Author + information
- Eric S. Williams, MD, MACC, Chair, Writing Committee Member,
- Jonathan L. Halperin, MD, FACC, Co-Chair, Writing Committee Member,
- James A. Arrighi, MD, FACC, Writing Committee Member,
- Eric H. Awtry, MD, FACC, Writing Committee Member,
- Eric R. Bates, MD, FACC, Writing Committee Member,
- Salvatore Costa, MD, FACC, Writing Committee Member,
- Rosario Freeman, MD, MS, FACC, Writing Committee Member,
- John A. McPherson, MD, FACC, Writing Committee Member,
- Lisa A. Mendes, MD, FACC, Writing Committee Member,
- Thomas Ryan, MD, FACC, Writing Committee Member,
- Chittur A. Sivaram, MBBS, FACC, Writing Committee Member and
- Howard H. Weitz, MD, FACC, Writing Committee Member
- ACC Competency Statement
- clinical competency
- general cardiologist
- interpersonal and communication skills
- lifelong learning
- maintenance of competence
- medical knowledge
- patient care
- practice-based learning and improvement
- procedural care
- systems-based practice
ACC Competency Management Committee
Eric S. Williams, MD, MACC, Chair
Jonathan L. Halperin, MD, FACC, Co-Chair
James A. Arrighi, MD, FACC
Eric H. Awtry, MD, FACC
Eric R. Bates, MD, FACC
John E. Brush, Jr, MD, FACC
Salvatore Costa, MD, FACC
Lori Daniels, MD, MAS, FACC
Susan Fernandes, LPD, PA-C
Rosario Freeman, MD, MS, FACC
Sadiya S. Khan, MD
Jeffrey T. Kuvin, MD, FACC
Joseph E. Marine, MD, FACC
John A. McPherson, MD, FACC
Lisa A. Mendes, MD, FACC
Chittur A. Sivaram, MBBS, FACC
Robert L. Spicer, MD, FACC
Andrew Wang, MD, FACC, FAHA
Howard H. Weitz, MD, FACC
Table of Contents
1. Introduction 2658
1.1. Document Development Process 2658
1.1.1. Writing Committee Organization 2658
1.1.2. Document Development and Approval 2658
1.2. Background and Scope 2659
Table 1. Framework of Cardiovascular Competencies for Lifelong Learning 2659
Table 2. Entrustable Professional Activities for Subspecialists in Cardiovascular Disease 2659
1.2.1. Lifelong Learning Competencies 2659
Table 3. ACGME Core Competencies 2660
1.2.2. Assessment Tools 2660
1.2.3. Research and Scholarly Activity 2660
2. Clinical Competencies 2660
Table 4. Ambulatory, Consultative, and Longitudinal Cardiovascular Care Lifelong Learning Competencies 2661
Table 5. Cardiovascular Disease Prevention Lifelong Learning Competencies 2663
Table 6. ECG/Ambulatory ECG Testing Lifelong Learning Competencies 2664
Table 7. Exercise ECG Testing Lifelong Learning Competencies 2665
Table 8. Echocardiography Lifelong Learning Competencies 2666
Table 9. Nuclear Cardiology Lifelong Learning Competencies 2668
Table 10. Cardiovascular Computed Tomography Lifelong Learning Competencies 2669
Table 11. Cardiovascular Magnetic Resonance Lifelong Learning Competencies 2670
Table 12. Invasive Cardiology Lifelong Learning Competencies 2671
Table 13. Stable Ischemic Heart Disease Lifelong Learning Competencies 2672
Table 14. Acute Coronary Syndromes Lifelong Learning Competencies 2674
Table 15. Valvular Heart Disease Lifelong Learning Competencies 2676
Table 16. Heart Failure Lifelong Learning Competencies 2678
Table 17. Pericardial Disease Lifelong Learning Competencies 2680
Table 18. Vascular Medicine Lifelong Learning Competencies 2681
Table 19. Cardiac Arrhythmias and Electrophysiology Lifelong Learning Competencies 2683
Table 20. Critical Care Cardiology Lifelong Learning Competencies 2685
Table 21. Adults With Simple Congenital Heart Disease (Atrial Septal Defects, Ventricular Septal Defects, Patent Ductus Arteriosus, Pulmonary Stenosis, Bicuspid Aortic Valve, Coarctation) Lifelong Learning Competencies 2687
Table 22. Adults With Complex Congenital Heart Disease (Ebstein’s Anomaly, Tetralogy of Fallot, Complex Cyanotic Congenital Heart Disease, Transposition of the Great Arteries, Single-Ventricle Physiology/Fontan) Lifelong Learning Competencies 2688
Table 23. Additional Professional Behavior Competencies Relevant to All Clinical Areas 2689
3. Leadership and Administrative Competencies 2690
Table 24. Leadership and Administrative Competencies 2690
Author Relationships With Industry and Other Entities (Relevant) 2693
Reviewer Relationships With Industry and Other Entities (Relevant) 2694
ECG Core Competencies: Pattern and Arrhythmia Recognition 2695
Beginning with publication of the first Core Cardiovascular Training Statement (COCATS) in 1995, the American College of Cardiology (ACC) has played a central role in defining the knowledge, experiences, skills, and behaviors expected of adult clinical cardiologists upon completion of fellowship training. Subsequent updates have incorporated major advances and revisions—both in structure and content—including, most recently, a transition to training based on competency outcomes under the 6 domains promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) and endorsed by the American Board of Internal Medicine (ABIM). Many hospital systems now use the 6-domain structure as part of medical staff privileging, professional competence assessments, and peer review. The ACC endorses a similar structure to align the competencies and lifelong learning objectives that all practicing cardiologists are expected to maintain throughout their careers.
