Advanced Heart Failure and Transplant Cardiology Milestones
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Advanced Heart Failure and
Transplant Cardiology Milestones
The Accreditation Council for Graduate Medical Education
Implementation Date: July 1, 2021
Second Revision: May 2021
First Revision: October 2014
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.Advanced Heart Failure and Transplant Cardiology Milestones
The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGME-
accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the
development of the fellow in key dimensions of the elements of physician competence in a specialty or
subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency,
nor are they designed to be relevant in any other context.
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.
iiAdvanced Heart Failure and Transplant Cardiology Milestones
Work Group
Noel Cardenas, FACHE John Herre, MD
Andrew Civitello, MD Line Kemeyou, MD
David DeNofrio, MD Todd Koelling, MD
Laura Edgar, EdD, CAE Paul Mather, MD
Chantal Elamm, MD Marty Tam, MD
Eman Hamad, MD
The ACGME would like to thank the following organizations for their continued support in the
development of the Milestones:
American Board of Internal Medicine
ACGME Review Committee for Internal Medicine
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.
iiiUnderstanding Milestone Levels and Reporting
This document presents the Milestones, which programs use in a semi-annual review of fellow performance, and then report to
the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME Competencies organized in a
developmental framework. The narrative descriptions are targets for fellow performance throughout their educational program.
Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert fellow in
the specialty or subspecialty. For each reporting period, the Clinical Competency Committee will review the completed evaluations
to select the milestone levels that best describe each learner’s current performance, abilities, and attributes for each
subcompetency.
These levels do not correspond with post-graduate year of education. Depending on previous experience, a junior fellow may
achieve higher levels early in his/her educational program just as a senior fellow may be at a lower level later in his/her
educational program. There is no predetermined timing for a fellow to attain any particular level. Fellows may also regress in
achievement of their milestones. This may happen for many reasons, such as over scoring in a previous review, a disjointed
experience in a particular procedure, or a significant act by the fellow.
Selection of a level implies the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see
the diagram on page vi).
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
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ivAdditional Notes
Level 4 is designed as a graduation goal but does not represent a graduation requirement. Making decisions about readiness for
graduation and unsupervised practice is the purview of the program director. Furthermore, Milestones 2.0 include revisions and
changes that preclude using Milestones as a sole assessment in high-stakes decisions (i.e., determination of eligibility for
certification or credentialing). Level 5 is designed to represent an expert fellow whose achievements in a subcompetency are
greater than the expectation. Milestones are primarily designed for formative, developmental purposes to support continuous
quality improvement for individual learners, education programs, and the specialty. The ACGME and its partners will continue to
evaluate and perform research on the Milestones to assess their impact and value.
Examples are provided for some milestones within this document. Please note: the examples are not the required element or
outcome; they are provided as a way to share the intent of the element.
Some milestone descriptions include statements about performing independently. These activities must occur in conformity to
ACGME supervision guidelines as described in the Program Requirements, as well as to institutional and program policies. For
example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight.
A Supplemental Guide is also available to provide the intent of each subcompetency, examples for each level, assessment
methods or tools, and other available resources. The Supplemental Guide, like examples contained within the Milestones, is
designed only to assist the program director and Clinical Competency Committee, and is not meant to demonstrate any required
element or outcome.
Additional resources are available in the Milestones section of the ACGME website. Follow the links under “What We Do” at
www.acgme.org.
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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vThe diagram below presents an example set of milestones for one subcompetency in the same format as the ACGME Report
Worksheet. For each reporting period, a fellow’s performance on the milestones for each subcompetency will be indicated by
selecting the level of milestones that best describes that fellow’s performance in relation to those milestones.
Selecting a response box in the Selecting a response box on the line in
middle of a level implies that between levels indicates that milestones
milestones in that level and in lower in lower levels have been substantially
levels have been substantially demonstrated as well as some
demonstrated. milestones in the higher level(s).
