.2.2 Discuss the medical and surgical management in patients with heart trauma.



ICS.7.2.2 Select appropriately non-invasive imaging

ICS.7.2.3 Manage patients with cardiac trauma


A.B. 7.2.1 Appreciate the importance of cooperation with cardiac surgeons

A.B. 7.2.2 Recognise the urgency of management required in patients with cardiac trauma


39

7.3 THROMBOEMBOLIC VENOUS DISEASE OBJECTIVES All trainees should be able to diagnose, treat, and prevent deep venous thrombosis and pulmonary

embolism.

KNOWLEDGE (K7.3) All trainees should be able to:

K.7.3.1 Describe the epidemiology & risk factors for deep venous thrombosis and

pulmonary embolism.

K.7.3.2 Describe the clinical presentation of deep venous thrombosis and pulmonary

embolism.

K.7.3.3 Outline the diagnosis of thromboembolic venous disease using different non-

invasive and invasive modalities.

K.7.3.4 Discuss different treatment modalities.

K.7.3.5 Discuss preventive measures.


ICS.7.3.1 Take a relevant history and perform an appropriate physical examination.

ICS.7.3.2 Interpret non-invasive and invasive diagnostic tools appropriately

ICS.7.3.3 Manage deep venous thrombosis


A.B. 7.3.1 Appreciate the difficulties in diagnosis based upon symptoms and signs.

A.B. 7.3.2 Collaborate with other imaging specialists

A.B. 7.3.3 Ensure patient understanding of the diseases and the importance of compliance.

7.4 PERIPHERAL ARTERIAL VASCULAR DISEASES OBJECTIVES All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with peripheral arterial vascular diseases.

KNOWLEDGE (K7.4) All trainee should be able to:

K.7.4.1 Describe the epidemiology, pathology and methods of diagnosis of peripheral

vascular diseases.

K. 7.4.2 Describe medical and invasive (interventional and surgical) management and their

relative merits in different situations.

K. 7.4.3 Explain the prognosis.

K. 7.4.4 Explain the association of peripheral vascular disease with vascular disease in other

areas, in particular carotid and renal arteries.

K. 7.4.5 Recognize the causes of acute limb ischemia and the urgency of their management.


ICS. 7.4.1 Take a relevant history and perform an appropriate physical examination, especially

the examination of peripheral pulses.


41

ICS. 7.4.2 Identify the risk factors and select appropriately the management strategy.

ICS. 7.4.3 Select and interpret diagnostic tools appropriately.

ICS. 7.4.4 Measure ankle-brachial index


A.B. 7.4.1 Appreciate the systemic nature of atherosclerosis and its implication keeping in

mind that peripheral vascular disease is a manifestation of generalized

atherosclerosis.

A.B. 7.4.2 Recognize the importance of risk factor modification in prevention of PVD

THEME 8. THE HEART IN SPECIAL GROUPS

8.1 DIABETIC HEART DISEASE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with Diabetes and Heart Disease.

KNOWLEDGE (K.8.1) Explain the pathophysiology of diabetes mellitus, its non-cardiac & cardiac

complications. K.8.1.1

Discuss the role of diabetes in coronary heart disease in the following areas:

• Epidemiology.

• Pathophysiology of cardiovascular complications.

• Role of risk factor intervention.

• Screening for CAD in diabetes.

• Screening for diabetes in CAD.

K.8.1.2

Outline treatment of diabetes mellitus including diet, exercise, hypoglycemic drugs

and insulin in cardiac patients. K.8.1.3

Discuss primary and secondary prevention of cardiovascular complications in

diabetic patients. .K 4.1.8

Discuss the management of cardiac patients with diabetic nephropathy and renal

failure. K.8.1.5


Diagnose and treat cardiovascular complications in the diabetic patient. ICS.8.1.1

Prevent cardiovascular complications associated with diabetes. ICS.8.1.2

Select appropriate pharmacologic and nonpharmacologic treatment for diabetic

patients with cardiovascular disease ICS.8.1.3


41


A.B. 8.1.1 Be aware of the importance of recognizing that the continuum extends from primary

prevention of diabetes to treatment of end organ damage.

A.B. 8.1.2 Actively participate in a multidisciplinary team in order to treat patients with

diabetes adequately according to disease state and complications.

8.2. PREGNANCY and HEART DISEASE OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment, counselling and treatment of women with heart disease who are

pregnant or who are planning to become pregnant, and to women who develop heart disease during

pregnancy.

KNOWLEDGE (K.8.2) Explain how pregnancy, delivery and the post partum period may affect cardiac

function in normal women and in those with pre-existing or incident cardiac disease. K8.2.1

Justify cardiac contraindication to pregnancy and indications for early termination. K.8.2.2

Explain indications for genetic counselling for inheritable diseases. K.8.2.3

Outline cardiac follow up of pregnant women with special emphasis on patients with

valvular heart diseases. K.8.2.4


ICS.8.2.1 Perform evaluation, risk assessment & treatment of cardiac patients planning for

pregnancy.

ICS.8.2.2 Perform cardiac follow up of the pregnant patients with heart disease.

ICS.8.2.3 Give advice on contraception to cardiac patients and when necessary seek specialist

advice.

ICS.8.2.4 Select safe drug therapies that can be used during pregnancy especially

anticoagulation therapy.

ICS.8.2.5 Evaluate the fetal and maternal risk of different cardiac interventions.

ICS.8.2.6 Manage cardiac condition after pregnancy & assess the cardiac risk of subsequent

pregnancies.

ATTITUDE & BEHAVIOR (AB.8.2) All trainees should be able to:

A.B. 8.2.1 Appreciate their role as cardiologists in the management of women preconception,

during pregnancy and post partum.

A.B. 8.2.2 Recognize the importance of education for women with heart disease on the

potential risks of pregnancy.

A.B. 8.2.3 Cooperate with obstetricians and anesthetists to plan delivery (date, methods, drug

therapy, medical environment).


42

8.3. ASSESSMENT OF PATIENTS WITH CARDIOVASCULAR

Disease Prior To Non-Cardiac Surgery OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment of patients with cardiovascular disease prior to non-cardiac surgery.

KNOWLEDGE (K.8.3) K.8.3.1 Outline the methods of risk assessment prior to non cardiac surgery for patients with

cardiac disease

K.8.3.2 Explain how to optimise a patient’s condition in order to minimize the risk of non

cardiac surgery.


ICS.8.3.1 Assess patients with cardiovascular disease prior to non-cardiac surgery, the

assessment include the risk of anaesthesia and surgery for individual patients.


A.B. 8.3.1 Discuss with colleagues, patients and patients’ relatives the suitability for non

cardiac surgery and the risks involved.

AB.8.3.2 Collaborate in planning for management of cardiac patients preoperative,

intraoperative and postoperative.

