Author + information
- A. Allen Seals, MD, FACC, Chair, ACC Board of Governors∗ ()
- ↵∗Address correspondence to:
A. Allen Seals, MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Fellowship training for a career in cardiology is arguably one of the most intense post-graduate programs in medicine. In most academic centers, general cardiology certification requires professional education in cardiovascular medicine, direct clinical patient care, noninvasive and invasive training, as well as experience in research, with additional years required for training in specific subspecialty fields of cardiovascular medicine. The constant flow of information from newly published basic research and clinical studies, as well as the introduction of innovative technologies, makes these years of fellowship training professionally gratifying, but challenging and sometimes even daunting. As stated by American College of Cardiology (ACC) Past President William Zoghbi, MD, MACC, in his remarks to fellows in training (FITs) at Houston Methodist DeBakey Heart and Vascular Center, “Fellowship is a special time in your career. Fellows should take the opportunity and the challenge to immerse themselves to improve as professionals” (1).
Academic Cardiology Fellowship Training
Over the past 20 years, the ACC has recognized and strongly supported the utilization of the COCATS (Core Cardiology Training Statement) to define the academic, clinical, and technical skills required for proficiency in adult cardiology. The COCATS provides the structure for general cardiology training programs by clearly defining the Accreditation Council for Graduate Medical Education core competencies as well as outlining the specific curriculum content and education/training milestones required of cardiology FITs (2).
However, with the changes in the health care landscape, all of these requirements have evolved over the years. Recognizing the need to include competencies beyond medical knowledge and clinical skills, the most recent iteration of COCATS (COCATS 4) aligns training on the basis of defined outcomes under the 6 domains developed by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties, and endorsed by the American Board of Internal Medicine (ABIM). These domains include interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice (3). As stated by JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC, “COCATS 4 emphasizes comprehensively training our cardiology fellows to be the best, most well-rounded doctors, which is critical to the future of their careers, clinical cardiac care, the health of our patients, and the advancement of our field of cardiovascular medicine” (4).
For the cardiology FIT, COCATS 4 translates into 3 levels of training in clinical cardiology.
Level I is defined as post-graduate education in all clinical disciplines that define consultative cardiology. In general, all cardiology FITs are expected to have demonstrated competency in Level I training. Level II is defined as additional training in 1 or more areas of specific diagnostic tests and procedures and/or advanced education in specialized care for specific patients and conditions. Level III is defined as highly specialized training to provide the FIT with the high level of expertise mandatory for a subspecialized career or a career in research cardiology. Additionally, for FITs, the Cardiovascular Disease Certification Examination by the ABIM (“Cardiology Boards”) remains an accepted requirement for the initial demonstration of academic knowledge and forms the initial base for ABIM’s Maintenance of Certification (MOC) Part III requirements.
From the perspective of current FITs and early career (EC) cardiologists, today’s professional education in cardiovascular medicine has been described as a fast-paced, demanding, and comprehensive experience. Cardiology FITs must demonstrate a commitment to a rigorous program of post-graduate medical education as well as a commitment of time measured in years. As noted by Georges Ephrem, MD, MSc, “If we consider an average age of graduation from high school of 18 years, 4 years of undergraduate studies with pre-medical requirements, 4 years of medical school, 3 years of internal medicine residency, and 3 years of general cardiology fellowship, we find 32-year-old individuals with sizable student loans pending, looking at more years of training [for Level II and Level III]” (5). In fact, the majority of FITs can expect to be closer to the age of 40 after formal cardiology training. However, as pointed out in this same publication, FIT and EC cardiologists rapidly recognize that they are entering a “career of lifelong learning, not lifelong training” (5).
ACC Developing Nonclinical Competencies
In addition to the formalized education and training outlined in COCATS 4, the ACC has focused on providing FITs with opportunities to further develop nonclinical competencies, such as professionalism, communication, practice-based learning, and systems-based practice. Shashank S. Sinha, MD, and Michael W. Cullen, MD, have described the power of professional societies in the development of nonclinical competencies, and have summarized the unique position of the ACC to complement the traditional post-graduate educational experience (6).
