Cardiovascular Fellowship Research Articles

Hands-on Gross Anatomy Instruction Improves Clinical Imaging Skills Among Cardiovascular Fellows.

Introduction:Multi-modality imaging is a crucial component of cardiovascular (CV) fellowship training and requires knowledge of CV anatomy for interpretation. We hypothesized that hands-on anatomy education would improve the imaging interpretation skills of CV fellows.Methods:The first-year CV fellowship class completed a hands-on cadaveric anatomy session correlated with clinical imaging. Fellows’ ability to identify CV structures on cardiac imaging was assessed using a 30-question assessment tool administered at baseline and 1 week and 6 months post intervention. Advanced CV fellows (second or third year) who had not attended the session were also tested. Scores were expressed as median [interquartile range].Results:Among 9 first-year fellows, the majority reported no formal anatomy training since medical school (N = 7) and rated their knowledge of CV anatomy as fair or poor (N = 7) prior to the intervention. The median assessment score was higher 1 week after intervention vs baseline (24 [23-25] vs 19 [17-21]; P = .013) and remained higher than baseline at 6 months (26 [26-28] vs 19 [17-21]; P = .009). The 6-month post-intervention score for first-year fellows was not significantly different than that of senior fellows (n = 10) not exposed to the intervention (26 [26-28] vs 26 [23-27]; P = .434).Conclusions:Gross anatomy instruction improved first-year CV fellows’ interpretation of CV imaging. Anatomic instruction may be a useful adjunct to multi-modality imaging education.

Gender Disparities in Cardiovascular Fellowship Training Among 3 Specialties From 2007 to 2017

Despite women accounting for nearly half of all U.S. medical school graduates, this balanced representation is lacking in the cardiovascular specialties. To explore this question further, gender-based trends in the selection of cardiovascular subspecialty fellowship training were investigated among three core specialties: anesthesiology, medicine, and surgery. Using enrollment and workforce data from the Accreditation Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges (AAMC), and the Journal of the American Medical Association Annual Report on Graduate Medical Education, trends in cardiovascular fellowship selection among women were examined over a 10-year period (2007-2017). An attempt was also made to better understand barriers that might contribute to any discrepancies, as well as factors that might influence women's choices of cardiovascular specialties over other fields.

AN ELECTRONICALLY-DELIVERED, MULTI-MODALITY IMAGING CURRICULUM TO INCREASE CARDIOLOGY TRAINEE EXPOSURE TO RARE DISORDERS

Exposure to rare diagnoses during imaging rotations in cardiovascular (CV) fellowship can be unevenly distributed. An evaluation of our imaging curriculum showed 65% of CV fellows were uncomfortable recognizing rare diagnoses on imaging modalities (echocardiography, computed tomography (CT),

EFFICACY OF AN IMMEDIATE POST-PROCEDURAL FEEDBACK SYSTEM IN THE CATHETERIZATION LABORATORY

In response to an increased emphasis on ensuring that cardiovascular fellows obtain more 360 degree and procedural feedback, we implemented a new smartphone-based procedural feedback system in the cardiac catheterization laboratory at our institution. Attending physicians completed a brief survey

Nutrition Education for Cardiologists: The Time Has Come.

Nutrition is a cornerstone of cardiovascular health, yet the training of cardiovascular specialists in nutrition has been called into question. This report summarizes the current state of nutrition education in the training of cardiovascular specialists and offers recommendations for curricular enhancements. Medical students receive an average of fewer than 20h of nutrition education, largely confined to basic sciences and discussion of vitamin deficiency states. Current guidelines for Internal Medicine residency and cardiovascular fellowship training do not contain any specific requirement for nutrition education. A recent survey showed that the vast majority of cardiologists report having received minimal nutrition training, although most cardiologists believe it is their personal responsibility to provide nutritional counseling to their patients. Cardiologists typically receive minimal training in nutrition and are not well equipped to deliver effective nutritional counseling and recognize opportunities for appropriate referral. The potential for cardiologists to become more effective team members in delivering nutritional interventions is considerable.

Genomic Medicine in Cardiovascular Fellowship Training.