8.4 MISCELLANEOUS OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

carry out specialist assessment and treatment of patients with renal, collagen, neurological and

hematological diseases as well as special groups as women, athletes and elderly


Recognize medical diseases (renal, collagen, neurological and hematological

diseases) affecting cardiovascular system and vice versa. K.8.4.1

Discuss the Impact of age and gender upon cardiovascular disease management in

outpatient and emergency settings .K 4.4.2

Describe the athlete heart and discuss the difference between physiological and

pathological changes .K 4.4.3


Analyze the clinical data of cardiac patients with systemic disorders. ICS.8.4.1

Select proper cardiac investigations for each clinical situation. ICS.8.4.2

Tailor cardiovascular disease management according to different comorbidities ICS.8.4.3


A.B. 8.4.1 Co-operate efficiently in a multi-professional team working

A.B. 8.4.2 Provide a proper counseling to patient according to his/her condition.


43

THEME 9. CARDIAC INVESTIGATIONS

9.1. EXERCISE ECG Testing OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to

perform and/or select appropriately and interpret correctly the exercise ECG for the diagnosis and

assessment of patients with cardiovascular disease.


K.9.1.1 Describe the physiology of exercise & different exercise test protocols

K.9.1.2 Discuss the indications & contraindications for exercise ECG testing


ICS.9.1.1 Perform and analyze exercise ECG

ICS.9.1.2 Select the appropriate step of management build upon test results

ICS.9.1.3 Identify signs of emergency to stop exercise & manage possible complications


A.B. 9.1.1 Appreciate the limitations of exercise ECG.

A.B. 9.1.2 Take appropriate precautions to ensure patient safety

A.B. 9.1.3 Provide support and encourage patient to continue exercising

9.2. ECHOCARDIOGRAPHY OBJECTIVE All trainees should be able to explain the role of echocardiography in the management of patients

with cardiac disease & satisfactorily perform, interpret and report echocardiography.


K.9.2.1 Describe the physical principles behind ultrasound image formation & Doppler

imaging.

K.9.2.2 Explain indications for echocardiography in emergency, in-patient and outpatient

settings.

K.9.2.3 Discuss the echocardiographic assessment of the anatomical and physiological

function of the heart

K.9.2.4 Describe echocardiographic pattern in different cardiovascular disorders

K.9.2.5 Describe the indications for advanced echocardiography, e.g. transoesophageal,

stress echocardiography, tissue Doppler and contrast echocardiography.


44


ICS.9.2.1 Select the appropriate echo probes and software.

ICS.9.2.2 Store data on software and how to recall it when needed

ICS.9.2.3 Perform transthoracic echocardiography for the diagnosis and assessment of patients

with cardiac disease.

ICS.9.2.4 Write a comprehensive echocardiogram report.

ICS.9.2.5 Interpret results of transoesophageal and basic tissue Doppler imaging.


A.B. 9.2.1 Interacts appropriately with patients and ensure patient safety.

A.B. 9.2.2 Be compassionate with patients and respect their dignity

A.B. 9.2.3 Appreciate the limitations of echocardiography

9.3. NUCLEAR CARDIOLOGY OBJECTIVE All trainees should explain the role of nuclear cardiology investigation in the management of

patients with cardiac diseases and able to interpret its results.

KNOWLEDGE (K. 9.3) All trainees should be able to:

K.9.3.1 Outline the different radionuclides and radiopharmaceuticals used in nuclear

cardiology.

K.9.3.2 Describe the different types of stress testing.

K.9.3.3 Explain the importance of radiation protection and radiation biological hazards

K.9.3.4 Explain the indications and the prognostic value of various investigations in the field

of nuclear cardiology.

K.9.3.5 Explain different methods to assess myocardial viability


ICS.9.3.1 Interpret the results of nuclear cardiology investigations and correlate them with

other imaging techniques.

ICS.9.3.2 Manage patients appropriately depending upon the results


A.B.9.3.1 Appreciate the value and limitations of nuclear cardiology.

A.B. 9.3.2 Appreciate the hazards of handling radioactive isotopes for patient & clinical staff.

A.B. 9.3.3 Encourage the staff members to have the optimal protection from radiation hazards

A.B. 9.3.4 Counsel patients regarding radiation hazards.

9.4 CARDIAC CATHETERIZATION OBJECTIVE All trainees should demonstrate adequate knowledge and deep understanding that enable them to use

cardiac catheterisation for diagnosis and management of cardiovascular disorders.


45


Outline the cardiac anatomy, physiology and haemodynamics relevant to right and

left cardiac catheterization. K.9.4.1

Describe the indications, findings and limitations of cardiac catheterization in

different cardiovascular diseases K.9.4.2

Describe potential complications of each procedure & outline methods of its

management. K.9.4.3


ICS.9.4.1 Interpret intracardiac pressure tracing & evaluate cardiac functions & valvular

diseases using these techniques.

ICS.9.4.2 Recognize normal & abnormal coronary arteries & evaluate the severity of coronary

artery diseases, then plan management accordingly.

ICS.9.4.3 Perform complete diagnostic coronary angiography

ICS.9.4.4 Interpret intracardiac oxygen saturation.

IC.9.4.5 Calculate cardiac output, systemic & pulmonary vascular resistance & intracardiac

shunts


A.B. 9.4.1 Appreciate the value and limitations of cardiac catheterization.

A.B. 9.4.2 Appreciate the importance of radiation protection.

9.5 ADVANCED IMAGING MODALITIES OBJECTIVE All trainees should be able to make use of CT, MRI appropriately and safely for the diagnosis of

patients with cardiovascular diseases.


K.9.5.1 Outline the basics of CT and MRI

K.9.5.2 Discuss indications and limitations of both CT and MRI


ICS. 9.5.1 Select the appropriate modality of CT or MRI for diagnosis of different CV

disorders

ICS.9.5.2 Interpret data derived from different tomographic views

Attitude & Behavior (AB.9.5) All trainees should:

A.B.9.5.1 Appreciate the high cost of these modalities and use them only when needed

A.B. 9.5.2 Recognize the risk of the use of ionizing radiation to patients and staff.

A.B. 9.5.3 Explain to patients and provide psychic support before performing these procedures


46

THEME 10. COMMON COMPETENCIES

10.1. HISTORY TAKING OBJECTIVE All trainees should be able to obtain a relevant history from patients, accurately record and analyze

the history with clinical examination to formulate a clear diagnostic plan.

KNOWLEDGE (K.10.1) All trainees should be able to recognize:

K.10.1.1 The importance of different elements of history:

Cardiac muscle symptoms (e.g. chest pain, palpitations)

Left sided heart symptoms (e.g. forward symptoms: low cardiac output;

backward symptoms: breathlessness (acute and chronic))

Right sided heart symptoms (e.g. forward symptoms: low cardiac output;

backward symptoms (systemic congestion))

K.10.1.2 Causes of and risk factors for conditions relevant to the presentation.

K.10.1.3 The way that the history should be informative to the examination, investigations

and management

K.10.1.4 The different possibilities (differential diagnosis) of the different clinical symptoms.

Intellectual & Clinical Skills (ICS.10.1) All trainees should be able to:

ICS.10.1.1 Find clues in the cardiac history to allow for provisional diagnosis and planned

management

ICS.10.1.2 Manage alternative and conflicting views from family, caregivers and friends

Attitude & Behavior (AB.10.1) All trainees should:

A.B. 10.1.1 Demonstrate respect, compassion and empathy for patients and caregivers

A.B. 10.1.2 Recognize and overcome barriers to effective communication

A.B. 10.1.3 Recognize and interpret the use of non verbal communication from patients and

caregivers

10.2. CLINICAL EXAMINATION & ASSESSMENT OBJECTIVE All trainees should be able to perform focused and accurate clinical examination and be able to

relate physical findings to history in order to establish diagnosis and formulate a management

plan.