The ACC Competency Management Committee (CMC) oversees the development and periodic revision of cardiovascular training and competency statements pertaining to general cardiology and advanced training in various areas for which there are ABIM added-qualification designations. Whereas COCATS focuses on general clinical cardiology, ACC advanced training statements define selected competencies beyond those expected of all cardiologists and that require training beyond a standard 3-year general cardiovascular fellowship. These include sub-subspecialties for which there are ABIM added-qualification designations, such as clinical cardiac electrophysiology, interventional cardiology, heart failure, and adult congenital heart disease. The advanced training statements also describe key experiences and outcomes necessary to maintain or expand competencies during practice.
A key feature of competency-based training and performance is an outcome-based evaluation system. All ACC competence and training statements, therefore, include examples of tools that can be used to assess achievement of the individual components of competency. Recommendations in these statements are based on available evidence and, where evidence is lacking, reflect expert opinion. The writing committees reflect the diversity of clinical cardiology, and typically include content experts, general cardiology and sub-subspecialty training program directors, practicing cardiologists, and early-career representatives. All documents are subject to rigorous peer review. Recommendations are intended to guide the assessment of the competence of cardiovascular care providers beginning independent practice as well as of those undergoing periodic review to help ensure that competence is maintained.
This Competency Statement complements the basic training in cardiovascular medicine required of all trainees during the standard 3-year cardiovascular fellowship by focusing on the core competencies reasonably expected of all general cardiologists throughout the span of their careers. It also identifies certain aspects of cardiovascular medicine that exceed core expectations and may be maintained or achieved by some general cardiologists, depending on their background and practice focus. This document provides examples of appropriate measures for assessing competence in the context of lifelong learning.
Writing committee members volunteered their time for this effort, which was supported exclusively by the ACC without commercial involvement. Meetings and conference calls were confidential and attended only by committee members. To avoid actual, potential, or perceived conflict of interest arising as a result of relationships with industry or other entities (RWI) on the part of writing committee members or peer reviewers of the document, each individual was required to disclose all current healthcare-related relationships, including those existing 12 months before initiation of the writing effort. The ACC Competency Management Committee determined that RWI were not relevant to the creation of a general cardiology competence statement but provided employment and affiliation information for authors and peer reviewers in Appendixes 1 and 2, respectively, along with disclosure reporting categories. In addition, to ensure transparency, comprehensive health care–related disclosure information, including relationships with industry and other entities (RWI) not pertinent to this document, has been posted online. Disclosure information for the ACC Competency Management Committee is also available online, as is the ACC disclosure policy for document development.
Eric S. Williams, MD, MACC
Chair, ACC Competency Management Committee
Jonathan L. Halperin, MD, FACC
Co-Chair, ACC Competency Management Committee
1.1 Document Development Process
1.1.1 Writing Committee Organization
The writing committee was selected by the American College of Cardiology (ACC) and included cardiovascular training program directors, cardiology clinic directors, early career cardiovascular disease prevention experts, experienced specialists representing both the academic and community-based practice settings, and physicians experienced in defining and applying training standards according to the core competencies structure promulgated by the ACGME and ABMS and endorsed by the ABIM. The writing committee met the College's disclosure requirements for RWI as described in the Preamble.
