Cardiology with General Internal Medicine (GIM) CESR Portfolio Guide

• Aware of, and adheres to, the GMC professional requirements
• Aware of public health issues including population health, social determinants of health and global health perspectives
• Demonstrates effective clinical leadership
• Demonstrates promotion of an open and transparent culture
• Keeps up to date through learning and teaching
• Demonstrates engagement in career planning
• Demonstrates capabilities in dealing with complexity and uncertainty
• Aware of the role and processes for commissioning
• Aware of the need to use resources wisely

• Aware of national legislation and legal responsibilities, including safeguarding vulnerable groups
• Behaves in accordance with ethical and legal requirements
• Demonstrates ability to offer apology or explanation when appropriate
• Demonstrate ability to lead the clinical team in ensuring that ethical and legal factors are considered openly and consistently

• Communicates clearly with patients and carers in a variety of settings
• Communicates effectively with clinical and other professional colleagues
• Identifies and manages barriers to communication (e.g. cognitive impairment, speech and hearing problems, capacity issues)
• Demonstrates effective consultation skills including effective verbal and non-verbal interpersonal skills
• Shares decision making by informing the patient, prioritising the patient’s goals and wishes, and respecting the patient’s beliefs, concerns and expectations
• Shares decision making with children and young people
• Applies management and team working skills appropriately, including influencing, negotiating, re-assessing priorities and effectively managing complex, dynamic situations

• Makes patient safety a priority in clinical practice
• Raises and escalates concerns where there is an issue with patient safety or quality of care
• Demonstrates commitment to learning from patient safety investigations and complaints
• Shares good practice appropriately
• Contributes to and delivers quality improvement
• Understands basic Human Factors principles and practice at individual, team, organisational and system levels
• Understands the importance of non-technical skills and crisis resource management
• Recognises and works within limit of personal competence
• Avoids organising unnecessary investigations or prescribing poorly evidenced treatments

• Manages clinical information / data appropriately
• Understands principles of research and academic writing
• Demonstrates ability to carry out critical appraisal of the literature
• Understands the role of evidence in clinical practice and demonstrates shared decision making with patients
• Understands public health epidemiology and global health patterns
• Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches in scientific enquiry
• Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice
• Follows guidelines on ethical conduct in research and consent for research
• Recognises potential of applied informatics, genomics, stratified risk and personalised medicine and seeks advice for patient benefit when appropriate

• Delivers effective teaching and training to medical students, junior doctors and other healthcare professionals
• Delivers effective feedback with action plan
• Able to supervise less experienced trainees in their clinical assessment and management of patients
• Able to supervise less experienced trainees in carrying out appropriate practical procedures
• Able to act as a clinical supervisor to doctors in earlier stages of training

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns, priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Recognises need to liaise with specialty services and refers where appropriate

• Able to manage patients who have been referred acutely to a specialised medical service as opposed to the acute unselected take
• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns, priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Demonstrates appropriate continuing management of acute medical illness in a medical specialty setting
• Refers patients appropriately to other specialties as required

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Demonstrates effective consultation skills
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Demonstrates appropriate continuing management of acute medical illness inpatients admitted to hospital on an acute unselected take or selected take
• Recognises need to liaise with specialty services and refers where appropriate
• Appropriately manages comorbidities in medial inpatients
• Demonstrates awareness of the quality of patient experience

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Demonstrates effective consultation skills
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately manages comorbidities in outpatient clinic, ambulatory or community setting
• Demonstrates awareness of the quality of patient experience

• Demonstrates effective consultation skills (including when in challenging circumstances)
• Demonstrates management of medical problems in inpatients under the care of other specialties
• Demonstrates appropriate and timely liaison with other medical specialty services when required

• Applies management and team working skills appropriately, including influencing, negotiating, continuously re-assessing priorities and effectively managing complex, dynamic situations
• Identifies appropriate discharge plan
• Ensures continuity and coordination of patient care through the appropriate transfer of information demonstrating safe and effective handover
• Effectively estimates length of stay
• Delivers patient centred care including shared decision making
• Recognises the importance of prompt and accurate information sharing with primary care team following hospital discharge