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
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viVersion 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Patient Care 1: Transplant
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies patients who Evaluates patients using Formulates a plan based Determines whether to Optimizes selection of
may benefit from program selection criteria on hemodynamics, risk list a patient for patients to meet the
advanced therapies assessment, and transplant and selects fiduciary responsibility to
comorbidities optimal timing based on the patient, the program,
and benefits of continued a complete evaluation and the community
medical therapy
Participates in the Manages patients peri- Manages donor Manages the
evaluation of donors operatively and selects selection prior to interdisciplinary team to
using program selection immunosuppressive transplant and manages formulate a care plan to
criteria and performs therapy based on early post-transplant achieve the best possible
ongoing reassessment of institutional protocol complications (e.g., outcome
the patient for continued primary graft failure,
eligibility for transplant rejection)
Uses institutional protocol Identifies complications of Manages complications Integrates patient and
to care for patients post- immunosuppression and of immunosuppression program specific
transplant comorbidities post- and comorbidities post- characteristics to estimate
transplant transplant and optimize expected
outcomes
Comments:
Not Yet Assessable
Critical Deficiencies
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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1Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Patient Care 2: Mechanical Circulatory Support (Temporary and Durable)
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies patients at Demonstrates the ability Manages patients on Manages the intra- and Optimizes patient care by
various stages of to evaluate a patient for temporary mechanical early post-operative negotiating the complex
cardiogenic shock in temporary mechanical support devices complications care of patients on
need of temporary support device associated with temporary mechanical
mechanical support temporary mechanical support devices
circulatory support during the weaning
devices process and recognizes
futility of further treatment
Recognizes the patient Demonstrates the ability Manages patients on Manages complications Manages end-of-life care
with chronic heart failure to assess suitability of a durable left ventricular of patients on durable for patients on durable
(Stage D) in need of a patient for durable left assist device support mechanical circulatory mechanical circulatory
durable left ventricular ventricular assist device devices devices including, but devices
assist device support based on current not limited to, bleeding,
guidelines and pump thrombosis, pump
institutional protocols failure, and stroke
Comments:
Not Yet Assessable
Critical Deficiencies
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2Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Patient Care 3: Acutely Decompensated Heart Failure
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies patients with Evaluates differential Formulates plan based on Recognizes the Discusses long-term
new onset heart failure diagnosis and selects diagnosis for optimizing significance of heart prognosis and outcomes
based on signs, testing necessary for guideline-directed medical failure education for associated with guideline-
symptoms, and other diagnosis according to therapy and device newly diagnosed heart directed medical therapy,
given variables guidelines therapy failure and educates the including basic data and
patient on self-care, risk assessment models
warning signs, and to increase patient
action plans understanding/awareness
Recognizes acutely Evaluates the etiology for Optimizes inpatient Evaluates barriers, Plans for patient-specific
decompensated heart readmission and works to management with diuretic including social transitions of care to
failure without shock improve cardiac, medical, protocols/algorithms and determinants, that might maintain outpatient follow
(heart failure profiles) or patient-related optimization of guideline- lead to high risk of up and prevent
etiologies directed medical therapy readmission readmissions using all
to assure compensation available resources
and response to
management before
discharge
Recognizes acutely Distinguishes various Manages each level of Recognizes time and Uses multidisciplinary
decompensated heart levels of shock based on shock as indicated by indication for temporary team for early patient
failure with shock clinical, lab, and guidelines/consensus and support device and assessment; integrates
diagnostic variables as internal protocol escalation of care program-specific
described by clinical guidelines to initiate
expert consensus evaluation for advanced
therapies
Comments:
Not Yet Assessable
Critical Deficiencies
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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3Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Patient Care 4: Management of Chronic Heart Failure
Level 1 Level 2 Level 3 Level 4 Level 5
Recognizes clinical signs Monitors patients for Manages patients with Manages patients with Manages an outpatient
and symptoms of chronic complications or changes stable chronic heart advanced and end- chronic heart failure
heart failure with related to chronic heart failure with reduced stage chronic heart program
reduced ejection fraction failure with reduced ejection fraction failure with reduced
