Rotation: Vascular Medicine

Rotation: Vascular Medicine

Director: Mark Robbins, M.D.

Learning Objectives

Patient Care

Objective / Teaching Methods / Assessment
Obtain and document complete medical histories, including review of patient medical records, and perform accurate examinations with an emphasis on the arterial, venous and lymphatic systems / Clinical Teaching, Clinical Experiences
Shadowing / Supervising Attending
360 evaluations
Self-assessment
Demonstrate appropriate decision making based on clinical assessment, interpretation of tests, patient preferences and current standards of evidence based medicine. / Clinical Teaching, Clinical Experiences,
Review pertinent literature,
Didactics / As above
Communicate effectively and compassionately information to patients and family members. Provide patient education. Discuss prognosis, and when appropriate, end of life issues. / Clinical teaching
Clinical experiences
Consultative services / As above

Medical Knowledge

Objective / Teaching Methods / Assessment
The cardiologist must be able to evaluate and manage common vascular disorders (see topic outline below) and refer patients appropriately to vascular surgeons, interventional cardiologists, hematologists, rheumatologists and other subspecialists where appropriate. / Clinical Teaching, Clinical Experiences, Didactics,
Shadowing / Supervising Attending,
360 evaluations,
Self-assessment,
In-training examination

Professionalism

Objective / Teaching Methods / Assessment
Demonstrate accountability and professional behavior towards patients, family members, and members of the health care team and adherence to ethical principles / Clinical Teaching,
Clinical Experiences,
Role Models / Supervising Attending,
360 evaluations,
Self-assessment
Demonstrate compassion and respect for others, including patients from a diverse cultural, social, and religious backgrounds / Clinical Teaching,
Clinical Experiences,
Role Models / Supervising Attending,
360 evaluations,
Self-assessment

Interpersonal and Communication Skills

Objective / Teaching Methods / Assessment
Communicate effectively with patients, families, and members of the health care team, including findings and diagnoses when appropriate to both patients and consulting physicians / Clinical Teaching,
Clinical Experiences,
Role Models / Supervising Attending,
360 evaluations,
Self-assessment
Maintain timely and comprehensive medical records / Clinical Teaching,
Role Models / Administrative Monitoring,
Supervising Attending
Program Director

Practice Based Learning and Improvement

Objective / Teaching Methods / Assessment
Identify both strengths and gaps in knowledge and expertise and set appropriate learning goals / Review rotation curriculum,
Review pertinent literature,
Role models / Self-assessment
Feedback from supervising attending
Utilize information technology to effectively locate, appraise, and utilize evidence based medicine with in current literature to improve patient care / Utilize on-line resources such as Knowledge Map, Vanderbilt Library, Cardiosource,
Up-to-Date / Self-assessment
Feedback from supervising attending
Utilize quality improvement methods to implement changes within the practice environment / Literature Review
Division and Institutional Resources and Committees / Self-assessment
Feedback from supervising attending

Systems Based Practice

Objective / Teaching Methods / Assessment
Work effectively as a member of the health care team, including coordination of patient care / Role Models
Clinical Teaching / Self-assessment
Feedback from supervising attending
Demonstrate understanding of cost-effectiveness and risk-benefit analysis and incorporate these into patient care / Literature Review
Division and Institutional Resources and Committees / Feedback from supervising attending and division QI committees
Advocate for and work towards patient safety and improved quality of care / Literature Review
Division and Institutional Resources and Committees / Feedback from supervising attending and division QI committees
Identify system errors and implement systems solutions / Literature Review
Division and Institutional Resources and Committees / Feedback from supervising attending and division QI committees

Rotation Format and Responsibilities:

Fellows have the opportunity to rotate on the Vascular Medicine Service. On this service, the fellow provides inpatient consultative services with one of our cardiologists who specializes in vascular and interventional vascular medicine. The fellow also sees patients with vascular disease in the outpatient vascular surgery and general cardiology clinics and has the opportunity to interpret noninvasive vascular studies. An opportunity to participate in specialty clinics other than cardiovascular medicine during this rotation are also available including pulmonary hypertension, hematology and vasculitis clinics.

Second and third year fellows also have the option to have a half day clinic a week in the vascular surgery clinic as part of their sub-specialty outpatient clinical training.

Curriculum Outline:

A. Arterial Disease

1. Normal: anatomy and physiology of the cerebrovascular, renal, and peripheral vascular beds

2. Atherosclerosis:

a. Pathogenesis

b. Risk factors: recognition, life-style modifications and interventions

3. Peripheral Arterial Disease:

a. epidemiology and natural history

i. claudication vs pseudoclaudication

b. clinical examination and role of vascular testing

c. life-style and risk factor modifications

d. novel risk factors: hyperhomocysteinemia, lipoprotein (a), etc.

e. Treatment:

i. antithrombotic and other pharmacologic therapy

ii. exercise therapy

iii. percutaneous and surgical indications and therapies

f. Complications of PAD

i. atheroembolism

ii. amputation

4. Extracranial Cerebrovascular Disease

a. Normal anatomy and physiology

b. Pathophysiology of CV disease

c. Clinical Presentations

d. Physical examination

e. Diagnostic testing and imaging modalities

f. Treatment:

i. Medical therapy

ii. Percutaneous and surgical indications and therapies

5. Renovascular Disease

a. atherosclerotic and non-atherosclerotic

b. renovascular hypertension: diagnostic work-up and treatment

6. Aortic Dissection, Penetrating Aortic Ulcer, Incomplete Aortic Rupture

a. definition and classification

b. etiology, natural history and clinical manifestations

c. Diagnosis: imaging modalities

d. Medical and surgical treatment

7. Aneurysmal Disease:

a. definition and classification

b. etiology, natural history and clinical manifestations

c. Abdominal Aortic aneurysms: infrarenal

i. risk factors, presentation, and natural history

ii. diagnosis

iii. pre-operative assessment

iv. endovascular and surgical repair

d. Thoracic and suprarenal abdominal aneurysms

i. risk factors, presentation, and natural history

ii. diagnosis

iii. indications for repair

iv. endovascular and surgical repair

B. Venous Disease

1. anatomy and physiology of upper and lower extremity veins

2. venous thromboembolism

1. acute DVT of lower extremities

2. upper extremity DVT

3. pulmonary embolism

4. catheter/device related thrombosis

3. thrombophilias (hereditary and acquired)

4. post-thrombotic syndrome

5. chronic venous insufficiency and venous stasis disease

6. varicose veins

C. Lymphedema

1. anatomy and physiology of the lymphatic system

2. causes, diagnosis and management

D. Miscellaneous Arterial Disease

1. thoracic outlet syndrome

2. popliteal artery entrapment

3. thromboangitis obliterans (Beuger's Disease)

4. vasculitis

E. Vasospastic Disorders

1. Raynaud's Phenomenon

2. Livedo Reticularis

3. Chronic Pernio

4. Erythromelalgia

F. Hypercoagulable Disorders

1. Antiphospholipid syndrome

2. Factor V Leiden Mutation

3. Heparin Induced Thrombocytopenia

4. Protein C/S Deficiency

5. Anti-thrombin III deficiency

6. Hyperhomocystinemia