K.10.2.1 The basis and relevance of physical signs

K.10.2.2 The limitations of physical examination & the need for adjunctive forms of

assessment


47


ICS.10.2.1 Carry out general examination with special emphasis on pulse, JVP, and L.L

edema.

ICS.10.2.2 Carry out a thorough cardiovascular examination and elicit physical signs that are

relevant to the presentation that is valid, targeted and time efficient

ICS.10.2.3 Elicit important clinical findings

ICS.10.2.4 Perform relevant adjunctive examinations

ATTITUDE & BEHAVIOR (AB.10.2) All trainees must:

A.B.10.2.1 Respect patients’ dignity and confidentiality

A.B.10.2.2 Acknowledge cultural issues

A.B.10.2.3 Appropriately involve relatives

A.B.10.2.4 Appreciate situations where there is the need for a chaperone.

10.3. INVESTIGATIONS OBJECTIVE All trainees must be able to describe the principles, application and side effects of commonly used

investigations. They must be able to choose the proper investigations and interpret the findings.

KNOWLEDGE (K.10.3) All trainees must be able to:

K.10.3.1 Explain the range of investigations available, and the circumstances in which they

are used.

K.10.3.2 Recognize the limitations of the investigation and the implications of a positive or

negative test result.

K.10.3.3 Recognize the possible discomfort and distress and risks to which the patient may

be exposed during the test


ICS.10.3.1 Prioritize, select and use appropriate investigations

ICS.10.3.2 Interpret the findings

ICS.10.3.3 Recognize when further action is required.

ATTITUDE & BEHAVIOR (AB.10.3) All trainees must:

AB.10.3.1 Recognize the cost and localize the resources involved.

AB.10.3.2 Provide explanations to patients as regarding the rationale for investigations,

limitations and possible unwanted effects.

10.4. DECISION MAKING & CLINICAL REASONING OBJECTIVE By the end of the training all trainees should be able to formulate a diagnostic and therapeutic plan

for a patient according to the clinical information available, priorities the diagnostic and therapeutic

plan and communicate the diagnostic and therapeutic plan appropriately


48

KNOWLEDGE (K.10.4) Demonstrate knowledge of:

K.10.4.1 Generation of hypotheses and differential diagnosis within the clinical context

K.10.4.2 The need to test, refine and verify hypotheses

K.10.4.3 Problem lists and action plans

INTELLECTUAL & CLINICAL SKILLS (ICS.10.4) Demonstrate the ability to:

ICS.10.4.1 Recognize critical illness and respond with appropriate urgency

ICS.10.4.2 Recognize the most urgent / important tasks and ensure that they managed rapidly

ICS.10.4.3 Interpret clinical features, their reliability and correlation to clinical scenarios

including recognition of the variability of presentation.

ICS.10.4.4 Formulate an evaluation plan for appropriate medical, laboratory, and radiological

examinations

ICS.10.4.5 Prioritize the investigations needed to reach final diagnosis

ICS.10.4.6 Construct an appropriate management plan and communicate this effectively to the

patient, parents and carers where relevant

ICS.10.4.8 Weigh risks and benefits of therapeutic intervention to an individual patient

ATTITUDE & BEHAVIOR (AB.10.4) All trainees should demonstrate the readiness to:

AB.10.4.1 Discuss with a patient the benefit/risk balance of therapeutic intervention and

facilitate patient choice

AB.10.4.2 Search for evidence to support clinical decision making

AB.10.4.3 Ask for senior advice on formulating plan

AB.10.4.4 Use expert advice, clinical guidelines and algorithms

AB.10.4.5 Communicates the impact of lifestyle and risk factors on the likelihood of future

events

10.5. COMMUNICATION OBJECTIVE All trainees must be able to communicate effectively and sensitively with patients, carers and

colleagues and be able to establish a doctor/patient/relatives relationship characterized by good

communication, understanding, trust, respect, empathy and confidentiality.

KNOWLEDGE (K.2.16) All trainees should demonstrate knowledge of:

K.10.5.1 How to structure an interview appropriately

K.10.5.2 The importance of the patient's background (including ethnicity and wealth),

culture (including spirituality and religion), education and preconceptions (ideas,

concerns, expectations) to the process


ICS.10.5.1 Establish a rapport with the patient and any relevant others (eg carers)

ICS.10.5.2 Deliver information compassionately, being alert to and managing their and your

emotional response (anxiety, antipathy etc)


49

ICS.10.5.3 Check the patient's/carer's understanding, ensuring that all their concerns/questions

have been covered

ICS.10.5.4 Communicate accurately, clearly, promptly and comprehensively with relevant

colleagues by means appropriate to the urgency of a situation (telephone, email,

letter etc), especially where responsibility for a patient's care is transferred

ICS.10.5.5 Ensure appropriate referrals (eg surgical) are optimally managed

ICS.10.5.6 Communicate effectively with administrative bodies

ATTITUDE & BEHAVIOR (AB.10.5) All trainees should demonstrate the ability to:

AB.10.5.1 Approach the situation with courtesy, empathy, compassion and professionalism

AB.10.5.2 Ensuring that the approach is inclusive and patient centered and respect the

diversity of values in patients, carers and colleagues.

10.6. TEAM WORKING, Teaching and Training of Others OBJECTIVE All trainees should recognize the importance of co-operation and team working with other healthcare

professionals involved in patient care and demonstrates willingness, enthusiasm and ability to

contribute to the teaching and training of junior trainees and other healthcare colleagues.


K.10.6.1 The roles and responsibilities of members of the healthcare team

K.10.6.2 The value of the multi-disciplinary team meeting

K.10.6.3 The role of the physician as an educator

INTELLECTUAL & CLINICAL SKILLS (ICS.10.6) All trainees should be able to

ICS.10.6.1 Work cooperatively as part of a clinical team and accept, where appropriate, the

role of the leader of the team.

ICS.10.6.2 Share information with colleagues

ICS.10.6.3 Prepare patient lists with clarification of problems and ongoing care plan

ICS.10.6.4 Keep records up-to-date and legible and relevant to the safe progress of the patient.

ICS.10.6.5 Demonstrate important cardiological signs to others

ICS.10.6.6 Develop basic PowerPoint presentation to support educational activity

ICS.10.6.7 Share in departmental teaching programs including journal clubs

ICS.10.6.8 Provide effective feedback after teaching

ATTITUDE & BEHAVIOR (AB.10.6) AB.10.6.1 Respect the views of others in achieving the common purpose of the team

AB.10.6.2 Arrange cover (Manage the deteriorating performance of colleagues e.g. due to

stress, fatigue)

AB.10.6.3 Act to maintain the dignity and safety of patients in discharging educational duties

at all times


51

10.7. PATIENT SAFETY in CLINICAL PRACTICE OBJECTIVE All trainees must ensure patient safety in the organization and during delivery of care.

