Coronary Care

Description of Rotation/Educational Purpose:

To provide an opportunity to enhance clinical and procedural skills and to develop a deeper understanding of decisions related to invasive, diagnostic and therapeutic interventions in the Cardiology arena.

Patient Care Goals and Objectives:

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents are expected to:

PGY 1

1. To learn clinical and physiological basis for management of acute cardiac illnesses, including myocardial infarction, arrhythmias, congestive heart failure and their complications.

PGY 2 and 3

1. To learn clinical and physiological basis for management of acute cardiac illnesses, including myocardial infarction, arrhythmias, congestive heart failure and their complications.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

1. To learn skills in physical examination and ability to relate abnormal physical findings to the results obtained from invasive and non-invasive diagnostic studies.

2. To learn the pharmacological properties and toxic effects of cardiovascular drugs.

3. To learn the indications for thrombolytic therapy and percutaneous interventions in acute coronary syndromes.

4. To demonstrate competence in EKG interpretation.

PGY 2 and 3

1. To learn skills in physical examination and ability to relate abnormal physical findings to the results obtained from invasive and non-invasive diagnostic studies.

2. To learn the pharmacological properties and toxic effects of cardiovascular drugs.

3. To learn the indications for thrombolytic therapy and percutaneous interventions in acute coronary syndromes.

4. To demonstrate competence in EKG interpretation.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. 

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

1. To learn how to function effectively as a member of the multi-disciplinary Cardiology team.

PGY 2 and 3

1. To learn how to function effectively as a member of the multi-disciplinary Cardiology team.

2. Supervise interns and medical students to facilitate their education.

Professionalism Goals and Objectives:

Goal:  Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. 

Residents are expected to demonstrate:

PGY 1

1. To learn ethical aspects of decisions required in the care of critically or terminally ill patients.

PGY 2 and 3

1. To learn ethical aspects of decisions required in the care of critically or terminally ill patients.

Interpersonal and Communication Skills Goals and Objectives:

Goal:  Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

Teaching methods are held daily with discussion of physiology, pathophysiology, differential diagnosis and management of all patients in the CCU both during rounds and in didactic sessions led by Attending physicians as well as Fellows. 

Mix of Diseases and Pathological Material:

Leading diagnoses include acute coronary syndromes, coronary artery disease, heart failure and cardiomyopathies, valvular disease, pericardial disease, and arrhythmias. Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients as well.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients as well.

Types of Clinical Encounters:

Residents evaluate and manage patients in an inpatient setting with supervision from other residents, Cardiology fellows and attendings. Residents also care for patients in the CCU and observe procedures in the cath lab and EP lab.

Procedures and Services:

Residents will be appropriately supervised for all procedures. Procedures for the rotation include arterial and central venous catheter placement, pulmonary artery catheter placement, arterial puncture, advanced cardiac life support, placement of temporary pacemakers, elective and emergent cardioversion, and appropriate EKG performance. The resident will be able to interpret hemodynamic monitoring, pulse oximetry, and telemetry. The trainee needs to know when to order certain tests and have a working knowledge of the meaning of these tests. These include but are not limited to coronary angiography and echocardiography.

Supervision:

Residents are directly supervised in their patient care duties by the Cardiology fellow and the Cardiology attending physician. The PGY 2 or 3 resident on the service supervises the PGY 1 residents and the senior medical student on service.

Educational Resources to be Used and Reading Lists:

Reading lists are supplied by faculty as pertinent to patients. Articles are supplied by faculty and other interested parties including pharmacology doctorate faculty. House staff is encouraged to attend each of the daily Cardiology Division conferences, particularly the Thursday Cardiology fellow/Cardiology house staff conference, which emphasizes patient care in a care presentation format.

Method of Evaluation of Resident Competence:

Residents are evaluated by the attending with the assistance of the fellow each month using the standard Departmental Evaluation form for each competency. Patient Care is assessed based on direct observation and chart review. Medical Knowledge is assessed through direct questioning on rounds. The resident must demonstrate competent EKG interpretation. Professionalism is assessed based on observation of the resident’s demeanor and behavior on this rotation. Interpersonal and Communication Skills is assessed by observing the resident’s interactions with patients, families, and staff. Systems-Based Practice is evaluated based on the resident’s ability to learn and improve his or her skills based on feedback, study, and literature review. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation.