ACC Offers Statement on Use of CBME for Training of Fellows During COVID-19

Doctor and patient wearing masks looking at laptop
The American College of Cardiology has published a statement regarding specialized guidance for the administration of competency-based medical education for cardiology fellows undergoing training during the continuing COVID-19 pandemic.

In light of the recent pandemic, the American College of Cardiology (ACC) offered a statement drafted by the ACC Competency Management Committee and published in the Journal of the American College of Cardiology regarding specialized guidance for the administration of competency-based medical education (CBME) for cardiology fellows undergoing training during the continuing COVID-19 crisis.

Whereas conventional CBME training relies heavily on numerical quotas for procedures performed and/or hours logged, COVID-19 has disrupted all aspects of health care, including this standard of operations, potentially putting some fellows in jeopardy of failing to meet these requirements. For this reason, the ACC recommends that the CBME principles outlined in the Core Cardiovascular and Advanced Training Statements be implemented and assessed with flexibility during this uniquely challenging time, offering several specific considerations regarding how to do so effectively.

Program directors are advised that numerical or time-based requirements are approximate estimates based on “typical” trainees and that some time- and case-based requirements can be satisfied concurrently. Final responsibility for reviewing and evaluating trainees’ progress lies with the director, who can and must use their discretion to certify competency, regardless of whether all quotas have been met.

Program directors should also keep in mind board certification requirements and consult any guidance these boards have issued regarding pandemic changes. Maintenance of rigorous educational standards coupled with enhanced flexibility will help mentors and trainees keep the public interest top of mind.

The committee endorsed the Accreditation Council for Graduate Medical Education recommendations regarding COVID-19 adjustments for fellowship training. Toward that end, they acknowledged that, as normal routines are likely to be disrupted by rotation shifts or alternate education methods, such as virtual learning, achievement of time- or volume-based measures may not be possible, and directors should carefully follow CBME guidelines and principles to determine advancement and board eligibility.

For persons concerned about fulfilling board or hospital requirements, the ACC Competency Management Committee offered some reassurance. Many cardiology boards —including those for cardiology, heart failure, and adult congenital disease — do not define minimum procedure numbers; and more procedure-heavy specialties (electrophysiology and interventional cardiology) often have some flexibility in these requirements. In addition, some non-American medical imaging boards are in the process of changing their programs’ requirements to enhance flexibility.

The committee urged all credentialing and certification entities to follow these leads during the pandemic, using the increased flexibility inherent to the CBME principles to ensure clinical competency of all graduating fellows. Demonstration of proficiency in skills and knowledge should be the primary consideration for advancement rather than fulfillment of numerical requirements.

Alternative training methods, such as remote case review or self-directed learning, may be necessary during the COVID-19 pandemic to meet these ends. Ultimately, the program director is responsible for certifying fellows’ competencies and endorsing their advancement.

“In brief, we urge both board certification bodies and credentialing authorities to consider adopting strategies that permit some flexibility while still maintaining the protection of the public interest,” noted the study authors.

They ended by recognizing the many sacrifices made by fellows and mentors alike to serve their communities and thanked all involved for their innovative adjustments to training and dedication to patient care during the COVID-19 pandemic.


Arrighi JA, Mendes LA, McConnaughey S. Competency-based medical education for fellowship training during the COVID-19 pandemic. J Am Coll Cardiol. 2021;77(13):1681-1683. doi:10.1016/j.jacc.2021.02.022