[Characteristics of cardiologist training in Latin America: a survey of the Interamerican Society of Cardiology]

Objectives

Describe the characteristics of the different cardiology medical residencies in Latin America.

Method

Cross-sectional study that aims to evaluate the characteristics of cardiology residencies in Spanish-speaking countries of Latin America, through self-administered electronic surveys.

Results

Three hundred seven residents of 147 residences were surveyed. Mean age was 31 years and 63% were male. Ninety eight percent carry out their training in the capital city. The average total training time is 4.8 years. Forty four percent complete their residency in internal medicine prior to starting cardiology, and 10% have no prior training. In cardiology training is 3 years in most countries. Fifty four percent present academic activities every day and 16% only once or less, consisting of theoretical classes (93%), clinical cases (85%), bibliographic workshops (69%), and writing scientific papers (68%). Supervision is carried out by the chief resident (45%), resident coordinator (44%), resident instructor (27%) or the department head (54%), while 2.6% do not present supervision. The main rotations were echocardiography (99%), hemodynamics (96%), coronary unit (93%), and electrophysiology (92%). Residents highlighted the need to improve academic activities (23%) and scientific production (12%).

Conclusions

There are important differences in the academic and practical training between the residences of the different countries of America.

Cost Perception of Cardiological Procedures Among -Medical Students and Doctors in Switzerland

INTRODUCTION

Aims: The aim of the present study was to analyze the cost awareness of cardiological tests and procedures among medical students, residents and doctors in Switzerland and discuss trends in cost perception in health expenditures. Methods: Using an online questionnaire, participants (randomly recruited by mailing lists, messaging app or via direct contact) had to estimate the costs of the 13 predefined cardiological procedures services, diagnostic tests and procedures in Swiss Francs (CHF). Short technical descriptions of the procedures and tests were provided. Estimated costs were considered accurate if they were within ±25 % of the reimbursement rate. Participant groups were defined: medical students, residents, hospital-based physicians and cardiologists in private practice (practitioners). Results: A total of 939 participants (172 physicians and 767 medical students) were enrolled. The overall proportion of medical gestures estimated correctly within ±25% of the reimbursement rate ranged from 10 % (students) to 55 % in practitioners. Residents (26 %) and hospital-based physicians (38 %) performed intermediately. In general, the costs were overestimated. Conclusions: The level of cost knowledge of cardiological tests and procedures among medical students, residents and doctors in Switzerland is modest. In general, the costs were overestimated. Increasing experience seems to sharpen the accuracy of cost estimation. Overestimation of costs is potentially problematic: Either in systems of governmental defined global budget or systems with substantial out-of-pocket costs for patients, overestimated costs will result in more restrictive ordering than it would be appropriate and affordable for the individual patient.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group

BACKGROUND

There is limited data on the organisation of paediatric echocardiography laboratories in Europe.

METHODS

A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs.

RESULTS

Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%).

CONCLUSION

Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.

European Society of Cardiology Core Curriculum for cardio-oncology

Cardio-oncology is a rapidly growing field of cardiovascular (CV) medicine that has resulted from the continuously increasing clinical demand for specialized CV evaluation, prevention and management of patients suffering or surviving from malignant diseases. Dealing with CV disease in patients with cancer requires special knowledge beyond that included in the general core curriculum for cardiology. Therefore, the European Society of Cardiology (ESC) has developed a special core curriculum for cardio-oncology, a consensus document that defines the level of experience and knowledge required for cardiologists in this particular field. It is structured into 8 chapters, including (i) principles of cancer biology and therapy; (ii) forms and definitions of cancer therapy-related cardiovascular toxicity (CTR-CVT); (iii) risk stratification, prevention and monitoring protocols for CTR-CVT; (iv) diagnosis and management of CV disease in patients with cancer; (v) long-term survivorship programmes and cardio-oncology rehabilitation; (vi) multidisciplinary team management of special populations; (vii) organization of cardio-oncology services; (viii) research in cardio-oncology. The core curriculum aims at promoting standardization and harmonization of training and evaluation in cardio-oncology, while it further provides the ground for an ESC certification programme designed to recognize the competencies of certified specialists.

Contemporary transesophageal echocardiography practice patterns among paediatric cardiology centres in the United States and Canada

OBJECTIVE

To characterise transesophageal echocardiography practice patterns among paediatric cardiac surgical centres in the United States and Canada.

METHODS

A 42-question survey was sent to 80 echocardiography laboratory directors at paediatric cardiology centres with surgical programmes in the United States and Canada. Question domains included transesophageal echocardiography centre characteristics, performance and reporting, equipment use, trainee participation, and quality assurance.

RESULTS

Fifty of the 80 centres (62.5%) responded to the survey. Most settings were academic (86.0%) with 42.0% of centres performing > 350 surgical cases/year. The median number of transesophageal echocardiograms performed/cardiologist/year was 50 (26, 73). Pre-operative transesophageal echocardiography was performed in most surgical cases by 91.7% of centres. Transesophageal echocardiography was always performed by most centres following Norwood, Glenn, and Fontan procedures and by < 10% of centres following coarctation repair. Many centres with a written guideline allowed transesophageal echocardiography transducer use at weights below manufacturer recommendations (50.0 and 61.1% for neonatal and paediatric transducers, respectively). Most centres (36/37, 97.3%) with categorical fellowships had rotations which included transesophageal echocardiography participation. Large surgical centres (>350 cases/year) had higher median number of transesophageal echocardiograms/cardiologist/year (75.5 [53, 86] versus 35 [20, 52], p < 0.001) and more frequently used anaesthesia for diagnostic transesophageal echocardiography ≥ 67% of time (100.0 versus 62.1%, p = 0.001).

