Hi, my name is Donna Polk, and I'll spend the next few minutes talking with you about the cardiology subspecialty requirements. There are basic core internal medicine requirements that are there for all the subspecialties, but what we'll spend the next few minutes talking about are the cardiology specific subspecialty requirements. This is really a key document for your success as a program director. You just need to read it, you just need to go through each of the elements of it. It may seem like there's lots of boxes to check, but it's important that we make sure that we have each of the core elements in our fellowship to make sure that our fellows get adequate training. There are opportunities, however, to make sure your program better, to really make the most of the situation and the resources that you have, to really offer a unique educational opportunity for your fellows. We'll go through each of the components, which include the institutional requirements, the program personnel and resources, fellow appointments, educational program, evaluation, and the learning and working environment. It's important to recognize that there are core requirements, so these are really the things that are non-negotiable. These are statements that define the structure, the resource, or the process elements that are essential to every GME program. These are the things that you cannot miss, you need to make sure are covered and are available to your fellows. There are then detail requirements, and these really describe the structure, the resource, or the process to achieve those core requirements. This allows you the opportunity to maybe have a different process, to innovate, to have a different way of doing things, but still make sure that you meet that core requirement. This document also defines the outcome requirements, and these are really the statements that specify what's expected of our fellows, what we can measure and observe, and know that when they leave, that they are competent cardiologists, and that they have progressed through fellowship, and we've been able to follow them and document that throughout. So those are all included in this document. So an example of what a core requirement would be is for the program director. There should be a single program director, there can't be co-directors, there has to be a single program director. An example of a detail requirement is the time that that program director needs to be in their position. They should certainly be in that position long enough to maintain leadership and program stability, but it doesn't define exactly how many years that is. An example of an outcome are how the fellow takes care of patients, so they have to demonstrate that they are competent in the practice of, and there's a list here of prevention, acute MIs, cardiomyopathy, that we need to know that they can take care of each of those patients with each of those diagnoses. So let's go through each of the sections. The first is the institution. There needs to be a single sponsoring institution, and that institution is responsible for many of the different things and the components that make up the resources and the structure of your fellowship. We'll talk about program director support as well as the program letters of agreement. So for program director support, the institution itself needs to provide the program director with adequate support to administer that fellowship. You cannot be required to generate clinical or other income to provide and buy out of your time so that you can be that administrator. That support should be 25 to 50 percent of your salary or your protected time, depending on the size of the program. There need to be program letters of agreement with any institution that your fellow goes to to receive any of their education that's outside of your sponsoring institution. This should really define what happens to your fellow there, who's supervising them, what they're doing, what the expectations are. That should all be within this program letter of agreement so that you set out the expectation of what that fellow is getting at the outside institution. We'll talk a little bit about the program director responsibilities and also about the resources that your fellows need. So qualifications to be a program director, again, there needs to be a single person in charge. They should be board certified, have some GME experience, and should be five years out of training. This section's really important to read. This is really your job description. It includes the things that you're expected to do, which are the curriculum, but it also includes things like you're in charge of making sure that supervision is appropriate wherever your fellow is, if they're off-site or at your site, approve the selection of the program faculty, adjust schedules to mitigate that service-education balance if that's disrupted. You are in charge of making sure that the schedule are adjusted to accommodate for that. As well as adjusting the schedule for fatigue mitigation. It's also important in your duty as a program director to establish a reporting relationship with both the program director of the internal medicine program, and if your program has sub-sub-specialties, to have that relationship with those dependent sub-sub-specialties. So to meet regularly with the program director for electrophysiology or interventional cardiology if you have those sub-sub-specialties at your institution. In order to be a key clinical faculty, you need to devote a sufficient time to that educational program. These are really your faculty that are engaged with the fellows, spend the time teaching the fellows, spend the time doing scholarly activities with the fellows. These are really your key faculty. So they need to be able to devote sufficient time. They must maintain an environment of inquiry and scholarship within an active research component. Some members may achieve that scholarly activity through