Subspecialty training in preventive cardiology: the current status and discoverable fellowship programs

Background:

Preventive cardiology is currently not an American Board of Medical Specialties‐recognized subspecialty. However, several programs offer nonaccredited fellowships throughout the country. No source currently exists listing all available programs, and finding programs requires time‐intensive search strategies. Our aim was to find all current preventive cardiology fellowships in the United States and describe their basic structure, duties, and faculty.

Methods:

We searched the Internet, contacted national organizations, and networked through any institution thought likely to have a fellowship.

Results:

We found 15 programs currently offering subspecialty training in preventive cardiology but with considerably different styles, structures, duties, clinical time, lengths, and hosting departments.

Conclusions:

We provided a list of these programs and discussed the implications for the future of formal subspecialty preventive cardiology education. © 2012 Wiley Periodicals, Inc. Dr. McBride is codirector of one of the fellowship programs listed, but otherwise has no relevant disclosures. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

The society for cardiovascular angiography and interventions structural heart disease early career task force survey results: Endorsed by the society for cardiovascular angiography and interventions

Over the last decade, structural heart disease interventions have emerged as a new field in interventional cardiology. Currently, the Accreditation Council for Graduate Medical Education accredited interventional cardiology fellowship programs in the United States provide high‐quality and well established training curriculum in coronary and peripheral interventions, but training in structural interventions remains in its infancy. The current survey seeks to collect relevant information and assess the opinion of interventional cardiology program directors in ACGME‐accredited institutions that are actively involved in structural interventional training. Our study describes the actual number of structural procedures performed by interventional cardiology fellows in ACGME‐accredited programs, the form of the structural training today and the suggestions from program directors who are actively trying to integrate structural training in the interventional cardiology fellowship programs. © 2012 Wiley Periodicals, Inc.     

The first certifying examination in geriatric medicine

On April 22, 1988, the first Certifying Examination in Geriatric Medicine was administered jointly by the American Board of Internal Medicine and the American Board of Family Practice to 4,282 diplomates (ABIM = 2,202; ABFP = 2,080). This paper addresses both an analysis of the examination and the relationship between performance on that examination and a group of characteristics of the examinees, collected as part of the registration process. The pass rate was 56%. Performance on the examination was positively correlated with scores on the general certifying examinations and with training in geriatric medicine. Data provided by the candidates in an addendum to the application were also available for analysis and were used to derive correlations with groups of questions. The performance of candidates was positively correlated with seeing large numbers of elderly in hospitals, nursing homes, or home settings, working in a University Hospital, teaching and research, and the size of the community in which the candidate practiced. Physicians from long-term care settings did exceptionally well. Working in a solo practice setting was negatively correlated with performance on the examination as was working in a for-profit setting.     

Sleep medicine training across the spectrum

There is now a new pathway and examination for sleep medicine, sponsored by the American Board of Internal Medicine, and a number of accredited sleep medicine fellowship programs through the Accreditation Council for Graduate Medical Education. This review takes an historical approach to discuss the process of education for sleep physiology and disorders not only in the postgraduate period but also at all levels of instruction. In reality, there is a continuum of knowledge that needs to be reinforced up and down the educational system, of which Sleep Medicine subspecialty training is just one part. Although progress has been made at all educational levels up to this point, the future of training and education will depend on a sustained effort at several levels from undergraduate to postgraduate continuing medical education and will be facilitated by professional societies and other specialties who will collectively promote the value of and outcomes for clinical sleep medicine.     

The Italian Association on Addiction Psychiatry (SIPDip), formerly The Italian Association on Abuse and Addictive Behaviours

