Residency Programme

Adult Cardiology

Adult cardiology deals with the evaluation and management of disorders of the cardiovascular system. These include coronary artery disease, valvular heart disease, heart failure, adult congenital heart disease, myocardial and pericardial diseases, arrhythmias and systemic hypertension.

Adult cardiology service began as soon as the University Hospital opened and by 1993 had evolved into a separate section within the Department of Internal Medicine. In 1997 a CPSP approved residency programme was initiated. Since then the programme has graduated 11 cardiologists who are currently serving as faculty not only within Aga Khan University Hospital but also at premier institutions throughout the country.

It is the most comprehensive training programme of its kind in Pakistan. It aims at providing training in all aspects of clinical and investigational cardiology including echocardiography, nuclear cardiology, invasive cardiology, cardiac electro-physiology as well as exposure to paediatric cardiology and cardiac surgery, thereby leading to development of independent, academically qualified and clinically competent cardiologists.

The nature of this specialty is such that it demands a great deal of time and effort in terms of patient care both on the part of faculty as well as the trainees. However, the training programme has been structured in such a way that it has a very strong academic and research component.

With the astronomical increase in the incidence and prevalence of cardiac diseases in our country, there is an ever growing need for well-trained cardiologists. In recent years several new institutions have opened throughout the country where graduates of our residency programme have been eagerly accepted. Moreover, some of our graduates have had the opportunity of further sub-specialised training in reputable institutions abroad.

Objective

The main objective of Cardiology Residency Programme is to produce knowledgeable and skilled cardiologists, who at the end of their training are able to:

• Manage all the routine and complex acute and chronic adult cardiac problems independently;
• Diagnose routine paediatric cardiac problems and start initial management;
• Manage ambulatory cardiac patients independently;
• Teach students and junior residents;
• Manage pre- and post-operative cardiac and hemodynamic complications in cardiac and non-cardiac surgical patients;
• Independently perform and interpret non-invasive cardiac diagnostic procedures, e.g. ETT, Echo colour/Doppler studies, ambulatory blood pressure and ECG monitoring and nuclear cardiac imaging;
• Independently perform central line insertion with bedside hemodynamic monitoring, temporary pacemaker insertion, and pericardiocentesis;
• Perform right and left cardiac catheterisation independently;
• Observe and assist in coronary and valvular interventions and electrophysiological studies and permanent pacemaker implantation;
• Understand the basic principles of research; design a study; conduct, analyse and present it and finally prepare a manuscript;
• Devote extended (elective) time acquiring in-depth skills in nuclear cardiology, stress echo, trans-esophageal echo, cardiac electrophysiology and cardiac intervention at AKU and outside institutions.

Duration of training

The selected candidates are required to undergo a comprehensive training for a period of three years.

Eligibility

• MBBS or equivalent degree approved by PM&DC
• One year of house job or internship, of which six months should be in medicine and six months in surgery or related fields
• Two years training in Internal Medicine
• Eligible to appear in Medicine Intermediate examination (MCPS) or FCPS (Medicine) examination conducted by CPSP. Candidates holding FCPS (Medicine) or equivalent diploma may have preference.

The selection process is based purely on merit.

Scope and content

The programme follows the recommendations of the College of Physicians and Surgeons, Pakistan and also incorporates the guidelines established by the American College of Cardiology for training in Adult Cardiovascular Medicine.

Direct patient management

Inpatient consults service (6 months), inpatient CCU service (6 months) and outpatient weekly clinic over three years will be utilised for clinical bedside teaching under the supervision of faculty.

Non-invasive (8 months)

Stress testing, EKG reading, echocardiography (including stress echos and trans-esophageal echocardiograms) and cardiac nuclear studies will be performed and interpreted by the resident under supervision.

Cardiac catheterisation (6 months)

The resident will perform left and right heart catheterisation under supervision. At the end of the residency, he will have had adequate training to perform these procedures independently. There will also be exposure to cardiac interventions.

Clinical electrophysiology and arrhythmias (6 months)
(Simultaneously with consultants)

The resident will participate in invasive electrophysiology studies, ablations and pacemaker/ICD implantations. S/he will also participate in a weekly pacemaker clinic.

Paediatric cardiology

Inpatient and outpatient clinics (1 month), paediatric echocardiography (6 months simultaneously with echo rotation) and invasive paediatric cardiology (6 months simultaneously with cardiac catheterisation rotation).

