Detailed Interventional Curriculum, Interventional Cardiology at the University of Minnesota


Learning Objectives Goals   Teaching Methods     Evaluation Method    
  To aquire: Textbook reading Lecture Clinical Test Faculty eval 360 Evaluation  
Knowlwedge base and clinical skills                
General physiology and diagnosis                
Atherosclerosis                
pathogenesis Understand the disease process and pathology of atherosclerosis Topol: Chapter 19     V      
preventive coronary therapy Undertsand the science and methods for preventing progression of atherosclerosis Topol: Chapter 6   V V      
General coronary physiology Understanging of coronary vasomotion and transport, from the epicardial arties to the microcirculation   R Bache, M.D.   V V    
Clinical coronary physiology Understanding of the application of coronary physiology to patients with coronary diseaseand the impact of intervention Kern:Chapter 10   V V V    
FFR     R. Wilson, M.D. V V      
CFR     R. Wilson, M.D. V V      
coronary vasodilators     R. Wilson, M.D. V V      
coronary vasospasm and PCI       V V      
Valvular heart disease Understanding of normal valvular anatomy and pathology.       V V    
Valvular stenosis morphology Understanding the interaction of valve morphology and successful valve dilation, including selction of patients for treatment Otto: Chapters 7 Pedersen (Aortic); Baran (Mitral, PV) V V V    
Valvular stenosis physiology Ability to quatitatively assess of valvular stenosis before and after intervention   Pedersen (Aortic); Baran (Mitral, PV) V V V    
Congenital heart disease General understanding of congenital heart disease anatomy and physiology amenable to percutaneous intervention Web module Das Lecture V V V    
ASD/PFO Understanding ASD/PFO anatomy and assessment fo the size of the defect Kern: Chapter 15 Topol: Chapter 45 Das Lecture   V V    
Anatomy         V V    
Physiology and paradoxical embolism Understanding the hysiology and incidence of paradoxical embolism       V V    
VSD     Bass Lecture V        
Post MI/congenital anatomy         V      
Physiology         V      
Cardiac and coronary imaging                
Radiation physics and safety Knowledge of radiation physics to allow optimal imaging and minimal exposure to the patient and staff   Alan Berger, M.D. V V      
Optimal coronary angiography for PCI Skill in selecting optimal angigraphic views to assess lesion morphology and suitability for PCI Kern: Chapter 3 Carl White, M.D. V V      
Coronary lesion assessment Knowledge of how to apply coronary physiology to clinical problem solving              
Physiologic   Kern: Chapter 10   V V      
FFR and CFR     R. Wilson, M.D. V V      
Clinical prediction of FFR/CFR     R. Wilson, M.D. V V      
IVUS Understanding the physics and types of available devices for intracoronary imaging and how the physics and materials effect imaging, including Topol: Chapter 42 Kern:Chapter 10            
Methods and types     Alan Berger, M.D. V V      
Interpretation Practical skills in interpreting IVUS images pre and post intervention, and knowledge of common artifacts and pitfalls   Alan Berger, M.D. V V      
Quantitative angiography Understanding of the images required for qualitative analysis and the methods of quantitative analysis, including common reporting parameters (MLD/ mCSA, ref D, loss index, and common graphical displays, etc) Topol: Chapter 39   V V      
CT Angio/MR perfusion An understanding of the imaging methods, strengths and weaknesses, with respect to clinical use for assessment of coronary anatomy, myocardial blood flow and viability assessment   John Lesser, M.D.   V      
Intracardiac ultrasound                
Methods and types Knowledge of the basic physics and views using ICE     V V V    
Interpretation Practical ability to interpret cardiac anatomy using ICE, particularly with respect to assessment of septal defects, measurements for device closure and assessment of the left atrium and valves.     V V V    
Indications for PCI Knowledge of the ACC/HA guidelines for intervention, surgery and medical therapy for coronary syndromes, with emphasis on special populations (diabetics, the elderly, women, patients with renal failure, etc.)     V V V    