1.1.2 Document Development and Approval
The writing committee initially adapted the 20 competency tables in COCATS 4 (1–16) to align with the lifelong learning environment that defines the practice of general clinical cardiology. Individual tables were then sent to the corresponding COCATS authoring groups for review and commentary. The writing committee reviewed this feedback and revised the tables to ensure applicability to general cardiologists in practice, including competencies pertinent to practice focus, and establish continuity across all tables. The writing committee then compiled the tables, aggregated a common set of professional behavior competencies (Systems-Based Practice, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism), and added Leadership and Administrative competencies in a separate section of the document. The writing committee approved the document for peer review by individuals selected by the ACC (see Appendix 2 for reviewer names, their affiliations in the review process, and their employment information) and simultaneously posted the document for public comment from November 2, 2015 to November 20, 2015. A total of 165 comments were received and addressed by the writing committee to finalize the document.
The final document was approved by the Writing Committee, ACC Competency Management Committee, and ACC Lifelong Learning Oversight Committee, and ratified by the ACC Board of Trustees and Executive Committee in February 2016. This document is considered current until the ACC Competency Management Committee revises, replaces, or withdraws it.
1.2 Background and Scope
In 2010, the ACC began an ambitious initiative to delineate: 1) the core clinical competencies essential for trainees to attain during a 3-year cardiovascular fellowship (COCATS 4); and 2) the aligned competencies that patients and accrediting bodies can reasonably expect clinical cardiologists in practice to acquire, maintain, or enhance through lifelong learning throughout their career. Key features of this outcomes-based curriculum include the 6-domain structure promulgated by the ACGME. The cardiovascular competencies, organized in a topical format (Table 1), provide a structure for the ACC learning pathways and underpin all ACC educational activities.
The first iterations of the core cardiovascular competencies were delineated in 2012. COCATS 4 expanded and updated these, and when published in March 2015, incorporated the new curricular competency format. This document aligns the lifelong learning competencies with the COCATS 4 training milestones. Although the COCATS 4 and lifelong learning competencies are similar, they are not identical, reflecting the impact of practice focus and patterns on expectations of competency. The aggregated lifelong learning competencies collectively underlie the Entrustable Professional Activities (EPAs) that patients and the public can reasonably expect all competent clinical cardiologists to be able to perform (Table 2).
1.2.1 Lifelong Learning Competencies
The lifelong learning competencies for general cardiologists are organized using the 6 domains promulgated by ACGME/ABMS and endorsed by ABIM (see Table 3). Section 2 focuses on clinical competencies, encompassing both the Medical Knowledge competencies and Patient Care and Procedural Skills competencies related to the 18 clinical areas identified in Table 1 (see Tables 4 to 22). These competencies are unique to each clinical area. In addition, Section 2 includes a common set of professional behavior competencies that pertain to all clinical areas (see Table 23), describing competencies for Systems-Based Practice, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism. Section 3 of the document focuses on leadership and administrative competencies that pertain to general clinical cardiologists, highlighting leadership, operational skills, professional identity, and personal balance (see Table 24).
22.214.171.124 Distinction Between Competencies Expected of All Clinical Cardiologists and Those Required Based on the Focus of Practice
All tables distinguish competency components expected of all clinical cardiologists (left column) from those expected of selected clinical cardiologists based on background, specialized knowledge, skills, experience, and practice focus (right column). It is important to note that the practice-focused designation in this document does not refer to the advanced competencies of cardiovascular sub-subspecialties—such as interventional cardiology, cardiac electrophysiology, advanced heart failure, and adult congenital heart disease—that require training beyond the standard training common to all clinical cardiologists. Rather, the practice-focused competencies in this document parallel, and are analogous to, the Level II competencies defined in COCATS 4.
1.2.2 Assessment Tools
There are a number of ways physicians can maintain competency and expand lifelong learning in the course of practice (ensuring currency with the evolving art and science of the field), and assess their own professional needs for education and performance improvement. Objective evaluation of competence in the practice setting can be challenging, but a number of tools are available for this purpose. These include, for example, certified continuing medical education (CME) activities relevant to an individual’s practice, review of practice or hospital data, performance assessment and improvement programs, and facilitated self-reflection. For procedural or diagnostic laboratory activities, assessment tools may include registry and/or hospital data, appropriate use criteria, and metrics developed by professional organizations. Patient surveys and multisource (360°) evaluations in hospital or practice environments can provide information about outcomes, communication skills, and professionalism. The ABIM is evolving a portfolio of professional development offerings, including components designed to facilitate maintenance and assessment of competency.