The Italian Association on Addiction Psychiatry (SIPDip) is a special section of the Italian Psychiatric Association (SIP). It started, under the name of the Italian Association on Abuse and Addictive Behaviours (SICAD), in 1989 from the awareness that the addiction field had been starved of a psychiatrists' contribution since 1975. SIPDip aims to improve and implement study, clinical, research and educational topics about substance abuse and addictive behaviours. The National Board composition aims to provide an equal distribution of psychiatrists working in psychiatric and addiction facilities inside the National Health System, and private non-profit agencies. All psychiatrists and members of the Italian Psychiatric Association can become SIPDip ordinary members, while other health professionals working in psychiatric and addiction fields can become associate members. SIPDip has its National Congress every second year. In 2001 it promoted a network called the National Council of Addiction Disorders. It is recognized officially by the Drug Policy National Department and was created under the direct authority of the Prime Minister. In this, SIPDip is particularly involved in review groups relating to ethical issues, substitutive therapies and dual diagnosis. Furthermore, it organized the first Consensus Conference on Dual Diagnosis, under the sponsorship of the Italian Psychiatric Association. This was held in June 2003 to implement relevant national guidelines. The SIPDip main topics that will be addressed in the near future are: psychiatric comorbidity in substance related disorders; intervention efficacy assessment; and special populations and novel addictions. The National Board meeting on 15 December 2002 decided to submit to the General Assembly in April 2003, a motion to modify the Association's byelaws and to rename the organization 'The Italian Association of Addiction Psychiatry'.     

Cardiovascular Disease Prevention: Training Opportunities,the Challenges,and Future Directions

Purpose

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, necessitating major efforts in prevention. This review summarizes the currently available training opportunities in CVD prevention for fellows-in-training (FITs) and residents. We also highlight the challenges and future directions for CVD prevention as a field and propose a structure for an inclusive CVD prevention training program.

Recent Findings

At present, there is a lack of centralized training resources for FITs and residents interested in pursuing a career in CVD prevention. Training in CVD prevention is not an accredited subspecialty fellowship by the American Council of Graduate Medical Education (ACGME). Although there are several independent training programs under the broad umbrella of CVD prevention focusing on different aspects of prevention, there is no unified curriculum or training.

Summary

More collaborative efforts are needed to identify CVD prevention as an ACGME-accredited subspecialty fellowship. Providing more resources can encourage and produce more leaders in this essential field.

     

Establishing the First Annual Meetings of the American Academy of Addiction Psychiatry

This paper describes the initial meetings of the American Academy of Addiction Psychiatry, and it compares and contrasts these relatively small meetings with the much larger meetings today. The paper is centered on the organization's initial focus on establishing itself in the mainstream of medicine and psychiatry. (Am J Addict 2020;00:00–00)     

Providing high-value, cost-conscious care: a critical seventh general competency for physicians

There is general agreement that the U.S. economy cannot sustain the staggering economic burden imposed by the current and projected costs of health care. Whereas governmental approaches are focused primarily on decreasing spending for medical care, it is the responsibility of the medical profession to become cost-conscious and decrease unnecessary care that does not benefit patients but represents a substantial percentage of health care costs. At present, the 6 general competencies of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) that drive residency training place relatively little emphasis on residents' understanding of the need for stewardship of resources or for practicing in a cost-conscious fashion. Given the importance in today's health care system, the author proposes that cost-consciousness and stewardship of resources be elevated by the ACGME and the ABMS to the level of a new, seventh general competency. This will hopefully provide the necessary impetus to change the culture of the training environment and the practice patterns of both residents and their supervising faculty.     

Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine

In response to public pressure for greater accountability from the medical profession, a transformation is occurring in the approach to medical education and assessment of physician competency. Over the past 5 years, the Accreditation Council for Graduate Medical Education (ACGME) has implemented the Outcomes and General Competencies projects to better ensure that physicians are appropriately trained in the knowledge and skills of their specialties. Concurrently, the American Board of Medical Specialties, including the American Board of Emergency Medicine (ABEM), has embraced the competency concept. The core competencies have been integral in ABEM's development of Emergency Medicine Continuous Certification and the development of the Model of Clinical Practice of Emergency Medicine (Model).¹ ABEM has used the Model as a significant part of its blueprint for the written and oral certification examinations in emergency medicine and is fully supportive of the effort to more fully define and integrate the ACGME core competencies into training emergency medicine specialists.To incorporate these competencies into our specialty, an Emergency Medicine Competency Taskforce (Taskforce) was formed by the Residency Review Committee–Emergency Medicine to determine how these general competencies fit in the Model.¹ This article represents a consensus of the Taskforce with the input of multiple organizations in emergency medicine. It provides a framework for organizations such as the Council of Emergency Medicine Residency Directors (CORD) and the Society for Academic Emergency Medicine to develop a curriculum in emergency medicine and program requirement revisions by the Residency Review Committee–Emergency Medicine. In this report, we describe the approach taken by the Taskforce to integrate the ACGME core competencies into the Model. Ultimately, as competency-based assessment is implemented in emergency medicine training, program directors, governing bodies such as the ACGME, and individual patients can be assured that physicians are competent in emergency medicine.     

