Experts recommend increased training for electrophysiologists




Starting in 2017, physicians who practice clinical cardiac electrophysiology (CCEP) will be required to have 2 additional years of specialized training following the required 3 years of cardiology training, according to a statement issued Sept. 18 by three major cardiology associations.

The American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) also recommended volume increases for numerous procedures that trainees perform prior to completing fellowships (J Am Coll Cardiol. doi 10.1016/j.jacc.2015.08.040).

The training requirements are necessary to meet the growing complexity of CCEP and ensure physicians are sufficiently trained, said Dr. Hugh Calkins, vice chair of the statement writing committee and director of the clinical electrophysiology laboratory and the arrhythmia service at the Johns Hopkins Hospital, Baltimore.

“Training in CCEP has become more complex as the clinical specialty has matured,” Dr. Calkins said in a statement. “Use of cardioactive drugs; implantation and use of implantable electronic devices and left atrial appendage occlusion devices; and performance of invasive catheter ablation procedures for arrhythmia management have reached a level of sophistication that has mandated a reevaluation of the training curriculum and the duration of training.”

The guide defines the six competencies – medical knowledge, patient care and procedural skills, practice-based learning and improvement, systems-based practice, interpersonal and communication skills, and professionalism – and provides curricular milestones for each as fellows progress through training. Additionally, the statement updates recommendations for the numbers of procedures trainees should perform during fellowship. For example, each trainee should perform at least 175 electrophysiologic procedures for arrhythmia evaluation, according to the statement. Over the 2-year CCEP fellowship, trainees should perform at least 160 ablation procedures, with at least 50 of these being supraventricular ablation procedures.

Trainees should also participate in mapping and ablation of at least 30 arrhythmias, the association recommends. Fellows are expected to gain competence in programmed electrical stimulation with cognitive skills in identifying the arrhythmia circuit using both activation and entrainment mapping, determine appropriate sites for ablation, and demonstrate conduction block across reentry circuit sites post ablation. Integration of knowledge related to three-dimensional mapping systems and reentrant mechanisms is also required. Of the 30 procedures, at least 20 typical atrial flutters and 10 other macro-reentrant ATs are expected.

The American Board of Internal Medicine (ABIM) previously required cardiologists to have 1 additional year of training in clinical cardiac electrophysiology. However, at the request of the ACC, AHA, and HRS, ABIM has increased the duration of training required to sit for examination in electrophysiology to 2 years starting in 2017. ABIM and the Accreditation Council for Graduate Medical Education (ACGME) will now review the proposed recommendations of the writing committee and decide how to incorporate the recommendations.

The recommended number of procedures for trainees was developed through published studies, competency statements, and the opinions of the writing committee. In addition, the writing committee surveyed 33 CCEP training-program directors to gain additional insight into procedural volumes.

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