2021 ACC/AHA/SVM/ACP Advanced Training Statement on Vascular Medicine (Revision of the 2004 ACC/ACP/SCAI/SVMB/SVS Clinical Competence Statement on Vascular Medicine and Catheter-Based Peripheral Vascular Interventions)

A Report of the ACC Competency Management Committee

Developed in Collaboration With the Association of Black Cardiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Nursing, and the Society for Vascular Surgery

ACC Competency Management Committee

James A. Arrighi, MD, FACC, Chair

Lisa A. Mendes, MD, FACC, Co-Chair

Jennifer Day, MSN, RN

G. William Dec Jr, MD, FACC

Ali Denktas, MD, FACC

David Drajpuch, ACNP-BC, CRNP, FNP-BC, MSN

Susan Fernandes, LPD, PA-C**

Sanjeev A. Francis, MD, FACC

Rebecca T. Hahn, MD, FACC

Susan D. Housholder-Hughes, DNP, ACNS-BC, ANP-BC, FACC

Sadiya S. Khan, MD, FACC

Kyle Klarich, MD, FACC**

Meera Devi Kondapaneni, MBBS, FACC

Kwan S. Lee, MD, FACC

C. Huie Lin, MD, PhD, FACC

Joseph E. Marine, MD, FACC**

Shannon McConnaughey, MD, FACC

Khusrow Niazi, MBBS, FACC

Thomas Ryan, MD, FACC

Frank E. Silvestry, MD, FACC

Michael A. Solomon, MD, MBA, FACC

Robert L. Spicer, MD, FACC

Andrew Wang, MD, FACC, FAHA**

Gaby Weissman, MD, FACC

Howard H. Weitz, MD, MACP, FACC**

Table of Contents

Preamble ▪

• 1. Introduction ………………………………………………………▪

• 1.1.2. Document Development and Approval  …………………………………..▪

1.2. Background and Scope ……………………………….▪

1.2.1. Evolution of Vascular Medicine ……………………………………….▪

1.2.2. Levels of Training ……………………………………….▪

2. General Standards …………………………………………….▪

2.1. Faculty …………………………………………….▪

2.2. Facilities …………………………………………….▪

2.3. Equipment …………………………………………….▪

2.4. Additional Resources ……………………………………….▪

3. Training Components …………………………………………….▪

3.1. Didactic Program ……………………………………….▪

3.2. Clinical Experience ……………………………………….▪

3.3. Hands-On Procedural Experience ……………………………………….▪

3.4. Diagnosis and Management of Emergencies and Complications ……………………………………….▪

3.5. Diagnosis and Management of Less Common Clinical Conditions and Syndromes …………………………………………….▪

3.6. Research and Scholarly Activity ……………………………………….▪

4. Training Requirements  ………………………………………▪

4.1. Development and Evaluation of Core Competencies ……………………………………….▪

Table 1. Competency Components and Curricular Milestones for Level III Training in Vascular Medicine ……………………………………….▪

Table 2. Common Professional Behavior Competencies Relevant to All Clinical Cardiovascular Disease Specialists ……………………………………….▪

4.2. Vascular Medicine ……………………………………….▪

4.2.1. Peripheral Artery Disease ……………………………………….▪

4.2.2. Renal and Mesenteric Artery Disease ……………………………………….▪

4.2.3. Cerebrovascular Disease ……………………………………….▪

4.2.4. Aortic Diseases ……………………………………….▪

4.2.5. Vasculitis, Vasospastic, and Temperature-Related Disorders ……………………………………….▪

4.2.6. Acute and Chronic Venous Diseases ……………………………………….▪

 4.2.6.1. Acute Venous Disease ……………………………………….▪

 4.2.6.2. Chronic Venous Disease ……………………………………….▪

4.2.7. Lymphatic Diseases and Lipedema ……………………………………….▪

4.2.8. Noninvasive Diagnostic Tests ……………………………………….▪

5. Leadership and Administrative Competencies ……………………………………….▪

6. Evaluation of Proficiency ……………………………………….▪

• References …………………………………………….▪

• Appendix 1

• Appendix 2

• Appendix 3

Preamble

Since publication of its first Core Cardiovascular Training Statement (COCATS) in 1995 (1), the American College of Cardiology (ACC) has defined the knowledge, experiences, skills, and behaviors expected of clinical cardiologists. Subsequent revisions have moved toward competency-based training based on the 6-domain competency structure promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties and endorsed by the American Board of Internal Medicine (ABIM). The ACC has taken a similar approach to describe the aligned general cardiology lifelong learning competencies that practicing cardiologists are expected to maintain. Many hospital systems now use the 6-domain structure as part of medical staff privileging, peer review, and professional competence assessments.

