The American College of Cardiology has developed competencies to cover the entire career spectrum of a cardiologist, from training through practice, as well as competencies for nurse practitioners (NPs) and physician assistants (PAs) who are members of a cardiovascular care team. These competencies define the knowledge, skills, and behaviors that healthcare providers, patients, the public and accrediting bodies can reasonably expect clinicians to achieve, maintain or enhance.

The competencies were developed using the 6 ACGME/ABMS competency domains that are endorsed by the ABIM, serve as the underpinning of all ACC education activities, lead to the overarching Entrustable Professional Activities (EPAs), and act as a mechanism for the development of needs assessment and personalized or focused education. Published statements cover core cardiovascular training, advanced sub-subspecialty cardiovascular training, and corresponding lifelong learning competencies for physicians and competencies for NPs and PAs who practice adult cardiovascular medicine.

Clinical Competencies

These competencies cover 18 clinical areas of practice, focusing specifically on Medical Knowledge and Patient Care/Procedural Skill competencies. In addition, Professional Behavior Competencies Relevant to All Clinical Areas delineate competencies related to Systems-Based Practice, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism.

Unified Lifelong Learning Competencies for General Cardiologists (PDF)

  1. Professional Behavior Competencies Relevant to All Clinical Areas
  2. Ambulatory, Consultative, and Longitudinal Care
  3. Cardiovascular Disease Prevention
  4. ECG:
  5. Echocardiography
  6. Nuclear Cardiology
  7. Cardiovascular Computed Tomography
  8. Cardiovascular Magnetic Resonance
  9. Invasive Cardiology
  10. Stable Ischemic Heart Disease
  11. Acute Coronary Syndromes
  12. Valvular Heart Disease
  13. Heart Failure
  14. Pericardial Disease
  15. Vascular Medicine
  16. Cardiac Arrhythmias and Electrophysiology
  17. Critical Care Cardiology
  18. Adults With Simple Congenital Heart Disease
  19. Adults With Complex Congenital Heart Disease

Leadership and Administrative Competencies

In addition to clinical competency, cardiologists are expected to function effectively as leaders in allied efforts to assure high quality care and promote individual and population health. Some of these activities and attributes fall outside the realm of clinical knowledge and skill and instead involve administrative roles in clinical practice, hospitals, health systems, professional societies, or other organizations.

  1. Leadership and Administrative

ACC Advanced Training Statements (ATS) define selected competencies that go beyond those expected of all cardiologists and require training beyond a standard 3-year cardiovascular disease fellowship. This includes sub-subspecialties for which there is an ABIM added-qualification designation, such as clinical cardiac electrophysiology (CCEP). ATS also describe the key experiences and outcomes necessary to maintain or expand competencies during practice. Additional ATS are under development.

ACC's Lifelong Learning Statements (LLS) use the same ACGME/ABMS core competence domain structure to identify lifelong learning competencies for sub-subspecialists, similar, though not identical to the competencies for advanced training, reflecting the impact of practice focus and patterns on expectations of competency. They also address additional principles pertaining to maintenance of competence such as procedural volume, assessment of competence, and research and scholarly activity. Additional LLS are under development.

This document delineates the key anticipated competencies for nurse practitioners (NPs) and physician assistants (PAs) who are members of a cardiovascular care team, including those in general cardiovascular practice and those in focused areas of cardiovascular medicine. It also identifies aspects of cardiovascular medicine that exceed core expectations and may be maintained or achieved by some specialized care team members depending on their expertise, skills, practice agreements, and licensure. The competencies cover 11 clinical areas of practice, focusing specifically on Medical Knowledge and Patient Care/Procedural Skills competencies. In addition, Core Competencies are delineated that cover Systems-Based Practice, Practice-Based Learning and Improvement, Interpersonal and Communications Skills, and Professionalism.

How do you assess competency in lifelong learning?

There are a number of ways physicians can maintain competency and expand lifelong learning in the course of practice (assuring currency with the evolving art and science of the field), and assess their own professional needs for education and performance improvement. These include, for example, certified CME activities relevant to an individual’s practice, review of practice or hospital data, performance assessment and improvement programs, and facilitated self-reflection. For procedural or diagnostic laboratory activities, assessment tools may include registry and/or hospital data, appropriate use criteria, and metrics developed by professional organizations. Patient surveys and multisource (360˚) evaluations in hospital or practice environments can provide information about outcomes, communication skills, and professionalism.

What is meant by practice-focused?

Competencies with this designation are only expected of selected clinical cardiologists based on background, specialized knowledge, skills, experience, and practice focus. It is important to note that the practice-focused designation in the Lifelong Learning Competencies for General Cardiologists document does not refer to the advanced competencies of cardiovascular sub-subspecialties – such as interventional cardiology, cardiac electrophysiology, advanced heart failure, or adult congenital heart disease – that require training beyond the standard training common to all clinical cardiologists. Rather, the practice-focused competencies in the Lifelong Learning Competencies document parallel, and are analogous to, the Level II competencies defined in COCATS 4.

What are Other Professional Behaviors Relevant to All Clinical Areas and why are they important?

The writing committee developed a common set of professional behavior competencies in the Lifelong Learning Competency Document that pertain to all clinical areas and describe proficiency in Systems-Based Practice, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism. These four areas are part of the ACGME’s six core competency domains – all designated by ACGME, ABMS and ABIM as minimum general competencies required of all practitioners.