Becoming a Parent During Cardiovascular Training

ACC/AHA/AAP RECOMMENDATIONS FOR TRAINING IN PEDIATRIC CARDIOLOGY

BackgroundThe objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach.MethodsA detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers.ResultsA total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004).ConclusionThe shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.

The perceived obstacles in performing patch test to detect allergic contact dermatitis: a comparison between community allergists and directors of allergy training programs

Introduction Resident doctors (RDs) in UK training programmes are contractually entitled to take study leave (SL) to pursue activity related to progression of training. In 2024, NHS Education for Scotland (NES) announced a temporary change to SL policy, indicating international attendance at educational events would no longer be supported. NES is also responsible for administration of the RD study budget (SB) in Scotland - one of the lowest in the UK. There is little data regarding Training Program Director (TPD) views on RD use of SL to pursue professional development (particularly internationally) and appropriateness of SB. Here, we present TPD views on international SL and SB with an aim to contribute to wider policy discussions. Methods A cross-sectional survey consisting of closed and open responses was developed by the authors to evaluate a range of TPD opinions related to international SL and current SB. The survey was published in Microsoft Office Forms. Initial pilot testing was carried out by the authors before survey review by a Scotland TPD for content validity. The authors conducted a final re-test before distribution via TPD email addresses available via public domain. All TPDs in Scotland were eligible to respond,which was confirmed via survey response. No incentive or prize was offered. Responses were anonymised before review. Response percentage and chi-square analysis were undertaken using Microsoft Excel. Qualitative analysis of free text comments was conducted with assistance from Google Gemini AI Software, with prompts to assist "thematic analysis" before review by the authors to identify trends in response. Results In total, responses were obtained from 16% of invited TPDs (N=26) across a variety of medical specialties. International SL had been approved by 65% (N=17) of TPDs in the last 12 months. International SL was actively encouraged by 77% (N=20). TPDs were significantly more likely to encourage international SL if they had approved international leave requests within the last 12 months. SB was not considered appropriate to cover mandatory training costs by 85% (N=22) of respondents. Personal costs to trainees were estimated to be at least £1000 per annum in 88.5% (N=23) of training programmes. Annual SB was felt to be adequate for trainees by 12% of respondents (N=3). TPDs indicated overall support for international SL with regard to international collaboration, networking, research opportunity and access to learning opportunity not available in the UK. Responses highlighted concern that removing international SL could reduce the quality of medical training in Scotland and affect recruitment and retention of medical trainees. Conclusion There is relative consensus from Scottish TPDs on the importance of international learning during medical training, highlightingbenefits for professional development, collaboration and education. The majority of TPDs view SB provided to trainees by NES as inadequate. Opportunity for suitable use of international SL could benefit RDs in Scottish training programmes with appropriate TPD oversight.Insights gathered from these responses could help inform policies to enhance international engagement in medical training programs within Scotland and the UK. Further exploration of differences in TPD opinion between specialties could highlight potential benefits of a level of autonomy in decisions made around resident doctor study budget funding and learning opportunities.

Is Nephrology Fellowship Training on the Right Track?

Engaging Trainees by Enriching Nephrology Elective Experiences.

Attitudes of Early-Career Cardiologists in Japan About Their Cardiovascular Training Programs

Development and Evaluation of a Three-Dimensional Multistation Cardiovascular Simulator

Childhood cancer survivors require life-long care by clinicians with an understanding of the specific risks arising from the prior cancer and its therapy. We surveyed North American pediatric hematology/oncology training programs to evaluate their resources and capacity for educating medical trainees about survivorship. An Internet survey was sent to training program directors and long-term follow-up clinic (LTFU) directors at the 56 US and Canadian centers with pediatric hematology/oncology fellowship programs. Perceptions regarding barriers to and optimal methods of delivering survivorship education were compared among training program and LTFU clinic directors. Responses were received from 45/56 institutions of which 37/45 (82%) programs require that pediatric hematology/oncology fellows complete a mandatory rotation focused on survivorship. The rotation is 4 weeks or less in 21 programs. Most (36/45; 80%) offer didactic lectures on survivorship as part of their training curriculum, and these are considered mandatory for pediatric hematology/oncology fellows at 26/36 (72.2%). Only 10 programs (22%) provide training to medical specialty trainees other than pediatric hematology/oncology fellows. Respondents identified lack of time for trainees to spend learning about late effects as the most significant barrier to providing survivorship teaching. LTFU clinic directors were more likely than training program directors to identify lack of interest in survivorship among trainees and survivorship not being a formal or expected part of the fellowship training program as barriers. The results of this survey highlight the need to establish standard training requirements to promote the achievement of basic survivorship competencies by pediatric hematology/oncology fellows.

A problem of scarcity

The 30th anniversary of the American Board of Allergy and Immunology: Then and now

Background: The COVID-19 pandemic created numerous challenges for graduate medical education, including defining the role of asynchronous virtual education in general cardiovascular (CV) fellowship training. The CardioNerds podcast introduced the CardioNerds Case Report (CNCR) series to provide continued high-quality cardiovascular education during the pandemic. Moving forward, the role and value of asynchronous education, and specifically medical podcasts, remain unknown. Methods: The CNCR series included a wide range of case-based episodes involving cardiology fellows, content experts, and program leadership from participating programs. Every accredited general cardiology fellowship program in the United States was invited. A survey assessing attitudes on a likert scale towards cased-based cardiology podcasts and medical podcasts was administered to all participating programs. Results: 44 cardiology fellowship programs participated in the CNCR series representing 137 fellows and 59 program directors and leaders (PDs). At this time, 76% of fellows and 63% of program directors have responded. 90% of both fellows and PDs agreed that the CNCR series was an effective way to teach core CV concepts and 74% of fellows felt that contributing to the CNCR series improved their clinical reasoning skills. 70% of PDs and 94% of fellows felt that medical podcasts in general added to their knowledge base. Fellows were more likely to strongly agree that medical podcasts changed their clinical practice compared to PDs (46% vs 8%, p = 0.02). Conclusion: Medical podcasts are becoming increasingly popular in cardiovascular education and training. Specifically, the CNCR platform has been well received by fellowship programs and has potentially influenced clinical practice. CV training programs and professional societies should invest in ensuring high quality medical podcasts are incorporated into CV training moving forward to supplement traditional CV education.

An invitational conference on Integrating Geriatrics into Cardiology Fellowship Training was held in Banff, Canada, August 11–16, 1996. The conference was funded by the Hartford Foundation under the auspices of the American Geriatrics Society and the Wake Forest-Bowman Gray School of Medicine, and it is part of an ongoing series of such conferences to bring academic geriatricians and medical sub-specialists together to develop strategies for incorporating principles of geriatric medicine into subspecialty training programs. As a secondary goal, the conference focused on identifying research needs. Co-chairs for the conference were Melvin D. Cheitlin, MD, of the University of California, San Francisco, and Michael W. Rich, MD, from the Washington University School of Medicine in St. Louis. Both are highly respected academic cardiologists with a long-standing interest in the cardiac care of older persons. Attendees consisted primarily of geriatricians with interest in cardiovascular disease in older people and cardiologists who have leading roles in academic cardiology in the United States. From the outset, it was clear that all of the attendees shared the common opinion that more training with regard to the principles of geriatric medicine and gerontologic research were needed in cardiology training programs. However, opinions varied greatly with regard to the amount and type of educational and research training that were needed. There was also some disagreement as to whether the major focus for geriatric medicine training should occur during the years of medical residency or during subspecialty training. In an attempt to arrive at some consensus, the group conducted a wide-ranging series of discussions focusing on issues of research, training, and public policy as it affects the management of cardiovascular disease in older persons. The magnitude of the clinical problem of cardiovascular disease in older people is obvious and sobering. Both the incidence and prevalence of cardiovascular disease increase exponentially with advancing age, and cardiovascular disease is the leading cause of death and major disability in individuals 65 years of age or older. Moreover, virtually all of the increase in age-adjusted mortality beyond age 65 is attributable to cardiovascular disease. Although persons more than 65 years of age comprise only 12% of the total US population, in 1990 they accounted for 59% of hospital admissions for acute myocardial infarction, 64% of admissions for cardiac arrhythmias, and 80% of admissions for congestive heart failure.1 More than half of all coronary artery bypass graft operations and more than three-fourths of all pacemaker implantations are in patients older than 65 years of age.1 In addition, more than 80% of hospital deaths related to myocardial infarction, coronary heart disease, congestive heart failure, and cerebral vascular disease occur in patients older than 65 years of age.1 In recognition of the growing importance of cardiovascular disease in older adults as a major public health concern, increasing interest and attention have been devoted to these issues in the last 12 to 15 years, both at the academic level and at the clinical level. For example, there have been at least 12 textbooks and monographs on geriatric cardiology published in the last decade, and there are currently two bimonthly journals devoted specifically to cardiovascular disease in older people. The American Heart Association and the American College of Cardiology have each allocated sessions to geriatric cardiology at their annual meetings, and the American Heart Association has a Committee on Cardiovascular Disease in the Elderly within the Council on Clinical Cardiology. In addition, an independent organization, the Council on Geriatric Cardiology, was established in 1985 and now includes approximately 400 members. See also p 638 Despite these advances, the overall level of interest of most cardiologists in the aging-related aspects of heart disease remains relatively low. Moreover, from the perspective of fellowship training, geriatric cardiology is not mentioned in the current ACGME requirements for training in cardiovascular disease, and there is a minimum of geriatrics content on the American Board of Internal Medicine (ABIM) certifying examination in cardiology. As discussions proceeded among attendees, agreement was reached on the following issues: . Although cardiologists do a very good job in managing cardiac illness in older persons, cardiologists have done little to develop integrated systems for enhancing the care of older persons with cardiovascular disease. The recently published randomized trial by Rich and colleagues, demonstrating the efficacy of a nurse- directed, multidisciplinary intervention for patients hospitalized with congestive heart failure,2 was cited as one example of the type of research and clinical work that cardiologists should be undertaking. . In general, clinical cardiologists do not focus as much on the tradeoffs of managing multisystem disorders and comorbidities as they should. . At times, geriatricians may well be too nihilistic with regard to the application of technology in older persons, whereas some cardiologists are probably too aggressive. All agreed that no real consensus needs to be reached on this issue, except that more training should be inserted into cardiology programs dealing with the delicate art of achieving a suitable balance between appropriate intervention, life trajectory, and quality of life in older persons while trying to minimize inappropriate or potentially harmful interventions that are unlikely to benefit the patient. . The group did not feel that a fundamental role change for subspecialty cardiologists is needed. Given the continuing growth of cardiovascular disease in older adults, there will continue to be a major role for consultant cardiologists to provide secondary and tertiary care for older people with heart disease. It was not felt to be appropriate or necessary to expect cardiologists to become primary care givers for older cardiac patients. . It was agreed that there is a very specific need to increase training in the principles of geriatric medicine and gerontologic research in cardiology training programs and that a multifaceted approach should be undertaken to accomplish this goal. Some of the recommended approaches are as follows: . A specific outline of proposed topics for didactic materials to be covered in cardiology training programs was developed. These didactic materials could be disseminated in several forms, including audio tapes developed in collaboration with the American College of Cardiology, slides and syllabus material developed through the American Geriatrics Society, and possibly a video series focusing on core concepts and syndromes in clinical geriatric medicine. . All agreed that the development of didactic materials alone would be an insufficient stimulus for change. It was agreed that directors of cardiology training programs will need to become re-educated or re-focused with regard to the importance of geriatrics concepts as they apply to older patients with cardiovascular disease. A variety of mechanisms were proposed to achieve this goal: . The group recommends that funding be developed through NIA and philanthropic foundations to create up to 30 third-year cardiology fellowship positions to train prospective academic cardiologists in the clinical and research aspects of cardiovascular disease in older people. . The appropriate boards and committees of both the American Geriatrics Society and the American College of Cardiology should be approached to develop educational and research initiatives. In this regard, formal liaison should be established between the American Geriatrics Society and the American College of Cardiology to facilitate ongoing research and educational program development. . Recognizing that the major driving force for inserting more geriatrics content into cardiology training programs is through the Residency Review Committee (RRC), it is recommended that the RRC develop specific guidelines requiring geriatrics training in cardiology fellowship programs. . Finally, it is recommended that more questions focusing on geriatric medicine and gerontologic research be included on the American Board of Internal Medicine cardiology subspecialty examination, the ABIM certifying examination in general internal medicine, and the re-certification examinations for both disciplines. The editors of this journal strongly endorse these initiatives. It is now incumbent on the attendees of the symposium, as well as on the American Geriatrics Society and the American College of Cardiology, to implement these important recommendations. We consider it a social imperative that more of the principles of geriatric medicine and gerontologic research be inserted formally into the education process for cardiology trainees.

