Clinical Training Component
Criteria for clinical competency in echocardiography and radionuclide scintigraphy are established by the Accreditation Council on Graduate Medical Education (ACGME) in the field of Internal Medicine with subspecialty training in cardiovascular disease (www.acgme.org).
The purpose, however, of this program is to provide additional expertise in imaging.
In addition, the ACGME has yet to define training criteria for cardiac CT and MRI. To define this level of expertise, we have adopted the Core Cardiology Training Symposia Criteria (COCATS) established by the American College of Cardiology (J Am Coll Cardiol 2006;47:894-7). These criteria are developed in conjunction with the Societies representing each modality in North America (For echocardiography, The American Society of Echocardiography; for radio-isotope imaging, The American Society of Nuclear Cardiology; for MRI, The Society for Cardiovascular Magnetic Resonance; and for CT, the Society for Cardiac Computed Tomography).
As defined by COCATS, Level I training consists of familiarity with a process or procedure, Level II training constitutes a proficiency level needed to perform and bill for services clinically, and Level III training provides the necessary experience to manage an entire laboratory in a respective modality.
To achieve Level II competency for CT, MRI, echocardiography, and radio-isotope imaging, 2, 3, 6, and 4 months of clinical experience are required, respectively. Also, in addition to the months of time, 150, 150, 300, and 300 cases are required, respectively, to be accomplished during those months.
Imaging trainees will be educated in advanced applications of the respective imaging modalities. For example, with echocardiography, trainees will perform transesophageal exams, resynchronization exams, and 3-D imaging. With MRI, they will perform, monitor, and report on cardiac stress tests. Importantly, staffing will be provided at all times for all imaging modalities that is at least Level II proficient in the modality currently performed.
Importantly, trainees participating in the clinical rotations will also participate in a bi-weekly appropriateness and quality control program. This program involves interpretation of images and studies in a group format and comparison of the results of studies with specific outcome measures, such as patient outcomes or other test modality results (i.e., catheterization results).
As with criteria established for Level II training, individuals receiving Level III training will meet criteria established by COCATS for this Level III certification. In general, this Level III certification requires a higher number of imaging procedures and academic proficiency (manuscripts, lectures, leadership) in the respective area. It is important to recognize that the Program and Adjunct faculty as well as the imaging resources and clinical material at Wake Forest University Baptist Medical Center assembled have the capability and have met all criteria established by COCATS and the ACGME to deliver Levels I through III competency in all of the noninvasive imaging modalities (MRI, CT, U/S, NUC) used to provide cardiovascular health care.
