美国路易斯安那州奥克斯纳诊所(Ochsner Clinic) 高磊

第二十六届长城国际心脏病学会议

第九届北京五洲国际心血管病会议2015

亚太心脏大会暨国际心血管病预防与康复会议2015   

        美国心脏科进修培训的设计目的是把进修候选人训练成高素质高能力的心脏专科医生。其中有三个主要的非盈利机构共同合作参与心脏科医生的培训并且确保全国范围内的培训规范化，他们是ACGME，ACC和ABIM。ACGME是具体负责规范和认证培训机构，ACC制定详细的心脏科医生培训计划，ABIM负责考核和颁发心脏专科医学委员会合格证书。

        在美国要进入心脏专科培训，进修医生首先需要通过三年内科住院医生培训和符合申请条件，通过全国NAMP相配系统与培训单位相互选择，最终进入心仪的培训单位。心脏科医生的教育培训必须达到三十六个月的时间。每一个培训轮转的设计和考核都必须符合ACGME制定的核心能力六规范，即医学知识，病人关怀，人际交往和沟通能力，专业素养，以实践为基本的学习和改进，系统化行医模式。每个进修医生在结束每个轮转后都会受到以能力考查为主的全方位评定。培训主任每年都要求与每一个进修医生有两次面谈回顾总结其培训进展。每次谈话都将记录在册以供ACGME查询。

        ACC颁布的心脏专科培训细则即COCATS是培训计划的重要组成部分，它是在ACGME提出的最低培训要求上对培训项目课程做出详细的分类说明。最新的版本COCATS第四版在今年五月份发表。COCATS 4详列了心脏科培训的15个独特的专案项目，包括：门诊会诊培训，预防医学培训，心电图门诊心电和运动试验培训，多模态成像培训，心超培训，心脏核医学培训，心脏计算机断层扫描培训，心脏磁共振培训，血管医学培训，心脏导管培训，心律失常的诊断和管理及心脏起搏电生理培训，心衰培训，重症心脏监护培训，成人先天性心脏病培训，心血管科研培训。每一个培训科目都基于ACGME要求的以能力培养为标准。新的COCATS 4培训指南不仅强调了科目培训时间和操作数量，而且更注重于以结果为基准的评估，具体科目的学习目标，和导师与进修医生的双向评估理念。ACC组织的每年一次全国心脏科进修培训考试一方面是客观检验进修医生的医学知识能力，另一方面也是考核培训机构的教育成果。

        完成三年正规培训后，进修医生有资格参加ABIM组织的心血管病学认证考试从而成为一名认证的心脏科医生。另外，三年培训中，进修医生完成了COCATS的第二级别科目培训要求，可以参加相关科目认证考试，主要包括：国家心超认证，心脏核医学认证，心血管计算机断层扫描认证和血管超声解读注册医生资格。心脏科医生可以选择进一步的心脏亚专科的培训从而成为一名专科医生，培训一般为期一年。目前ABIM认证的心脏亚专科有：临床心脏电生理，心脏导管介入，重症心衰和心脏移植，成人先天性心脏病学。

        成为一名认证心脏科医生只是职业生涯的开始。之后的继续医学教育受到各州医委会和ABIM认证维持项目的共同监管。

        【注】：

        ACGME Accreditation Council for Graduate Medical Education美国毕业后医学教育评审委员会

        NRMP National Resident Matching Program国家住院医生相配系统

        ACC American College of Cardiology 美国心脏病学会

        COCATS Core Cardiovascular Training Statement 心血管核心培训声明

        ABIM American Board of Internal Medicine 美国内科医学委员会

How to become a board certified cardiologist in the US?——

The standard training requirement, tests and management

        Cardiology fellowship training in USA is designed totrain the physician candidates to become highly competent specialists in all areas of cardiovascular disease. There are three major independent non-for-profit organizations working together to regulate the cardiology training and secure the standard outcome nationally wide. They are ACGME, ACC and ABIM. Whereas the ACGME regulates and accredits the training programs, ACC specifies detailed training protocol, and ABIM certifies the individual as specialist in cardiovascular disease.

        To acquire the cardiology specialty training, the fellow candidate is required to finish 3-year general internal medicine residency training, meet the prerequisite of subspecialty application, and finally be selected by ACGME accredited training program through the national Match process (NRMP). The educational program in cardiovascular disease must be 36 months in length. Each rotation is designed under constructs of ACGME 6 core competencies as medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. The fellow will be assessed with 360 degree by competency-based evaluation method. The program director will have semi-annual performance meeting with each fellow to discuss his or her progress toward goals and objectives for the year.Each meeting will be documented and be kept in record for ACGME future review.

        Cardiology training guideline (COCATS) released by ACC has been an important contributor to the fundamental of the training requirements for cardiovascular disease. COCATS provides additional curricular content detail beyond the ACGME minimum requirements for cardiovascular program to define progressive training skill levels and competency in designated areas. Latest vision COCATS 4 was recently published in May 2015. COCATS 4 outlines 15 distinct Task Forces and each report covers a specific field of competency in cardiovascular disease. Those are Training in Ambulatory, Consultative, and Longitudinal Cardiovascular Care; Training in Preventive Cardiovascular Medicine; Training in Electrocardiography, Ambulatory Electrocardiography and Exercise Testing; Training in Multimodality Imaging; Training in Echocardiography; Training in Nuclear Cardiology; Training in Cardiovascular Computed Tomographic Imaging; Training in Cardiovascular Magnetic Resonance Imaging; Training in Vascular Medicine; Training in cardiac Catheterization; Training in Arrhythmia Diagnosis and Management, Cardiac Pacing and electrophysiology; Training in Heart Failure; Training in Critical Care Cardiology; Training in Care of Adult Patients with Congenital Heart Disease; Training in Cardiovascular Research and Scholarly Activity. The current competency-based curriculum in COCATS 4 emphasizes not only on minimal case volume and exposure time requirements, but also on outcome-based evaluations, specific learner objectives, and bidirectional evaluations, in which both faculty and trainees mutually evaluate and provide constructive feedback to one another. Annual In-Training exam held by ACC has been designed to provide an objective assessment instrument for the medical knowledge competency and also the opportunity to evaluate the training program.

        After successful completion of 3-year training in an ACGME accreditation program, the fellows will meet the requirement to sit for the ABIM Cardiovascular Disease certifying examination and became board certified general cardiologists. In addition, all fellows will get COCATS level 2 experience in all Task Forces, which make them eligible for multiple board certification exams in cardiovascular disease, including but not limited to: National Board of Echocardiography, Certification Board of Nuclear cardiology, Certification Board of Cardiovascular Computed Tomography and Registered Physician in Vascular Interpretation. To achieve advanced expertise in subspecialized areas in cardiovascular disease, the general cardiologists can have additional training and obtain ABIM board certification in areas of clinical cardiac electrophysiology, interventional cardiology, advanced heart failure and transplant cardiology, and adult congenital heart disease.

        Being a certified cardiologist is only the beginning of the career training life. Continuing medical education is regulated by both state medical license board and ABIM maintenance of certification program.