As genomic testing becomes more accessible for both clinical indications and patients’ personal curiosity, cardiologists are increasingly asked to interpret the results in terms of future risk of disease. In many cases, patients hope that such testing will yield detailed, personalized recommendations regarding their own medical care as well as their family’s. However, given the lack of formal instruction in genomic analysis during cardiovascular training, a gap exists between some patients’ desires and our own abilities to incorporate genomic information into practice. Patient care and biomedical research will undoubtedly be increasingly influenced by genomic medicine efforts in the coming years. In his 2016 budget proposal, President Obama allocated $215 million to fund the Precision Medicine Initiative.1 The goal of this program is to develop data lakes compiling vast arrays of patient data, including genomic information and detailed phenotypic, epigenomic, proteomic, transcriptomic, and metabolomic data. By using the computational power of such an effort, clinicians will hopefully be able to better predict disease and tailor therapies at the population and individual levels. Given the enormous resource investment and global burden of cardiovascular disease, the cardiovascular community will likely play a key role in this movement. Therefore, it is critical that we begin to incorporate training modules on genomic …

Educating Cardiovascular Fellows in the Contemporary Era

Educating Cardiovascular Fellows in the Contemporary Era

Proximal‐tubule‐select dual knockout of insulin and insulin‐like‐growth factor (type I) receptors in mice alters responses to dietary fructose

The monosaccharide, fructose is a common dietary constituent, but metabolized quite differently from glucose. One site of fructose metabolism is the renal proximal tubule (PT). How and whether insulin or the related hormone, insulin‐like‐growth‐factor, type 1 (IGF1), modulate fructose metabolism at this site is not known. To address this, we bred mice with dual knockout (KO) of the insulin receptor (IR) and the IGF1 receptor (IGF1R) from PT by Cre‐lox recombination using a γ‐glutamyltransferase promoter. Male (M) and female (F) wild‐type (WT) and KO mice were fed control (C) or high fructose (Fr) diet (60%) for 4 weeks (n = 10–12/group). KO mice had marginally lower body and/or kidney weights. Fructose feeding did not affect final body weight. Glucose tolerance was significantly impaired by fructose feeding, but only in the WT mice. KO mice also had a phenotype suggesting renal tubular acidosis, i.e., with significantly elevated blood chloride levels, and decreased blood total CO2 levels. Plasma sodium was also reduced in male KO by fructose, but not in the WT or females. Western blotting of cortex homogenates revealed significantly reduced (2‐way ANOVA) band densities for IR, IGF1R, and NaPi‐2 (sodium phosphate cotransporter) in the KO mice. However, no genotype differences were found for band densities of the fructose transporter (GLUT5) and ketohexokinase (KHK), the first enzyme in fructose metabolism, although the abundances of these two proteins were significantly increased in males and in fructose‐fed animals. The sodium bicarbonate cotransporter (NBC) was reduced in KO, but not WT males by fructose‐feeding. Females, overall, had significantly lower levels of NBC. Overall, genotype differences in the metabolic responses to fructose suggest a role for PT IR/IGF1R expression as a modulator of PT metabolism and/or acid‐base homeostasis.Support or Funding InformationMarriott Cardiovascular Fellowship and Georgetown Internal funding

Elizabeth McNally: A Muscular Approach.

Elizabeth McNally, MD, PhD, has spent three decades studying the genetics of heart and muscle disease. Her work has yielded new insights into the development and presentation of cardiomyopathy and muscular dystrophy. Dr McNally’s interests are rooted in her days as an undergraduate student at Barnard College. She earned her medical degree and doctorate in microbiology and immunology from Albert Einstein College of Medicine. She did her internship, residency and cardiovascular fellowship at Brigham and Women’s Hospital, and genetics fellowship at Boston Children’s Hospital. Before joining Northwestern University last year, Dr McNally, a Chicago native, had been at the University of Chicago since 1996. Among her nearly 200 publications are studies on developing genetic profiling to identify mutations underlying cardiomyopathy, including a collaborative project associating a single mutation with a range of outcomes,1 and research demonstrating the utility of whole-genome sequencing to find individual mutations in cardiomyopathy patients,2 and of a supercomputer to facilitate whole-genome analysis.3 She has explored how molecular modifiers—focusing on the TGF-beta pathway—change disease outcomes, both in animal models4–6 of muscular dystrophy and cardiomyopathy, and in patients7 with Duchenne muscular dystrophy. Recent work has proposed a novel approach8 to modulating this pathway. Other studies have identified a new modifier pathway mediating cell repair in striated muscle9 and elucidated the role of KATP channels in the neonatal heart’s shift to adult metabolism.10 In September, McNally became director of Northwestern’s Center for Genetic Medicine, with the goal of transforming how genetic information is used clinically. She plans to capitalize on advances in genetic sequencing, leverage the high heritability of cardiovascular and neurological disease, and navigate the dynamic genetics of cancer, to improve patient outcomes. I lived in the northwest suburbs of Chicago and really was not raised in a …