KNOWLEDGE (K.10.7) All trainees should be able to define:

K.10.7.1 The features of a safe working environment

K.10.7.2 The hazards of medical equipment in common use

K.10.7.3 The dangers of sharps and blood contamination

K.10.7.4 The side effects and contraindications of medications prescribed

K.10.7.5 The local safe sedation protocols

INTELLECTUAL & CLINICAL SKILLS (ICS.10.7) Demonstrate the ability to:

ICS.10.7.1 Recognize when a patient is not responding to treatment, reassess the situation

ICS.10.7.2 Recognize when different strategies are required in those not responding to a

particular therapy

ICS.10.7.3 Recognize and respond to the manifestations of a patient’s deterioration Ensure the

Correct and Safe use of medical equipment

Attitude & Behavior (AB.10.7) Demonstrate:

AB.10.7.1 A high level of safety awareness at all times

AB.10.7.2 Encouragement of feedback from all members of the team on safety issues

10.8 INFECTION PREVENTION & CONTROL OBJECTIVE All trainees should be able to prevent and control transmission of infection to patients in different

healthcare settings. Also they should protect themselves from exposure to biological hazards and

adhere to the management plan on exposure.


K.10.8.1 Outline the principles of infection control as defined by the national guidelines of

MOH

K.10.8.2 Describe the principles of preventing infection in high risk groups

K.10.8.3 Describe principles of aseptic techniques

K.10.8.4 Recognize types of immunization that should be received by healthcare workers

K.10.8.5 Outline work restriction policy for healthcare workers

K.10.8.6 Recognize management plan for healthcare workers exposed to biological

workplace hazards

INTELLECTUAL & CLINICAL SKILLS (ICS.10.8) All trainees should:

ICS.10.8.1 Actively engage in local infection control monitoring and reporting processes

ICS.10.8.2 Prescribe antibiotics according to local antibiotic guidelines

ICS.10.8.3 Detect potentials for cross-infection in clinical settings

ICS.10.8.4 Practice aseptic technique whenever relevant and maintains high standard of

infection control during interventional procedures

ICS.10.8.5 Strictly adhere to standard precautions and transmission based precautions


51

ICS.10.8.6 Triage and refer patients with infectious disease that require isolation to the suitable

facilities with available isolation rooms

ICS.10.8.7 Efficient use of personnel protective equipment to protect themselves and their

patients from biological hazards

ICS.10.8.8 Assess the risk of transmission of bloodborne pathogens

ATTITUDE & BEHAVIOR (AB.10.8) All trainees should be able to:

AB.10.8.1 Recognize that standard precautions are sufficient to protect against BBPs and

avoid over exaggeration when caring for patients with BBPs

AB.10.8.2 Encourage of all staff, patients and relatives to observe infection control principles

AB.10.8.3 Take appropriate steps to protect patients when their own health is affected by

illness or disability.

AB.10.8.4 Protect themselves, their colleagues and their patients by being immunized against

vaccine preventable diseases (HBV, influenza,…etc)

AB.10.8.5 Notify occupational health service with exposures and needle stick injuries and

adhere to the post exposure management plan.

10.9. MEDICAL ETHICS All trainees should know, understand and apply appropriately the principles, guidance and laws

regarding medical ethics and confidentiality and be able to obtain valid consent from the patient and

respond to the patient's level of understanding and mental state.

KNOWLEDGE (K.10.9) All trainees should be able to recognize

K.10.9.1 The principles of medical ethics

K.10.9.2 The factors influencing ethical decision making: religion, moral beliefs, cultural

practices.

K.10.9.3 Components of valid consent

K.10.9.4 Persons from whom consent should be taken

K.10.9.5 Situations where patient consent, while desirable, may not required for disclosure

e.g. communicable diseases

INTELLECTUAL AND CLINICAL SKILLS (ICS.10.9) All trainees should be able to:

ICS.10.9.1

Explain to the patient and family his or her disease, natural history, prognosis,

management plans, all care options and possible complications.

ICS.10.9.2 Obtain a valid consent

ICS.10.9.3 Practice and promote accurate documentation within clinical practice

ATTITUDE AND BEHAVIOR (AB.10.9) All trainees should:

AB.10.9.1 Respond to the patient's level of understanding and mental state and how this may

impair their capacity for informed consent.

AB.10.9.2 Demonstrate balanced attitude to deliver the information in the consent without ease or

frightening to the patient and his/her family.

AB.10.9.3 Respect patient’s requests for information not to be shared, unless this puts the patient,

or others, at risk of harm

AB.10.9.4 Demonstrate honesty and openness in any financial arrangements with patients

AB.10.9.5 Conforms to codes of practice.


52

10.10.AUDIT OBJECTIVE All trainees should progressively develop the ability to perform an audit of clinical practice and to

apply the findings appropriately

KNOWLEDGE (K.10.10) All trainees should recognize:

K.10.10.1 The uses of audit (developing patient care, risk management etc)

K.10.10.2 The steps involved in completing the audit cycle

K.10.10.3 The uses of local systems for reporting and learning from clinical incidents and

near misses


ICS.10.10.1 Use the findings of an audit to develop and implement change


AB.10.10.1 Recognize the need for audit in clinical practice for quality improvement

AB.10.10.2 Attend departmental audit meetings

AB.10.10.3 Support audit by junior medical trainees and within the multidisciplinary team

10.11. RESEARCH APPRAISAL OBJECTIVE All trainees should be able to recognize research principles and methodology and critically evaluate

scientific papers

KNOWLEDGE (K.10.11) All trainees should recognize:

K.10.11.1 The principles of formulating a clinical question that could be answered by research

results

K.10.11.2 The Principles behind qualitative, quantitative and epidemiological research

methods

INTELLECTUAL & CLINICAL SKILLS (ICS.10.11) All trainees should:

ICS.10.11.1 Demonstrate critical appraisal skills & the ability to interpret important statistical

data

ICS.10.11.2 Present data in a clear, honest and critical fashion

ATTITUDE & BEHAVIOR (AB.10.11) All trainees should be:

AB.2.10.11 Appreciate the importance of research in generating knowledge that could be

applied in medical practice.

10.12. PROFESSIONALISM and PROBITY OBJECTIVE All trainees should be trusted and are known to act fairly in all situations to be able to manage

complex human, legal and ethical problem.


53

KNOWLEDGE (K.10.12) All trainees should demonstrate understanding of:

K.10.12.1 The overall approach of value based practice and how this relates to ethics, code of

practice, law and decision making


ICS.10.12.1 Behave with honesty and probity and act with honesty and sensitivity in a non-

confrontational manner

ICS.10.12.2 Admit to errors early and pro-actively

Attitude & Behavior (AB.10.12) All trainees must demonstrate

AB. 10.12.1 All trainees must demonstrate honesty and openness in any arrangements with

patients by providing valid information.

