Q J Med 2015; 108:353–354 doi:10.1093/qjmed/hcv002 Advance Access Publication 21 January 2015
Commentary How should specialist competencies in heart valve disease be recognized? J. CHAMBERS1, B. CAMPBELL2, J. WILSON3, C. ARDEN4 and S. RAY1 From the 1British Heart Valve Society, 2Society for Cardiological Science and Technology, 3British Association of Nursing for Cardiac Care and 4Royal College of General Practitioners Address correspondence to J. Chambers, Cardiothoracic Centre, East Wing, St. Thomas’ Hospital, London SE1 7EH, UK. email: [email protected]
Introduction The need for specialization arises when a condition is frequent, its management is complex and limitations in current care exist. Moderate or severe heart valve disease now occurs in 13% aged 75 as a result of degenerative diseases reflecting expanding life-spans.1 Management decisions may often be complex2 and there is an abundant evidence of limitations in care.3,4 National and International consensus documents, therefore, recommend specialist multidisciplinary valve teams.2,4 Specialist valve services (Table 1) now exist in 60% of tertiary centres in the UK and 11% of district general hospitals.5 Despite this, how the disciplines involved with these services develop and maintain specialist competencies has never been discussed.
Specialist training in valve disease Teaching on valve disease for medical students should ideally be expanded but the main focus must be in postgraduate training. The British Heart Valve Society (BHVS) has drawn up a minimum knowledge base (www.bhvs.org.uk) suitable for all disciplines (physicians, surgeons, clinical scientists and nurses). This is an expansion of the more generic syllabus provided by the Postgraduate Medical Education Training Board and the Royal College of Surgeons. Valve-focused training is delivered at regional training days, at national and international meetings and by web-based learning (www.bhvs.
org.uk). All disciplines should receive experience in a specialist valve service (Table 1). In general practice, improved detection and management of valve disease will usually be supported by local programmes developed by hospital-based specialist valve clinics. General practitioners with a specialist interest in cardiology should receive a similar training to a cardiology registrar including sessions at a specialist valve clinic. The cardiac physiology career path is being revised and the BHVS valve syllabus is included within the curriculum for the new clinical scientist. There are a range of modules contained within the Higher Specialist Scientist Training programme which are relevant to valve disease including clinical examination and transoesophageal echocardiography. There is already a significant specialization within cardiology nursing. Clinical competencies for an advanced nurse practitioner in heart valve disease could be defined and achieved with clinical and medical supervision within multidisciplinary clinics, as well as through accredited university education.
Recognition of competencies There is no formal accreditation process. Demonstration of competencies could include: (i) a record of training within a centre with recognized expertise in valve disease; (ii) valve-related programmed activity, e.g. valve clinics, inpatient care, involvement with valve-specific multidisciplinary team meetings, complex echocardiograms to
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
354
J. Chambers et al.
Table 1 Roles of a specialist valve service
Detection of valve disease and management planning Surveillance of asymptomatic patients with moderate and severe valve disease Timing of intervention Setting and maintain standards for valve interventions including surgical valve repair and replacement and percutaneous techniques Short- and long-term postoperative follow-up Management of endocarditis Assessment before non-cardiac surgery or pregnancy Education and training in valve disease (patients, medical students, junior doctors, general practitioners, non-cardiac physicians) Audit of results
assess valve disease, research; (iii) continuous medical education; (iv) registration of interest with membership of a recognized national body including BHVS or the European Society of Cardiology working group on valve disease.
Conclusion The expansion of valve disease as a distinct subspecialist interest is recent. Specialist valve clinics and
multidisciplinary meetings are widely accepted as best practice and this requires sufficient training and experience in valve disease. There is a need to formalize valve competencies to ensure that all disciplines involved with clinical care are adequately appraised, supported and educated. Conflict of interest: None declared.
References 1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368:1005–11. 2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. AHA/ACC Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 2014; 63:2438–48. 3. Iung B, Baron G, Butchart EG, Delahaye F, GohlkeBa¨rwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 2003; 24:1231–43. 4. Chambers J, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart 2013; 99:1714–6. 5. Bhattacharyya S, Chambers J, Lloyd G. Survey of valve clinics in the UK. Q J Med 2015; 108:113–7.
