Fellowship Training in Cardiology

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 68, NO. 21, 2016

ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 0735-1097/$36.00

PUBLISHED BY ELSEVIER

http://dx.doi.org/10.1016/j.jacc.2016.10.006

LEADERSHIP PAGE

Fellowship Training in Cardiology Finding Synergies Between Academic Program Clinical Competencies and ACC-Developed Nonclinical Competencies A. Allen Seals, MD, FACC, Chair, ACC Board of Governors

F

ellowship training for a career in cardiology

education/training milestones required of cardiology

is arguably one of the most intense post-

FITs (2).

graduate programs in medicine. In most aca-

However, with the changes in the health care land-

certification

scape, all of these requirements have evolved over the

requires professional education in cardiovascular

years. Recognizing the need to include competencies

medicine, direct clinical patient care, noninvasive

beyond medical knowledge and clinical skills, the most

and invasive training, as well as experience in

recent iteration of COCATS (COCATS 4) aligns training

research, with additional years required for training

on the basis of defined outcomes under the 6 domains

in specific subspecialty fields of cardiovascular medi-

developed by the Accreditation Council for Graduate

cine. The constant flow of information from newly

Medical Education and the American Board of Medical

published basic research and clinical studies, as well

Specialties, and endorsed by the American Board of

as the introduction of innovative technologies, makes

Internal Medicine (ABIM). These domains include

these years of fellowship training professionally grat-

interpersonal and communication skills, profession-

ifying, but challenging and sometimes even daunting.

alism, practice-based learning and improvement, and

As stated by American College of Cardiology (ACC)

systems-based practice (3). As stated by JACC Editor-

Past President William Zoghbi, MD, MACC, in his

in-Chief Valentin Fuster, MD, PhD, MACC, “COCATS 4

remarks to fellows in training (FITs) at Houston

emphasizes comprehensively training our cardiology

Methodist DeBakey Heart and Vascular Center,

fellows to be the best, most well-rounded doctors,

“Fellowship is a special time in your career. Fellows

which is critical to the future of their careers, clin-

should take the opportunity and the challenge to

ical cardiac care, the health of our patients, and

immerse themselves to improve as professionals” (1).

the advancement of our field of cardiovascular

demic

centers,

general

cardiology

medicine” (4).

ACADEMIC CARDIOLOGY

For the cardiology FIT, COCATS 4 translates into 3

FELLOWSHIP TRAINING

levels of training in clinical cardiology.

Over the past 20 years, the ACC has recognized and

clinical disciplines that define consultative cardiol-

strongly supported the utilization of the COCATS

ogy. In general, all cardiology FITs are expected to

(Core Cardiology Training Statement) to define the

have demonstrated competency in Level I training.

academic, clinical, and technical skills required for

Level II is defined as additional training in 1 or more

Level I is defined as post-graduate education in all

proficiency in adult cardiology. The COCATS provides

areas of specific diagnostic tests and procedures and/

the structure for general cardiology training programs

or advanced education in specialized care for specific

by clearly defining the Accreditation Council for

patients and conditions. Level III is defined as highly

Graduate Medical Education core competencies as

specialized training to provide the FIT with the high

well as outlining the specific curriculum content and

level of expertise mandatory for a subspecialized

JACC VOL. 68, NO. 21, 2016

Seals

NOVEMBER 29, 2016:2376–8

Leadership Page

career or a career in research cardiology. Additionally,

Leadership Academy, now in its second year, pro-

for FITs, the Cardiovascular Disease Certification

vides aspiring FIT and EC leaders with a 2-year formal

Examination by the ABIM (“Cardiology Boards”)

hands-on training and skills program that can be

remains an accepted requirement for the initial

applied to leadership positions within their training

demonstration of academic knowledge and forms the

programs, their current or future hospital or practice

initial base for ABIM’s Maintenance of Certification

setting, and/or within the ACC itself. With respect to

(MOC) Part III requirements.

leadership skills, former ACC President, Pat O’Gara,

From the perspective of current FITs and early

MD, MACC, has stated: “To truly realize [the College’s]

career (EC) cardiologists, today’s professional educa-

reach and to understand its mission, value and

tion in cardiovascular medicine has been described as

potential, you must invest time, involve others, con-

a fast-paced, demanding, and comprehensive expe-

sult mentors, seek consensus, and promote the careers

rience. Cardiology FITs must demonstrate a commit-

and aspiration of those who follow” (7). The ACC

ment to a rigorous program of post-graduate medical

firmly believes that these leadership skills will be

education as well as a commitment of time measured

particularly important in a team-based care environ-

in years. As noted by Georges Ephrem, MD, MSc, “If

ment where reimbursement will be tied to improved

we consider an average age of graduation from high

outcomes and quality of care. Understanding how to

school of 18 years, 4 years of undergraduate studies

lead within a team of cardiovascular care providers

with pre-medical requirements, 4 years of medical

managing the long-term care of complex cardiovas-

school, 3 years of internal medicine residency, and

cular patients will be critical for the next generation of

3 years of general cardiology fellowship, we find

cardiovascular professionals (8).

