Knowledge Gaps in Implantable Cardioverter Defibrillator Therapy: a Survey of Trainees in Internal Medicine and Cardiology

• Main Authors: Nicholas Joseph Costa, Jeffrey Rottman
• Format: Article
• Language: English
• Published: Shaheed Beheshti University of Medical Sciences and Health Services 2018-01-01
• Series: Journal of Medical Education
• Subjects: IMPLANTABLE CARDIOVERTER DEFIBRILLATORS, SURVEY, TRAINING, CLINICAL PRACTICE GUIDELINES
• Online Access: http://journals.sbmu.ac.ir/jme/article/view/17190
• ISSN: 1735-3998; 1735-4005

Background: Knowledge of clinical practice guidelines for Implantable Cardioverter Defibrillator (ICD) therapy is a pre-requisite for effective application of this life-saving technology. The level of trainee familiarity with these guidelines is unknown. The objective of this study was to assess trainee familiarity with clinical practice guidelines for ICD therapy.<br />Methods: This study surveyed 32 clinicians of varying training levels in internal medicine and cardiology at a large VA medical center. This is a survey study conducted from a population of all trainees in internal medicine at the medical center; the sample included trainees from PGY-1 through PGY-7 as well as attending physicians in internal medicine. Analysis of the collected survey data was performed using either Chi-square tests for comparison of categorical variables or unpaired t-tests for<br />comparison of means.<br />Results: Of all respondents, 69% reported that they were familiar with published guidelines, and consistent with previously published data. Cardiologists were significantly more likely to report familiarity than internists (85% vs 42%, P=0.01). Most respondents (75%) reported satisfactory or better knowledge of published guidelines, though only 34% self-reported their knowledge as good or very good. The majority of respondents (86%) underestimated the usual cost of ICD implantation,<br />while most respondents (78%) agreed that implantation of an ICD was cost-effective for secondary prevention, cardiologists were far more likely to agree than internists (95% vs. 50%, P&lt;0.03).<br />Conclusion: There are considerable knowledge gaps evident among trainees with regard to clinical practice guidelines for ICD therapy. This likely represents a modifiable barrier to ICD implantation.<br />Structured education for medical trainees on the appropriate use and referral practices consistent with practice guidelines may reduce knowledge gaps and increase appropriate ICD implantation.<br />Keywords: IMPLANTABLE CARDIOVERTER DEFIBRILLATORS, SURVEY, TRAINING, CLINICAL PRACTICE GUIDELINES