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Societies update clinical competencies needed for performing PCI
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Three cardiology societies have updated a 2007 statement on clinical competencies for performing PCI, indicating that the criteria for evaluation should be expanded beyond procedural volume and incorporate a number of other factors, including evaluation of risk-adjusted outcomes and periodic case reviews of patient selection.
The full statement will be published in the June 11 issue of the Journal of the American College of Cardiology and co-published online in Circulation and Catheterization and Cardiovascular Interventions.
Catalysts for change
The updated statement, which features input from the American College of Cardiology, American Heart Association and Society for Cardiovascular Angiography and Interventions, highlights new and adjusted benchmarks to assist with measuring and evaluating operator and institution performance of coronary-related procedures.
Theodore A. Bass
Currently, procedural volume is widely used as a surrogate for competency, with the belief that higher volumes equate to greater success rates in PCI, particularly improved clinical outcomes. However, one of the problems with using this metric alone, according to Theodore A. Bass, MD, with the University of Florida Shands Cardiovascular Center in Jacksonville, Fla., and vice chair of the writing committee of the statement, is that procedural volume for coronary interventions has changed, decreasing by more than 30% since 2006, while the workforce has not changed much.
“Another reason we updated this statement is because it is no longer satisfactory to just have cognitive competence, which is just one of the components,” Bass, who will be inducted as SCAI president at the society’s annual meeting later this week, said in an interview. “Now we are looking at not only what people know, but also what skills they have and how they apply their skills and knowledge, and eventually the final result. Because what our patients want to know is not how smart their doctors are, but how competent they are — are they delivering optimal health care?”
Furthermore, he said, the practice of interventional cardiology has expanded beyond coronary procedures, and many clinicians are also now performing peripheral and structural interventions.
“With those competencies, although not exactly the same as the competencies required to perform coronary interventions at a high level, there is some overlap, so we needed to integrate them,” Bass said. “So the time was right to update this statement.”
Six domain structure
To address the increasing complexity in coronary interventions and the process of evaluating physicians’ knowledge and skills, the updated statement offers a roadmap of determining the desirable experience and skill sets. It is the first CV competency statement to fully utilize the six domains of structure promoted by the Accreditation Council for Graduate Medical Education and adopted by the American Board of Internal Medicine. The six domains include:
- Medical knowledge;
- Patient care and procedures;
- Practice-based learning;
- Systems-based practice;
- Interpersonal and communication skills; and
- Professionalism.
According to the statement, these six domains are increasingly utilized not only for training programs, but also for demonstration of maintenance of competency for practicing physicians.
“In terms of maintaining certification, it’s not how much you know, although that is the foundation for this, it’s how you practice,” Bass said. “These six domains deal with a lot of the components involved with delivering competent care.”
Reaching the patient
With this more current and applicable statement that addresses the changing landscape of intervention and places procedural volume in the proper context, Bass said the ultimate goal is to deliver the best possible care that facilitates the attainment of optimal patient outcomes.
“A truly competent physician is the tool to help facilitate that,” he said. – by Brian Ellis
Disclosure: Bass is a consultant for Daiichi Sankyo/Eli Lilly.