Stable coronary disease   ACC/AHA guidelines Alan Berger, M.D. V V V    
Non-STEMI   ACC/AHA guidelines   V V V    
STEMI   ACC/AHA guidelines   V V V    
Special groups   ACC/AHA guidelines   V V V    
Pre-transplantation       V V V    
Pre non-cardiac surgery       V V V    
Diabetics       V V V    
Renal failure       V V V    
Elderly       V V V    
          V V    
Patient preparation for PCI         V V    
General   Patient preparation hand-out     V V    
history/physical/labs       V V V    
consent process       V V V    
Special circumstances         V V    
renal failure       V V V    
diabetes       V V V    
coagulation abnormalities       V V V    
Technical Aspects of PCI                
Vascular Access                
femoral Advanced knowledge of and technical skills for femoral artery vascular access, prevention of complications, hemostasis incl closure) and treatment of complications   Panetta   V V    
radial Advanced knowledge of and technical skills for radial and brachial artery access and management of complications   Panetta   V V    
Specific methods and tools                
Guidewires Understanding how guidewire construction translates to performance, and appropriate selection of guidewires for specific vessels   7-16-04 V V V    
Guide catheters Understanding how guide catheter construction and curves translate to performance, and appropriate selection of guide catheters for specific vessels and aortic dimensions Kern: Chapter 1 Ginete and Chou 7/9/2004 V V V    
Balloon PCI Knowledge of balloon catheter material and construction, any how to select the appropriate balloon for specific vessels/lesions       V V    
balloon types/performance   Kern: Chapter 1 Ginete and Chou 7/16/2004 V V V    
selection and passage Technical skills in balloon passage, including guide catheter/balloon catheter interaction Kern: Chapter 1   V   V    
Stenting                
Stent design Knowledge of stent types and materials, and how these affect clinically relevant properties (conformability, passage, radial strength, etc) Topol: Chapter 28 Ginete and Chou-7/23/2004   V V    
Drug elution Knowledge of 1. drug elution methods (polymers, ceramics, bonding) and 2. pharmacology o drugs used to prevent restenosis and thrombosis. Topol: Chapter 30 Kern: Chapter 7 Lecture   V V    
Implantation method   Topol: Chapter 27 Kern: Chapter 1   V V V    
Atherectomy                
Rotational 1. Knowledge of device physics, construction and setup. 2. Understanding of appropriate patient selection, vessel selection and technical skills for use of the device 3. Knowledge of device complications and management Topol: Chapter 26 Kern: Chapter 6 Wilson Ginete, M.D. 7/30/2004 and Debate: Bilal Murad v Alan Berger V V V    
Directional/Extraction 1. Knowledge of device physics, construction and setup. 2. Understanding of appropriate patient selection, vessel selection and technical skills for use of the device 3. Knowledge of device complications and management Topol: Chapter 25 Kern: Chapter 6   V V V    
Laser 1. Knowledge of device physics, construction and setup. 2. Understanding of appropriate patient selection, vessel selection and technical skills for use of the device 3. Knowledge of device complications and management Topol: Chapter 31     V V    
Distal protection devices 1. Knowledge of device constructions, appropriate patient selection, and deployment methods. 2 Knowledge of clinical trial results and impact on clinical use Topol Chapter 12 Wendy Shear, M.D. V V V    
Brachytherapy 1. Knowledge of basic radiation physics and dosimetry of coronary brachytherapy (beta and Gamma) Topol: Chapter 33 Kern: Chapter 7 Wes Pedersen, M.D. V V      
Special circumstances 1. Knowledge of the impact of lesion/vessel characteristics on procedural strategy, complications and long-term outcome. 2. Ability to select the optimal therapy for each lesion Topol: Chapters 10, 15,17 and 18 Kern: Chapter 8     V      
Vascular calcification   7   V        
Tortuosity   7   V        
Ostial stenosis   7   V        
Bifurcation lesions   7   V        
Thrombosis   7   V        
Aneurismal disease   7   V        
Chronic total occlusions   7            
Restenotic lesions                
Role of CAB surgery   Topol: Chapter 21 Ken Liao, M.D.          