An Assessment of Oral Health Training Among Geriatric Fellowship Programs: A National Survey

Oral health (OH) has profound effects on the overall health of elderly people. While oral disease is prevalent in the geriatric population and access to care is a major issue, it is unclear the extent of OH training among US geriatric fellowship programs. A 19‐item electronic survey was sent to all 148 accredited geriatric fellowship training programs via the Association of Directors of Geriatric Medicine. Directors were asked about hours of trainings, barriers, and evaluation of trainees among other topics. Univariate and bivariate analyses were performed. Seventy‐five directors completed the survey (51% response rate). Sixty‐three percent (46/73) report their fellows receive 1 to 2 hours of OH instruction (ie, lectures, workshops) during their training. Almost a quarter (23%; 17/73) reported 0 hours of OH content. Only 17% (13/75) have clinical experiences in a dental setting. Barriers to more OH education include competing priorities or lack of time (57%; 43/75), lack of faculty expertise (55%; 41/75), and no clear geriatric national educational competencies (44%; 33/75). Programs with an OH champion or dental school/residency affiliation had more hours of OH instruction. Geriatric fellowships appear to need more OH training, which could be achieved by creating OH champions and connecting fellowships with dental schools/residencies. Barriers could be overcome by exposing fellowships to existing resources and creating national competencies. J Am Geriatr Soc 67:1079–1084, 2019.     

Geriatrics Education Team Model Results in Sustained Geriatrics Training in 15 Residency and Fellowship Programs and Scholarship

Caring for the growing elderly population will require specialty and subspecialty physicians who have not completed geriatric medicine fellowship training to participate actively in patient care. To meet this workforce demand, a sustainable approach to integrating geriatrics into specialty and subspecialty graduate medical education training is needed. This article describes the use of a geriatrics education team (GET) model to develop, implement, and sustain specialty‐specific geriatrics curricula using a systematic process of team formation and needs assessment through evaluation, with a unique focus on developing curricular interventions that are meaningful to each specialty and satisfy training, scholarship, and regulatory requirements. The GET model and associated results from 15 specialty residency and fellowship training programs over a 4‐year period include 93% curriculum sustainability after initial implementation, more than half of the programs introducing additional geriatrics education, and more than 80% of specialty GETs fulfilling their scholarship requirements through their curriculum dissemination. Win–wins and barriers encountered in using the GET model, along with the model's efficacy in curriculum development, sustainability, and dissemination, are summarized.     

A Survey-Based Evaluation of Self-Perceived Competency after Nephrology Fellowship Training

Background and objectives: There have been no recent analyses of the adequacy of training in U.S. nephrology training programs or the importance of specific aspects of fellowship training in the careers and practices of nephrologists who recently completed training.Design, setting, participants, & measurements: An internet-based survey was sent to members of the American Society of Nephrology who completed nephrology training in 2004 to 2008. Respondents were asked to rate their fellowship training (little or no training, some training but not enough to feel competent, well trained and competent) in specific areas and the importance of each area to their current careers and practices.Results: Among 133 recent adult nephrology trainees, most felt well trained and competent in many areas of patient care and core content. A significant percentage of respondents reported receiving little or no training, or some training but not enough to feel competent in other specific areas, such as genetic renal disease, care of adults with childhood kidney disease, pregnancy complications, poisoning, nutrition, end-of-life care, clinical pharmacology, home and self-care hemodialysis, peritoneal dialysis, plasmapheresis, interpretation and performance of renal ultrasound and other renal imaging, renal biopsy pathology interpretation, business and administrative aspects of nephrology, research, and research funding. Many of these areas were also identified as somewhat or very important to the careers and practices of respondents.Conclusions: Nephrology training programs are perceived as doing an excellent job training fellows in many areas. Gaps in training should be addressed in fellowship training and post-training education.There have been no recent systematic analyses of the quality and comprehensiveness of training received in United States nephrology training programs. The Accreditation Council for Graduate Medical Education (ACGME) requires that education and training in certain core content areas and procedural skills are included during fellowship and that each program assess its trainees'' competence in these areas, but it does not itself directly assess competence. The core subject knowledge of nephrologists who have completed training is assessed by the American Board of Internal Medicine (ABIM) nephrology and American Board of Pediatrics subspecialty examinations. There are, however, no current assessments available of actual or perceived clinical competence of nephrologists who have recently completed their fellowship training. The most recent previous assessment of perceived training adequacy was published more than 15 years ago and addressed training that occurred more than two decades ago (1). A more recent survey-based analysis evaluated training and clinical experience during training in various procedures (2) and found great variability among programs in the scope and extent of procedural training and in expectations for clinical competency.To assess the adequacy of training during fellowship in a wide variety of core knowledge, patient care, procedural, research, and business/administrative aspects of nephrology as perceived by nephrologists who recently completed their fellowship training, a web-based survey was developed and administered in conjunction with the American Society of Nephrology (ASN). The survey also queried respondents as to the importance of each area to their current practice or career situation.     

