VA Cardiology Consultation Service

Educational Purpose:

The VA Cardiology Consult Service was developed to give the medicine residents additional exposure to Cardiology, in general, and stress testing/EKG interpretation, in particular.

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 perform consultations on patients with known or suspected cardiovascular diseases throughout the VA Hospital.

PGY 2 and 3

1. To perform consultations on patients with known or suspected cardiovascular diseases throughout the VA Hospital.

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 perform consultations on patients with known or suspected cardiovascular diseases throughout the VA Hospital.
2. To develop skills in cardiac diagnosis and functional assessment.
3. To develop experience and expertise in interpretation of 12-Lead electrocardiograms.
4. To develop expertise in the performance of exercise stress testing.
5. To understand the indications for invasive and non-invasive cardiac diagnostic studies.

PGY 2 and 3

1. To perform consultations on patients with known or suspected cardiovascular diseases throughout the VA Hospital.
2. To develop skills in cardiac diagnosis and functional assessment.
3. To develop experience and expertise in interpretation of 12-Lead electrocardiograms.
4. To develop expertise in the performance of exercise stress testing.
5. To understand the indications for invasive and non-invasive cardiac diagnostic studies.
6. To gain experience interpreting echocardiograms.

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

PGY 2 and 3

1. Supervise interns and medical students on the rotation and further 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

PGY 2 and 3

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:

Residents will have teaching rounds with the Cardiology Fellow and the Cardiology attending. There will be direct observation of the residents’ skills in EKG interpretation and stress test administration. Residents will attend Cardiology Case Conference at MUSC on Friday mornings.

Mix of Diseases and Pathological Material:

Leading diagnoses include acute coronary syndromes, coronary artery disease, heart failure and cardiomyopathies, valvular disease, pericardial disease, and arrythmias. 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 in some sites.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adult males,

Types of Clinical Encounters:

Residents will evaluate new consults from a variety of inpatient Medical and Surgical services. Residents are expected to develop a care plan for each patient encounter to discuss with their fellow and attendings. In addition, there are several opportunities to participate in outpatient clinics as well.

Procedures and Services:

Residents will have the opportunity to perform and interpret EKG’s as well as observe or assist in other procedures including echocardiograms, heart catheterizations, stress tests, EP studies, elective cardioversions.

Supervision:

Upper level residents’ rotation on the VA Cardiology Consult Service is supervised by the Cardiology fellow and attending. They in turn supervise the senior medical students rotating on the service.

Educational Resources to be Used and Reading Lists:

A reading list is provided by attending faculty. Texts include The Cardiology Rotation and EKG Interpretation, by Dr. George Taylor, one of the attending physicians on the service.

Method of Evaluation of Resident Competence:

The teaching physician evaluates Patient Care and Medical Knowledge through direct observation and questioning on rounds. Systems-Based Practice is emphasized in that the resident interacts with multiple members of the health care team including attendings, fellows, other residents, students, and the nurse practitioner. The resident also gains experience in the role of a medical consultant. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations. Interpersonal and Communication Skills and Professionalism is assessed by the attending physician via the global evaluation form.