美國路易斯安那州奧克斯納診所(Ochsner Clinic) 高磊

第二十六屆長城國際心髒病學會議

第九屆北京五洲國際心血管病會議2015

亞太心髒大會暨國際心血管病預防與康複會議2015

美國心髒科進修培訓的設計目的是把進修候選人訓練成高素質高能力的心髒專科醫生。其中有三個主要的非盈利機構共同合作參與心髒科醫生的培訓並且確保全國範圍內的培訓規範化，他們是ACGME，ACC和ABIM。ACGME是具體負責規範和認證培訓機構，ACC製定詳細的心髒科醫生培訓計劃，ABIM負責考核和頒發心髒專科醫學委員會合格證書。

在美國要進入心髒專科培訓，進修醫生首先需要通過三年內科住院醫生培訓和符合申請條件，通過全國NAMP相配係統與培訓單位相互選擇，最終進入心儀的培訓單位。心髒科醫生的教育培訓必須達到三十六個月的時間。每一個培訓輪轉的設計和考核都必須符合ACGME製定的核心能力六規範，即醫學知識，病人關懷，人際交往和溝通能力，專業素養，以實踐為基本的學習和改進，係統化行醫模式。每個進修醫生在結束每個輪轉後都會受到以能力考查為主的全方位評定。培訓主任每年都要求與每一個進修醫生有兩次麵談回顧總結其培訓進展。每次談話都將記錄在冊以供ACGME查詢。

ACC頒布的心髒專科培訓細則即COCATS是培訓計劃的重要組成部分，它是在ACGME提出的最低培訓要求上對培訓項目課程做出詳細的分類說明。最新的版本COCATS第四版在今年五月份發表。COCATS 4詳列了心髒科培訓的15個獨特的專案項目，包括：門診會診培訓，預防醫學培訓，心電圖門診心電和運動試驗培訓，多模態成像培訓，心超培訓，心髒核醫學培訓，心髒計算機斷層掃描培訓，心髒磁共振培訓，血管醫學培訓，心髒導管培訓，心律失常的診斷和管理及心髒起搏電生理培訓，心衰培訓，重症心髒監護培訓，成人先天性心髒病培訓，心血管科研培訓。每一個培訓科目都基於ACGME要求的以能力培養為標準。新的COCATS 4培訓指南不僅強調了科目培訓時間和操作數量，而且更注重於以結果為基準的評估，具體科目的學習目標，和導師與進修醫生的雙向評估理念。ACC組織的每年一次全國心髒科進修培訓考試一方麵是客觀檢驗進修醫生的醫學知識能力，另一方麵也是考核培訓機構的教育成果。

完成三年正規培訓後，進修醫生有資格參加ABIM組織的心血管病學認證考試從而成為一名認證的心髒科醫生。另外，三年培訓中，進修醫生完成了COCATS的第二級別科目培訓要求，可以參加相關科目認證考試，主要包括：國家心超認證，心髒核醫學認證，心血管計算機斷層掃描認證和血管超聲解讀注冊醫生資格。心髒科醫生可以選擇進一步的心髒亞專科的培訓從而成為一名專科醫生，培訓一般為期一年。目前ABIM認證的心髒亞專科有：臨床心髒電生理，心髒導管介入，重症心衰和心髒移植，成人先天性心髒病學。

成為一名認證心髒科醫生隻是職業生涯的開始。之後的繼續醫學教育受到各州醫委會和ABIM認證維持項目的共同監管。

【注】：

ACGME Accreditation Council for Graduate Medical Education美國畢業後醫學教育評審委員會

NRMP National Resident Matching Program國家住院醫生相配係統

ACC American College of Cardiology 美國心髒病學會

COCATS Core Cardiovascular Training Statement 心血管核心培訓聲明

ABIM American Board of Internal Medicine 美國內科醫學委員會

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.