PCP OBE-CBTP RTP-ACC Form # 13 2019

PCP OBE-CBTP IN INTERNAL MEDICINE

LEARNING CONTRACT
Section of Cardiovascular/Circulatory System
City of General Trias Doctors Medical Center

Name of Resident:______________________________
Inclusive Dates of Rotation: _________________
Section Chief: _______________________________________
Section Training Officer: ________________________________

I. Expected general outcome of rotation: After the one month sub-specialty rotation in Cardiovascular/Circulatory
System during YL II, the medical resident is expected to acquire the competences for YL II in
Cardiovascular/Circulatory System for conditions Listed under Cardiovascular/Circulator System in the contents of
Terminal Competencies of Internists (PCP OBE-CBTP Document #2) in Cardiovascular/Circulator System
encountered in the Medical Ward, Emergency room and OPD; as well as special issues related to Program
Outcomes # 2 to 8.
II. Expected specific outcomes of rotation or (intermediate competencies and corresponding contents):

1. Intended for Program outcome # 1: Clinical Competence in Cardiology

A. Assess common medical problems in Cardiovascular/Circulatory System:

Common Recommended Minimum (#) Actually Certified Correct by

Medical number of Cases Encountered encountered (X) Section Chief
Problems for Clinical Competence Read Only (signed: initials)
() No Idea
1. Dyspnea 20
2. Edema 20
3. Hypertension 20
4. Syncope 5
5. Palpitations 20
6. Chest Pain 20
7. Claudication 5
8. Cough 20
9. Hypotension 20

B. Diagnose and initiate management of common but complicated medical conditions/ diseases of
Cardiovascular/Circulatory System and refer to appropriate subspecialists (Cardiologist):

Medical Conditions/Diseases Recommended (#) Actually Certified Correct

Minimum number of encountered (X) by Section Chief
Cases Encountered Read Only (signed: initials)
for Clinical () No Idea
Competence
1. Essential Hypertension 20
2. Coronary Artery Disease (Unstable 10
Angina/Chronic Ischemic Heart Disease)
3. Acute Heart Failure 10
4. Chronic Compensated/Decompensated Heart 10
Failure
5. Cor Pulmonale 5
6. Infective Endocarditis 3
7. Rheumatic Fever/Rheumatic Heart Disease 3
8. Venous Thromboembolism (Deep Venous 3
Thrombosis/Pulmonary Embolism/Acute
Pericarditis)
9. Peripheral Artery Disease (Renal artery 3
disease/Chronic Limb Ischemia/Venous
Insufficiency)

C. Diagnose and initiate management on common but complicated medical conditions/diseases and refer to
appropriate subspecialists in Cardiovascular/Circulatory System:

Medical Conditions/Diseases Recommended Minimum (#) Actually Certified Correct

number of Cases encountered (X) by Section Chief
Encountered for Clinical Read Only (signed: initials)
Competence () No Idea
1. Secondary Hypertension 5
2. Bradyarrhythmias (Sinus and AV nodal diseases) 1
3. Supraventricular Tachyarrhythmias, uncontrolled 5
(Atrial Fibrillation/Atrial Flutter/Supraventricular
Tachycardia)
4. Ventricular Tachyarrhythmias, uncontrolled 2
(Ventricular tachycardia/fibrillation/Torsades de
pointes)
5. Cardiomyopathies 2
(Restrictive/Hypertrophic/Dilated/Myocarditis)
6. Aortic Aneurysm 1
7. Valvular Heart Disease 2
8. Pericardial Diseases (Constrictive 1
pericarditis/Pericardial Effusion)
9. Peripheral Artery Disease (Acute/Critical Limb 1
Ischemia)
10. Mesenteric Artery Disease 1
11. Pulmonary Hypertension 1
12. Toxins at the heart 1
13. Trauma 1
14. Cardiovascular Manifestations of Connective Tissue 1
Diseases (Takayasu arteritis/Giant cell
arteritis/SLE/Other vasculitides)
15. Cardiac Diseases in Pregnancy 5
16. Congenital Heart Diseases in the Adult 2

D. Diagnose and manage common emergency conditions in Cardiovascular/Circulatory System:

Emergency Conditions Recommended Minimum (#) Actually Certified Correct by

number of Cases encountered (X) Section Chief
Encountered for Clinical Read Only (signed: initials)
Competence () No Idea
1. Hypertensive Crisis 5
2. Acute Coronary Syndrome (STEMI- Killip 5
I-II/NSTEMI Killip I-II/Unstable Angina)
3. Pulmonary Embolism 2
4. Decompensated Heart Failure 5
 E. Diagnose and initiate management on common but complicated emergency conditions and refer to
appropriate subspecialist in Cardiovascular/Circulatory System

Emergency Conditions Recommended Minimum (#) Actually Certified Correct by

number of Cases encountered (X) Section Chief
Encountered for Clinical Read Only (signed: initials)
Competence () No Idea
1. Acute Coronary Syndrome (STEMI- Killip 5
III-IV/NSTEMI Killip III-IV)
2. Sudden Cardiac Death 5
3. Arrhythmias (if complicated)- AFV with 5
RVR/SVT/Ventricular tachycardia-
fibrillation/Torsades de
pointes/Symptomatic AV block
4. Pericardial Tamponade 1
5. Acute Limb Ischemia 1