AB. 10.12.2 Recognize the importance of personal development as a role model to guide

trainees in aspects of good professional behavior


54

MARKS & STANDARDS

THEME

FIRST

PART

SECOND

PART

THIRD

PART TOTAL

1. Heart Failure

10

15 10 8

2. DYSRHTHMIAS 15 10 8

3. Ishemic Heart Disease 20 10 12

4. HTN 10 10 7

5. STRUCTURAl HEART DISEASE 20 15 13

6. ANGIOLOGY 5 10 5

7. SPECIAL GROUPS 5 10 7

8. INVESTIGATIONS 20

10

10 8

9. COMMON COMPETENCES 40 10 12

10. BASIC SCEINCE 30 5 20

Examination Methods

1) First part exam (200 marks): MCQ (100 marks) and SNQ (100 marks) each trainee has to pass

the exam in order to sit for the second part exam.

Formative assessment: Candidates are assessed annually in the annual review meeting and in

addition they are assessed through the described Mini-CEX and through Procedure Based

Assessment (PBA).

In addition, further clinical and procedural skills will be assessed through:

a. The log book (LB), in which 70% of all its items concerning the clinical attendance,

the observation, assistance or performance of procedures should be fulfilled.

b. Trainee assessment forms

c. Supervisor reports

2) Second part exam.

Candidate is only allowed to sit for the second part exam after successful completion of training,

acceptance of the logbook and achieving (ARP 5).

This is a written exam.

This exam is divided into 3 papers on 2 separate days:

1st day (2 sessions)

a. Paper 1 100 MCQs for 100 marks

b. Paper 2 100 MCQs for 100 marks

2nd

day (1 session)

c. Paper 3 short essay questions for 100 marks

The Exam Blue print is available in electronic form and could be accessed from the

fellowship website.


55

The candidate is allowed to enter this exam after the end of his training program 3 years and is

allowed for re-sit exam 3 times maximum and maximum within 3 years.

Candidate has to pass the written exam to be legible to sit for the third part. The pass mark will be

determined by Angoff method.

FORMAT OF THE EXAMINATION There are two written exam forms; short essay notes and multiple choice papers. Each MCQ paper

comprises 100 questions with a single best answer. Each question consists of an initial stem followed

by 5 possible answers, identified A, B, C, D and E. Candidates should select one item they believe to

be correct. The duration of each paper is 2 hours. There is no negative marking.

THIRD PART EXAM

Candidate performance will be assessed by means of Objective Structured Practical Examinations

(OSPEs) arranged in (25) stations the pass mark is calculated according Angoff method. The OSPE

stations are of 100 marks and stations will compensate each other.

In addition, they will be assessed by clinical exams (one long case, 4 short cases) and viva exam

which all compensate for each other and pass mark in stations will be calculated according to the

borderline regression method

a) 2 Viva stations (100 marks)

b) 4 short cases (200 marks)

c) 1 Long case (100 marks).

Candidate who fail to pass the third part exam are allowed to re-sit for 3rd

part only 3 times

maximum.

TIMING AND VENUE

The written examination is held twice a year at the Egyptian fellowship building, Cairo, Egypt. The

clinical exams is held once per year and the timing is announced by the fellowship administration.

SUGGESTED READING The following is a list of textbooks that are suitable reading material for the examination. Some of

the books require detailed reading, whereas in others only certain sections are directly relevant to the

examination. Reference should be made to the examination syllabus in this regard. Titles that are in

bold are of particular importance although questions in the examination will arise from all sections

of the syllabus.

Braunwald ‘s Heart Disease: A Textbook of Cardiovascular Medicine, 9th edition

Hurst's the Heart, 13th Edition

Topol Textbook of Cardiovascular Medicine 3rd edition

Agreed upon items between American and European Guidelines in the last three years and

National Guidelines.

http://www.amazon.com/Hursts-Heart-13th-Two-Set/dp/0071636463/ref=sr_1_1?s=books&ie=UTF8&qid=1344084431&sr=1-1&keywords=hurst%27s+the+heart

http://www.google.com.eg/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CGUQFjAA&url=http%3A%2F%2F1aim.net%2Ffourm%2Fshowthread.php%3F4909-%25DF%25CA%25C7%25C8-Topol-Textbook-of-Cardiovascular-Medicine&ei=QxwdUPCGOsjmtQbkh4HICg&usg=AFQjCNHIomFI_UK8yyM5F8ub_4C5AyWkxA


56

Teaching Plan ST3

20 central teaching days (2 days per month for 10 months) covering theme 1 (basic science/applied

basic science) and theme 10 (common competencies)

ST3 Central teaching days Agenda THEME 1

Anatomy and embryology

o Basic science: 1 day = 6 hours (lectures, tutorials)

o Applied basic science 1 day = 6 hours (interactive problem based learning (PBL),

group discussion, and videos)

Physiology

o Basic science = 10 hours (didactic teaching)

o Clinical applied physiology = 14 hours (interactive problem based learning (PBL),


Biochemistry

o Basic science = 5 hours (didactic teaching)

o Clinical applied biochemistry = 7 hours (interactive problem based learning (PBL),


Pathology

o Basic Pathology = 6 hours (didactic teaching)

o Clinical applied biochemistry = 6 hours (interactive problem based learning (PBL),

group discussion, tracings and videos)

Pharmacology

o Basic pharmacology = 6 hours (didactic teaching)

o Clinical applied pharmacology= 6 hours (interactive problem based learning (PBL),


Basic and advanced life support (1.6) & sudden cardiac death (3.4) :Mandatory course as

prerequisite for entry fellowship of cardiovascular medicine

THEME 10

History taking

o Symptoms and signs of cardiac patients= 6 hours

o Applied clinical skill= 6 hours (real patients (role players), PBL)

Clinical examination & Assessment

o Symptoms and signs of cardiac patients= 6 hours

o Applied clinical skill= 6 hours (real patients (role players), PBL, videos)

Investigations

o Lectures= 6 hours

o Applied clinical skill= 6 hours (PBL, videos, tracings)

Mandatory courses will be given for:

o Patient safety

o Infection prevention and control

o Communication skills and team working


57

o Medical ethics and consent

o Audit & Research


58

Key of Methods of teaching: A=Lectures, B=Case based and problem learning, C=Journal Club,

D=Self and online directed learning, E=Structured training, F=Competency based learning,

G=Audiovisuals, H=Clinical sessions, I=Simulation and role player, J=Structured course

ST3 Agenda (CTDs)

Subject key Teaching

hours

Hemostasis, coagulation & fibrinolysis processes A 1

Evaluation of coagulation and fibrinolysis in different clinical settings B, D, G 1

The basis of acid – Base Balance, water and electrolyte regulation A 1

Interpretation of related physiological tests e.g ABG B, D 1

The mechanism of capillary Circulation, body fluids formation, edema

& tissue blood flow

A 1

Pathophysiology of heart failure (1) B, H 1

Cardiac cycle A 1

Different types of shocks A 1

Cardiac sounds G 1

JVP, arterial pulse G, H 1

ECG (1) B, G 1

ECG (2) B, G 1

Self-directed learning

Clinical applications of:

1- Thrombosis and platelet functions

2- Kidney functions on CV functions

3- Arteriolar, venular and capillary function

4- Pressure volume loop

Subject key Teachin

g hours

Embryology of the heart & aortic arch A 1

Pathological anatomy of congenital heart defects B, D, G 1

Anatomy and histology of cardiac chambers A 1

Cardiac chambers and valves in different imaging modalities B, D, G 1

Anatomy of the aorta & its branches A 1

Invasive and noninvasive imaging of the aorta B, D, G 1

Anatomy of the pulmonary circulation, Surface anatomy of lungs & pleura A 1

Pulmonary circulation imaging in different modalities B, D, G 1

Peripheral vessels A 1

Imaging modalities of peripheral vessels B, D, G 1

Anatomy of the coronary circulation A 1

Imaging modalities of the coronaries B, D, G 1

Self-directed learning: Normal anatomical variations and their appearance in different

imaging modalities (collected in trainee’s portfolio)


59


hours

Measurement of blood pressure in different clinical settings B, H 1

The physiology of Cardiac Muscles A 1

Pathophysiology of heart failure (2) B, H 1

Cardiac Performance & pressure volume loop A 1

Normal intracardiac pressure tracings B, G 1

Calculation of cardiac output B, D 1

Pulmonary and cerebral Circulation A 1

Interpretation of related physiological tests B 1

Coronary Circulation A 1

Pathophysiology of ischemia D, G 1

The autonomic regulation of cardiovascular system A 1

Autonomic cardiovascular tests B, H 1



1. Respiratory functions on CV functions

2. Mycocyte functions

3. Cardiac reserve

4. Coronary circulation


hours

Metabolism: carbohydrate, lipids and minerals A 1

Metabolism: Lipoproteins & cholesterol A 1

Prescribe diets & counseling for dyslipedemia (1) B, D 1

Prescribe diets & counseling for dyslipedemia (2) B, D 1

Prescribe diets & counseling for hypertension and heart failure (1) B, D 1

Prescribe diets & counseling for hypertension and heart failure (2) B, D 1

Diagnostic cardiac enzymes and other related enzymes A 1

Interpretation of related biochemical tests B, D 1

Inflammatory biomarkers and acute phase reactants Free radicals and

cardiovascular diseases

A 1

Interpretation of related biochemical tests B, D 1

Basis of molecular biology & genetic engineering A 1

Gene therapy D, G 1



1. Molecular biology and genetic engineering

2. Related Enzymes and inflammatory markers

3. Diet prescription for dyslipedemia

4. Diet prescription for hypertension and heart failure


61


hours

Inflammatory and rheumatic heart diseases A 1

Interpretation of pathological changes in different imaging modalities B, G 1

Degenerative diseases A 1


Atherothrombosis and myocardial infarction A 1


Infections (bacterial and nonbacterial) A 1


Myocardial diseases and cardiomyopathy A 1


Vascular diseases A 1


Assignment Collection of images of different pathological lesions and their correlated images in

different imaging modalities (added in trainee’s portfolio)


hours

Pharmacokinetics, pharmacodynamics, mode of action, side effects, drug interaction, phases

of drug trial and clinical application, of:

Antihypertensive drugs (1) A 1

Antihypertensive drugs (2) B, C, D 1

Anti-ischemic drugs (1) A 1

Antihypertensive drugs (2) B, C, D 1

Anti-failure drugs (1) A 1

Anti-failure drugs (2) B, C, D 1

Anticoagulants and antiplatelets (1) A 1

Anticoagulants and antiplatelets (2) B, C, D 1

Antiarrhythmic drugs (1) A 1

Antiarrhythmic drugs (2) B, C, D 1

Drug therapy for dislipedemia (1) A 1

Drug therapy for dislipedemia (2) B, C, D 1


1. Clinical applications of phases of drug trials

2. Drug/drug interactions & drug/diet interactions

3. Impact of pharmacodynamics on timing of drug intake

4. Drug monitoring in different situations


61


hours

Pulmonary congestive symptoms A 1

Systemic venous congestive symptoms A 1

Low cardiac output symptoms A 1

Palpitations A 1

Clinical applications and case studies (1&2) B, D, E, H, I 2

Chest pain A 1

Clinical application and case studies B, D, E, H, I 1

Embolic & constitutional symptoms A 1

Syncope A 1

Clinical application and case studies B, D, E, H, I 1

Integrated case studies B, D, E, H, I 1


Differential diagnosis of:

1. Pulmonary and systemic venous congestive symptoms

2. Low cardiac output symptoms & palpitations

3. Chest pain

4. Embolic & constitutional symptoms and Syncope

Subject key Teachin

g hours

General examination A 1

JVP, Pulse, B.P A 1

Clinical applications (1&2) B, D, E, G, H 2

Inspection and palpation of the pericordium A 1

Clinical applications B, D, E, G, H 1

Heart sounds and additional sounds A 1

Clinical applications B, D, E, G, H 1

Murmurs (systolic, diastolic, continuous & dynamic auscultation) (1 &2) A 2

Clinical applications (1&2) B, D, E, G, H 2


1. Impact of general examination and vital signs on diagnosis

2. Impact of local signs of inspection and palpations on diagnosis

3. D.D of murmurs (1)

4. D.D of murmurs (2)


62


hours

Right and left sided catheterization A 1

Clinical applications B, E, F, G 1

Basis of Coronary angiography A 1


Basis of different interventional modalities (EPS, PCI, valvular & device

closure)

A 1


Multislice CT A 1


Cardiac MRI A 1


Integrated investigations (1) B, E, F, G 1

Integrated investigations (2) B, E, F, G 1

Self-directed learning Clinical applications and guidelines of:

1.Right and left heart catheterization

2.Coronary angiography

3.Multislice and CMR

4.Integrated imaging

ST4 & ST5 Theme Lectures CBD, videos,…etc

Heart failure (6 hours) (28 hours)

Dysrhythmias (18 hours) (24 hours)

IHD (12 hours) (60 hours)

HTN (6 hours) (28 hours)

Structural heart disease (12 hours) (60 hours)

Angiology (6 hours) (26 hours)

The heart in special groups (6 hours) (28 hours)


63

THEME 2. HEART FAILURE


hours

Definition, epidiemiology and precipitating factors of ADHF A 2

Causes, pathogenesis, and pathophysiology of ADHF A 2

Appropriate selection of investigations in patients with ADHF. B, D, 1

Management of critically ill patients with hemodynamic

disturbances.

B, D, E, G 1

Monitoring and interpretation of hemodynamic parameters. B, D, E, F, G 1

Application of central venous catheterization & CVP

measurement.

