Frequently Asked Questions: Interventional Cardiology Review Committee for Internal Medicine ACGME Question Answer Introduction Are fellowships allowed to include non-coronary Fellowships may provide educational experience to fellows in peripheral, renal, carotid, etc. if appropriate faculty member expertise is available for that education and if the fellows can interventions in the educational program? achieve all required competencies for interventional cardiology education, particularly [Program Requirement: Int.B] competence in coronary interventions. Can fellows also receive educational experience As noted above, fellowships may provide educational experience in peripheral, renal, carotid, in peripheral artery interventions during the etc. interventions if appropriate faculty member expertise is available for fellow education, and if program? the peripheral vascular education does not interfere with meeting the required interventional cardiology educational experiences. Program Requirement: Int.B] Faculty Why must faculty members perform 75 All supervising faculty members (at the primary clinical or at participating sites) must maintain a interventions at the site of supervision? minimum volume of 75 interventions at the site where they supervise fellows. This is to ensure that fellows are not supervised by low-volume operators, and that faculty members are familiar [Program Requirement: II.B.7] with the lab, personnel, procedures, etc., at the location where they supervise program fellows. Resources Is it acceptable for a program to use two No. A single primary laboratory must be located at the primary clinical site and must maintain a laboratories equally at the primary clinical site if minimum of 400 interventions per year. If there is a secondary lab that is utilized by the program, each laboratory performs 200 interventions per the Review Committee expects that lab to maintain a minimum of 200 interventions per year. In year, for a total of 400? addition, the Review Committee expects that the secondary lab be staffed by the same faculty members, or be located in an affiliated hospital that is part of the core internal medicine [Program Requirement: II.D.3.a).(1)] residency program with separate faculty members. At sites other than the primary clinical site (i.e., participating sites), labs must maintain at least 400 interventions per year.

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Question Fellow Appointment Can a program have fellows complete their interventional cardiology education between the second and third years of a cardiology fellowship?

Answer Non-sequential education (i.e., two years of cardiology, followed by an interventional cardiology fellowship, then followed by the third year of a cardiology program) is not acceptable to the Review Committee. Fellows are expected to complete three years of cardiology prior to entering an interventional cardiology fellowship. The Review Committees rationale for this position is as follows:

[Program Requirement: III.A.1] • •

Can a program accept international medicine graduates (IMGs) without ACGME-accredited cardiology educational experience? [Program Requirement: III.A.1] Educational Program Does a fellow who assists in an interventional cardiology procedure receive credit for that procedure? [Program Requirement: IV.A.2.a).(4).(b)] Can a dedicated month or more of research or other non-clinical, non-interventional cardiology education be included in the 12 months of required clinical education?

The minimum required four months of cardiac catheterization experience would not be adequate preparation for fellows entering an interventional cardiology fellowship. Additional catheterization experience – in the third year of a cardiology program – would be necessary in order for fellows to be sufficiently proficient at catheterization techniques to complete all of the interventional cardiology requirements in the accredited 12 months.

In addition, the Review Committee is concerned about fragmentation of education and peer interaction. Programs may accept up to 25 percent of their fellows with international foreign (non-ACGMEaccredited) cardiology fellowship education. However, these fellows are expected to have the equivalent of three years of cardiology education before entering an interventional cardiology fellowship.

Fellows must act as the primary operator in order for procedures to count toward their procedural competency. Interventional procedures for which fellows assist in should not be counted.

Each month must include clinical interventional cardiology. Fellows may participate in research, but each rotation must have a clinical component.

[Program Requirement: IV.A.3.a)]

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Question Can the interventional cardiology and specialty conferences be shared?

Answer The clinical case and core curriculum conferences are specialty-specific, and therefore cannot be shared on a regular basis. A separate conference series is necessary for each.