Targeting clinical outcomes: Endovascular simulation improves diagnostic coronary angiography skills.

The purpose of this study is to determine the effects of simulation-based medical education (SBME) on the skills required to perform coronary angiography in the cardiac catheterization laboratory. Cardiovascular fellows commonly learn invasive procedures on patients. Because this approach is not standardized, it can result in inconsistent skill acquisition through exclusion of concepts and skills. Also, the learning curve varies between trainees yielding variability in skill acquisition. Therefore, coronary angiography skills are an excellent target for SBME in an environment in which direct patient care is not jeopardized. From January 2013 to June 2013, 14 cardiovascular fellows entering the cardiac catheterization laboratory at a tertiary care teaching hospital were tested on an endovascular simulator to assess baseline skills. All fellows subsequently underwent didactic teaching and preceptor-lead training on the endovascular simulator. Topics included basic catheterization skills and a review of catheterization laboratory systems. Following training, all fellows underwent a post-training assessment on the endovascular simulator. Paired t tests were used to compare items on the skills checklist and simulator defined variables. Cardiovascular fellows scored significantly higher on a diagnostic coronary angiography skills checklist following SBME using an endovascular simulator. The mean pretest score was 66.6% (SD = 9.7%) compared to 86.0% (SD = 6.3%) following simulator training (P < 0.001). Additional findings include significant reduction in procedure time and use of cine-fluoroscopy at posttest. SBME significantly improved cardiovascular fellows' performance of simulated coronary angiography skills. Standardized simulation-based education is a valuable adjunct to traditional clinical education for cardiovascular fellows.

Multidisciplinary training in cardiovascular fellowship programs

The management of complex cardiovascular disease is rapidlyshifting from individual physician based practice towards a multidisci-plinary team approach. The plethora of scientific data and the develop-ment of new strategies of care led to the wide adoption of the ‘HeartTeam’ or the ‘Cardiovascular Team’ concept, where cardiologists workclosely with cardiacsurgeons, vascular surgeons, neurologists, anesthe-siologists, radiologists, interventional radiologists and other specialiststo deliver a high-quality cardiovascular care. The importance of this‘patient-centered’ and not ‘specialty-centered’ approach is well recog-nizedbymultiplesocietiesanditsadoptionisthereforestronglyrecom-mended in most contemporary guidelines [1]. The evolution of thiscollaborative team approach has transformed how cardiovascularspecialists interact and provide patient care, and possibly resultedin improved outcomes. Unfortunately, educational models have notkept pace with these changes. In most cardiovascular fellowshiptraining programs, fellows' exposure to other key specialtiesislimit-ed to didactic lectures, and scattered patient-care related interac-tions. In the era of multispecialtyteam approach, this exposure ofcardiovascular fellows to their future team collaborators is far fromadequate.The most recent guidelines for Training in Adult CardiovascularMedicine acknowledge the importance of multidisciplinary trainingbutdonotprovidespecificrecommendationswithregardtoitsapplica-tion [2]. The guidelines states that ‘specialists in cardiovascular diseasemust interact with generalists and specialists in other areas and haveknowledge of other specialties to provide excellent patient care. Close

The current state of medical simulation in interventional cardiology: A clinical document from the Society for Cardiovascular Angiography and Intervention's (SCAI) Simulation Committee

To assess the current use and application of simulators in interventional cardiology. Despite a paucity of data on the efficacy of simulation in medicine, cardiovascular simulation training is now a mandated part of cardiovascular fellowship training. Additionally, simulators have been endorsed by the Food and Drug Administration as a way to teach physicians new and novel procedures. We sought to establish the current use of simulators in cardiovascular medicine. A systematic review was done of available training programs, and currently existing data regarding simulation training. A panel of experts was convened to review this data and provide recommendations as how simulation should be used in the field of interventional cardiology. This document provides a comprehensive review of the current state of simulation and how we as a society must formulate well validated studies to more closely examine and explore how this technology can be further studied and validated. Simulation will likely take on a larger role in cardiovascular training and maintenance of certification, but at the current time lacks a large body of evidence for its use.

