Author + information
- Nishant R. Shah, MD, MPH, MSc∗ (, )
- Michael W. Cullen, MD,
- Michael K. Cheezum, MD,
- Howard Julien, MD, MPH,
- Chittur A. Sivaram, MBBS and
- Prem Soman, MD, PhD
- ↵∗Noninvasive Cardiovascular Imaging Program, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115
Rapid technological advances have made it challenging for trainees to gain independent interpretive competency in 1 or more of the cardiovascular imaging modalities during a standard 3-year cardiology fellowship. Consequently, many general cardiology fellows choose to dedicate at least 1 year of additional training to advanced cardiovascular imaging (ACVI).
Unfortunately, no standardized central resource from which to obtain information about training opportunities in ACVI exists. Similarly, ACVI training program directors must rely on word-of-mouth and institutional websites to attract potential trainees. Finally, before recent delineation of key principles for multimodality imaging training (1), ACVI training program directors have had to develop unique curricula. The resulting heterogeneity in training has led to uncertainty about the quality of any single ACVI training program.
To begin addressing these issues, we aimed to characterize the current state of ACVI training in the United States. More specifically, we sought to capture the heterogeneity of ACVI training programs and to create a standardized central database of these programs for American College of Cardiology (ACC) members.
In conjunction with the ACC Cardiovascular Imaging Section Leadership Council, FIT Section Leadership Council, and Cardiology Training and Workforce Committee, we created an online, response-adaptive survey designed to identify and characterize ACVI training programs at U.S. academic training institutions. The survey was administered in October 2014 to all 191 program directors of accredited adult general cardiology fellowships. Nonrespondents were automatically identified and received a second e-mail request. Data in survey responses identifying an ACVI training program were verified by written communication with the ACVI training program director.
Eighty-two academic institutions responded (43% survey response rate), including large universities, smaller universities, and community hospitals. Among responding institutions, 57% (n = 47) do not currently offer ACVI training. Among these institutions, 40 (85%) cited insufficient funding, 14 (30%) insufficient faculty, and 15 (32%) insufficient case volume as a reason for the lack of an ACVI training program. Nevertheless, 7 of these institutions intend to start an ACVI training program within 1 to 2 years and 12 others within 3 or more years.
The 35 institutions offering ACVI training are all large universities, including 11 in the Northeast, 12 in the South, 7 in the Midwest, and 5 in the West. The percentage of these 35 institutions offering training in cardiac MRI, cardiac computed tomography (CT), echocardiography, cardiac single-photon emission CT, cardiac positron emission tomography, vascular magnetic resonance angiography, and vascular CT are shown in Figure 1. Twenty-seven of 35 institutions (77%) offer a single advanced cardiovascular (CV) imaging training pathway, 6 offer 2 pathways, and 2 offer 3 pathways.
Among the 45 ACVI training pathways that we identified, 65 to 70 new trainees are accepted annually. Pathway duration varies from 1 year (56%) to 2 years (31%), with the remaining 13% flexible between 1 and 2 years. Thirty pathways (67%) include both cardiologists and radiologists among the teaching faculty, whereas 15 (33%) include only cardiologists across all advanced CV imaging training pathways. A large majority of pathways (84%) accept external candidates, among which a minority (37%) accept graduates from foreign cardiology fellowship programs.
Acknowledging the inherent limitations of survey-based investigation and our response rate, these results provide a first glimpse into the state of ACVI training in the United States. The information that we obtained on ACVI training opportunities is now available on ACC.org (2). In addition, we have shown 2 key findings among respondents: 1) a minority of large universities currently offer ACVI training, with significant geographic variation; and 2) among institutions that provide ACVI training, marked differences exist in the duration of training and modalities offered.
Given these findings, we believe that the ACC and the ACVI professional societies should work together to augment the quality and availability of ACVI training. First, they should jointly develop a more comprehensive multimodality imaging training statement with structured ACVI training pathways exclusive of the basic exposure to ACVI required for general cardiology fellowship. This will help to ensure high quality of all ACVI training programs and trainees. After standardization of training curricula, the ACC and the ACVI professional societies should dedicate the necessary resources to define and measure the value that ACVI experts add to clinical, research, and educational programs. Doing so will incentivize more institutions to invest in ACVI training. Ultimately, improvements in the quality and availability of ACVI training will help to establish ACVI as a board-certified subspecialty.
Please note: Dr. Sivaram is a data safety monitoring board member of Medtronic. Dr. Soman has received grant support from Astellas Pharma. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2016 American College of Cardiology Foundation
- Narula J.,
- Chandrashekhar Y.S.,
- Dilsizian V.,
- et al.
- ↵Advanced Imaging Training Program Database. Available at: http://www.acc.org/membership/sections-and-councils/imaging-section/training-resources. Accessed November 12, 2015.