Interventional approach   Topol: Chapter 22   V        
Vascular closure devices Detailed understanding of suture and procoagulant vascular closure devices, appropriate patient selection for each device and management of complications              
Selection and use   Topol: Chapter 37 R. Wilson, M.D. V        
Clinical outcome   Topol: Chapter 37 R. Wilson, M.D. V        
Stable coronary disease intervention                
Indications 1. Knowledge of the factors that influence patient outcome with respect to revascularization. 2. Ability to properly select patients for revascularization, and to select the optimum approach3. Strategies that reduce complications       V V    
Symptomatic patients   AHA/ACC guidelines   V V V    
Asymptomatic/high risk   AHA/ACC guidelines   V V V    
Special patient groups   AHA/ACC guidelines     V V    
Pre-transplantation       V V V    
Pre non-cardiac surgery       V V V    
Diabetics       V V V    
Renal failure       V V V    
Other non-atherosclerotic coronary disease   AHA/ACC guidelines   V V V    
Kawasaki (MCLNS)         V V    
collagen vascular diseases         V V    
radiation arteriopathy         V V    
coronary transplant arteriopathy         V V    
                 
Acute coronary syndromes                
Physiology of unstable angina and MI A detailed understanding of the pathology and physiology of acute coronary syndromes 2. Optimal imaging and physiological diagnostic methods for assessing ACS Topol Chapter 6     V      
Coronary events         V      
plaque rupture and thombosis         V      
IVUS findings     Berger: IVUS   V V    
Myocardial necrosis     The Troubles part 1   V      
embolization and microvascular injury         V      
myocyte necrosis, inflamation and healing         V      
          V      
Clinical course and complications Understanding of the clinical correlates of the ACS physiololgy and pathology and how they relate to outcome. Topol Chapter 12 Henry: Clinical trials   V V    
non-STEMI ACS       V   V    
STEMI       V   V    
Interventional treatment of non-STEMI           V    
Indications for intervention Optimal patient selection for intervention, including strategic decisions that affect case approach and long-term outcome AHA/ACC guidelines   V   V    
Acute revasculariztion Ability to optimallyand safely plan and perform ACS revascularization     V   V    
techniques to avoid embolization/slow flow       V   V    
complete v incomplete revascularization     Lecture V   V    
prophylactic circulatory support     Das: Circulatory support V V V    
Follow-up teatment Optimal post procedure care and institution of evidence based prevention regimens     V V V    
drug/prevention therapy       V V V    
Interventional treatment of acute MI Skills for optimal patient selection for interventional therapy, including strategic decisions that affect case approach, understanding of system issues to optimize timing of therapy and post MI therapy     V V V    
Indications and timing of intervention   AHA/ACC guidelines   V V V    
timing/system performance       V   V    
rescue and late reperfusion       V   V    
            V    
Acute reperfusion Abiltity to rapidly manage and perform acute reavscuarization with PCI     V   V    
anticoagulation       V Level One program, UM cath call   V    
revacsularization methods       V   V    
adjunctive salvage therapy       V   V    
circulatory support       V   V    
role of thrmbolytic drugs       V   V    
Follow-up teatment       V   V    
drug/prevention therapy       V   V    
ICD indications       V   V    
                 
Bypass graft intervention                
Pathology of graft disease Understanding of the interplay between the pathology of bypass graft disease and the therapeutic approach   Wendy Shear, M.D.   V      
early (<1 year)       V V      
late (>1 year)       V V      
Methods of bypass graft intervention Ability to plan and perform interventions in bypass grafts, with attention to embolism protection and no-reflow. Topol: Chapter 16 Wendy Shear, M.D.     V    
guide selection       V   V    
ostial lesions       V   V    
body lesions       V   V    
coronary insertion lesions       V   V    
embolism protection devices/methods       V   V    
anticoagulation       V   V    
Complications of bypass graft PCI   Topol: Chapter 16 Wendy Shear, M.D. V   V    
slow/no flow     R. Wilson, M.D. V   V    
perforation       V   V    
Follow-up treatment/drugs   Topol: Chapter 16 Wendy Shear, M.D. V   V    
            V    
Complications of PCI                