• Demonstrates prompt assessment of the acutely deteriorating patient, including those who are shocked or unconscious
• Demonstrates the professional requirements and knowledge of legal processes associated with consent for resuscitation
• Participates effectively in decision making with regard to resuscitation decisions, including decisions not to attempt CPR, and involves patients and their families
• Demonstrates competence in carrying out resuscitation

• Identifies patients with limited reversibility of their medical condition and determines palliative and end of life care needs
• Identifies the dying patient and develops an individualised care plan, including anticipatory prescribing at end of life
• Demonstrates effective consultation skills in challenging circumstances
• Demonstrates safe and effective use of syringe pumps in the palliative care population
• Able to manage non complex symptom control including pain
• Facilitates referrals to specialist palliative care across all settings
• Demonstrates compassionate professional behaviour and clinical judgement

• Assess, investigate and instigate management in the patient presenting with symptoms suggestive of acute coronary syndromes
• Assess, investigate and instigate management in the patient presenting with symptoms suggestive of stable ischaemia
• Appropriately prescribe anti-anginal, anti-platelet and anti-coagulant agents
• Appropriately manage patients before and after percutaneous coronary intervention
• Manage patients with angina and related conditions refractory to anti-anginal medication and revascularisation
• Manage presentations consistent with ischaemia with unobstructed coronary arteries
• Identify and treat risk factors for primary and secondary prevention of cardiovascular events
• Provide advice to primary care on management of patients with known or suspected cardiac problems in the community
• Provide cardiology advice on management of patients under other specialities including intensive care, cardiac and non-cardiac surgery
• Present and discuss patients with coronary artery disease and associated conditions at Heart Team and other multidisciplinary team meetings
• Perform invasive coronary angiography under supervision
• Insert arterial lines and central venous cannulae independently

• Assess, investigate and instigate management in patients presenting with symptoms or signs suggestive of structural heart disease
• Manage the acutely unwell patient with structural heart disease including suspected and proven endocarditis
• Plan and conduct clinical follow up of patients with known structural heart disease
• Manage patients with, or at risk of, aortopathy and recognise the need for pre-conceptual counselling and specialist care in pregnancy
• Appropriately refer to and support inherited cardiac conditions/cardio-genetics services
• Identify, investigate and appropriately refer elective and emergency patients for valve surgery and catheter intervention
• Perform and report an echocardiogram independently across a full range of cardiac pathology
• Understand the indications and limitations of cardiac CT. Report CT coronary angiograms under direct supervision
• Refer appropriately for cardiac and vascular imaging modalities to assess structure, function, ischaemia, viability and infection

• Assess, investigate and instigate management in acutely unwell patients with arrhythmias
• Assess, investigate and instigate management in patients with suspected arrhythmia including syncope
• Appropriately request and interpret non-invasive investigations for suspected arrhythmia
• Risk stratify and counsel patients at thrombo-embolic risk from arrhythmias
• Demonstrate theoretical knowledge of pathophysiology and pharmacology of arrhythmias
• Assess, investigate and instigate management in asymptomatic and symptomatic patients at risk of arrhythmic events
• Advise patients with cardiac conditions on lifestyle and occupational considerations
• Recognise the psychological and socioeconomic implications of arrhythmias and related conditions
• Identify patients with or at risk of arrhythmias who will benefit from inherited cardiac conditions/cardio-genetics referral
• Present and discuss patients at arrhythmia and device multidisciplinary team meetings
• Identify and instigate management in patients with complications of devices and ablation
• Perform basic interrogation and programming of implantable devices
• Implant a loop recorder independently
• Implant a transvenous pacemaker under supervision
• Perform temporary transvenous pacing independently
• Perform electrical cardioversion independently

