Postgraduate teaching of cardiovascular prevention and rehabilitation in Europe: first results

Cardiovascular rehabilitation is a cost-effective, life-enhancing and life-saving treatment for patients with cardiovascular disease, particularly for patients recovering from an acute cardiovascular event. A limited number of patients with cardiovascular disease benefit from rehabilitation procedures, partly because of a limited number of rehabilitation services, and partly because of a lack of adequately trained professionals [1]. Indeed, health professionals involved in cardiovascular rehabilitation should present clearly specified competencies and an accredited programme of education and training to meet proposed standards for the management and rehabilitation of coronary heart disease should be available [2–4]. Similarly, cardiovascular prevention (CVP) is a cornerstone regarding the fight against cardiovascular disease, and several guidelines have been issued [5]. Nevertheless, low counseling rates for cardiovascular disease prevention have been noted [6]. As there is currently very little or no information on the current status of CVP and rehabilitation (CVP and R) training in Europe, we conducted a pilot survey to assess this issue. In January 2009, we sent a questionnaire on postgraduate teaching on CVP and R to 376 medical schools from 35 European countries. The addresses were collected from the Institute for International Medical Education (www.iime.org). The questions included the number of students, total teaching time (in hours or European Credit Transfer and accumulation System) and the topics covered. A course was considered ‘complete’ if all the following topics were covered: cardiovascular risk factors, individual cardiac risk evaluation, physical activity, nutrition, smoking cessation and psychology [7]. Similar questionnaires on postgraduate courses and continuous medical education were sent to 44 cardiology societies and 31 heart foundations. All questionnaires were in English, but the answers could be provided in any language and an addressed envelope was provided for the response. A second mail was sent if no response was obtained from the institutions. Data was collected till July 2009. One hundred and twenty medical schools (32% response rate) answered the questionnaires. Only 32 (27%) of them reported providing postgraduate CVP and R courses (43 courses overall). The median number of students was 25 (range: 4–140) and the median number of teaching hours was 72 (3–518h). The topics most frequently taught were cardiovascular risk factors, physical activity, global risk estimation and smoking cessation, whereas nutrition and psychology were the least frequently provided. Only 22 courses (51%) included all the topics (Fig. 1). Eighteen cardiology societies and 11 heart foundations answered the questionnaires (response rate of 41 and 34%, respectively). For the 26 countries for which data were available, 14 (54%) reported having postgraduate CVP and R teaching but only four (15%) – Belgium, France, Hungary and Ireland – reported continuous medical education on the topic. Teaching was aimed essentially at cardiologists; in three countries (France, Germany and Ireland) internists, neurologists and other health professionals (nurses, paramedics) could also attend. Topics provided in the cardiovascular prevention and rehabilitation postgraduate courses. Only one out of four medical schools that responded provided postgraduate training in CVP and R, and only half of the curricula covered all topics recommended by the European Society of Cardiology [7]. The fact that no postgraduate courses on CVP and R were available in some countries does not indicate a lack of interest in this topic but might be because of the fact that the population size or the number of hospitals/cardiovascular events is too small to economically justify setting up such training. For instance, small countries like Malta, Cyprus or Slovenia might not justify the considerable human, intellectual and economic effort to set up a course that will probably provide in a single year more specialists in CVP and R than the country will ever need for the next decades. Although medical education might be one of the many factors related to the successful implementation of CVP and R programmes, setting a European postgraduate course providing adequate, accredited training in CVP and R would be of considerable importance if such small countries are willing to benefit from trained professionals able to deliver fully implemented CVP and R programmes [4]. The current revision of the core curriculum for the general cardiologist of the European Society of Cardiology [7] should set a benchmark for the minimum qualifications and core competencies for health professionals in the area of CVP and R [3], as it is currently the case in the USA [8]. This study has some limitations. First, the participation rate was rather low, albeit in agreement with other studies conducted in medical schools [9, 10]. Second, it is possible that medical schools that provided postgraduate teaching on CVP and R were more prone to respond, leading to an overestimation of the prevalence of postgraduate courses. Nevertheless, this study provides interesting preliminary data on CVP and R, and a more extensive survey with more detailed questions and more intense follow-up, will be conducted in 2011. In summary, our data indicates that postgraduate courses on CVP and R are infrequent in Europe, and the topics covered vary considerably. Setting European courses providing adequate, accredited training in CVP and R would be of great benefit. The study was supported by European Association of Cardiovascular Prevention and Rehabilitation (EACPR). Conflicts of interest: none declared.