Acute complications, treatment and prevention Knowledge of acute complications, including: 1: Incidence of individual complications, 2: conditions making each complication more likely, 3: appropriate methods to reduce the liklihood of complications, 4: optimal management of complications       V V    
Dissection         V      
Coronary     The Troubles (part 1) V V      
Aortic     The Troubles (part 1) V V      
Peripheral vascular     The Troubles (part 1) V V      
Vasospasm     The Troubles (part 1) V V      
Thrombosis     The Troubles (part 1) V V      
Embolization     The Troubles (part 1) V V      
Slow/No flow     The Troubles (part 1) V V      
Myocardial infarction         V      
Mechanisms and prevention       V V      
Treatment       V V      
Stroke       V V      
Peripheral vascular     The Troubles (part 1)   V      
Hematoma/bleeding     The Troubles (part 1) V V      
Pseudoaneurysm/AV fistuala     The Troubles (part 1) V V      
Embolization (non-renal)     The Troubles (part 1) V V      
Renal failure     The Troubles (part 1)   V      
contrast induced     The Troubles (part 1) V V      
embolization/other     The Troubles (part 1) V V      
Stroke     The Troubles (part 1) V V      
Predictors of poor outcome     Harbingers of failure V V      
Late complications         V      
Restenosis Understaing of the pathophysiology and risk factors for restenosis       V      
pathophysiology     Pathobiology of restenosis   V      
clinical predictors       V V V    
treatment Ability to tailor the type and location of restenosis to the best therapy     V V V    
Progressive disease 1. knowledge of the impact of residual disease on early and late outcome, 2. ability to develop a revascularization strategy based on the patient's underlying conditions, coronary anatomy, and predicted outcome (evidence based).       V V    
complete vs incomplete revascularization     Complete v incomplete revascularization V V V    
predictors of late MI or death     Harbingers of failure   V      
                 
Interventional valvular therapy                
Indications for intervention of stenotic valve disease Knowedge of the natural disease course and optimal timimng for intervention of valvular heart disease   Pedersen: Aortic valvuloplasty   V      
aortic     Pedersen: Aortic valvuloplasty Perform 2 aortic valvuloplasties V      
mitral     Baran: Mitral and pulmonary valvuoplasty Perform 2 mitral valvuloplasties V      
pulmonary     Baran: Mitral, TC and pulmonary valvuoplasty Perform procedures as available V      
tricuspid     Baran: Mitral, TC and pulmonary valvuoplasty Perform procedures as available V      
prosthetic valve     Baran: Mitral, TC and pulmonary valvuoplasty Perform procedures as available V      
Techniques and complications Clinical experience performing a limited number of aortic and mitral valve dilations, with a knowledge of procedural approach and common complications   Lectures as above Perform procedures as available (>5 Ao, >2 mitral) V V    
aortic       >5   V    
mitral       >2   V    
pulmonary       V   V    
tricuspid       V   V    
prosthetic valve       V        
            V    
Congenital heart disease intervention                
ASD/PFO closure Knowledge of indications for ASD and PFO closure and the ability to close common defects Kern: Chapter 15 Topol: Chapter 45 Gladwin Das, M.D. Perform >5 closures V      
Indications for treatment         V      
Interventional techniques and device selsction 1. Ability to use TEE and ICE to evaluate septal defects and select appropiate patients, select propoerly size devices, and evaluate results 2. Performance of 15 closures     Perform >5 closures   V    
Follow-up treatment Knowledge of follow-up complications, follow-up imaging, antiplatelt therapy and BE prophylaxis     Perform >5 closures with follow-up V      
VSD closure An introduction to experimental devices used for VSD closure and factors that influence patient selection   John Bass, M.D.   V      
Indications for treatment                
Surgical v experimental device therapy                
Interventional techniques and device selsction                
Follow-up treatment                
Hypertrophic cardiomyopathy 1. Ability to appropriately dignose and select pateinst for ASA, 2. Knowledge of the procedural methods, including imaging interpretation and assess ment of resluts/stopping points 3. Understanding of incidence and treatment of complications of ASA Kern: Chapter 14 Topol: Chapter 47 R. Wilson, M.D. Nick Burke, M.D.          