ejection fraction ejection fraction
Recognizes clinical signs Monitors patients for Manages patients with Manages patients with Advances quality of
and symptoms of chronic complications or changes stable chronic heart advanced and end- clinical practice in the
heart failure with related to chronic heart failure with preserved stage chronic heart treatment strategies for
preserved ejection failure with preserved ejection fraction failure with preserved chronic heart failure
fraction ejection fraction ejection fraction
With direct supervision, With indirect supervision, Effectively participates Effectively develops and
effectively participates in effectively participates in in team-based care, implements team-based
team-based care in team-based care in including palliative care, care models in
management of common management of common in management of management of chronic
chronic heart failure with chronic heart failure with advanced or end-stage heart failure
reduced ejection fraction reduced ejection fraction chronic heart failure
and heart failure with and heart failure with with reduced ejection
preserved ejection preserved ejection fraction and heart failure
fraction fraction with preserved ejection
fraction
Comments:
Not Yet Assessable
Critical Deficiencies
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
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4Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Patient Care 5: Pulmonary Hypertension
Level 1 Level 2 Level 3 Level 4 Level 5
Discusses the clinical Identifies the basic Selects tests for the Independently interprets Advances quality of
features of pulmonary evaluation of the patient evaluation and monitoring testing results to clinical practice in the
hypertension with pulmonary of the patient with develop individual treatment strategies for
hypertension, including pulmonary hypertension treatment strategies for pulmonary hypertension
history and physical, pulmonary hypertension
echocardiogram,
hemodynamic evaluation,
and laboratory evaluation
Discusses risk factors, Discusses options for Develops team-based Independently develops Identifies strategies to
outcomes, and survival therapy for pulmonary care and treatment individual treatment develop a pulmonary
of patients with hypertension strategies for pulmonary strategies for pulmonary hypertension program
pulmonary hypertension hypertension, with hypertension, including
supervision lung or heart-lung
transplant referral
Comments: Not Yet Assessable
Critical Deficiencies
Patient Care
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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5Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Medical Knowledge 1: Transplant
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Knows the intra- and early Knows the long-term Applies knowledge of Demonstrates knowledge
knowledge of the post-operative complications of heart potential complications of the pillars of a
indications for and complications of heart transplantation after heart successful heart
contraindications to heart transplantation transplantation to transplant program,
transplantation optimize patient including outcomes and
outcomes resource allocation
Knows the mechanism of Knows the strengths and Applies knowledge of
Knows the principles of
action, adverse effects, limitations of strategies transplant immunology
immunology pertinent to
and drug-drug used to detect, monitor, and pharmacology to
heart transplantation
interactions of and treat transplant optimize patient
immunosuppressant rejection outcomes
therapies
Comments: Not Yet Assessable
Critical Deficiencies
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6Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Medical Knowledge 2: Mechanical Circulatory Support
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Knows the indications for Knows intra- and early Applies knowledge of Demonstrates knowledge
knowledge of the and contraindications for post-operative selection and use of of the pillars of a
characteristics of temporary mechanical complications of temporary mechanical successful mechanical
temporary mechanical circulatory support temporary mechanical circulatory assist circulatory support
support devices circulatory support devices to optimize program, including
patient outcomes outcomes and resource
allocation
Demonstrates Knows the indications for Knows the clinical Applies knowledge of
knowledge of the and contraindications for determinants favoring left selection and use of
characteristics of durable durable mechanical ventricular assist device durable mechanical
mechanical support circulatory support versus transplantation as circulatory assist
devices long-term durable devices to optimize
strategies patient outcomes
Comments:
Not Yet Assessable
Critical Deficiencies
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7Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Medical Knowledge 3: Heart Failure
Level 1 Level 2 Level 3 Level 4 Level 5
Lists a differential Provides a Provides a focused Diagnoses patients with Advances knowledge in
diagnosis for common comprehensive differential diagnosis challenging heart failure pathophysiology and
clinical presentations for differential diagnosis for a based on individual heart presentations and treatment of heart failure
heart failure patients wide range of clinical failure patient uncommon disorders
heart failure presentations presentation
Lists therapeutic options Explains risks and Justifies optimal Develops therapeutic Disseminates knowledge
for common clinical benefits of standard therapeutic option based plan for patients with of challenging heart