Pulmonary Hypertension Roundtable: The Challenging Spectrum of PH in Liver and Kidney Transplantation Patients

On August 16, 2013, a group of physicians with clinical expertise related to management of pulmonary hypertension (PH) patients who are undergoing evaluation for or having liver or kidney transplantation was convened by telephone to discuss this challenging topic. These complex patients represent a spectrum of clinical types of PH and require complete evaluations utilizing a team-oriented and multidisciplinary approach to ensure appropriate treatment and safe transplantation. Facilitated by the guest editors of this issue, Charles Burger, MD, and Paul Forfia, MD, discussants included Michael Krowka, MD, Professor of Medicine, Pulmonary Division, Mayo Clinic, Rochester, Minnesota; José Diaz-Gómez, MD, Medical Director-ICU, Departments of Anesthesiology and Critical Care, Mayo Clinic, Jacksonville, Florida; Anna Hemnes, MD, Assistant Professor, Assistant Director, Pulmonary Vascular Disease Program Vanderbilt University Medical Center, Nashville, Tennessee; and Michael Mathier, MD, Assistant Professor of Medicine, Director, Pulmonary Hypertension Program, and Associate Director, Cardiovascular Fellowship Program of the University of Pittsburgh Medical Center.

Pulmonary Hypertension Roundtable: Pulmonary Roundtable – Bariatric Surgery and the PAH Patient

As guest editor of this issue on perioperative issues in PAH patients, Sean Studer, MD, MSc, convened a group of experts to discuss the implications of bariatric surgery for the pulmonary hypertension patient. Given the prevalence of obesity and its sequelae related to PH patients, it's not an uncommon topic. The approach to patient counseling, minimizing surgical risks, and working with the interdisciplinary team were addressed among the wide range of topics by clinicians on the front lines. Taking part in the conversation were Michael Mathier, MD, Assistant Professor of Medicine, Director, Pulmonary Hypertension Program, and Associate Director, Cardiovascular Fellowship Program of the University of Pittsburgh Medical Center; Dana P. McGlothlin, MD, Medical Director of Combined Heart-Lung Transplantation and Mechanical Circulatory Support, Medical Director of the Cardiac Intensive Care Unit, and Associate Director of the Pulmonary Hypertension Program at the University of California, San Francisco; Ramesh C. Ramanathan, MD, is a surgeon specializing at the University of Pittsburgh Medical Center. Deborah J. Levine, MD, Associate Professor, Pulmonary Disease and Critical Care Medicine, Director, Pulmonary Hypertension Clinic, University of Texas Health Science Center, San Antonio, added comments from the pulmonary perspective to the transcript of the discussion.

The Cardiovascular Fellows Bootcamp

General surgery residents graduate with an inconsistent knowledge of cardiovascular disease and an inadequate skill set for the practice of vascular surgery. Vascular educators have proposed to overcome these challenges by incorporating standardized milestones and simulation curricula into vascular education, but at present, nonclinical vascular education remains nonstandardized. The first step in this direction is to lay a foundation of knowledge and skill for trainees nationwide, and regionalized courses have begun to be offered to address this need. Through the Methodist DeBakey Institute for Cardiovascular Education, we have developed our own course, The Cardiovascular Fellows Bootcamp. The principles behind The Cardiovascular Fellows Bootcamp are teach early, teach the basics, teach broadly, and teach multiple cardiovascular disciplines, and over a 3-day weekend of didactic lectures and skill training, we aim to lay a foundation for cardiovascular training that prepares the trainees for their fellowship. In this article, we describe the way in which our course is run and the thought process behind our approach. We also address some of the practical concerns that make hosting a course of this magnitude feasible and our plans for improving and expanding in the future.

