RESUMO
INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant decrease in volume of electrophysiology (EP) procedures. There has been concern that trainees may not achieve the procedural numbers required to graduate as independent electrophysiologists within the usual timeline. We sought to determine the impact of the COVID-19 pandemic on the percentage of clinical cardiac EP (CCEP) fellows in jeopardy of not meeting procedural volume requirements and overall sentiments regarding preparedness of fellows for independent practice. METHODS: We surveyed CCEP fellows and program directors about baseline procedural volumes, curriculum changes due to the pandemic, and attitudes about preparedness for board examinations and independent practice. RESULTS: Ninety-nine fellows and 27 program directors responded to the survey. Ninety-eight percent of responding fellows reported a decrease in procedural volume as a result of the pandemic. Program directors reported an overall decrease in annual number of ablations and device procedures performed by each fellow during the 2019-2020 academic year compared to the preceding year. Despite this, a minority of fellows and program directors reported concerns about meeting Accreditation Council for Graduate Medical Education procedural requirements for devices (9% and 4%, respectively) and ablation (19% and 9%) or preparedness for independent practice after a 2-year fellowship. CONCLUSIONS: The COVID-19 pandemic has resulted in a decrease in procedural volume for CCEP trainees, but the majority of fellows and program directors do not anticipate major barriers to timely graduation. This may change with COVID-19 resurgence and further interruptions in training.
Assuntos
COVID-19 , Eletrofisiologia Cardíaca/educação , Cardiologistas/educação , Educação de Pós-Graduação em Medicina , Técnicas Eletrofisiológicas Cardíacas , Adulto , Eletrofisiologia Cardíaca/tendências , Cardiologistas/tendências , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/tendências , Técnicas Eletrofisiológicas Cardíacas/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Carga de TrabalhoRESUMO
The learning health system is a conceptual model for continuous learning and knowledge generation rooted in the daily practice of medicine. While companies such as Google and Amazon use dynamic learning systems that learn iteratively through every customer interaction, this efficiency has not materialized on a comparable scale in health systems. An ideal learning health system would learn from every patient interaction to benefit the care for the next patient. Notable advances include the greater use of data generated in the course of clinical care, Common Data Models, and advanced analytics. However, many remaining barriers limit the most effective use of large and growing health care data assets. In this review, we explore the accomplishments, opportunities, and barriers to realizing the learning health system.
Assuntos
Big Data , Cardiologistas/educação , Cardiologia/educação , Prestação Integrada de Cuidados de Saúde , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Sistema de Aprendizagem em Saúde , Acesso à Informação , Confidencialidade , Humanos , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à SaúdeAssuntos
Cardiologistas/educação , Cardiologia/educação , Doenças Cardiovasculares/terapia , Prestação Integrada de Cuidados de Saúde , Educação de Pós-Graduação em Medicina , Cateterismo Cardíaco , Doenças Cardiovasculares/diagnóstico , Competência Clínica , Angiografia Coronária , Cuidados Críticos , Currículo , Transplante de Coração/educação , Humanos , Equipe de Assistência ao Paciente , Intervenção Coronária Percutânea/educaçãoAssuntos
Cateterismo Cardíaco , Eletrofisiologia Cardíaca/educação , Cardiologistas/educação , Educação de Pós-Graduação em Medicina , Técnicas Eletrofisiológicas Cardíacas , Internato e Residência , Adolescente , Adulto , Certificação , Competência Clínica , Currículo , Europa (Continente) , Feminino , Humanos , Masculino , Adulto JovemRESUMO
The present-day cardiac catheterization laboratory (CCL) is home to varied practitioners who perform both diagnostic, interventional, and complex invasive procedures. Invasive, non-interventional cardiologists are performing a significant proportion of the work as the CCL environment has evolved. This not only includes those who perform diagnostic-only cardiac catheterization but also heart failure specialists who may be involved in hemodynamic assessment and in mechanical circulatory support and pulmonary hypertension specialists and transplant cardiologists. As such, the training background of those who work in the CCL is varied. While most quality metrics in the CCL are directed towards evaluation of patients who undergo traditional interventional procedures, there has not been a focus upon providing these invasive, noninterventional cardiologists, hospital/CCL administrators, and CCL directors a platform for quality metrics. This document focuses on benchmarking quality for the invasive, noninterventional practice, providing this physician community with guidance towards a patient-centered approach to care, and offering tools to the invasive, noninterventionalists to help their professional growth. This consensus statement aims to establish a foundation upon which the invasive, noninterventional cardiologists can thrive in the CCL environment and work collaboratively with their interventional colleagues while ensuring that the highest quality of care is being delivered to all patients.
Assuntos
Benchmarking/normas , Cateterismo Cardíaco/normas , Cardiologistas/normas , Prestação Integrada de Cuidados de Saúde/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Cateterismo Cardíaco/efeitos adversos , Cardiologistas/educação , Certificação/normas , Competência Clínica/normas , Consenso , Educação de Pós-Graduação em Medicina/normas , Humanos , Especialização/normasAssuntos
Institutos de Cardiologia/organização & administração , Cardiologistas/organização & administração , Serviço Hospitalar de Cardiologia/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Capacitação em Serviço/organização & administração , Unidades de Terapia Intensiva/organização & administração , Administração de Recursos Humanos em Hospitais , Admissão e Escalonamento de Pessoal/organização & administração , Cardiologistas/educação , Competência Clínica , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/organização & administração , Pesquisas sobre Atenção à Saúde , Disparidades em Assistência à Saúde , Humanos , Estados UnidosRESUMO
Simulation-based training as an educational tool for healthcare professionals continues to grow in sophistication, scope, and usage. There have been a number of studies demonstrating the utility of the technique, and it is gaining traction as part of the training curricula for the next generation of cardiologists. In this review, we focus on the recent literature for the efficacy of simulation for practical procedures specific to cardiology, focusing on transesophageal echocardiography, cardiac catheterization, coronary angioplasty, and electrophysiology. A number of studies demonstrated improved performance by those trained using SBT when compared to other methods, although evidence of this leading to an improvement in patient outcomes remains scarce. We discuss this evidence, and the implications for practice for training in cardiology.
Assuntos
Cardiologistas/educação , Cardiologia/educação , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Treinamento por Simulação/métodos , Cateterismo Cardíaco , Cardiologia/métodos , Competência Clínica , Currículo , Ecocardiografia Transesofagiana , Técnicas Eletrofisiológicas Cardíacas , Humanos , Curva de Aprendizado , Intervenção Coronária Percutânea/educaçãoRESUMO
For several decades, treating patients with pacemakers has been the privilege of cardiologists. However, in the last 30 years, researchers have found new targets for electrical stimulation in different clinical subspecialities, such as deep brain stimulation (for the treatment of Parkinson's disease, essential tremor, dystonia, and some psychiatric illnesses); spinal cord stimulation (for refractory angina, chronic pain, and peripheral artery disease); and sacral (for diverse urologic and proctologic conditions), vagal (for epilepsy), and phrenic nerve stimulation (for sleep apnoea). The purpose of this article is to familiarize cardiologists with these 'extra-cardiac pacemakers' and to discuss potential issues that must be addressed when these patients undergo cardiac procedures.