Addiction Research Centres and the Nurturing of Creativity. Substance abuse research in a modern health care centre: the case of the Centre for Addiction and Mental Health

The Centre for Addiction and Mental Health is one of the premier centres for research related to substance use and addiction. This research began more than 50 years ago with the Addiction Research Foundation (ARF), an organization that contributed significantly to knowledge about the aetiology, treatment and prevention of substance use, addiction and related harm. After the merger of the ARF with three other institutions in 1998, research on substance use continued, with an additional focus on comorbid substance use and other mental health disorders. In the present paper, we describe the structure of funding and organization and selected current foci of research. We argue for the continuation of this successful model of integrating basic, epidemiological, clinical, health service and prevention research under the roof of a health centre.     

Research training in six selected internal medicine fellowship programs

BACKGROUND: Effective July 1997, the American Board of Internal Medicine (ABIM) established a research pathway to certification to encourage research training of general internists and subspecialists. OBJECTIVE: To document the current status of research training in six selected subspecialty programs, to examine opportunities available for trainees to undertake formal course work, and to report the percentage of subspecialty programs that might accept research pathway fellows. DESIGN: National Study of Graduate Education in Internal Medicine questionnaires from 1996-1997 and 1997-1998. SETTING: Programs in internal medicine subspecialties accredited by the Accreditation Council for Graduate Medical Education. PARTICIPANTS: 1163 (84%) and 1094 (79%) directors of internal medicine subspecialty programs in 1996-1997 and 1997-1998, respectively. MEASUREMENTS: Survey questions on the amount of time fellows usually spend conducting research and available opportunities to pursue course work leading to an advanced degree. RESULTS: On average, during their last year of training, fellows enrolled in infectious disease, nephrology, endocrinology, and rheumatology programs spent 40% to 50% of their time conducting research, whereas fellows in gastroenterology and cardiology spent 25% to 30% of their time conducting research. Compared with programs sponsored by major teaching hospitals, a greater percentage of programs sponsored by academic medical center hospitals planned to accept persons interested in pursuing the new ABIM Research Pathway (28% vs. 8%) and to provide opportunities for fellows to obtain an advanced degree (60% vs. 14%). CONCLUSIONS: Few internal medicine subspecialty programs are currently designed to provide adequate research training as defined by the Institute of Medicine and the ABIM.     

American Geriatrics Society/Association of Directors of Geriatric Academic Programs Curricular Milestones for Graduating Geriatric Fellows

This article describes the curricular milestones for geriatric fellows and the process used to develop them. The curricular milestones were developed to determine what every graduating geriatric fellow should be able to demonstrate to ensure that they will be able to practice effectively and safely in all care settings and with different older adult populations. Three major domains were identified: Caring for the Elderly Patient, Systems‐Based Care for Elder Patients, and Geriatric Syndromes. Six hundred thirty‐five geriatricians each reviewed and commented on one domain. These geriatricians represented important stakeholder groups: geriatric fellowship program directors; Association of Directors of Geriatric Academic Programs (ADGAP) members, who are primarily geriatric program and fellowship directors; the American Geriatrics Society (AGS) and ADGAP Education Committee; the AGS Teacher's Section; Geriatric Academic Career Award awardees; and through the American Board of Internal Medicine and the American Board of Family Medicine, board‐certified geriatricians who spend more than 50% of their time in clinical practice. The AGS and ADGAP boards approved the final set of 76 Geriatric Curricular Milestones, which were posted on the Portal of Geriatric Online Education in December 2012. These curricular milestones are intended to assist geriatric fellowship directors as they develop curricula and assessments to inform program director reporting to the Accreditation Council for Graduate Medical Education in the Next Accreditation System, which begins in July 2014.     