CONCLUSIONS

There is significant variability in transesophageal echocardiography practice patterns and training requirements among paediatric cardiology centres in the United States and Canada. Findings may help inform programmatic decisions regarding transesophageal echocardiography expectations, performance and reporting, equipment use, trainee involvement, and quality assurance.

Fetal Cardiology Bioethics: An Innovative New Curriculum for Cardiology Trainees

Decision-making in fetal cardiology is fraught with ethical issues yet education in bioethics for trainees is limited or nonexistent. In this innovation report, we describe the development of a fetal cardiology bioethics curriculum designed to address this gap. The curriculum was developed to supplement the core curriculum for cardiology fellows and fetal cardiology subspecialty trainees. The series combines didactic and interactive teaching modalities and contains 5 key components: (1) introduction to bioethics and its role in fetal cardiology, (2) counseling and pathways for compassionate terminal care, (3) case vignette-based ethical analysis and discussion cases, (4) fetal counseling considerations for shared decision-making and recommendations, (5) facilitated communications role play. The curriculum was refined using session evaluations from end users. This report describes the innovative curriculum as a starting point for further incorporation and study of bioethical education in pediatric cardiology and fetal training programs.

Perceived Gaps in Knowledge for the Advanced Heart Failure and Transplant Cardiology Fellow: the Results of a National Needs-Assessment Survey

BACKGROUND

The field of Advanced Heart Failure and Transplant Cardiology has evolved greatly since it was first established. We sought to elicit program directors' and fellows' viewpoints on potential curricular deficits so we can better meet the educational goals of current and future fellows.

METHODS AND RESULTS

We surveyed advanced heart failure and transplant cardiology program directors and fellows concerning their perceptions of the current adequacy of training and their desire for additional training needed to achieve medical competency in advanced heart failure and transplant cardiology at their institutions, as defined by the 2017 ACC Advanced Training Statement. Survey results identified key competencies deemed to be inadequately addressed during training and those in which a moderate or significant additional amount of training was desired. These competencies were identified within the 4 main domains of the fellowship: heart failure, pulmonary hypertension, mechanical circulatory support, and heart transplantation.

CONCLUSIONS

This study highlights key medical-knowledge competencies that are inadequately addressed by current fellowship training in advanced heart failure and transplant cardiology. Fellowship programs should develop curricula that focus on the integration of these competencies into training to ensure that fellows are well equipped to care for patients.

[Cardiologist training in Chile and contributions from the Chilean Society of Cardiology and Cardiovascular Surgery]

The Chilean Society of Cardiology and Cardiovascular Surgery (SOCHICAR) is a scientific society whose mission is to improve the nation's cardiovascular health. Its primary goals include discussing issues affecting the specialty and engaging in various activities that support its advancement. To achieve these goals, numerous educational initiatives are undertaken for health professionals, including physicians in cardiology training programs. Training specialists in Chile is the responsibility of the universities, which design the curriculum and plan the program according to the graduate profile. SOCHICAR seeks to integrate these new generations of cardiologists, setting up tasks that contribute to their training. It seemed relevant to us to state our position as a Scientific Society in importants aspects related to this process: the graduate profile of the clinical cardiologist, the necessary competencies for their performance nationally, the identification of deficient areas in their training period, and the Society's contributions to this university-dependent process. A total of 15 cardiologists from SOCHICAR, at different stages of professional development, various geographic areas, and areas of performance and functions, were invited to participate in three working groups. This SOCHICAR position statement may be useful and an important source of information to be considered by authorities, accrediting entities, training centers, and the Chilean Society of Cardiology.

Comparative study of AR infographic posters vs. offline videos for micro-video delivery in cardiology education

Augmented reality has promised a new paradigm in medical education. Multimedia videos are the most preferred assent for augmentation. So, this study aimed to assess the effect of using an augmented reality infographic poster for delivering micro-videos on the knowledge and satisfaction of medical students in cardiology rotation. Sixty students participated in this quasi-experimental study and were allocated to three study groups; namely routine method, routine method plus offline micro-video delivery, and routine method plus micro-video delivery in an augmented reality infographic poster. The students' knowledge and satisfaction were evaluated through a multiple-choice question pre and post-test and a satisfaction questionnaire respectively. Within-group comparison of pre and post-test scores showed a significant increase in each study group (all p-values = 0.000). The highest post-test score was for the offline micro-video delivery group and pairwise comparisons of post-test scores showed a significant difference between this group and the control one (p-value = 0.013). Additionally, the augmented reality infographic poster group had the highest satisfaction score (p-value = 0.000). This experience showed the positive effect of micro-videos in clinical education. Although students were satisfied with accessing these videos through an augmented reality infographic poster, their knowledge acquisition was better when they received them offline.