1.2.3 Research and Scholarly Activity
The topic areas in Table 1 define the core clinical, leadership, and administrative competencies for practicing cardiologists. Scholarly activity and clinical research are also important in lifelong learning and professional competency. All physicians should have the skills to assess new research findings and appropriately incorporate new diagnostic and treatment modalities in patient care. In addition, a scholarly approach is required to evaluate evidence, address clinical questions, and enhance outcomes through literature review, including at the point of care. Knowledge should also be maintained and enhanced through regular reading of journals and other sources of reliable information and through attending scholarly scientific meetings and professional congresses. Referral of patients for participation in well-designed clinical trials is encouraged for both academic and nonacademic cardiologists.
3 Leadership and Administrative Competencies
In addition to clinical competency, cardiologists are expected to function effectively as leaders in allied efforts to assure high-quality care and promote individual and population health. Some of these activities and attributes fall outside the realm of clinical knowledge and skill and instead involve administrative roles in clinical practice, hospitals, health systems, professional societies, or other organizations. Specific competencies expected of all general cardiologists and selected competencies that should be maintained by those whose careers involve greater involvement in administrative, managerial, or advocacy positions are delineated in Table 24.
President and Staff
American College of Cardiology
Kim Allan Williams, Sr, MD, FACC, President
Shalom Jacobovitz, Chief Executive Officer
William J. Oetgen, MD, MBA, FACC, Executive Vice President, Science, Education, Quality, and Publications
Dawn R. Phoubandith, MSW, Director, Competency Management
Kimberly Kooi, MHA, Education Design Associate
Amelia Scholtz, PhD, Publications Manager, Science, Education, Quality, and Publications
Appendix 1 Author Relationships With Industry and Other Entities (Relevant)—2016 ACC Lifelong Learning Competencies for General Cardiologists
Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)—2016 ACC Lifelong Learning Competencies for General Cardiologists
Appendix 3 ECG Core Competencies: Pattern and Arrhythmia Recognition
Appendix 4 Abbreviation
ABIM = American Board of Internal Medicine
ABMS = American Board of Medical Specialties
ACC = American College of Cardiology
ACGME = Accreditation Council for Graduate Medical Education
CME = continuing medical education
COCATS = Core Cardiovascular Training Statement
ECG = electrocardiography
EPA = Entrustable Professional Activities
MET = metabolic equivalent
NSTE-ACS = Non—ST-elevation acute coronary syndrome
STEMI = ST-elevation myocardial infarction
The document was approved by the American College of Cardiology Board of Trustees and Executive Committee in February 2016. For the purpose of transparency, disclosure information for the ACC Board of Trustees, the board of the convening organization of this document, is available at: http://www.acc.org/about-acc/leadership/officers-and-trustees.
The American College of Cardiology requests that this document be cited as follows: Williams ES, Halperin JL, Arrighi JA, Awtry EH, Bates ER, Costa S, Freeman R, McPherson JA, Mendes LA, Ryan T, Sivaram CA, Weitz HH. 2016 ACC lifelong learning competencies for the general cardiologist: a report of the ACC Competency Management Committee. J Am Coll Cardiol 2016;67:2656–2695.
Copies: This document is available on the World Wide Web site of the American College of Cardiology (www.acc.org). For copies of this document, please contact Elsevier. Reprint Department, fax (212) 633-3820, email .
Permissions: modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology. Requests may be completed online via the Elsevier site (http://www.elsevier.com/about/policies/author-agreement/obtaining-permission).
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- ACC Competency Management Committee
- Table of Contents
- 1 Introduction
- 2 Clinical Competencies
- 3 Leadership and Administrative Competencies
- President and Staff
- Appendix 1 Author Relationships With Industry and Other Entities (Relevant)—2016 ACC Lifelong Learning Competencies for General Cardiologists
- Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant)—2016 ACC Lifelong Learning Competencies for General Cardiologists
- Appendix 3 ECG Core Competencies: Pattern and Arrhythmia Recognition
- Appendix 4 Abbreviation