B, D, E, F, G 1

Pharmacological and non-pharmacologic management of ADHF A 2

Complications and prognosis of ADHF A 2

Risk assessment in secondary prevention including drug therapy B, C, D 1

Inotropic drugs; indications and limitations B, C, D 1

Definition, classification and causes of chronic heart failure A 2

Epidemiology and pathophysiology of chronic heart failure A 2

Natural history, Prognosis and complications of chronic HF. A 2

Clinical presentation of patients with chronic HF B, C, D, G, 1

Diagnostic procedures in the patient with known or suspected

chronic HF and Appropriate selection for investigations

B, C, D, G, 2

Medical management of chronic HF. A 2

Device therapies for chronic heart failure (CRT and ICDs) and

indications for surgical interventions

A 2

Appropriate selection for drug and device therapy for individual

patients with heart failure

B, D, G, H, I 1

Follow-up of chronic heart failure patients B, D, E, H, I 1

Risk factors management B, C, D, H, 1

SELF LEARNING

Recent advances in diagnosis of ADHF

Recent advances in management of ADHF

Recent advances in diagnosis of chronic HF

Recent advances in management of chronic HF

Guidelines for device therapy and surgical therapy


64

THEME 3. CARDIAC RHYTHM DISORDERS

SUBJECT KEY TEACHING

HOURS

Definition, classification, pathophysiology & management of

syncope

A 2

Differentiate syncope from the other causes of Loss of

consciousness

B, D, G, E, H 1

Select investigations in patients with syncope B, D, G, E, H 1

Perform risk stratification in syncope cases. B, D, G, E, H 1

Develop a management plan for patients with syncope. B, D, G, E, H 1

The genetics, epidemiology, pathogenesis, natural history&

prognosis of dysrhythmias.

A 2

Classification of dysrhythmias A 2

Management of dysrhythmias A 2

Select investigations in patients with dysrhythmias B, D, E, G 1

Classification of dysrhythmias by standard electrocardiogram. B, D, E, G 1

Management of acute dysrhythmias with drugs or cardioversion B, D, E, G 1

Prescription of preventive pharmacological therapy in cases of

dysrhythmias.

B, D, E, G 1

Interpretation of electrophysiological studies. B, D, E, G, F 1

Assessment of patient for pacing. B, D, E, G, F 1

Interpretation of Holter’s monitoring studies. B, D, E, G, F 1

Follow up of patients with pacemakers including interrogation

and programming of the device.

B, D, E, G 1

Epidemiology, prognosis and pathophysiology of AF. A 2

Diagnosis of AF, clinical features and impact on quality of life. A 2

Risk of embolic complications in patients with AF A 2

AF management in terms of:

Rhythm vs. rate control, Different forms of conversion to sinus

rhythm, Antithrombotic therapy, Prevention of recurrences,

Pacemaker-defibrillator therapy, Catheter ablation or surgery

A 2

The use of ECG, transthoracic echocardiogram, prolonged ECG

monitoring and exercise testing in patients with AF

B, D, E, G 1

Antithrombotic strategies for prevention of ischaemic stroke and

systemic embolism,

B, D, E, G 1

selection of patient for cardioversion. B, D, E, G 1

Selection and referral of patients for:Electrophysiological studies. B, D, E, G, F 1

Atrial catheter ablation or surgical ablation. B, D, E, G, F 1

Pacemaker and defibrillator implantation. B, D, E, G, F 1


65


HOURS

Definition, epidemiology, etiology, pathology, pathophysiology &

clinical presentation of the different condition which may lead to

SCD.

A 2

Acute management of patients with SCD. B, D, H, J 1

Management of patient with threatened or aborted SCD including

risk stratification, investigation and treatment.

B, D, G 1

Prodromal symptoms, underlying causes and prognosis of SCD

survivor.

B, H 1

ECG, long-term ECG monitoring, echocardiography in patients

with SCD.

B, D G 1

Follow-up of SCD survivors & selection of appropriate long-term

therapeutic options.

B, D, E, H 1

Risk-stratification and management of individuals at elevated risk

including family members of SCD.

B, D, E, H 1

SELF LEARNING

Definition, classification & management of syncope

Classification of Dysrhythmias

Mangement of dysrhythmias

Epidemiology & Classification of AF

Risk of embolism & antithrombotic strategies in AF

Short & long term management of AF

Acute management of SCD cases

Diagnostic work up of SCD survivors

Recent guidelines

THEME 4. ISCHEMIC HEART DISEASE


hours

Chest pain, Evaluation and Categorization. A 2

Clinical presentations and differential diagnosis B, D, H 2

Indications, limitations and risks of noninvasive and invasive

investigations.

B, D, H 2

Classification of ACS A 2

Epidemiology, etiology, and pathophysiology of ACS A 2

Clinical features of ACS B, D, H 2

Diagnosis of unstable angina B, D, G, H 2

Diagnosis of NSTEMI B, D, G, H 2

Diagnosis of STEMI B, D, G, H 2

Management strategies for patients with ACS. A 2


66


hours

Pharmacological treatment including analgesic, antiplatelet,

antithrombotic and anti-ischaemic therapy.

A 2

Reperfusion therapy. B,C,D,F,H 1

Management and prognosis of potential complications of ACS. B,C,D,F,H 2

Primary PCIs indications and guidelines B,C,D,F,H 2

Epidemiology,pathology, pathophysiology of chronic IHD and their

risk factors.

A 2

Clinical presentation, Risk-stratifications and management strategies

for patients with chronic ischemic heart diseases

B,C,D,F,H 4

Assessment and prognosis of chronic IHD. A 2

Management of chronic IHD including lifestyle measures,

pharmacological management and interventional management..

A, B,C,D,F,H 4

Merits of medical therapy and revascularization (percutaneous

coronary intervention of coronary artery bypass surgery) in the patient

with IHD

B, D 2

Interpretation of non-invasive, and invasive diagnostic tools for the

evaluation of ischemia, viability, left ventricular structure and function

and coronary anatomy

B,C,D,F,G, H 2

Rehabilitation for IHD. A 2

Different types of dyslipidemias and possible genetic transmission A 2

Management of patients with lipid disorders. A 2

Investigations required for diagnosing patients with lipid disorders. B 1

Self learning:

Recent guidelines for ACS

Recent guidelines for STEMI

Recent guidelines for chronic stable angina.

Recent advances for lipid disorders.


67

THEME 5. SYSTEMIC AND PULMONARY HYPERTENSION

Subject KEY TEACHING

HOURS

Epidemiology, pathophysiology and prevention of hypertension A 2

Essential hypertension; diagnosis, complications and management A 2

Essential hypertension; diagnosis, complications and management B, C, D, H 2

Secondary hypertension and its various causes & their management. A 2

Secondary hypertension and its various causes & their management. B 2

Resistant hypertension causes and management. A 2

Resistant hypertension causes and management. B 2

Hypertensive emergencies and urgencies. A 2

Global cardiovascular risk A 2

Global cardiovascular risk B 2

Epidemiology, pathology, genetic basis and pathophysiology of

different classes of pulmonary hypertension.

A 2

Clinical features and diagnostic investigations of pulmonary

hypertension.

B 2

Pharmacological, interventional and surgical modalities in treatment

and prognosis of pulmonary hypertension.

B, H 2

Self learning

Recent Guidelines for systemic hypertension (national and international)

Recent Guidelines of pulmonary hypertension


68

THEME 6. STRUCTURAL HEART DISEASE


HOURS

Epidemiology natural history and etiology of rheumatic fever A 2

Epidemiology natural history and etiology of valvular heart disease A 2

Analysis and interpretation patient clinical picture and mange

accordingly

B, D, G, E, H 1

Comparison between the different cardiac investigations &

determine the most the appropriate method for each clinical

situation

B, D, G, E, H 1

Risk stratification in valvular heart cases. B, D, G, E, H 1

Selection of the anticoagulation regimes appropriate for patients

with valve disease and valve prostheses and its follow-up.

