Learning Objectives - Structured Case Experience

  1. Pre-procedural evaluation and management of the patient - Clinical Assessment Sheet Appendix D)
  2. Progressive practical experience
    1. Principles of patient preparation and risk assessment
    2. IV conscious sedation
    3. Assessment and execution of femoral access
    4. Manipulation of the central circulation
    5. Coronary imaging - principles and views
    6. Angiographic lesion analysis
    7. Technical Interventional Primer
      1. Preparation of the operative field
      2. Segmentation of the primary and secondary operator roles
      3. Formalized relationship between the primary and secondary roles
      4. Formalized two-handed technique: the three stations
      5. Guiding catheter selection and manipulation
      6. Advancing selective catheter devices
      7. Withdrawing selective catheter devices
      8. Balloon and guide wire management
      9. Balloon angioplasty
      10. Coronary stenting
      11. Assessment of results
    8. Advanced techniques (IVUS, RA, NOGA mapping, PTMR/DMR, etc.)
    9. Results and prognosis in context
    10. Evaluation and management of complications
    11. Post-procedure management of the patient

Model Program of Advancement of Technical Role

Operator Role Manuever Difficulty Case Risk Level
Secondary   All     All
Primary  Low  Low-risk 
Primary  Low  Nominal and High-risk
Primary  Nominal  Low-risk 
Primary  Nominal  Nominal-risk 
Primary  High  Low-risk 
Primary  Nominal  High-risk 
Primary  High  Nominal-risk 


High-risk and difficulty maneuvers in high-risk cases will be reserved to the staff except in unusual circumstances.
 
Fellow Responsibilities

  1. Pre-operative evaluation and preparation of the patient
  2. Screening and enrollment of patient in research protocols (assist research staff)
  3. Pre-operative evaluation of patient data and angiographic anatomy
  4. Equipment and patient preparation in the catheterization laboratory
  5. Execution of assigned technical role during procedure
  6. Post-procedure documentation, orders and patient management in lab
  7. Completion of database case report forms
  8. Post-procedural evaluation and management of the patient during inpatient recovery phase
  9. Collation and preparation of case material for teaching conferences
  10. Discussion of case issues and completion of case performance evaluation form with supervising attending staff

Research Activities

  1. Individual research program – developed with staff and research division of THI
  2. Daily participation in patient screening and enrollment in research protocols
  3. Daily entry and review of research database case report forms (Appendix D)