Competency-Based Medical Education: Do the Cardiac Imaging Training Guidelines Have it Right?

Area of Science:

• Cardiology
• Nuclear Cardiology
• Medical Education

Background:

• Competency-based medical education (CBME) is increasingly adopted.
• CBME requires novel methods for assessing clinical competence.
• CBME application in cardiac imaging needs further study.

Purpose of the Study:

• Evaluate current myocardial perfusion imaging (MPI) training volume guidelines for competence.
• Identify potential training volume thresholds for achieving competence in MPI interpretation.
• Explore the feasibility of CBME in nuclear cardiology.

Main Methods:

• Trainees independently interpreted myocardial perfusion imaging (MPI) studies.
• Expert readers reviewed the same MPI studies.
• Trainee-expert agreement (kappa) was measured every 50 cases using summed scores and % left ventricular (LV) ischemia.

Main Results:

• 24 trainees interpreted 9,668 MPI studies over 37 months.
• Trainee-expert agreement improved with MPI case volume but varied among trainees.
• Average trainee competence threshold (2 SDs below interobserver agreement) was met after 800 MPI studies or 400 abnormal MPI studies.

Conclusions:

• Competency-based medical education (CBME) is feasible in nuclear cardiology.
• Current MPI training guidelines may be insufficient; increased case volumes are suggested.
• Focus should shift from volume-based learning to target agreement thresholds for trainee competence.