The ACC has developed programs for FIT nonclinical proficiency under the general framework of mentorship, leadership, and teamwork. The College’s mentorship program, developed in concert with the EC Member Section and Leadership Council, pairs FITs and EC members with more experienced mentors to guide their career transitions. In addition to this formal mentorship program, an informal network between FITs and senior cardiologists has emerged at ACC educational events, including the Leadership Forum and Annual Scientific Session. The ACC Leadership Academy, now in its second year, provides aspiring FIT and EC leaders with a 2-year formal hands-on training and skills program that can be applied to leadership positions within their training programs, their current or future hospital or practice setting, and/or within the ACC itself. With respect to leadership skills, former ACC President, Pat O’Gara, MD, MACC, has stated: “To truly realize [the College’s] reach and to understand its mission, value and potential, you must invest time, involve others, consult mentors, seek consensus, and promote the careers and aspiration of those who follow” (7). The ACC firmly believes that these leadership skills will be particularly important in a team-based care environment where reimbursement will be tied to improved outcomes and quality of care. Understanding how to lead within a team of cardiovascular care providers managing the long-term care of complex cardiovascular patients will be critical for the next generation of cardiovascular professionals (8).
In addition, the College has developed educational programs and tools to help inform the next generation of cardiovascular professionals about the importance of professionalism. The ACC’s Medical Professionalism MOC Part II module has gained considerable attention from ACC members, as well as from nearly 30 other medical specialty societies. This online education module allows participants to earn MOC credits by answering questions on the topic of medical professionalism, including integrity and accountability, fair and ethical use of health care resources, self-regulation, and commitment to excellence (9).
The ACC FIT Section
The College’s FIT Section has evolved from a “working group” into a separate formally recognized section, and now indeed it is a section of prominence, with over 5,500 members today. The FIT Section has produced an impressive variety of educational programming for its members and is a training resource unto itself, allowing FITs to extend their academic education into areas that are synergistic with their basic clinical programs.
For example, the FIT Section contributed to several high-quality sessions during this year's Annual Scientific Session (ACC.16), expanded online learning opportunities on topics ranging from advocacy to career development, and has developed a growing cadre of FIT leaders who contribute regular content of interest to FITs on ACC’s online FIT Section Page (www.ACC.org/FIT). In addition, the section produces a popular monthly webinar series, “FITs on the GO,” featuring video interviews from major cardiovascular meetings. In its initial debut, the FIT Jeopardy competition has emerged as an extremely exciting and successful educational event. The FIT Jeopardy has facilitated and encouraged FIT engagement with their respective state chapters. Importantly, numerous scholarships and travel awards have generously been provided from various sources to provide support for FITs to attend ACC educational conferences.
ACC state chapters are another vital resource for FITs. Almost all chapters have an FIT representative on their respective leadership councils, and many key state chapter committees also include FIT representation. Additionally, a number of chapters include opportunities for FIT research presentations at their annual meetings, and new International Chapter Exchange Programs between ACC’s domestic and international chapters are increasingly providing opportunities for FITs to be involved in educational and research-related collaboration with their colleagues in other countries.
Advocacy stands out as another example where FITs can build nonclinical competencies through effective and meaningful involvement. At the ACC Legislative Conference, FITs have the opportunity to participate along with other ACC members in meetings with members of Congress on Capitol Hill, oftentimes delivering a viewpoint from a cardiology professional at the beginning of their medical career. This perspective has assisted members of Congress to better understand the long-term implications of federal policy involving health care reform, physician value-based reimbursement, cardiovascular research funding, team-based care, and other ACC advocacy issues. State-level advocacy also provides opportunities for FITs to enhance leadership skills and participate in important chapter-driven advocacy objectives.
In a rapidly changing medical environment, there is a pressing need to ensure that the next generation of cardiovascular professionals are prepared both clinically and nonclinically. The ACC will continue to work with academic training programs to align the competencies outlined in COCATS 4 with important nonclinical competencies. The ACC has placed a high priority on assisting FITs to develop these lifelong nonclinical proficiencies associated with a successful professional cardiovascular career. The ACC firmly believes that productive engagement with FIT and EC cardiologists in the early stages of professional development will undoubtedly lead to meaningful improvements in patient outcomes and will ultimately fulfill our mission to transform cardiovascular care and improve heart health as we head into the future.
- American College of Cardiology Foundation
- Sandoval Y.
- ↵(2015) ACC 2015 Core Cardiovascular Training Statement (COCATS 4) (Revision of COCATS 3): a report of the ACC Competency Management Committee. J Am Coll Cardiol 65:1721–1723.
- Sinha S.S.,
- Julien H.M.,
- Krim S.R.,
- et al.
- American College of Cardiology
- Ephrem G.
- Sinha S.S.,
- Cullen M.W.
- O'Gara P.T.
- American College of Cardiology
- American College of Cardiology