Indications for treatment                
Interventional methods                
Complications and management                
Follow-up treatment                
                 
Advanced/experimental therapies                
Stem cell therapy for acute MI and CHF A basic understanding of stem cell therapy and approaches to treatment of acute MI and heart failure Topol: Chapter 38 Tim Henry, M.D.   V      
Angio and vascular genesis A basic understanding of approaches to angiogenic therapy, patient selection for trials, trial design, and clinical results of on-going trials   Tim Henry, M.D.   V      
Growth factors                
Gene therapy                
PMR                
System management and quality assessment/improvement                
Cath lab QI management Tools for assessing and improving cath lab quality   Wilson: Cath lab QA systems and management Cath lab M&M V      
Multidisciplinary approach Effective team development and functioning     Film@5 multidisciplinary team   V V  
Professionalism and communication                
Professional ethics       Clinical role modeling   V    
Effective communication with referring physicians Develop tools for effective communication with referring physicians and healthcare team     Clinical communication with housestaff   V    
Teaching development Develop skills for effective presentations     Journal club presentations   V    
Effective communication with cath lab team       Clinical communication with team/360 eval feedback     V  
Practice based learning                
Complication management and avoidance       Clinical mentoring/ M&M conference   V    
Clinical decision making       Clinical case mentoring/ Film@5   V V  

Sheet2


Week Date Theme Reading Test Lecture Journal Club
1 (27) 2-July Orientation        
2 9-July Basic equipment     Guides  
3 16-July Basic equipment     Wires and balloons  
4 23-July Basic equipment Topol: Chater 28   Stents  
5 30-July Basic equipment Kern: Chapter 6   Niche devices: Rotablator  
6 6-Aug Basic equipment Kern: Chapter 6   Niche devices: pressure/flow wires  
  13-Aug       Niche devices: Laser and Angiojet  
7 20-Aug Basic equipment     Das: Cardiogenic shock (IABP/drugs/VAD)  
8 27-Aug Basic equipment Patient preparation and informed consent handout Basic equipment and patient preparation LAB: Equipment set-up for RA, IVUS and Angiojet  
9 3-Sep Coronary physiology     Bache:Basic coronary physiology  
10 10-Sep Coronary physiology Kern: Chapter 10   Wilson: Clinical coronary physiology  
11 17-Sep Cardiac and coronary imaging Kern: Chapter 3   Berger: Radiation physics and safety  
12 24-Sep Cardiac and coronary imaging Topol: Chapter 39   White: Optimal coronary angiography and quatitative angiography  
14 1-Oct TCT Week TCT abstracts   No Lecture  
13 8-Oct Cardiac and coronary imaging Topol: Chapter 43; Kern: Chapter 10   Berger: IVUS  
15 15-Oct Cardiac and coronary imaging     Lesser: CT and MR m  
16 22-Oct Indications for PCI ACC/AHA guidelines for PCI and ACS Physiology, Cardiac and coronary imaging