Due to the complex nature of clinical cardiac electrophysiology, an updated training statement released by the American College of Cardiology (ACA), the American Heart Association (AHA) and the Heart Rhythm Society (HRS), is calling for increased training requirements for practitioners in the field.
Previously, the American Board of Internal Medicine (ABIM) required one additional year of training in clinical cardiac electrophysiology for cardiologists following the required three years of cardiology training. Due to the increased complexity and scope of the field of electrophysiology, the ABIM board, at the request of the ACC, AHA and HRS, voted to increase the duration of training required to sit for examination in electrophysiology to two years. This change will take effect in 2017. The updated training statement also increases the recommended volume for numerous procedures that trainees should perform prior to completing their fellowship.
“This Advanced Training Statement addresses the added competencies required of sub-specialists in clinical cardiac electrophysiology (CCEP) for diagnosis and management of patients with cardiac arrhythmias and conduction disturbances at a high skill level,” says Douglas P Zipes, distinguished professor of medicine at Indiana University School of Medicine, and chair of the writing committee.
The training statement defines the six competencies for training in electrophysiology: Medical knowledge, patient care and procedural skills, practice-based learning and improvement, systems-based practice, interpersonal and communication skills, and professionalism. Curricular milestones for each competency provide a “developmental roadmap” for fellows as they progress through training. Another important update is the detailed recommendations for procedural numbers that trainees should perform during their fellowship. These numbers have been increased from the previous training statement and are also presented with greater granularity.
“Training in CCEP has become more complex as the clinical specialty has matured,” says Hugh Calkins, director of the clinical electrophysiology laboratory and the arrhythmia service at the Johns Hopkins Hospital, and vice chair of the writing committee. “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 re-evaluation of the training curriculum and the duration of training.”