The rotation on clinical electrophysiology (EP) enables fellows to achieve the knowledge, skills and competence of cardiologists in the evaluation and management of patients with cardiac arrhythmias. Learning occurs through the following methods:
- Attending rounds
- Bedside teaching
- Bi-weekly electrophysiology (EP) conferences
- Participation in procedures
- Supervised clinical experiences
Expert Training in Cardiac Arrhythmias
Attending physicians are expected to reinforce fellows' understanding of the etiology, pathogenesis and clinical presentation of cardiac arrhythmias. Trainees are expected to develop skills in arrhythmia recognition, diagnosis and utilize evidence-based medicine in the management of these patients.
Fellows should be able to recognize and treat arrhythmia emergencies. In addition, fellows will participate in interviewing patients in order to enhance and develop their communication and interpersonal skills and navigating system issues impacting patient care.
Electrophysiology Rotation Goals and Objectives
Fellows will participate in the education of the house staff. Fellows are expected to contribute to rounds by bringing appropriate, relevant medical literature for the house staff and provide a preliminary management plan. Senior fellows are expected to demonstrate increased clinical leadership as well as familiarity with published guidelines.
Appropriate utilization of the health system resources is of utmost importance in the management of patients with cardiac devices and/or a history of previous arrhythmia. Fellows are expected to gather information prior to attending rounds. Trainees will be able to participate fully in management recommendations as they become familiar with:
- Anti-arrhythmic drug use
- Previous device evaluations
- Results of diagnostic tests
- Review of telemetry
Fellows are expected to communicate effectively with the patient, patient's family, house staff, nursing staff, referring physicians and the electrophysiology laboratory personnel. All fellows are expected to progress in the six Accreditation Council for Graduate Medical Education (ACGME) competencies.
Electrophysiology Principle Teaching Methods
Direct supervision of patient care: An attending physician provides supervision to all members of the cardiac arrhythmia service. The service includes a cardiology fellow or cardiac electrophysiology fellow and clinical nurse practitioner. Fellows will provide additional supervision to the nurse practitioner and any rotating medical students or residents.
Case-based learning: Attending physicians are expected to teach during team rounds in addition to discussing routine patient management; teaching time will average five hours a week. Fellows are expected to take on leadership and teaching roles on rounds commensurate with their experience and knowledge. The expectation is that fellow leadership and teaching will progress during training.
Electrophysiology Clinical Training
Patient characteristics: During the electrophysiology pacing rotation, the mix of patients includes consultative care for patients with arrhythmias admitted to any location within the hospital, including:
- Cardiac intensive care unit
- Emergency room
- Medical intensive care unit
- Operating suites
- Patients on telemetry units
- Patients on the general medical and surgical units
- Recovery room
- Surgical intensive care unit
In addition, fellows will participate in the care of cardiac arrhythmia patients admitted to an inpatient electrophysiology service comprising:
- Patients initiating anti-arrhythmic drugs
- Patients with a primary arrhythmia diagnosis
- Patients with device complications
Procedures: Fellows will learn to perform device interrogation and reprogramming under the direct supervision of an attending physician and/or cardiac device nurse. Fellows should attend procedures in the cardiac electrophysiology laboratory. Fellows will have the opportunity to participate in device implantation and radiofrequency ablation.
Principal educational material used: Fellows have 24-hour access to the Core Library located in the hospital. Computer access to literature searching, online journals and textbooks are available on all wards. Fellows are expected to be proficient in obtaining requisite information on pathophysiology from standard textbooks and medical literature.
Current therapeutics should be guided by the medical literature with emphasis given to clinical guidelines and consensus statements issued by the American College of Cardiology, American Heart Association and the Heart Rhythm Society.
Objectives by Post-Graduate Year
Fellows are expected to assume responsibility for the initial evaluation and management of patients referred for EP consultation. With the assistance of an attending physician, who is always available for emergent consultation, fellows are responsible for formulating a diagnostic and therapeutic plan. Attending physicians document their involvement in the evaluation and management of patients.
For More Information
For more information on the Electrophysiology Rotation, please contact:
Judith Mackall, MD