To Be Certified or Not to Be: Is That the Question?

Abstract

Interventional cardiology, more than any other discipline in medicine, sprang forth like Athena, if not as fully armed, at the specific time when Andreas Gruentzig performed the first coronary angioplasty in 1977. As this procedure became the principle raison d’etre for a subspecialty of cardiology, a movement for establishing accredited training and testing was mounted by the Society for Cardiac Angiography and Interventions and the American College of Cardiology. The purpose of establishing formalized, recognized training and testing certification was the same as it was for internal medicine practitioners 80 years before, that is, to recognize “to their peers and the public that these physicians have the clinical judgment, skills and attributes essential for the delivery of excellent patient care.”1 Conversely, it is to identify those who do not possess these qualifications so that they might consider a different line of work. How did it work before boards? In the late 1970s and 1980s, many physicians desiring to perform percutaneous interventions (present author included) attended 1-week courses observing percutaneous coronary angioplasty (percutaneous coronary intervention) and then attempting it on their own. Others, after participating in such a short course, would bring patients with their angiograms and scrub in with those of us who had more experience. Training programs of various durations were established by individual institutions. We began a 1-year clinical fellowship in 1981, headed of course by Andreas Gruentzig. Throughout the 1980s and most of the 1990s, fellowship programs proliferated, and by the mid-1990s there was a growing interest in defining the requirements for adequate training. The establishment of training standards, largely developed by the American College of Cardiology activity and eventually approved by the American Board of Medical Specialists, was a parallel effort to the application for a testing component, the Certificate of Added Qualification of the …