peer-reviewed funding, could be through publications such as original research or textbook chapters, could be through publication or presentation of a case report at both a local, regional, or national meeting. Or they may participate in national committees or educational organizations, but continue to maintain that environment of inquiry, which is really critical in making sure our fellows get appropriate education. So that key clinical faculty really needs to be the ones that are engaged with your fellows. They should devote at least 10 hours a week to your fellows. They need to be board certified, be engaged in scholarship. These are the ones, these are your faculty members that are going to be on your clinical competency meeting. They're going to be the ones that are on your program evaluation committee. These are the ones that are really engaged with your fellowship. There need to at least be three other than you as the program director. That's the minimum number. You may need more depending on what your complement size is. So what resources should you have for your fellowship? The institution needs to provide those adequate resources. There needs to be enough space and equipment, and that includes computers, workspace, study space, needs to be lounge space when they're on call. The fellows need ancillary staff to help them. They shouldn't be doing all the clerical activities. There also needs to be a broad range of cardiovascular services and laboratory services at the primary clinical site. They may go elsewhere for certain clinical experiences, but cath lab, echo lab, those core components need to be at the primary clinical site. There needs to be adequate variety in patients, and that includes gender and age. We need to make sure that there's enough of a geriatric population and a female population to provide adequate training for our fellows. So in order to be eligible for a cardiovascular ACGME-accredited fellowship program, the fellows need to have gone through a traditional ACGME-accredited internal medicine program. They can also now go through the Royal College of Physicians and Surgeons of Canada. There are fellows, however, that do not fall into one of the two of those that are considered nontraditional, and there is a pathway if they're exceptionally qualified applicants. These fellows will be under close scrutiny in the beginning parts of their training to make sure that they really are at the level that they should be in order to be in the ACGME-accredited program. Be aware, though, that they may not have the same pathway for ABIM certification if they come through a nontraditional pathway. This portion of the document also allows you to know what information you need to either accept a fellow and transfer or write a letter on behalf of a fellow that's transferring out of your program. This document also highlights the educational program, what you need to do for your cardiology fellowship program. These are really the core components. It allows you to have competency-based goals and objectives for each of the assignments, what the expectations are around conferences, journal club, contains topics related to medical knowledge and patient care to make sure that your fellows have exposure to each and every one of those. It also defines the teaching relationship between the teaching faculty and the fellows. It does define the minimal procedural experience according to the ACGME, what those fellows need, defines the curriculum organization and the fellowship experiences. It also outlines the continuity ambulatory clinic, the minimum number of patients they need, the minimum number of sessions they need per year, and really defines what that looks like for the fellows. It also defines the fellows' scholarly expectations, what we expect them to do for scholarship as well as quality improvement. A critical portion of this document really defines how we engage in that evaluation process for our fellows. It defines the clinical competency committee, which should meet at least semi-annually, should have three members of the program. These are often your key clinical faculty. It also defines formative evaluation, which should happen after each of those clinical experiences, and also the summative evaluation, which is at the end of your fellows' experience that becomes part of their permanent record. They should have access to that, they should have a copy of that, and that really defines what they achieve during their fellowship. This document also talks about faculty evaluation and lastly about the program evaluation committee. This should meet at least annually, should have at least two program faculty and definitely at least one fellow, and really defines the metrics of your program. It looks and follows fellows, faculty, and graduate performances. This is when you pull in ABIM scores, what scholarly activity fellows are doing and faculty is doing. This really defines who your program is, what your fellows are doing. This gets then reported in the annual program evaluation, or the APE, and really gives you a stepping stone for program improvement and quality improvement each year in your program. The last thing that this document defines is the learning and working environment. Describes the patient safety and quality improvement and your fellows' engagement in that, talks about supervision, direct, indirect, talks about professionalism, well-being, fatigue mitigation, teamwork and transitions of care, as well as the duty hours and the clinical experience. So the ACGME cardiology subspecialty requirements are really an important part of how you're going to get your job done as the program director. Take the time to read it. It really is your job description. It defines all those key components of your program and you may be able to leverage some of the core requirements to secure those resources for your fellows and your fellowship.

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