presentations for heart therapeutic options for on individual heart failure challenging heart failure failure presentations and
failure patients heart failure patient presentation presentations and uncommon disorders
uncommon disorders
Comments: Not Yet Assessable
Critical Deficiencies
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8Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Medical Knowledge 4: Advanced Heart Failure Diagnostics
Level 1 Level 2 Level 3 Level 4 Level 5
Knows types of Demonstrates knowledge Demonstrates knowledge Applies knowledge of Advances knowledge in
advanced heart failure of indications and of appropriate selection appropriate selection indications,
diagnostics contraindications of and use of diagnostics for and use of diagnostics contraindications, and
advanced heart failure the routine advanced for patients with appropriate use for
diagnostics heart failure population complex advanced advanced heart failure
heart failure patients diagnostics
Knows the basic Identifies key diagnostic Identifies key diagnostic Advances knowledge in
measurements and data findings in common findings in complex defining the role of
output from the various advanced heart failure advanced heart failure advanced heart failure
advanced heart failure conditions conditions diagnostics
diagnostics
Comments:
Not Yet Assessable
Critical Deficiencies
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9Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Medical Knowledge 5: Pulmonary Hypertension
Level 1 Level 2 Level 3 Level 4 Level 5
Discusses the World Discusses physiology of Discusses the Assesses prognosis in Demonstrates knowledge
Health Organization the right ventricle and pathophysiology of pulmonary hypertension of the pillars of a
(WHO) classifications of distinction between and pulmonary hypertension multidisciplinary
pulmonary hypertension pre- and post-capillary pulmonary hypertension
pulmonary hypertension program
Discusses the types of Identifies drugs used to Discusses the Identifies treatment Integrates all options in
drugs used to treat treat different classes of pharmacology of the modalities, including the treatment of
pulmonary hypertension pulmonary hypertension drugs used in pulmonary investigational agents pulmonary hypertension
hypertension and multi-drug regimens including drugs, surgical
procedures, and lung
transplantation
Comments: Not Yet Assessable
Critical Deficiencies
Medical Knowledge
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
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10Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Systems-Based Practice 1: Patient Safety and Quality Improvement
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Identifies system factors Participates in analysis of Conducts analysis of Actively engages teams
knowledge of common that lead to patient safety patient safety events patient safety events and processes to modify
patient safety events events (simulated or actual) and offers error systems to prevent
prevention strategies patient safety events
(simulated or actual)
Demonstrates Reports patient safety Participates in disclosure Discloses patient safety Role models or mentors
knowledge of how to events through of patient safety events to events to patients and others in the disclosure of
report patient safety institutional reporting patients and their families their families (simulated patient safety events
events systems (simulated or (simulated or actual) or actual)
actual)
Demonstrates Describes quality Participates in quality Demonstrates the skills Creates, implements, and
knowledge of basic improvement initiatives at improvement initiatives at required to identify, assesses quality
quality improvement the institutional or the institutional or develop, implement, improvement initiatives at
methodologies and departmental level departmental level and analyze a quality the institutional or
metrics improvement project community level
Comments:
Not Yet Completed Level 1
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11Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Systems-Based Practice 2: System Navigation for Patient-Centered Care
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates Coordinates care of Coordinates care of Role models effective Analyzes the process of
knowledge of care patients in routine clinical patients in complex coordination of patient- care coordination and
coordination situations, effectively clinical situations, centered care among leads in the design and
using the roles of the effectively using the roles different disciplines and implementation of
interprofessional teams of the interprofessional specialties improvements
teams
Identifies key elements Performs effective Performs effective Role models and Improves quality of
for effective transitions of transitions of care in transitions of care in advocates for effective transitions of care within
care routine clinical situations complex clinical situations transitions of care within and across health care
and across health care delivery systems to
delivery systems optimize patient outcomes
Demonstrates general Identifies financial, Adapts practice to Leads innovations and
knowledge of financial, cultural, and social address the financial, advocates for populations
cultural, and social barriers to adherence of cultural, and social with health care inequities
barriers to adherence to care to specific barriers to adherence of
care populations care
Comments:
Not Yet Completed Level 1
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12Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Systems-Based Practice 3: Physician Role in Health Care Systems
