Researchers from Brown University conducted a nationwide survey assessing advanced cardiovascular imaging (ACVI) education in cardiology fellowships, finding a lack of centralized resources and literature establishing the value of ACVI. 

Advanced ACVI provides valuable diagnoses of common heart conditions including cardiovascular disease and adult congenital heart disease, but cardiovascular fellows often leave their institutions without the skills to reliably interpret ACVI modalities such as MR or CT.

“Rapid advances in technology have made it challenging for trainees to gain independent interpretive competency in one or more of the cardiovascular imaging modalities during a standard 33-year cardiology fellowship,” wrote Shah et al. “Consequently, many general cardiology fellows choose to dedicate at least a year to ACVI training.”

This is partly because of the lack of resources for ACVI.  According to Shah et al, the training programs rely on word of mouth or their institutional websites to attract applicants, and there’s no standardized curriculum so trainees may be uncertain about the quality of any given program. While the American College of Cardiology recently published an outlining of key principles of an ACVI program, it will take time for meaningful change to occur.

The issue with ACVI is simple: Not enough institutions are offering it. More than half of the 82 survey respondents reported no ACVI program, although 19 indicated a desire to start one within the next few years. The biggest barrier to ACVI training is money; 85 percent of surveryed universities who lacked a ACVI program pointed to insufficient funding as the reason for not offering the program. A lack of faculty experienced in ACVI was another common reason for not offering an ACVI training program.

Unsurprisingly, all 35 institutions offering a program are large research universities, reflecting both their large budgets and ability to retain seasoned faculty. However, Shah et al put forth strategies for increasing the number of ACVI training programs, with the ultimate goal of establishing ACVI as a board-certified subspecialty.

“First, they should jointly develop a more comprehensive multimodality imaging training statement with structured ACVI training pathways exclusive of the basic exposure to ACVI required for general cardiology fellowship. This will help to ensure high quality of all ACVI training programs and trainees,” they wrote. “After standardization of training curricula, the ACC and the ACVI professional societies should dedicate the necessary resources to define and measure the value that ACVI experts add to clinical, research, and educational programs. Doing so will incentivize more institutions to invest in ACVI training.”