Copyright of QJM: An International Journal of Medicine is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Commentary How should specialist competencies in heart valve disease be recognized? J. CHAMBERS1, B. CAMPBELL2, J. WILSON3, C. ARDEN4 and S. RAY1 From the 1British Heart Valve Society, 2Society for Cardiological Science and Technology, 3British Association of Nursing for Cardiac Care and 4Royal College of General Practitioners Address correspondence to J. Chambers, Cardiothoracic Centre, East Wing, St. Thomas’ Hospital, London SE1 7EH, UK. email: [email protected]
Introduction The need for specialization arises when a condition is frequent, its management is complex and limitations in current care exist. Moderate or severe heart valve disease now occurs in 13% aged 75 as a result of degenerative diseases reflecting expanding life-spans.1 Management decisions may often be complex2 and there is an abundant evidence of limitations in care.3,4 National and International consensus documents, therefore, recommend specialist multidisciplinary valve teams.2,4 Specialist valve services (Table 1) now exist in 60% of tertiary centres in the UK and 11% of district general hospitals.5 Despite this, how the disciplines involved with these services develop and maintain specialist competencies has never been discussed.
Specialist training in valve disease Teaching on valve disease for medical students should ideally be expanded but the main focus must be in postgraduate training. The British Heart Valve Society (BHVS) has drawn up a minimum knowledge base (www.bhvs.org.uk) suitable for all disciplines (physicians, surgeons, clinical scientists and nurses). This is an expansion of the more generic syllabus provided by the Postgraduate Medical Education Training Board and the Royal College of Surgeons. Valve-focused training is delivered at regional training days, at national and international meetings and by web-based learning (www.bhvs.
org.uk). All disciplines should receive experience in a specialist valve service (Table 1). In general practice, improved detection and management of valve disease will usually be supported by local programmes developed by hospital-based specialist valve clinics. General practitioners with a specialist interest in cardiology should receive a similar training to a cardiology registrar including sessions at a specialist valve clinic. The cardiac physiology career path is being revised and the BHVS valve syllabus is included within the curriculum for the new clinical scientist. There are a range of modules contained within the Higher Specialist Scientist Training programme which are relevant to valve disease including clinical examination and transoesophageal echocardiography. There is already a significant specialization within cardiology nursing. Clinical competencies for an advanced nurse practitioner in heart valve disease could be defined and achieved with clinical and medical supervision within multidisciplinary clinics, as well as through accredited university education.
Recognition of competencies There is no formal accreditation process. Demonstration of competencies could include: (i) a record of training within a centre with recognized expertise in valve disease; (ii) valve-related programmed activity, e.g. valve clinics, inpatient care, involvement with valve-specific multidisciplinary team meetings, complex echocardiograms to
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
354
J. Chambers et al.
Table 1 Roles of a specialist valve service
Detection of valve disease and management planning Surveillance of asymptomatic patients with moderate and severe valve disease Timing of intervention Setting and maintain standards for valve interventions including surgical valve repair and replacement and percutaneous techniques Short- and long-term postoperative follow-up Management of endocarditis Assessment before non-cardiac surgery or pregnancy Education and training in valve disease (patients, medical students, junior doctors, general practitioners, non-cardiac physicians) Audit of results
assess valve disease, research; (iii) continuous medical education; (iv) registration of interest with membership of a recognized national body including BHVS or the European Society of Cardiology working group on valve disease.
Conclusion The expansion of valve disease as a distinct subspecialist interest is recent. Specialist valve clinics and
multidisciplinary meetings are widely accepted as best practice and this requires sufficient training and experience in valve disease. There is a need to formalize valve competencies to ensure that all disciplines involved with clinical care are adequately appraised, supported and educated. Conflict of interest: None declared.
References 1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368:1005–11. 2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. AHA/ACC Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 2014; 63:2438–48. 3. Iung B, Baron G, Butchart EG, Delahaye F, GohlkeBa¨rwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J 2003; 24:1231–43. 4. Chambers J, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart 2013; 99:1714–6. 5. Bhattacharyya S, Chambers J, Lloyd G. Survey of valve clinics in the UK. Q J Med 2015; 108:113–7.
Copyright of QJM: An International Journal of Medicine is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
