ACC's Updated Training Recommendations for Cardiology Fellows Define Core Competencies

March 13, 2015—The American College of Cardiology (ACC) released the newest iteration of the Core Cardiovascular Training Statement (COCATS 4), updating training recommendations for cardiovascular fellows. The statement defines for the first time the full core competencies expected of a clinical cardiologist. The full ACC 2015 COCATS 4 statement was published online on the ACC’s website (www.acc.org).

The COCATS 4 steering committee included Eric S. Williams, MD; Jonathan L. Halperin, MD; and Valentin Fuster, MD. Dr. Williams and Dr. Halperin are cochairs of the document.

The ACC advised that the competency-based education focuses on outcomes assessment, rather than time and volume of experience, with defined evaluation tools. As a result, COCATS 4 extends beyond knowledge and skills to also include communication, professionalism, practice-based learning, and systems-based practice. The six competency domains were developed by the Accreditation Council for Graduate Medical Education and endorsed by the American Board of Internal Medicine and the American Board of Medical Specialties.

According to the ACC, the goal of COCATS 4 is to facilitate development of the knowledge and skills all cardiologists should possess and align additional competencies with each fellow's career focus. The processes formalized in COCATS 4 define the program characteristics and requisite competencies that will better prepare cardiovascular specialists to meet the future needs of patients and society.

The document’s steering committee also highlights the impact these updates may have on patients. The competencies form the basis for the Entrustable Professional Activities for Subspecialists in Cardiovascular Disease, which are the activities patients and the public expect cardiologists to perform. They include cardiovascular consultation, acute cardiac care, chronic cardiovascular disease management, cardiovascular testing, disease prevention and risk factor control, team-based care, and lifelong learning.

In the ACC press release, Dr. Williams stated, “The recommendations in the statement are aimed at training program directors, faculty, and trainees in our cardiovascular disease fellowship programs. But as the competencies defined in COCATS 4 are also aligned with those of Lifelong Learning for practicing cardiologists, the impact extends across the spectrum of our profession and is part of the foundational structure of the educational activities of the ACC.”

Also in the ACC announcement, Dr. Halperin stated, “Optimal performance in patient care requires a combination of behavior, attitude, and action. By laying the foundation in fellowship to not only learn the skills needed to perform the actions our patients expect, but also learn to communicate and work more effectively with patients, their families, and all the members of the cardiovascular care team, we're helping fellows develop into highly skilled and more compassionate cardiologists.”

Dr. Fuster added, “In specific terms, the COCATS 4 document emphasizes training in ambulatory, consultative, and longitudinal cardiovascular care. Furthermore, it more generically emphasizes comprehensively training our cardiology fellows to be the best, most well-rounded doctors, which is critical to the future of their careers, clinical cardiac care, the health of our patients, and the advancement of our field of cardiovascular medicine.”