• Recognise signs and symptoms suggestive of congenital heart disease in adults
• Instigate appropriate investigation and management in patients with signs and symptoms of congenital heart disease
• Appropriately refer newly diagnosed adults with congenital heart disease to specialist services
• Apply knowledge of the epidemiology, anatomy and pathophysiology of common congenital heart abnormalities to practice
• Support patients transitioning from paediatric to young adult services under supervision
• Provide contraceptive advice and pre-pregnancy counselling for patients with congenital, inherited and acquired cardiac conditions under supervision
• Initiate management in patients with known congenital heart disease during acute cardiac presentations
• Provide advice on patients with congenital heart disease undergoing non-cardiac treatment
• Manage patients in adult congenital heart disease clinics under supervision
• Prepare and present patients at congenital heart disease multidisciplinary team meetings
• Manage patients with congenital, acquired and inherited heart disease during pregnancy under supervision
• Investigate and instigate management in pregnant patients presenting with cardiac symptoms
• Safely prescribe in pregnant and breast-feeding patients

• Assess, investigate and instigate management in patients presenting acutely with symptoms suggestive of heart failure
• Recognise, appropriately investigate and initiate treatment in patients presenting with heart failure in pregnancy
• Investigate patients with heart failure to identify the underlying aetiology
• Optimise management in patients with established heart failure diagnoses
• Manage patients with heart failure syndromes in collaboration with primary and intermediate care
• Appropriately refer to and support cardiac rehabilitation services
• Identify and refer patients in need of specialist or advanced heart failure services
• Advise on heart failure patients undergoing treatment for non-cardiac conditions
• Apply knowledge of genetics and inherited cardiac conditions to diagnosis and management of patients
• Assess, investigate and instigate management in patients presenting with symptoms suggestive of pulmonary vascular disease
• Manage patients with cardiac consequences of oncological disease and treatment
• Participate in multi-speciality Cardio-Oncology multidisciplinary team meetings
• Identify patients approaching end of life and collaborate with palliative care team
• Prepare and present cases at the heart failure multidisciplinary team meetings
• Assess, investigate and instigate management in patients with symptoms suggestive of pericardial disease
• Perform pericardiocentesis independently

• Use clinical factors and non-invasive investigations to assess ischaemia and viability and plan further management
• Lead multidisciplinary team meetings to discuss merits of medical therapy, percutaneous and surgical options for revascularisation
• Prepare patients to safely undergo invasive coronary investigation and treatment
• Perform left heart catheterisation independently, safely access the arterial system including use of ultrasound guidance
• Independently perform simple percutaneous coronary intervention procedures in stable and acute coronary syndromes
• Independently perform primary percutaneous coronary intervention for acute myocardial infarction
• Perform complex percutaneous coronary intervention in anatomies such as bifurcation lesions, coronary bypass grafts and calcific disease
• Perform emergency coronary angiography and intervention in shocked patients and after cardiac arrest
• Manage haemodynamically unstable in patients before, during and after percutaneous coronary intervention
• Assist in percutaneous revascularisation for chronic total occlusion
• Contribute to pre-pregnancy counselling and pregnancy management of women with coronary artery disease
• Identify appropriate patients to consider interventions for valvular or structural heart disease

• Provide expert advice on use of imaging techniques to manage patients in ischaemia and viability
• Provide expert advice on use of imaging techniques to manage patients with cardiomyopathies
• Provide expert advice on use of imaging techniques to manage patients at with or at risk of disease of the great vessels
• Provide expert advice on the use of imaging techniques to investigate for potential cardiac infection
• Provide expert advice on the use of imaging techniques in the investigation of cardiac tumours
• Provide expert advice on the use of imaging techniques in the management of pericardial disease
• Contribute to pre-pregnancy counselling and pregnancy management of women with acquired structural cardiovascular disease
• Provide expert advice on use of imaging techniques to manage patients with structural heart disease
• Weigh the benefits of nuclear, MRI, echo and CT based techniques in clinical scenarios
• Identify novel imaging techniques and emerging evidence base or guidelines to apply to patient management
• Lead an imaging service through competence to perform, supervise and teach techniques in at least one and deliver a second out of nuclear, MRI, echo and CT
• Deliver imaging of patients with adult congenital heart disease in cooperation with ACHD specialists