F. Explain the indications and steps of Common diagnostic tests, interpret and correlate results with the
patient’s condition in Cardiovascular/Circulatory System:

Diagnostic Tests Recommended (#) Actually Certified Correct

Minimum number of encountered (X) by Section Chief
Cases Encountered for Read Only (signed: initials)
Clinical Competence () No Idea
1. Troponins 20
2. CK-MB/Total CK 10
3. D-dimer 5
4. HS CRP 1
5. 24-hour Holter monitoring 1
6. 24-hour ambulatory BP monitoring 1
7. Treadmill Stress Test 2
8. 2D Echocardiography with Doppler Studies 5
9. Treadmill Stress Echo 1
10. Doppler scans: Carotid/Transcranial/Abdominal/ 1
Aorta/Renal/Arterial/Venous/Graft/Penile/Portal
Vein/Carotid
11. Ankle-brachial index 1

G. Perform common diagnostic and therapeutic procedures in Cardiovascular/Circulatory System:

Procedures Recommended Minimum (#) Actually Certified Correct by

number of Cases encountered (X) Section Chief
Encountered for Clinical Read Only (signed: initials)
Competence () No Idea
1. 12-L ECG 3

2. Intended for Program outcomes 2 to 8:

A. Discuss essential lifestyle modifications including diet, exercise and smoking cessation to hypertensive patients
B. Apply journal recommendations and clinical practice guidelines in the management and treatment of different
cardiovascular diseases.
C. Describe the presenting signs of symptoms of the different cardiovascular diseases.
D. Understand the potential complications and consequences of the disease and various treatment options; evaluate
prognosis.
E. Make informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based
on clinical judgment, scientific evidence, and patient preference.
 F. Explain the indications and limitations of laboratory and radiologic study abnormalities in the context of disease-specific
pathophysiology and formulate a plan for therapeutic intervention, when appropriate.
G. Develop communication skills with patients and families with cardiovascular conditions.
H. Develop discharge skills and how to arrange for follow up for patients with cardiovascular diseases.

3. Duration of Rotation: 2 Months

4. Schedule of teaching-learning activities and workplace assessment processes:

Mondays Tuesdays Wednesdays Thursdays Fridays

1st  Orientation  Rounds/Answer  Rounds/Answer  Rounds/Answer  Rounds/Answer
Week  Discussion on referrals from referrals from referrals from referrals from other
how the other areas other areas other areas areas
learning  RCI with  RCI with  RCI with  RCI with Cardiologists
contract will be Cardiologists Cardiologists Cardiologists  ECG reading
accomplished  ECG reading  ECG reading  ECG reading  Cardio conference
 Rounds/Answer
referrals from
other areas
 Cardiology
Clinic
 RCI with
Cardiologists
 ECG reading
2nd
 Rounds/Answer  Rounds/Answer  Rounds/Answer  Rounds/Answer  Rounds/Answer
Week referrals from referrals from referrals from referrals from referrals from other
other areas other areas other areas other areas areas
 Cardiology  RCI with  RCI with  RCI with  RCI with Cardiologists
Clinic Cardiologists Cardiologists Cardiologists  ECG reading
 RCI with  ECG reading  ECG reading  ECG reading
Cardiologists
 ECG reading
3rd  CbD and/or  Hematology  Rounds/Answer  Hematology  Rounds/Answer
Week Mini-CEX Clinic referrals from Clinic referrals from other
 Rounds/Answer  Rounds/Answer other areas  Rounds/Answer areas
referrals from referrals from  RCI with referrals from  RCI with Cardiologists
other areas other areas Cardiologists other areas  ECG reading
 Cardiology  RCI with  ECG reading  RCI with  Cardio conference
Clinic Cardiologists Cardiologists
 RCI with  ECG reading  ECG reading
Cardiologists
 ECG reading
4th  Rounds/Answer  Hematology  Rounds/Answer  Hematology  Rounds/Answer
Week referrals from Clinic referrals from Clinic referrals from other
other areas  Rounds/Answer other areas  Rounds/Answer areas
 Cardiology referrals from  RCI with referrals from  ECG reading
Clinic other areas Cardiologists other areas  RCI with Cardiologists
 RCI with  RCI with  ECG reading  RCI with Prepare and do
Cardiologists Cardiologists Cardiologists endorsement to next
 ECG reading  ECG reading Exit Exam rotator
 ECG reading  Completion of
learning Contracts
 Topics Fulfilled/not
fulfilled/ completed/not
completed
 Feedback
 Filling up of MSF/Self-
Assessment
 Submission of
 documents to Dept of
medicine

III. Additional cases, topics and procedures that the rotating resident is interested to acquire.
a. ____________________
b. ____________________
c. ____________________

Date of initial discussion of this learning contract: ______________

Signed:

__________________ __________________________ _________________________

Cardiology Rotator Training Officer (Cardiology) Section Chief (Cardiology)

Date of final discussion/ assessment / feedback / completion of learning contract: ___________________

Signed:

__________________ __________________________ _________________________

Cardiology Rotator Training Officer (Cardiology) Section Chief (Cardiology)