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The importance of quality training during interventional fellowship

by Dmitriy N. Feldman, MD, FSCAI, FACC, FSVM

SAN DIEGO — We all aim to deliver “quality” care to our patients. Sometimes quality is too broadly defined, and physicians and patients may perceive “quality care” somewhat differently. Simply stated, for interventional cardiologists, cath lab teams and our patients, delivering quality care means performing the right procedure for the right patient in the right way.

How best to teach quality assessment/improvement to our fellows in training (FIT) is debatable. Some may think that we all already do it by simple “osmosis” that occurs from daily interactions with faculty during training. Despite having clinical guidelines, expert consensus statements and appropriate use criteria developed by professional societies, no specific recommendations have been made as to the necessary training requirements and essential knowledge base needed for invasive and/or interventional cardiology FITs in this specific area.

Dmitriy N. Feldman

The newly published American College of Cardiology 2015 Core Cardiovascular Training Statement (COCATS 4) addresses the overall training requirements in diagnostic and interventional cardiology. However, specific and detailed listing of the necessary knowledge base of available quality improvement tools is not well delineated in the current guidelines, but rather is approached in broad concepts and generalities. Given the evolving complexity of quality improvement measures and toolkits, the time has come for FITs and practicing interventional cardiologists to receive more structured training in order to participate and lead quality improvement efforts in their institutions.

During the 2015 Society for Cardiovascular Angiography and Interventions Scientific Sessions, a timely document, SCAI Core Curriculum for Adult and Pediatric Interventional Fellowship Training in Continuous Quality Assessment and Improvement, was published. This consensus document outlines practical ways that FITs should receive quality education during fellowship training without disrupting the workflow of our already busy days. The document emphasizes avenues for continuous quality assessment engagement, awareness and how to effectively implement quality measures in clinical practice. We envision program directors using this document to establish a strong curriculum for quality assessment/improvement for their trainees. Quality is too important for the future of cardiac and interventional care and accordingly warrants a shift in culture to “active” rather than “passive” learning.

Key recommendations

Below is a summary of the key recommendations for training of FITs in quality improvement during fellowship training:

  • FITs should participate in peer-review conferences and morbidity and mortality conferences during fellowship. For instance, FITs should learn how to evaluate the appropriateness of PCIs based on specific NCDR registry criteria as well as angiographic and clinical criteria.
  • FITs should be well versed in reviewing and interpreting NCDR registry reports. They should be able to understand the definitions, statistics and methodology for reporting on specific performance metrics, process metrics, and clinical outcomes.
  • Each FIT should design and implement a quality improvement project during fellowship.
  • FITs should participate in institutional quality improvement committees.

You can also get involved. Contact SCAI at info@scai.org and volunteer to serve on the SCAI Quality Improvement Committee. We want to know what you think and hear your concerns.

What do you think? Please share your thoughts on this important document and the implications of the structured training of FITs in quality improvement programs by commenting on this Eye on Intervention blog.

References:

King SB, et al. COCATS 4 Task Force 10: Training in Cardiac Catheterization. J Am Coll Cardiol.  2015;65:1844-1853.

Jennings HS, et al. SCAI Core Curriculum for Adult and Pediatric Interventional Fellowship Training in Continuous Quality Assessment and Improvement. Catheter Cardiovasc Interv. 2015.

Dmitriy N. Feldman, MD, FSCAI, FACC, FSVM, is an interventional cardiologist at Weill Cornell Medical College/New York-Presbyterian Hospital and is a director of endovascular services at Cornell. He is also one of 12 members of the 2013-2015 class of Emerging Leader Mentorship (ELM) Fellows at SCAI.

Disclosure: Feldman reports no relevant financial disclosures.

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