B, D, G, E, H 1

Timing of surgery B, D, G, E, H 1

Recent guidelines 1

Epidemiology, the pathology, pathogenesis and microbiology of

endocarditis.

A 2

Appropriate selection of laboratory investigations and diagnostic

procedures

B, D, G, E, H 1

Appropriate selection of antibiotic regimen B, D, G, E, H 1

Indications for surgery B, D, G, E, H 1

Antibiotic prophylaxis B, D, G, E, H 1

Different types epidemiology, pathophysiology including genetics,

clinical features & diagnostic criteria of cardiomyopathies.

A 2

The role of medical therapy, implantable cardioverter defibrillators,

CRT, catheter based and surgical based treatments of the

cardiomyopathies

B, D, E, G 1

Interpretation of diagnostic tools B, D, E, G 1

Appropriate selection and interpretation of cardiovascular

procedures needed for the patients

B, D, E, G 1

Assessment and management of cardiovascular presentations in

emergency settings to reach diagnosis or differential diagnosis in

patients with diseases of the myocardium and pericardium

B, D, E, G 1

Different types. epidemiology, pathophysiology clinical features &

diagnostic criteria of myocarditis

A 2

Clinical features, pathology and diagnostic criteria of infective and

non-infective myocarditis

B, D, E, G 1

Different treatment modalities for patients with myocarditis and its

complications.

B, D, E, G 1

Prognostic indicators for myocarditis B, D, E, G 1

Epidemiology, classification pathophysiology and etiology of

Acute pericarditis (infective, idiopathic or malignant)

A 2

Epidemiology, classification pathophysiology and etiology of

Chronic pericarditis. Constrictive pericarditis..

A 2


69


HOURS

Relevant investigation: (non-invasive and invasive) for pericardial

diseases

B, D, E, G 1

Differentiation between constrictive pericarditis from restrictive

cardiomyopathy

B, D, E, G 1

Management of pericarditis B, D, E, G 1

Complications of pericardial diseases B, D, E, G 1

Epidemiology, etiology, prevention, pathophysiology of congenital

heart diseases

A 2

Genetic basis of inherited and non-inherited congenital heart

diseases.

A 2

Clinical presentations of cyanotic congenital heart disease whether

associated with increased or decreased pulmonary blood flow

A 2

Clinical presentations of acyanotic congenital heart disease whether

associated with increased or decreased pulmonary blood flow

A 2

Relevant clinical investigations: non-invasive and invasive for CHD B, D, E, G 1

Principles of management in outpatient and emergency settings B, D, E, G 1

Recent advances in technologies (occluders, stents, balloon

valvuloplasty, etc) in the field of congenital heart disease

B, D, E, G 1

Cardiac catheterization and intervention procedures for congenital

heart disease

B, D, E, G 1

Surgical procedures and indications for congenital heart disease B, D, E, G 2

Epidemiology, classification pathology, presentation and natural

history of cardiac tumours

A 2

Investigations used in the assessment of cardiac tumors B, D, E, G, F 1

Management of cardiac tumors in outpatient and emergency

settings.

B, D, E, G, F 1

Differential diagnosis of cardiac masses. B, D, E, G, F 1

SELF LEARNING

Recent guidelines in management of valvular heart disease

Recent advances in management of valvular heart disease

Recent guidelines in management of infective endocarditis

Recent advances in diagnosis and management of congenital heart disease

Recent advances in management of pericardial and myocardial diseases

Recent advances in management of cardiac masses


71

THEME 7. ANGIOLOGY AND TRAUMA OF THE HEART


hours

Pathogenesis, epidemiology, genetics, presentation and management of

aortic dissection and aortic aneurysms

A 2

non-invasive imaging of patients with aortic disease B, C, D, G 2

Assessment& management of patients with acute aortic syndromes A 2

The causes, natural history & management of patient with trauma to the

heart and aorta

B, C, D, G 2

Assessment, management and advice for patients with cardiac trauma B, C, D, G 1

Epidemiology & risk factors for deep venous thrombosis and pulmonary

embolism.

A 2

Clinical presentation of deep venous thrombosis and pulmonary

embolism

B, C, D, G 2

Diagnosis & treatment of thromboembolic venous disease using

different non-invasive and invasive modalities.

B, C, D, G 1

Interpretation of non-invasive and invasive diagnostic tools of DVT B, C, D, G 1

Diagnosis, management & duration of anticoagulant therapy of deep

venous thrombosis

B, C, D, G 1

Epidemiology, pathology and methods of diagnosis of peripheral

vascular diseases.

A 2

Medical and invasive (interventional and surgical) management and

their relative merits in different situations

A 2

Association of peripheral vascular disease with vascular disease in other

areas, in particular carotid and renal arteries.

B, C, D, G 1

Causes of acute limb ischemia and their management. B, C, D, G 1

Selection and interpretation of diagnostic tools in patients with

peripheral al vascular diseases

B, C, D, G 1

Identification of the risk factors and appropriate selection of the

management strategy.

B, C, D, G 2

SELF LEARNING

Recent guidelines in management of patients with aortic diseases

Recent advances in management of cardiac trauma

Recent guidelines in management of venous thromboembolic diseases

Recent advances and guidelines in management of patients with peripheral vascular

diseases


71

THEME 8. THE HEART IN SPECIAL GROUPS


HOURS

Diabetes mellitus; pathophysiology, management and complications A 2

Diabetes and heart diseases A 2

Prevention & Treatment of cardiovascular complications in the

diabetic patient

B, D, G,

E, H

1

Cardiovascular functions & pregnancy, delivery & post-partum period A 2

Pregnancy and cardiovascular diseases A 2

Risk assessment & treatment of cardiac patients planning for

pregnancy.

B, D, E, G 1

Cardiac follow up of the pregnant patients with heart disease. B, D, E, G 1

Contraception to cardiac patients B, D, E, G 1

Selection of safe drug therapies that can be used during pregnancy A 2

Evaluation of the fetal and maternal risk of different cardiac

interventions

B, D, E, G 1

Risk assessment prior to non cardiac surgery for patients with cardiac

disease and how to minimize the risk.

A 2

Planning for management of cardiac patients preoperative,

intraoperative and postoperative

B, D, H, J 1

Renal diseases affecting cardiovascular system. A 1

Clinical data analysis of cardiac patients with renal disorders. B, D, E, H 1

Collagen diseases affecting cardiovascular system. A 1

Clinical data analysis of cardiac patients with collagen disorders. B, D, E, H 1

Neurological diseases affecting cardiovascular system. A 1

Clinical data analysis of cardiac patients with neurological disorders. B, D, E, H 1

Hematological diseases affecting cardiovascular system. A 1

Clinical data analysis of cardiac patients with hematological disorders. B, D, E, H 1

Impact of age and gender upon cardiovascular disease management in

outpatient and emergency settings

A 2

The athlete heart A 2

Self Learning

Recent guidelines in management of cardiac patients with diabetes

Recent guidelines in management of cardiac patients with pregnancy

Recent advances in management of cardiac patients with systemic disorders

the egyptian fellowship board for cardiovascular medicine§لقلب.pdf · the egyptian fellowship...

Documents