32-year-old individuals with sizable student loans

In addition, the College has developed educational

pending, looking at more years of training [for Level

programs and tools to help inform the next generation

II and Level III]” (5). In fact, the majority of FITs can

of cardiovascular professionals about the importance

expect to be closer to the age of 40 after formal car-

of professionalism. The ACC’s Medical Professional-

diology training. However, as pointed out in this

ism MOC Part II module has gained considerable

same publication, FIT and EC cardiologists rapidly

attention from ACC members, as well as from nearly 30

recognize that they are entering a “career of lifelong

other medical specialty societies. This online educa-

learning, not lifelong training” (5).

tion module allows participants to earn MOC credits by answering questions on the topic of medical profes-

ACC DEVELOPING

sionalism, including integrity and accountability, fair

NONCLINICAL COMPETENCIES

and ethical use of health care resources, self-

In addition to the formalized education and training outlined in COCATS 4, the ACC has focused on

regulation, and commitment to excellence (9).

THE ACC FIT SECTION

providing FITs with opportunities to further develop nonclinical competencies, such as professionalism,

The College’s FIT Section has evolved from a

communication,

and

“working group” into a separate formally recognized

systems-based practice. Shashank S. Sinha, MD, and

section, and now indeed it is a section of prominence,

Michael W. Cullen, MD, have described the power of

with over 5,500 members today. The FIT Section has

professional

of

produced an impressive variety of educational pro-

nonclinical competencies, and have summarized the

gramming for its members and is a training resource

unique position of the ACC to complement the tradi-

unto itself, allowing FITs to extend their academic

tional post-graduate educational experience (6).

education into areas that are synergistic with their

practice-based

societies

in

the

learning,

development

The ACC has developed programs for FIT nonclin-

basic clinical programs.

ical proficiency under the general framework of

For example, the FIT Section contributed to several

mentorship, leadership, and teamwork. The College’s

high-quality sessions during this year’s Annual Sci-

mentorship program, developed in concert with the

entific Session (ACC.16), expanded online learning

EC Member Section and Leadership Council, pairs

opportunities on topics ranging from advocacy to

FITs and EC members with more experienced men-

career development, and has developed a growing

tors to guide their career transitions. In addition to

cadre of FIT leaders who contribute regular content of

this formal mentorship program, an informal network

interest to FITs on ACC’s online FIT Section Page

between FITs and senior cardiologists has emerged

(www.ACC.org/FIT). In addition, the section pro-

at ACC educational events, including the Leader-

duces a popular monthly webinar series, “FITs on

ship Forum and Annual Scientific Session. The ACC

the GO,” featuring video interviews from major

2377

2378

Seals

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NOVEMBER 29, 2016:2376–8

cardiovascular meetings. In its initial debut, the FIT

policy involving health care reform, physician value-

Jeopardy competition has emerged as an extremely

based reimbursement, cardiovascular research fund-

exciting and successful educational event. The FIT

ing, team-based care, and other ACC advocacy issues.

Jeopardy has facilitated and encouraged FIT engage-

State-level advocacy also provides opportunities for

ment with their respective state chapters. Impor-

FITs to enhance leadership skills and participate in

tantly, numerous scholarships and travel awards have

important chapter-driven advocacy objectives.

generously been provided from various sources to provide support for FITs to attend ACC educational

SUMMARY

conferences. ACC state chapters are another vital resource for

In a rapidly changing medical environment, there is a

FITs. Almost all chapters have an FIT representative

pressing need to ensure that the next generation of

on their respective leadership councils, and many key

cardiovascular professionals are prepared both clini-

state chapter committees also include FIT represen-

cally and nonclinically. The ACC will continue to work

tation. Additionally, a number of chapters include

with academic training programs to align the com-

opportunities for FIT research presentations at their

petencies outlined in COCATS 4 with important

annual meetings, and new International Chapter

nonclinical competencies. The ACC has placed a high

Exchange Programs between ACC’s domestic and

priority on assisting FITs to develop these lifelong

international chapters are increasingly providing

nonclinical proficiencies associated with a successful

opportunities for FITs to be involved in educational

professional cardiovascular career. The ACC firmly

and research-related collaboration with their col-

believes that productive engagement with FIT and EC

leagues in other countries.

cardiologists in the early stages of professional

Advocacy stands out as another example where

development will undoubtedly lead to meaningful

FITs can build nonclinical competencies through

improvements in patient outcomes and will ulti-

effective and meaningful involvement. At the ACC

mately fulfill our mission to transform cardiovascular

Legislative Conference, FITs have the opportunity to

care and improve heart health as we head into the

participate along with other ACC members in meetings

future.

with members of Congress on Capitol Hill, oftentimes delivering a viewpoint from a cardiology professional

ADDRESS CORRESPONDENCE TO: A. Allen Seals,

at the beginning of their medical career. This

MD, FACC, American College of Cardiology, 2400 N

perspective has assisted members of Congress to bet-

Street NW, Washington, DC 20037. E-mail: chapters@

ter understand the long-term implications of federal

acc.org.

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2. ACC 2015 Core Cardiovascular Training Statement (COCATS 4) (Revision of COCATS 3): a report

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of the ACC Competency Management Committee. J Am Coll Cardiol 2015;65:1721–3.

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