Table 1

Core Competency Components and Curricular Milestones for Training in Invasive Cardiology

Competency ComponentMilestones (Months)
MEDICAL KNOWLEDGE122436Add
1Know the indications/contraindications and potential complications of cardiac catheterization for assessment of coronary, valvular, myocardial, and basic adult congenital heart diseases.I
2Know the principles of radiation safety.I
3Know the use and complications of contrast media and the role of renal protection measures.I
4Know the indications for, and clinical pharmacology of, antiplatelet and anticoagulant drugs and vasopressor and vasodilator agents used in the cardiac catheterization laboratory.I
5Know normal cardiovascular hemodynamics and the principles and interpretation of waveforms, pressure, flow, resistance, and cardiac output measurements.I
6Know the characteristic hemodynamic findings with myocardial, valvular, pericardial, and pulmonary vascular diseases.I
7Know the methods to detect and estimate the magnitude of intracardiac and extracardiac shunts.I
8Know coronary anatomy, its variations and congenital abnormalities, and its coronary blood flow physiology.I
9Know the angiographic features of coronary artery disease and how to assess the anatomic and physiologic severity.I
10Know the vascular anatomy and the indications and contraindications for, and complications of, peripheral vascular angiography.I
11Know the indications and potential complications of percutaneous coronary, peripheral, valvular, and structural heart interventions.I
12Know the indications and contraindications for, and the complications of, endomyocardial biopsy and pericardiocentesis.I
13Know the indications for, and the mechanisms of action of, mechanical circulatory support devices.I
14Know the indications for, and complications of, vascular access and closure strategies and devices.I
EVALUATION TOOLS: conference presentation, direct observation, in-training examination, logbook, and simulation.
PATIENT CARE AND PROCEDURAL SKILLS122436Add
1Skill to perform preprocedural evaluation, assess appropriateness, obtain informed consent, and plan procedure strategy.I
2Skill to perform venous and arterial access and obtain hemostasis.I
3Skill to perform right heart catheterization.I
4Skill to analyze hemodynamic, ventriculographic, and angiographic data and to integrate with clinical findings for patient management.I
5Skill to manage postprocedural patients, including complications and coordination of care.I
6Skill to perform endomyocardial biopsy.II
7Skill to perform pericardiocentesis.II
8Skill to perform diagnostic left heart catheterization, ventriculography, and coronary angiography.II
9Skill to place an intra-aortic balloon pump emergently.II
10Skill to perform diagnostic peripheral (excluding carotid) angiography.II
11Skill to perform percutaneous coronary interventions.III
12Skill to perform peripheral, carotid, valvular, and structural heart interventions.III
13Skill to insert and manage percutaneous left ventricular support devices.III
EVALUATION TOOLS: chart-stimulated recall, conference presentation, direct observation, logbook, and simulation.
SYSTEMS-BASED PRACTICE122436Add
1Coordinate care in an interdisciplinary approach for patient management, including transition of care.I
2Utilize cost-awareness and risk/benefit analysis in patient care.I
EVALUATION TOOLS: chart-stimulated recall, conference presentation, direct observation, and logbook.
PRACTICE-BASED LEARNING AND IMPROVEMENT122436Add
1Locate, appraise, and assimilate information from scientific studies, guidelines, and registries in order to identify knowledge and performance gaps.I
2Document number and outcomes of diagnostic and therapeutic procedures.I
EVALUATION TOOLS: conference presentation, direct observation, logbook, and reflection and self-assessment.
PROFESSIONALISM122436Add
1Practice within the scope of expertise and technical skills.I
2Know and promote adherence to guidelines and appropriate use criteria.I
3Interact respectfully with patients, families, and all members of the healthcare team, including ancillary and support staff.I
EVALUATION TOOLS: conference presentation, direct observation, multisource evaluation, and reflection and self-assessment.
INTERPERSONAL AND COMMUNICATION SKILLS122436Add
1Communicate with and educate patients and families across a broad range of socioeconomic, ethnic, and cultural backgrounds, including obtaining informed consent.I
2Communicate and work effectively with physicians and other professionals on the healthcare team regarding procedure findings, treatment plans, and follow-up care coordination.I
3Complete procedure records and communicate testing results to physicians and patients in an effective and timely manner.I
EVALUATION TOOLS: direct observation and multisource evaluation.

Add = additional months beyond the 3-year cardiovascular fellowship.