In Memoriam Tribute to James A. Shaver, MD

Dr James A. Shaver, our friend and colleague, died of pneumonia on April 13, 2012, after a long history of chronic renal disease. At the time of his death, he was professor of medicine and the former chief of the division of cardiology at the University of Pittsburgh School of Medicine. Born in Ridgway, Pennsylvania, he was elected to Phi Beta Kappa at the University of Pennsylvania and to Alpha Omega Alpha at the Hahnemann Medical College, from which he graduated in 1959. Dr Shaver trained in internal medicine at the University of Pennsylvania and the University of Pittsburgh, where he also completed his cardiology fellowship. He joined the Pitt faculty in 1965 and rose through the ranks to become a full professor in 1977. He was director of the cardiac diagnostic laboratories and then became director of the division from 1971 to 1994. Dr Shaver also served as director of the Cardiovascular Fellowship Program from 1971 to 2006, training more than 325 fellows, many of whom went on to assume leadership positions of their own. Since he left the division directorship, he led the medical school second-year course in physical diagnosis and continued to play an active role as a consulting cardiologist and a charismatic teacher at all levels of medical education. Dr …

Abstract 214: Multidisciplinary Approach to Improve Process Measures and Prevent Heart Failure Readmissions

Background: Approximately 5.2 million Americans have heart failure (HF). HF morbidity and mortality is high, and 27% of patients are readmitted at 1 month and 50% at six months. Objective: To determine the effect of a multidisciplinary approach on Hospital Quality Alliance (HQA) performance and 30-day HF readmission rates. Methods: A one year, prospective, observational study on the effect of a multidisciplinary approach on 30-day HF readmissions was performed and compared to the prior year’s readmission rate at a University affiliated community hospital. HF patients were identified by case and unit nurse managers, who also screened for intravenous diuretic use to determine if patients had HF but were admitted under another diagnosis. HF patients were clustered geographically where daily multidisciplinary rounds with the unit nurse and care manager, pharmacist, social worker, nutritionist, medical and nursing staff took place. The goal was to ensure compliance with the established HQA Performance Measures, initiate appropriate discharge planning, and assess functional status. Patients were educated on 2 gram sodium diet, 2 liter fluid restriction, daily weight monitoring, and smoking cessation. Follow-up appointments with their PCP or cardiologist were scheduled. Upon discharge, nursing and medical staff provided medication and home management instructions. The patient’s PCP was called by the attending physician or cardiovascular fellow as well as the Skilled Nurse Facility, Rehabilitation, and Home Care staff, when applicable. Targeted in-home support immediately following discharge from the hospital was provided. High risk patient had an in-home 2-3 day post discharge visit by VNA and a Pharmacist to access their weight, medications, and physical activity progress. Results: During the intervention year, 355 CHF patients were discharged and compared to 318 patients in the year prior. The 30 day readmissions were reduced from 79 (24.8 %) to 64 (18.03%), p = 0.04 by Wilcoxon Signed-Rank Test. The Heart Failure National Inpatient Quality Measures performance increased from 95% ± 3.8% (2010) to 99.6% ± 0.5% (2011) - p = 0.008 . Conclusions: With implementation of penalties by Medicare in 2013 for 30 day HF readmissions, strategies to reduce them are critical. A comprehensive intervention involving multiple specialties and appropriate patients’ disposition can reduce 30-day readmission rates as well as improve Heart Failure National Inpatient Quality Performance Measures. Further evaluation of this treatment approach, including an assessment of cost-effectiveness, is warranted.

Empirical cardiovascular CT training standards: Did we get it right?