Cardiothoracic surgery (1 month)

Apart from a dedicated one-month rotation through cardiothoracic surgery, residents continuously learn about management of cardiac surgical patients through regular interaction during their inpatient/consultation and cathlab rotations.

Research (3 months)

Strong emphasis is placed on research; protected time for research activities and teaching in research methodology will be provided. All residents are expected to produce papers that would be of calibre, to be published in peer-reviewed journals.

Electives (2 months)

Residents are encouraged to spend time at outside institutions to enable them to get a broader experience.

Leave

Three months, with one month per year.

Structured academic/teaching activities

Apart from the abovementioned rotations, Cardiology residents are expected to attend the following teaching sessions organised by the Department of Medicine and Section of Cardiology

Department of Medicine

• Case presentation - Medicine Grand Rounds
• Clinical practice guidelines presentation
• Journal club
• Mortality and morbidity meeting
• Professor's lecture
• Clinical quality indicators
• Residents Grand Round

Section of Cardiology

Weekly

• Weekly audit
• EKG rounds
• Resident presentation

Monthly

• Echocardiography conference
• Fellow presentation - core curriculum topics
• Cardiac cath conference
• Journal club

On-call duties

During the first year, the resident will take call once every fourth night in the hospital. During second year, residency on-call schedule is every sixth night and only one in ten days in the final year.

Positions available

Two residents are recruited each year.

Administrative set-up

The Cardiology section is an independent functioning unit within the Department of Medicine. It has eight full-time faculty and 10 non full-time faculty members. Dr Sajid Dhakam, Associate Professor is the Head of Cardiology section. Dr Javed Tai, Assistant Professor is the programme director and Dr Fateh Ali Tipoo, Assistant Professor is the coordinator of the Cardiology Residency programme.

Full-time Faculty

Professor

Dr Mohammad Ataullah Khan
MBBS Sindh, FRCP London, FACP USA

Associate Professors

Dr Sajid Dhakam
MBBS AKU, FACC, FSCAI
Diplomate American Boards of Internal Medicine, Cardiovascular Diseases and Interventional Cardiology

Dr Fahim H. Jafary
MBBS AKU
Diplomate American Boards of Internal Medicine, Cardiovascular Diseases and Interventional Cardiology
Diplomate Certification Board in Nuclear Cardiology

Assistant Professors

Dr Aamir Hameed
MBBS Punjab; FCPS (Internal Medicine and Cardiology) Pakistan

Dr Fatehali Tipoo Sultan
MBBS Karachi; FCPS (Internal Medicine and Cardiology) Pakistan; Diploma (Clinical Cardiology)
Programme Coordinator

Dr Javed Majid Tai
MBBS Karachi; FCPS (Medicine and Cardiology) Pakistan
Programme Director

Dr Sohail Abrar Ahmed Khan
MBBS Karachi; FCPS (Medicine & Cardiology) Pakistan

Dr S.M. Najaf Ali Nadeem
MBBS Karachi; FCPS Pakistan

Senior Instructor

Dr Sumera Naseem
MBBS; FCPS (Medicine and Cardiology) Pakistan

Part-time Faculty

Dr Abdus Samad
MBBS Lahore
Diplomate American Board of Internal Medicine and Internal Medicine (Cr)

Dr Abu Bakr Shaikh
MBBS Karachi
Diplomate American Boards of Internal Medicine and Cardiovascular Diseases

Dr Asad Pathan
MBBS Karachi; FACC, FSCAI
Diplomate American Boards of Internal Medicine, Cardiovascular Diseases and Interventional Cardiology

Dr Azam Shafqat
MBBS AKU
Diplomate American Boards of Internal Medicine, Cardiology and Cardiac Electrophysiology

Dr Irfan Chandna
MBBS Karachi; FCPS Pakistan

Dr Khawar Abbas Kazmi
MBBS Punjab; FCPS Pakistan

Dr Khursheed Hassan
MBBS Karachi; FCPS Pakistan

Dr Mohammad Ishaq
MBBS Peshawar; FRCP Edinburgh, Glasgow and London; FACC USA

Dr Mohammad Sharif
MBBS Karachi; FRCP Edinburgh and Glasgow; FCPS Pakistan

Dr Nageeb Basir
MBBS Peshawar; FRCP Ireland; Diploma in Cardiology, London