MedStar Educators Investigate the Impact of Training Statement on Cardiology Fellowships

Recent research from MedStar Health investigators and educators sought to understand the impact and perception of a newly implemented training statement for cardiovascular education. The research was the first to collect data from program directors in cardiology fellowships on how they understand and implement the new training guidelines.

The research as published in Journal of the American College of Cardiology. The research team was led by Gaby Weissman, MD, and included Alex J. Auseon, DO; James A. Arrighi, MD; Lisa A. Mendes, MD; Paul Theriot, BSBA; Marty C. Tam, MD; and Julie B. Damp, MD.

American College of Cardiology wanted to address the rapid advancement of knowledge for treating cardiovascular disease. Initially developed in 1995, the Core Cardiovascular Training Statement (COCATS), provided a uniform set of curricular recommendations for training in cardiovascular disease. The most recent iteration, COCATS4, differs from previous versions in that it added elements of competency-based medical education as well as adding new domains of knowledge such as critical care cardiology and it changed the duration of training that needed to be devoted to gaining clinical skills and knowledge. 

Of the 229 cardiovascular disease training programs based in the United States, 130 (57%) responded to the survey over a month-long period. Each program self-reported their size based on fellows (small to large, one through 18+) and program type (university hospital-based, community hospital/university-affiliated, community-based, or military hospital).

Half of the program directors found the guidelines to be helpful in assessing competency, with an additional 30% finding it somewhat useful. Many program directors (57%) found the COCATS4 guidelines to be extremely useful, with an additional 35% finding it somewhat useful. The majority of program directors (69%) found that the COCATS4 guidelines are better aligned with the needs of today’s job market.

Despite the new guidelines, almost one-half (45%) of programs had made no significant changes since the release of COCATS4, however 22% of programs increased the number of clinical months, 8% decreased the number of clinical months, and 11% increased the number of required echocardiography months. 57% of responding programs indicated that resource limitations impacted the lack of direct clinical experience. This included lack of subspecialty programs within their institutions. Another important finding was that over half of programs reported that they lacked the ability to deliver direct clinical experience in at least one domain of cardiovascular care. 

This research helped to identify gaps in training programs based on the guidelines, finding that programs may need to utilize alternative educational experiences to ensure that their fellows are meeting the guidelines. This data can be used as a comparison for future research, as it can create a benchmark of training programs. Importantly, it should serve as a call for national organizations to help fill in the educational gaps that cardiology training programs may have.

Journal of the American College of Cardiology, 2019. DOI: 10.1016/j.jacc.2019.03.488