Whereas COCATS and the associated Lifelong Learning Competencies for General Cardiologists (2) focus on general clinical cardiology, ACC Advanced Training Statements and associated Lifelong Learning Statements define selected competencies beyond those expected of all cardiologists and that typically require training beyond a standard 3-year cardiovascular disease fellowship. This includes, but is not limited to, those disciplines for which there is an ABIM subspecialty certification. The Advanced Training Statements describe key experiences and outcomes necessary to acquire skills in a defined subspecialty area of cardiology in a structured training program. These are supplemented by Lifelong Learning Statements that address the commitment to sustaining and enriching competency over the span of a career.

The ACC Competency Management Committee oversees the development and periodic revision of the cardiovascular training and competency statements. A key feature of competency-based training and performance is an outcome-based evaluation system. Although specific areas of training may require a minimum number of procedures or duration of training to ensure adequate exposure to the range of clinical disorders, the objective assessment of proficiency and outcomes demonstrates the achievement of competency. Evaluation tools include examinations, direct observation, procedure logbooks, simulation, conference presentations, and multisource (360°) evaluations. For practicing physicians, these tools also include professional society registry or hospital quality data, peer review processes, and patient satisfaction surveys. A second feature of competency-based training is recognition that learners gain competency at different rates. For multiyear training programs, assessment of representative curricular milestones during training can identify learners or areas that require additional focused attention.

The recommendations in ACC Cardiovascular Training and Lifelong Learning Statements are based on available evidence and, where evidence is lacking, reflect consensus expert opinion. The writing committees are broad-based, and typically include early-, mid-, and later-career specialists; general cardiology and subspecialty training directors; practicing cardiologists; people working in institutions of various sizes and in diverse practice settings across the United States; and nonphysician members of the cardiovascular care team. All documents undergo a rigorous process of peer review and public comment. Recommendations are intended to guide the assessment of competence of cardiovascular care providers beginning independent practice as well as those undergoing periodic review to ensure that competence is maintained.

This Advanced Training Statement addresses the core competencies required of vascular medicine specialists and complements the training in vascular medicine required of all physician trainees during the standard 3-year general cardiovascular fellowship. Furthermore, this statement identifies selected competencies of vascular medicine specialists that go beyond core expectations that may be achieved by some advanced trainees either during formal fellowship training or through subsequent training experiences. This document provides examples of appropriate measures for assessing competence in the context of training.

The work of the writing committee was supported exclusively by the ACC without commercial support. Writing committee members volunteered their time to this effort. Conference calls of the writing committee were confidential and attended only by committee members. To avoid actual, potential, or perceived conflict of interest resulting from relationships with industry (RWI) or other entities held by writing committee members or peer reviewers of the document, individuals were required to disclose all current healthcare-related relationships, including those existing 12 months before initiation of the writing effort. The ACC Competency Management Committee reviewed these disclosures to identify products (currently marketed or under development) pertinent to the document topic. Based on this information, the writing committee was selected to ensure that the chair and a majority of members had no relevant RWI. RWI was reviewed at the start of all meetings and conference calls and updated as changes occurred. Relevant RWI for authors is disclosed in Appendix 1. To ensure transparency, comprehensive RWI for authors, including RWI not pertinent to this document, is posted in Online Supplemental Appendix 1. Employment information and affiliations of the peer reviewers are shown in Appendix 2. There are no RWI restrictions for participation in peer review, in the interest of encouraging comments from a variety of constituencies to ensure that a broad range of viewpoints inform final document content. Reviewers are required, however, to disclose all healthcare-related RWI and other entities, and their disclosure information is posted in Online Supplemental Appendix 2. Disclosure information for the ACC Competency Management Committee is available online as well as the ACC disclosure policy for document development.

James A. Arrighi, MD, FACC Chair, ACC Competency Management Committee Lisa A. Mendes, MD, FACC Co-Chair, ACC Competency Management Committee