CV program directors: Most training programs forget preventive care

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The majority of U.S. cardiology training programs may need to better focus on preventive cardiovascular medicine, according to survey results published in the July issue of the American Journal of Cardiology. Results showed that many  training programs in the U.S. do not adhere to preventive cardiovascular medicine Core Cardiovascular Training Symposium recommendations.

The American College of Cardiology Foundation (ACCF), the American Heart Association and American College of Physicians guidelines suggest a one-month focus on preventive medicine, including cardiac rehabilitation, lipid management and diabetes management. However, an anonymous survey sent to 182 U.S. cardiology program directors and fellows found that this may not be occurring at the majority of programs. Of the 182 program directors, 43 completed the survey; 56 cardiology fellows completed the survey.

“The current adherence to these guidelines is unknown, and previous studies have suggested that the amount of prevention training delivered in the curriculum is low,” Quinn R. Pack, MD, of Henry Ford Hospital in Detroit, and colleagues wrote. “In addition, formal opportunities for advanced training in preventive cardiology appear to be uncommon.”

Of the responding programs, 24 percent met the Core Cardiology Training Symposium recommended rotation structure: 20 percent reported a one-month dedicated rotation and 4 percent reported a one-day/week rotation within a three-month period. Of those who responded, 24 percent reported no rotation in preventive cardiology and 52 percent reported providing prevention experience in some other format.

Only 18 percent of the programs reported evaluating fellows in preventive cardiology. In these instances, 50 percent were evaluated in a written exam, 39 percent were evaluated in a clinical evaluation, 22 percent underwent a chart review and 5 percent underwent an oral exam. Five survey respondents discussed financial limitations, including low reimbursements for preventive cardiology measures.

“The results of this survey suggest there is a substantial lack of adherence by general cardiology fellowship programs to guidelines for preventive cardiology training as prescribed by the COCATS [Core Cardiology Training Symposium III], ACCF, and ACGME [Accreditation Council on Graduate Medical Education],” the authors wrote.

Pack et al said that these results are not unexpected and noted that the Institute of Medicine has labeled hypertension as a “neglected disease. It has been suggested that cardiologists should remember their position as role models when it comes to lifestyle and diet; however, they receive little education (either clinical or lecture-based) during medical school, residency, or cardiology fellowship training,” they added.

But while the number of programs that focus on these preventive measures still needs improving, it is better than what was recorded nearly a decade ago.

The authors concluded that more attention be placed on the development of curriculum that include preventive cardiology measures and said that perhaps the ACC could prepare an online knowledge module to help improve fellowship training in this area.