Recovering Physicians in Addiction Psychiatry Fellowships

In this report, the authors describe the characteristics and experiences of recovering fellows in a university addiction subspecialty fellowship. Four stages of adjustment were identified: 1) initial adjustment, 2) role conflict, 3) role integration, and 4) graduation. From a faculty viewpoint, it is particularly important to separate clinical from educational responsibilities in dealing with recovering fellows. Despite some continuing conflict about treatment models, most fellows achieved their training goals and were able to successfully adapt to post-training practice. However, some fellows were unable to integrate personal recovery and professional roles.     

Training the Next Generation’s Nephrology Workforce

The subspecialty of nephrology faces several critical challenges, including declining interest among medical students and internal medicine residents and worrisome declines in the number of applicants for nephrology fellowships. There is an urgent need to more clearly define the subspecialty and its scope of practice, reinvigorate meaningful research training and activities among trainees, and ensure that fellows who complete training and enter the practice of nephrology are experts in the broad scope of nephrology. This need requires a critical look at fellowship training programs and training requirements. A new workforce analysis is also needed that is not focused on primarily meeting estimated future clinical needs but rather, ensuring that there is alignment of supply and demand for nephrology trainees, which will ensure that those entering nephrology fellowships are highly qualified and capable of becoming outstanding nephrologists and that there are desirable employment opportunities for them when they complete their training.     

Training and certifying gastroenterologists as physician nutrition specialists

Because nutrition is an integral aspect of the science and practice of gastroenterology, all gastroenterology fellows should receive training in core aspects of nutrition (level 1 training). Some gastroenterologists also wish to train more extensively in nutrition (level 2) and become physician nutrition specialists. The Intersociety Professional Nutrition Education Consortium, composed of representatives from eight national societies with significant nutrition interests, including the American Gastroenterological Association, and three credentialing bodies, has developed a paradigm and training requirements for physician-nutrition specialists that recognizes their varied backgrounds and areas of interest. Opportunities exist for gastroenterology fellows to obtain physician nutrition specialist training within their gastroenterology fellowships and to be eligible to take the Certification Examination for Physician Nutrition Specialists offered by the new American Board of Physician Nutrition Specialists.* This article reviews the development of consensus on subspecialty training for physicians in nutrition; it also encourages directors of gastroenterology fellowships to develop training opportunities and gastroenterology fellows to consider identifying nutrition as an area of emphasis for their careers.     

Retooling for an Aging America: Building the Healthcare Workforce

In Chicago, Illinois, on May 7, 2009, a group of 53 medical educators representing many U.S. certification boards, residency review committees, and medical societies met to review and approve a white paper intended to promote Recommendation 4.2 of the Institute of Medicine report of April 14, 2008, “Retooling for an Aging America: Building the Healthcare Workforce.” This recommendation is one of 14 and states: “All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion.” Background information given included the growing numbers of older adults, review of a 15‐year initiative by a section of the American Geriatrics Society (AGS) to include geriatric education in all surgical and some related medical specialties, a recent announcement of 26 elder care competencies to be expected of graduating medical students from Association of American Medical Colleges (AAMC) affiliated schools, and the American Board of Medical Specialties (ABMS) approach to “Reinforcing Geriatric Competencies through Licensure and Certification Examinations.” Nine points involved in the implementation of this recommendation received discussion, and approaches to realization were presented. In conclusion, this white paper, which those listed as being in attendance approved, proposes that all ABMS member boards whose diplomates participate in the care of older adults select the floor competencies enumerated by the AAMC that apply to their specialty and add or subtract those completed during their trainees' initial (intern) year and then define those needed in subsequent years of residency and ultimate practice. This would fulfill the requirements of Recommendation 4.2 above.