New training guidance for interventional cardiology
The American College of Cardiology, the American Heart Association and the Society for Cardiovascular Angiography and Interventions have jointly issued a clinical document outlining competency-based training requirements for interventional cardiology trainees. This is the first document of its kind to define the training requirements for the full breadth of interventional cardiology for adults, which lay the foundation for coronary interventions, peripheral vascular (PVI) and structural heart interventions (SHI).
Advanced Training Statements describe the necessary learning experiences and outcomes needed to achieve competency in a subspecialty area of cardiology through a structured training program.
“With this groundbreaking document, the writing committee provides a roadmap for both program directors and interventional cardiology trainees to help them progress through important training milestones,” said Theodore A. Bass, MD, chair of the Advanced Training Statement writing committee. “The document defines the required competencies for the full scope of interventional cardiology, providing trainees for the first time with the information to support training across all these areas.”
The training pathway for cardiovascular fellows to gain the necessary experience in interventional cardiology includes: 1) a three-year general cardiovascular disease fellowship (successful completion consists of Level I competency in all aspects of cardiovascular medicine and Level II competency in diagnostic cardiac catheterization to pursue interventional cardiology training); 2) a one-year accredited interventional cardiology fellowship, the focus of which is coronary intervention with the opportunity to gain procedural experience in various aspects of PVI or SHI (Level III competency); and 3) an option for additional post-fellowship training based on the trainee’s career goals.
Level III training aims to give interventional cardiology trainees a well-rounded, competency-based education, including didactic instruction, clinical experience in the diagnosis and care of patients, and hands-on procedural experience. Competency requirements are defined using the Accreditation Council for Graduate Medical Education’s six competency domains: Medical Knowledge; Patient Care and Procedural Skills; Practice-Based Learning and Improvement; Systems-Based Practice; Interpersonal and Communication Skills; and Professionalism. These competencies are essential for all interventional cardiology trainees, as well as additional select competencies in PVI and SHI for trainees based on career focus.
To support the attainment of competencies, the writing committee recommends a minimum of 250 interventional cardiology procedures. Of the 250 procedures, 200 should be coronary procedures, with the remaining 50 specialized in coronary, PVI or SHI, which allows the fellows to customize training based on their career goals. Adjunctive procedures related to physiologic assessment and intracoronary imaging are also required (25 of each). These minimum numbers are meant to provide trainees with exposure to a variety and spectrum of complexity of clinical case material and give supervising faculty sufficient opportunity to evaluate trainees’ competency.
Trainees must also acquire experience working as part of a multidisciplinary team to provide a holistic approach to patient care. The document also highlights the importance of cardiovascular health equity, mentorship and lifelong learning beyond initial training.
The “2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions)” will be published simultaneously in the Journal of the American College of Cardiology, Circulation: Cardiovascular Interventions, and the Journal of the Society of Cardiovascular Angiography and Interventions.
The statement was developed in collaboration with and endorsed by the American Association for Thoracic Surgery, the American Society of Echocardiography, the Heart Failure Society of America, the Heart Rhythm Society, the Society of Cardiovascular Anesthesiologists, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, the Society of Thoracic Surgeons and the Society for Vascular Medicine.
2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions), Journal of the American College of Cardiology (2023). DOI: 10.1016/j.jacc.2022.11.002
Journal of the American College of Cardiology
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