Training standards for initial competency in cardiovascular CT have been defined by both the American College of Cardiology 1 Budoff M.J. Cohen M.C. Garcia M.J. Hodgson J.M. Hundley W.G. Lima J.A. Manning W.J. Pohost G.M. Raggi P.M. Rodgers G.P. Rumberger J.A. Taylor A.J. Creager M.A. Hirshfield Jr., J.W. Lorell B.H. Merli G. Rodgers G.P. Tracy C.M. Weitz H.H. American College of Cardiology Foundation; American Heart Association; American College of Physicians Task Force on Clinical Competence and Training; American Society of Echocardiography; American Society of Nuclear Cardiology; Society of Atherosclerosis Imaging; Society for Cardiovascular Angiography & Interventions: ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol. 2005; 46: 383-402 Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar and the American College of Radiology. 2 Jacobs J.E. Boxt L.M. Desjardins B. Fishman E.K. Larson P.A. Schoephf J. American College of Radiology: ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol. 2006; 3: 677-685 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar Although they differ in their specifics, both share a common element of empiricism. That is, they are solely guided by expert opinion in that such standards are determined without formal testing of whether they meet, exceed, or fall beneath their intent which is to identify the training parameters, typically guided by case numbers, that are associated with procedural competency. Indeed, in 2005 and 2006 when these respective documents were published, the field of cardiovascular CT was just beginning to burgeon. The cottage industry of cardiovascular CT training courses was similar in its infancy. Few opportunities for structured training existed within American College of Graduate Medical Education or American Board of Radiology training programs because of the incomplete penetrance of technology and limited faculty expertise. 3 Taylor A.J. Udelson J.E. Fuster V. Training cardiovascular fellows in cardiovascular magnetic resonance and vascular imaging; Current status following the core cardiovascular training symposium (COCATS-2) guidelines. J Am Coll Cardiol. 2004; 43: 2108-2112 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Now, 5 years later, it is reasonable to ask the question, “did we get it right?”

Training in cardiovascular computed tomography: The Fellows-In-Training perspective

Cardiovascular computed tomography angiography (CCTA) is an emerging diagnostic technique in the evaluation of patients with suspected coronary artery disease. The recent CoCATS guidelines recommend that all cardiovascular fellows be exposed to CCTA in their training programs; however, not all programs have the ability to provide such training. This study aims to describe the present opinions of Fellows-in-Training (FIT) toward CCTA training. Cardiovascular FITs in the state of Michigan were contacted through the American College of Cardiology, Michigan chapter, e-mail list and were asked to complete a 12-question anonymous survey examining attitudes toward CCTA. Sixty (54%) of 112 FITs completed the survey. Ninety-one percent of respondents had a CCTA program at their hospital and 52 (87%) considered CCTA important toward increasing their professional competitiveness. In addition, 93% had interest in obtaining at least level 2 training irrespective of their future career plans. The most important factors influencing their choice of third-party courses were cost, number of live cases, and student-to-faculty ratio. Finally, 47% supported creating an additional fourth year of training in advanced imaging, and 40% would pursue such training. Most cardiovascular FITs are interested in seeking advanced training in CCTA. Cardiovascular training programs should incorporate CCTA in their core curriculum to meet the increasing interest in CCTA among trainees.

Accreditation Council for Graduate Medical Education Initiatives Improve the Education of Cardiology Fellows

Training cardiovascular specialists in the present era is highly complex. The list of topics and procedures continues to grow; the required knowledge base for providing cutting-edge clinical care and passing examinations is increasing; and technologies and research are advancing rapidly. Cardiology fellows face a changing template of demands from training programs, governing bodies, professional societies, and potential employers. At the completion of the cardiovascular fellowship training process, it is imperative that graduates are highly capable and complete physicians. Certainly, strict accreditation and adjudication of the fellowship training process are necessary to ensure the highest-quality training of cardiologists and other healthcare providers. Response by Bashore and Wang p 531 Established in 1981, the Accreditation Council for Graduate Medical Education (ACGME) is a private, not-for-profit organization that evaluates, accredits, and oversees >100 000 postgraduate medical trainees in nearly 8400 training programs representing 126 specialties and subspecialties in the United States. Cardiovascular fellowship programs represent a large portion of these trainees. There are presently 177 general cardiology fellowship programs with 2362 filled positions. In addition, there are 95 electrophysiology and 130 interventional subspecialty cardiology fellowship programs with 173 and 290 filled spots, respectively. The member organizations of ACGME include the American Board of Medical Specialties, American Hospital Association, American Medical Association, Association of American Medical Colleges, and the Council of Medical Specialty Societies. Each member organization appoints 4 members to the Board of Directors, which also includes 2 resident members, 3 public directors, the chair of the Council of Review Committee Chairs, and a federal representative. The ACGME has 28 review committees: 1 committee for each of the 26 specialties, 1 for the 1-year transitional-year program, and 1 for institutional review. Before the ACGME, postgraduate medical training was managed by the Liaison Committee for Graduate Medical Education, which was established in 1972. The …