Article 1
CENTRAL MONITORING AUTHORITY for CARDIOLOGY at EU LEVEL
1.1. The central monitoring authority for the specialty will be the
European Board for the Specialty of Cardiology (EBSC), which has been
constituted from members of the UEMS specialist section for cardiology and the
European Society of Cardiology (ESC). It is chaired by a representative of the
UEMS specialist section for cardiology. It includes representatives of the AEPC
and of the non-EC countries and representative of PWG (cardiologists in training).
1.2. When necessary or at the request of the UEMS, the EBSC will make
recommendations for the minimum (but also optimal) requirement for training in
cardiology. When important modifications are proposed, these should be sent -
after acceptance by the cardiology section of the UEMS and by the executive
structures of the UEMS - to the scientific and professional organizations with
the aim to incorporate these modifications by the National Boards into the
regulations for recognition of training institutions and teachers.
1.3. The EBSC will make recommendations to the National Boards to
assure the quality of training. This may include a programme for site
inspections of training institutions
1.4. 1.4 Responsibility for recognition and regulation of training
institutions and trainers rests with National Training Boards. Applicants for
the Diploma of European Cardiologist from the EBSC will be asked to confirm that
all or part of their training has taken place in an approved training centre.
1.5. The EBSC will conduct surveys of training systems throughout
Europe, establish a system of regular liaison between directors of National
Training (where they exist), and request notification when significant changes
to training systems is undertaken.
1.6. Recommendations for manpower planning will be dealt with by a separate
manpower committee comprising members of the EBSC and the cardiology section of
the UEMS.
Article 2
GENERAL ASPECTS of TRAINING in the SPECIALTY
2.1 Candidates for training in the specialty should be physicians
licensed in a country of the EU or they should have an equivalent qualification
approved by the host country. It is the primary responsibility of each training
institution to establish further criteria for entry into their training
programme.
2.2 The minimum duration of training in cardiology will be 6 years
following registration as a medical doctor, consisting of a common trunk of
general internal medicine (excluding cardiology) with a duration of at least 2
years. It further contains 3 years of basic training in cardiology and one
flexible year which may be devoted to internal medicine, cardiovascular research,
cardiovascular pharmacology, cardiovascular epidemiology, cardiovascular
preventive medicine or rehabilitation, angiology or general cardiology or other
related aspects of CV disease. It is the strong recommendation of the EBSC that
postgraduate training lasts for a minimum of 6 years. Nevertheless, candidates
whose national training programmes comprise 5 rather than 6 years may be
eligible for the European Cardiology Diploma if they can demonstrate that
following a minimum of 2 years of general training (common trunk) and 3 years of
Cardiology training, they have continued to train in post (as a recognized
national specialist) for a minimum of one further year.
2.3 The content of each training programme should be under the
surveillance of the National Boards (ref. C4 Charter). The medical knowledge
that is required includes the basic sciences of anatomy, pathology, physiology
and pharmacology as well as an understanding of aetiology, cardiovascular
physiology, pathology and experience of general care of all cardiac disorders in
adult patients (e.g. congenital, valvular, coronary, hypertensive, primary
myocardial and pericardial diseases, diseases of the aorta and peripheral
vessels, congestive heart failure, cardiac arrhythmias, cardiopulmonary disease),
as well as in preventive and rehabilitative cardiology.
The training programmes should include theoretical knowledge and practical
experience of the non-invasive techniques, management of rhythm disturbances
including common pacing techniques, experience in managing patients in the
cardiac intensive care unit as well as cardiac patients having non-cardiac and
cardiac surgery. A minimum period of six months in a centre performing cardiac
surgery is required. Furthermore it must include knowledge, observation and
participation in cardiac catheterization, coronary angiography, and percutaneous
intervention and basic electrophysiological techniques and anti-arrhythmia
device use in an approved institution.
2.4 There will be an annual assessment of the progress of the trainee
as well as of the training process by the head of the training programme. The
head of the training may seek advice from the National Board if a trainee is
considered unsuitable for training. If the National Board deems it appropriate,
the success of training should undergo independent evaluation. Each training
programme should be assessed at least every 5 years by the National Board. The
EBSC will monitor the system of training programme appraisal in each country.
2.5 The EBSC will give recommendations for the appropriate number of
trainees in a programme in relation to the facilities (in terms of staff and
equipment available in a given training programme.
2.6 The EBSC will stimulate the exchange of trainees between European
Union and associated countries with approved training programmes. There will be
recognition of periods of training spent in recognized institutions in such
countries.
2.7 Candidates who have trained outside Europe are eligible and may be
considered for election as a European Cardiologist if (1) they are registered as
a national specialist in a European country and (2) their training complies with
the minimum requirements as laid-down in this Chapter. It should be noted that
registration as a national specialist in a European Country is a prerequisite,
but is not in itself sufficient to acquire the European Cardiologist Diploma.
2.8 The European Cardiologist would normally be regarded as the
competent expert in managing the cardiovascular conditions referred to in
article 2.3
Article 3
REQUIREMENTS for TRAINING INSTITUTIONS
3.1 Training institutions should receive official recognition by their
National Boards as being eligible to provide training either complete or in part
(ref. C4 Charter). The EBSC will receive a list of training institutions issued
by the National Boards.
