Exercise Stress Testing Training in FM Residencies

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Presentation transcript:

Exercise Stress Testing Training in FM Residencies Hiren Patel, MD Robert Newman, MD April 25, 2010

Learning Objectives 1) Participants will realize that office based exercise stress testing (EST) without nuclear imaging has a Class I (highly recommended) indication for evaluation of intermediate pre-test probability chest pain patients, as recommended by the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines.

Learning Objectives 2) Participants will understand that only 12% of family physicians perform EST for their patients, despite the many indications for its use. 3) Discussion will be encouraged as to whether there needs to be a standardized EST curriculum in Family Medicine residency programs, with the goal of increasing the number of family physicians that offer this test in their Patient Centered Medical Homes

Background Information Chest pain is an extremely common complaint in primary care Only 12.8% of family physicians perform EST-AAFP practice survey 53% of FM residencies offer EST training-1993 survey-no data since Barriers - lack of training, cost of equipment and low reimbursement

Background EST without imaging- Class 1 indication by ACC/AHA guidelines for intermediate risk pre-test probability chest pain evaluation This group accounts for the vast majority of primary care patients ECU Family Medicine study of 339 ESTs-99.4% negative predictive value for negative test

Purpose of Study To provide updated information regarding EST training in US FM residencies Assess need for a standardized EST curriculum for FM training Method-e-mail survey of 450 US FM residency program directors-handout Requested to complete 3 minute survey on EST survey web site

Discussion Current FM Curriculums exist which could serve as models in residency training Ken Grauer, MD-University of Florida-EST basics handbook Corey Evans, MD-Teaches EST workshop at AAFP Annual Scientific Assembly John Pfenninger,MD-EST procedure workshops offered around the country by the National Procedures Institute

Problems 40% response rate to survey after multiple e-mail contacts-179 responses Possible response bias Those doing EST may be more likely to respond to survey

Summary Survey showed majority of programs want to train their residents in EST Strong case can be made for training more family physicians to perform EST in office Important service to offer in the Patient Centered Medical Home-cost efficient and convenient triage of chest pain patients