[Program Requirement: IV.A.3.c).(1)]

However, interventional cardiology programs may combine other conferences (journal clubs, research conferences, morbidity and mortality, and quality improvement conferences) with the parent subspecialty program’s conferences if: 

What is an acceptable outpatient clinic experience for fellows? [Program Requirement: IV.A.3.e)]

all fellows attend the same conferences (not just when interventional cardiology topics are discussed);  key clinical faculty members from the interventional cardiology fellowship program attend the conferences;  topics in the interventional cardiology fellowship area are discussed regularly; and, interventional cardiology fellows are exposed to and discuss both the recent and classic literature in the interventional cardiology area. • The follow-up/continuity clinic should not solely consist of evaluating patients post-procedure for complications. Interventional cardiology fellows are required to have an ambulatory experience at least weekly. Each fellow must see four-to-eight patients per week, including patients being evaluated before or after electrophysiology/device procedures. These four-toeight ambulatory patients need may be seen over the course of the week. Fellows should see at least 25 percent of the patients on whom they perform interventions in follow-up. Some of the follow-up contact may be by telephone, but no more than 50 percent on average. 07/2012

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Appendix I Review Committee for Internal Medicine Calculation of Minimum Key Clinical Faculty (KCF) and KCF Scholarship Participation/Productivity Interventional Cardiology Minimum 2 KCF or 1:1.5 faculty-fellow ratio for programs with 4 or more fellows fellows PRODUCTIVITY PARTICIPATION Pubs for All KCF & non-KCF in KCF with at Least Minimum Certified Majority of Past 3 Years 1 SA in Approved Fellow KCF Minimum KCF (1/yr x 3 yrs) Past 3 Years Complement (incl PD) (50%) [259] [259] 2 2 1 1 3 3 2 1 1 3 4 3 2 2 6 5 4 2 2 6 6 4 2 2 6 7 5 3 3 9 8 6 3 3 9 The Review Committee requires that fellowship education occurs in an environment of inquiry, scholarship, and research productivity. The Review Committee requires that KCF demonstrate both participation and productivity in scholarship of discovery and dissemination as evidenced by: • Participation Expectation: 50% of the certified, minimum-required-number of KCF must demonstrate at least one acceptable product of scholarship in the past three years. (See definition of acceptable products of scholarship below) • Productivity Expectation: Total acceptable scholarly products for KCF and non-KCF (There must be at least one product per year x three years x the 50% of the minimum required KCF. The nonKCF are counted as long as they contribute to fellow education and devote at least 10 hours a week to the program. Acceptable Products of Scholarship The Review Committee defines acceptable products of scholarship as follows: • Publication of original research manuscripts in a peer-review journal • Publication of a review article in a peer-review journal • Publication of an editorial in a peer-review journal • Publication of a book chapter published in medical textbooks (full citation required including publisher and date) o This includes chapters published in specialty society review texts, such as MKSAP, NephSAP, ACCSAP, the Geriatrics Review Syllabus, etc. • Publication of a case report indexed in PubMed o A copy of the case report must be included o Case reports published as an abstract, letter, correspondence, or illustration do not count • Peer-review funding of research such as NIH, NCI, or other external funding organizations • In press or accepted for publication in a peer-review journal The following will not fulfill requirements for scholarship: • Submitted or in preparation • Abstracts, letters-to-editor, correspondence, or illustrations • Case reports published as an abstract, letter, correspondence, or illustration • Non-peer-review publications • Non-peer review funding, such as industry funding, or internal institutional funding, or multicenter

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industry funding, or other non-peer-review grant o Exception: Pharmaceutical studies in which the KCF is the overall PI (lead investigator) for all sites will be accepted as counting as one product of scholarship The Review Committee expanded its expectation for participation in scholarship to include the “Acceptable Products of Scholarship” as listed above as well as the following: o Presentations at national, international or regional meetings o Leadership roles in national medical organizations or serving as a reviewers or editorial board members for peer-reviewed journals This broadened expectation does not extend to scholarly productivity. Scholarly products are limited to what appears above under the title “Acceptable Products of Scholarship.” Summary/Example: • For an application for a new six-fellow endocrinology program there must be four KCF (which includes the program director). • In order to meet the Participation Expectation, two of the four KCF must have evidence of a scholarly project or activity from the last three calendar years. • In order to meet the Productivity Expectation, there must be at least six scholarly products across the KCF and non-KCF. Note: • •

Publications with several KCF as authors can only be counted once “Last three calendar years” means that the Review Committee will count the scholarly products (as defined above) from 2011, 2012, 2013, and 2014 for an application that is submitted in 2014. 

See summary of KCF minimum numbers and research productivity in Appendix I

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