American College of Cardiology Training Directors Symposium: ACC 06

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American College of Cardiology Training Directors
Symposium ACC 06

• Update on the Bethesda Conference 35 proposal
  for a new cardiology training paradigm

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Bethesda Conference 35

• Growing cardiologist demand-supply mismatch
• Particular need for clinical cardiologists
• Under-representation of women and minorities in
  cardiology and in cardiology training programs
• Duration of training and debt of trainees
• Increasing complexity within cardiology

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Bethesda Conference 35 Priority Recommendations

• Development of short track clinical training
  model
• Filling of all ACGME-approved cardiology training
  positions
• Fostering the training of the clinical
  cardiologist
• Promote cardiovascular team models through local
  chapters

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Bethesda Conference 35 Priority Recommendations

• Development of short track clinical training
  model
• Filling of all ACGME-approved cardiology training
  positions
• Fostering the training of the general
  cardiologist
• Promote cardiovascular team models through local
  chapters

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Short Track Models for Training General Clinical
Cardiologists
Certification ABIM ABIM-CVD
IM
Clinical Cardiology
IM
Clinical CV Medicine
Clinical Cardiology
Incl. focused rotations in Endocrinology, Clin.
Pharm, Clin. Res.
COCATS II
Core Training In IM
Certification ABIM ABIM-CVD
IM
Clinical Cardiology
IM
Clinical Cardiology
Clinical Cardiology
ACGME/COCATS II
Core Training In IM
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A COMBINED FIVE-YEAR INTERNAL MEDICINE-
CARDIOLOGY TRAINING PARADIGM
Certification ABIM ABIM-CVD
IM
Clinical Cardiology
IM
Clinical Cardiology
Clinical Cardiology
ACGME/COCATS II
Core Training In IM
Includes additional experience metabolic
syndrome/diabetes/lipid management, preventive
cardiology.
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CV Short Track Paradigm

• Letter of introduction to ABIM, July 2004
• Concept presented at ABIM Foundation retreat and
  to CEOs of IM organizations
• ACC in-person presentation to ABIM, February 2005
• More detailed paradigm sent to ABIM-CV board,
  March 2005

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IM ACGME Requirements Met In IM/CV Short Track

• Minimum 12 mos in-patient experience
• Minimum 3 mos critical care
• Minimum 1 mo Emergency Medicine
• Inclusion of geriatrics, neurology, and specified
  IM subspecialties
• Didactic/conference yearly requirements

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IM ACGME Requirements Not Met By 2-3 Paradigm

• 24 v 36 mos total training duration
• At least one-third of training in ambulatory
  setting.
  
• IM continuity clinic and conference curriculum 24
  v 36 mos
• Modified experiences in one or more psychiatry,
  dermatology, medical opthomology, office
  gynecology, ENT, non-operative orthopaedics.

(But additional experience 3 yr CV)
( 3 yrs CV)
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IM ACGME Requirements Not Met By 2-3 Paradigm

• 24 v 36 mos total training duration
• At least one-third of training in ambulatory
  setting.
  
• IM continuity clinic and conference curriculum 24
  v 36 mos
• Modified experiences in one or more psychiatry,
  dermatology, medical opthomology, office
  gynecology, ENT, non-operative orthopaedics.

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IM Additional Rotation Consequences of Short
Track

• Reduced elective rotations
• Reduced schedule flexibility
• Reduced number of senior IM residents

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CV ACGME Requirements Met In Short Track Paradigm

• All current clinical and didactic requirements
• Level II echocardiography competency
• Increased experience in preventive cardiology,
  diabetes/metabolic syndrome/lipid management
• Scholarly activity (but limited protected
  research time)

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ACC Training Directors- Presentations and Input

• Bethesda Task Force representation 03
• ACC Training Directors Committee 03, 04
• ACC Training Directors Symposia 03, 04
• Association of Professors of Cardiology 04
• ACC Training Directors Symposia- 05

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Training Directors Responses

• Initially mixed, but growing support for the
  concept
• Concern about increased curricular needs within
  cardiology, and desires of trainees
• Avoidance of two classes of cardiologists
• Timing of candidates career decisions, and
  programs selection of trainees
• Blended year service coverage and curriculum
  control

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CV Short Track Paradigm

• ABIM-CV board approved forwarding the proposal to
  the ABIM Board of Directors subcommittee on
  training- March 2005
• Concept proposal not accepted by the
  subcommittee, unless in context of broader
  re-design of IM training.
• AAIM/ABIM Retreat Recognizing Focused Practice
  and Redesigning the Educational Continuum-
  December 2005

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5) SHORT TRACKS FOR CERTIFICATION IN INTERNAL
MEDICINE AND ITS SUBSPECIALTIES
Core Training Advanced Training Certification/Adde
d Qualifications Primary
care Certification in internal training (1
year) Medicine and AQ
in Adult Office
Medicine Inpatient training Certification in
Internal (1 year) Medicine and AQ in Adult

Hospital Medicine
Subspecialty Certification in
internal or other training Medicine
Certification in (1-4 years) subspecialty
(and/or AQ)
Medicine Core (2 years)
L Goldman. Am J Med 2004 117133
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Alliance for Academic Internal Medicine/ American
Board of Internal Medicine

• Stakeholder Retreat, December 2005

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AAIM/ABIM Retreat Key Issues

• Recognition of focused practice within general IM
  in hospital medicine, comprehensive ambulatory
  medicine, or both
• Redesigning IM training to attract the best into
  careers in IM.
• Related issue preparation of residents to enter
  subspecialty training

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AAIM/ABIM Retreat/ APM Recommendations

• Internal Medicine training duration should remain
  3 years
• IM core competencies should be specifically
  defined, along with more structured mechanisms to
  evaluate them
• Ability to complete core competencies during
  first 2 IM years

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AAIM/ABIM Retreat/ APM Recommendations, cont

• Third IM year more flexible and focused on
  specific career goals (e.g. hospital or
  ambulatory medicine, subspecialty)
• Third year could contain experiences that count
  both toward IM and subspecialty required
  competencies (jointly established by the IM and
  CV training directors)

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Additional ABIM/AAIM Retreat Recommendations

• ABIM should pursue certification policy that
  permits shortening of the overall time to
  subspecialty certification, without diminishing
  the 3 years initial IM requirement.
• ABIM should develop methods to include core IM
  knowledge in each subspecialty and added
  qualification examination

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• Represents evolving desire of ABIM to move from
  time-based to competency-based certification.
• ABIM invitation for ACC to work with them toward
  further development of specifics of
  curriculum/competency for shortening CV training.

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ACC Taskforce on Workforce

• Appointed 2001
• Bethesda Conference 35, Cardiology Workforce,
  October 2003
• Report endorsed by ACC Board of Trustees, March
  2004