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

2. 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.

3. 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

4. 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

5. 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

6. 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- survey of 450 US FM residency program directors-handout
Requested to complete 3 minute survey on EST survey web site

18. 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

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

20. 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