• Provide expert management of patients suffering with or at risk from arrhythmia in general cardiology
• Provide expert input on patients suffering from or at risk of arrhythmia in the inherited cardiac conditions and adult congenital heart disease services
• Provide expert management of patients suffering from or at risk from arrhythmia in cardiac surgical patients
• Contribute to pre-pregnancy counselling and pregnancy management of women with implantable cardiac devices
• Assist in atrial fibrillation, atrial tachycardia and ventricular ablation
• Assist in implantation of implantable defibrillator and cardiac resynchronisation devices
• Assist in transvenous lead extraction
• Lead an arrhythmia service with full competence to perform and teach at least one of advanced device implantation or advanced ablation capabilities
• Provide expert management of arrhythmias in an ablation service with competence to perform independently and teach diagnostic arrhythmias
• Interrogate and reprogram pacemakers and complex devices independently
• Provide expert management of patients with complications of device therapy including identifying indications for lead extraction
• Implant pacemakers independently
• Perform and interpret diagnostic electrophysiological studies under supervision
• Perform atrial flutter, slow pathway and accessory pathway ablation under supervision

• Diagnose, assess and manage adults presenting with new diagnoses of congenital heart disease
• Perform transthoracic echocardiography in adults with congenital heart disease and interpret results to manage care
• Manage patients with known congenital heart disease transitioning from paediatric to adult care
• Perform transoesophageal echocardiography in adults with congenital heart disease and interpret results to manage care
• Understand indications and interpret MRI to investigate adults with congenital heart disease in conjunction with imaging specialists
• Understand indications and interpret CT to investigate adults with congenital heart disease in conjunction with imaging specialists
• Manage heart failure in adults with congenital heart disease patients
• Manage arrhythmias in adults with congenital heart disease
• Manage pulmonary hypertension in adults with congenital heart disease patients in collaboration with National PH Centres
• Lead the Adult Congenital Heart Disease multidisciplinary team
• Identify, investigate, counsel and refer patients appropriately for surgical and catheter interventions
• Contribute to the care of the peri-operative adult patients with congenital heart disease in theatre, intensive care and the ward
• Manage adult patients with congenital heart disease patients after interventional procedures
• Identify adult patients with congenital heart disease with indications for cardiac transplantation
• Diagnose and manage the long-term sequelae of native, repaired and palliated congenital heart disease lesions
• Identify adults with congenital heart disease who would benefit from supportive and palliative care
• Contribute to pre-pregnancy counselling and pregnancy management of women with congenital heart disease
• Assist with diagnostic catheterisation and intervention in the adults with congenital heart disease

• Provides expert management of inpatients with heart failure both as primary responsible physician and through consultation
• Provides expert leadership of an outpatient service for heart failure assessment and management across community, secondary and tertiary care
• Is an expert in the diagnosis and management of heart failure syndromes including rare causes of heart failure
• Manages heart failure patients with co-morbidity and frailty in conjunction with the multidisciplinary team
• Assess and refers suitable heart failure patients for transplantation and mechanical support
• Investigates and manages patients with heart failure and related problems due to cancer or cancer therapy
• Investigates and treats patients with heart failure and pulmonary hypertension
• Manages patients with hereditary heart failure conditions in conjunction with the Inherited Cardiac Conditions service
• Contribute to pre-pregnancy counselling and pregnancy management of women with or at risk of heart failure
• Assesses prognosis in heart failure, communicates effectively with patients and family including breaking bad news
• Is an expert in interpretation of transthoracic echocardiography in heart failure
• Understands and can interpret the reports of Cardiovascular MRI, nuclear and Cardiac CT scans in heart failure
• Interpret cardio-pulmonary exercise test data to guide heart failure management
• Interprets right heart catheterisation independently
• Interprets heart failure diagnostics on implantable devices to help patient mangement

Currency Window

Evidence of your recent practice will be given more weight to reflect current capabilities and we suggest that approximately 50% of your evidence for a curriculum outcome is drawn from within the last five years of clinical practice (WTE).

Evidence Volume

around 100 electronically uploaded documents