3.2 The training institution should provide an optimal training
climate. There should be opportunities for direct consultation with other
specialty services. The institution should possess a library with bibliographic
facilities and have access to major international journals related to internal
medicine and cardiology
3.3 The training institution will set up a programme to assess the
quality of training subject to peer review.
The training institution or combination of institutions making up any given
training programme should have the following facilities as a minimum:
a. A fully equipped out-patient department for cardiological patients,
including emergencies, a sufficient number of beds for in-patients and for
intensive care medicine. The intensive care unit should have at least 6 beds,
fully equipped for electrocardiographic and haemodynamic monitoring,
anti-bradycardiac pacing, cardioversion and defibrillation and preferably
haemodynamic support devices (intra-aortic balloon pumps, haemofiltration etc.).
The programme must include an institution with a cardiac surgical programme.
b. Equipment should be available for all types of non-invasive
investigation and procedures such as X-ray, ECG, exercise testing, long-term ECG,
echocardiography including Doppler echocardiography and transesophageal
echocardiography (TEE), pacemaker check-up and nuclear medicine facilities.
c. Facilities for invasive cardiological examinations including
coronary angiography, cardiac catheterization and electrophysiological studies.
d. A conference room for seminars and tutorial sessions
e. An adequate desk and office space for each trainee.
The special category of institutions without the full range of cardiac
facilities will only be recognized for limited periods of training.
Article 4
REQUIREMENTS for TRAINERS within CARDIOLOGY
4.1 The trainer must have access to the previously mentioned
facilities. He/she should have been practicing the specialty for at least 5
years before appointment. He/she should be a suitably qualified specialist with
a commitment to training and be recognized by the National Board. He/she should
have experience in research and postgraduate education.
There should be a staff of well qualified specialists who participate in the
training programme and who can guarantee that the full range of cardiology is
covered.
There should be a minimum number of senior trained specialists in the unit to
ensure adequate protected teaching time and continuity of training.
4.2 A National Director of training/Chairman of the national training
board should devise and ensure that the curriculum complies with the minimum
requirements of the EBSC. The local director of training will be responsible for
a training programme for each trainee in accordance with national rules and the
recommendations of the EBSC for training programmes in cardiologyArticle 5
REQUIREMENTS for TRAINING
5.1 In order to gain sufficient experience the trainee should be
involved in the management of an appropriate number of in-patients, day-care
patients and out-patients (ambulatory). Trainees should also perform a
sufficient number of practical procedures of sufficient diversity.
5.2 The trainee should have sufficient linguistic abilities to
communicate with patients and colleagues in the country of training. He/she
should be taught how to analyse, interpret and utilize medical literature.
5.3 The trainee must keep a personal log-book of his/her training
activities and present this before certification by the National Board.
5.4 The success of training can be evaluated by a national or local
assessment as specified before (2.4.).
5.5 Specifications of training:
Training should place in a full-time position for at least one year. The
remaining training programme may take place in a part-time position which then
will have to be correspondingly prolonged.
Practical participation in the clinical management of inpatients, including
the coronary care unit and provision of cardiac consultations for other
services, should constitute a minimum of one year of training, preferably in the
first or second year.
Supervised involvement in the management of outpatients, including new and
return cases, should be undertaken at least once a week, for at least one year
of training.
The trainee should have an on-call commitment for Cardiology (rather than
General Internal Medicine or unselected medical emergencies) of at least 100
nights during cardiology training.
The training programme must include a structured training session of two
hours per week.
The training department should have at least 500 in-hospital admissions per
trainee and a corresponding number of out-patients.
5.6 It is recognized that determination of core competencies is a
complex process, involving much more than a simple count of procedures
encountered or performed by the trainee. Nevertheless confirmation of specific
experience contributes usefully to the evaluation process and is required.
The number and degree of participation in performing the following procedures
should be documented by the trainees in their log-books. Minimum numbers and
degree of participation recommended for the European Cardiology Diploma are
indicated (assistance - A; interpret - I; perform - P)
Training program in Cardiology
CHAPTER 6 - Final agreed version 15/05/2003
ECG . . . . . . . . . . . . . . . . | 1000 | I |
Ambulatory ECG . . . . . . . . . . . | 200 | I |
Exercise ECG testing . . . . . . . . | 300 | P/I |
Echo-Doppler studies . . . . . . . . | 350 | P/I |
Transoesophageal echos. . . . . . . . | 50 | A20/P30 |
Nuclear studies . . . . . . . . . . . | 50 | A,I |
MRI . . . . . . . . . . . . . . . . . | 20 | A,I |
Anti-arrhytmia device programming . . | 50 | A/P |
Pacemaker implantation . . . . . . . | 50 | A/P |
ICD implantation . . . . . . . . . | 20 | A |
Coronary and LV angiograhy . . . . . | 300 | A200/P100 |
Temporary pacemaker implantation . . | 25 | A/P |
Electrophysiological studies . . . | 50 | A |
Percutaneous Intervention . . . . . | 100 | A |
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