ESC Core Curriculum for the General Cardiologist (2013).

Preface The previous Core Curriculum for the General Cardiologist defined a model for cardiology training in Europe and it has been adopted as the standard for regulating training, for access to the specialty (certification), and for revalidation in several countries.1 During the last 5 years we have witnessed profound changes in cardiological practice. The work of both hospital and independent cardiologists has been better integrated with that of general practitioners. It has taken into account the requirements of national authorities, re-imbursement organizations, and hospital administrations. Cardiologists face changing patient expectations. General cardiologists, interventional cardiologists, anaesthetists, and cardiac surgeons work together in Heart Teams.2,3 The age of cardiac patients has increased and they are presenting with more co-morbidities. Knowledge, technology, and treatment are constantly advancing: new imaging modalities have become widely available. Stent technology has evolved and competes with cardiac surgery for all but complex cases.2 Percutaneous valve implantations are increasingly successful.4 Interventional electrophysiology and device therapy have become cornerstones in the practice of cardiology.5,6 Care of the patient with heart failure is now a multi-disciplinary undertaking.7 New powerful anti-thrombotic and anticoagulant therapies have been introduced and are often used in combination, with clear benefits but increased bleeding risks.6,8,9 Use of diagnostic and therapeutic tools and the approaches to management of common conditions have been systematically clarified in regularly updated ESC consensus guideline documents. Against the background of these developments, the Board of the ESC decided in 2011 to revise and update the Core Curriculum. The chairman of the Committee for Education 2010–2012, Otto A. Smiseth, delegated this project to a task force, whose members were drawn from general cardiologists. The 2013 version of the Core Curriculum outlines the knowledge and skills of the general clinically oriented cardiologist, rather than those required for the sub-specialties. The document provides a framework for training and certification, continuous medical education (CME), and recertification. The Core Curriculum will inevitably continue to evolve as authors and reviewers are aware that there are still important differences in training and means throughout Europe and ESC member states. In the Core Curriculum, the ESC is setting a standard that national societies can use in their dealings with political institutions and national authorities. A deliberate decision was taken to outline an optimal rather than a minimum standard, allowing for the fact that not every training system will be able, or may not wish, to adopt the full curriculum. In countries (or centres) that are currently unable to deliver training in all its aspects, the Core Curriculum can and should be used as a benchmark to promote improvement. The 2013 Core Curriculum defines the clinical, patient-oriented, training of the general cardiologist. The overall structure of the previous version has been retained, but the table format has been abandoned to limit the number of printed pages and to make the document more easily searchable on-line. In most subject areas, there was a wide if not unanimous consensus among the task force members on the training required for the cardiologist of the future. The document recommends that acquisition of competence in general cardiology requires at least 6 years of full-time postgraduate training, of which 4 years are devoted to cardiology. The general aspects of training and all individual chapters have been updated. The document focuses on knowledge of mechanisms of disease, clinical and communication skills, empathy for the patient and their relatives, and teamwork. A clear boundary has been set between the competencies required of the general cardiologist and those of the sub-specialist.10–13 The first part of the curriculum covers general aspects of training, and is followed by a comprehensive description of the specific components in 28 chapters. Each of the chapters includes statements of the objectives, and is further sub-divided into the required knowledge, skills and behaviours, and attitudes. Some chapters have been renamed and/or sub-divided into sub-sections. The most salient changes are summarized here. Non-invasive imaging (Chapter 2.3) has been divided into five sections: Non-invasive imaging (general aspects), Echocardiography, Cardiac magnetic resonance (CMR), Cardiac X-ray computed tomography, and Nuclear techniques. Cardiovascular prevention (Chapter 2.7) has been divided into sections on Cardiovascular risk factors and Arterial hypertension. Cardiac tumours (Chapter 2.12) has been replaced by a new and broader chapter on Oncology and the heart. The chapter Cardiac Rehabilitation and Exercise Physiology (Chapter 2.19) has become Physical activity and Sport in primary and secondary prevention and includes sections on Sports cardiology and Cardiac rehabilitation. A new chapter entitled Acute cardiovascular care (Chapter 2.27) has been added. The Cardiac consult (Chapter 2.28) has been expanded and divided into sections dealing with the patient undergoing non-cardiac surgery, the patient with neurological symptoms or diseases, and the patient with conditions not presenting primarily as cardiovascular disease [elderly patients, patients with diabetes, chronic kidney disease (CKD), erectile dysfunction, and others]. The 2013 Core Curriculum underwent a thorough review process based on the template of the review of the ESC guidelines. The document does not include minimum or optimal numbers of procedures to be undertaken, and does not address periodic evaluation, certification, or revalidation. This does not obviate the importance of regular, structured, and formally documented assessment, which is crucial to implementation of the curriculum. This should include knowledge-based assessments (formative and summative), formally observed procedures and practices, a log-book, and a recognition of the potential of simulation techniques in both training and assessment.