Aim: Limited information exists on perceptions and professional development preferences on how trainees choose their sub-specialty. This study plan was set up to explore trainee cardiologists’ views of sub-specialty choice, with particular emphasis on career choices. Methods: This study was undertaken using questionnaires – “predetermined” through a web-based survey method. All cardiology trainees in the Health Education England North West (HEE NW) based in Merseyside and Manchester were asked to participate. This study had ethics approval from Edge Hill University and HEE research governance group. Results: The survey was sent to 49 trainees in the region and out of them 32 the completed survey. 25% were females, 66% were in their Specialty Training (ST) ST3-ST5 training, 78% had their under-graduate training in the UK, 94% were full time trainees and 69% were in the 30 to 35-year age group. The stimulating career, positive role model, family friendly and stable hours were found to be the key professional developmental factors in sub-specialty choice. Female friendly was less favored. Interference with family life, intellectually stimulating, and compensation and integration were key perception on sub-specialty choice. Adverse job conditions were not perceived as influential in sub-specialty choice. Prior clinical experience and easy access to training were the other factors influencing the trainee’s choice of sub- specialty. The adverse job conditions including exposure to radiation, unplanned on-calls and long operating time were associated with procedural related sub-specialties. The interference with family life, more financial benefit, positive role models, professional challenges and patient focus were associated with interventional Cardiology. Female friendly, family friendly, stable hours, compensation / integration were associated with imaging sub-specialty. Conclusion: Studying in depth into trainees’ perceptions and preferences may help in any efforts to make sub-specialty choice attractive and also help match work force to demand in the region.

CHARACTERISTICS OF CARDIOVASCULAR TRAINING PROGRAMS AND PROGRAM DIRECTORS: INITIAL RESULTS OF THE CARDIOVASCULAR PROGRAM DIRECTORS’ SURVEY