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies key Describes how Discusses how individual Manages various Advocates for or leads
components of the components of a complex practice affects the components of the systems change that
health care system (e.g., health care system are broader system (e.g., complex health care enhances high-value,
hospital, skilled nursing interrelated, and how this length of stay, system to provide efficient, and effective
facility, finance, impacts patient care readmission rates, clinical efficient and effective patient care and transition
personnel, technology) efficiency) patient care and of care
transition of care
Describes basic health Delivers care with Engages with patients in Advocates for patient Participates in health
payment systems, (e.g., consideration of each shared decision making, care needs (e.g., policy advocacy activities
government, private, patient’s payment model informed by each community resources,
public, uninsured care) (e.g., insurance type) patient’s payment models patient assistance
and practice models resources) with
consideration of the
limitations of each
patient’s payment
model
Demonstrates essential Seeks knowledge in non- Applies knowledge in Educates others in non-
skills for documentation clinical topics needed for non-clinical topics clinical topics to prepare
required for independent independent practice needed for independent them for independent
practice (e.g., electronic (e.g., malpractice practice practice
health record, insurance, government
documentation required regulation, compliance)
for billing and coding)
Comments:
Not Yet Completed Level 1
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13Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Systems-Based Practice
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
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14Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates how to Articulates clinical Locates and applies the Critically appraises and Develops initiatives to
access and use available questions and elicits best available evidence to applies available, educate others to critically
evidence to manage a patient preferences to the care of patients with potentially conflicting appraise and apply
patient with cardiac guide evidence-based complex cardiac disease evidence to guide care evidence for complex
disease care while integrating patient of an individual patient patients and/or
preference participates in the
development of guidelines
Comments:
Not Yet Completed Level 1
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Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Growth
Level 1 Level 2 Level 3 Level 4 Level 5
Accepts responsibility for Demonstrates openness Occasionally seeks Systematically seeks Coaches others to seek
personal and to feedback and feedback and feedback and feedback and
professional performance data to form performance data with performance data with performance data
development by goals adaptability and humility adaptability and humility
establishing goals
Acknowledges limits and Analyzes the factors Creates and implements Uses performance data Facilitates the design and
gaps between which contribute to limits a learning plan to assess learning plan implementation of
expectations and and gaps; demonstrates and improves it when learning plans for others
performance; appropriate help-seeking necessary
demonstrates self- behaviors
awareness
Comments:
Not Yet Completed Level 1
Practice-Based Learning and Improvement
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
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16Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Professionalism 1: Professional Behavior and Ethical Principles
Level 1 Level 2 Level 3 Level 4 Level 5
Identifies and describes Demonstrates insight into Demonstrates Recognizes situations Coaches others when
potential triggers for professional behavior in professional behavior in that may trigger their behavior fails to
professionalism lapses routine situations complex or stressful professionalism lapses meet professional
situations and intervenes to expectations
prevent lapses in
oneself and others
Demonstrates Applies knowledge of Recognizes the need to Uses appropriate Identifies and seeks to
knowledge of ethical ethical principles to seek help in managing resources for managing address system-level
principles (e.g., informed routine situations and resolving complex and resolving ethical factors that induce or
consent, advance ethical situations dilemmas (e.g., ethics exacerbate ethical
directives, confidentiality, consultations, risk problems or impede their
patient autonomy) management) resolution
Comments:
Not Yet Completed Level 1
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Professionalism 2: Accountability
Level 1 Level 2 Level 3 Level 4 Level 5
Takes responsibility for Performs tasks and Performs tasks and Recognizes situations Engages with the system
failure to complete tasks responsibilities in a timely responsibilities in a timely that may impact others’ to improve outcomes
and responsibilities, manner with appropriate manner with appropriate ability to complete tasks
identifies potential attention to detail in attention to detail in and responsibilities in a
contributing factors, and routine situations complex or stressful timely manner
describes strategies for situations
ensuring timely task
completion in the future
Recognizes the Recognizes personal Seeks assistance in Identifies, discloses,
principles of conflict of potential conflicts with managing personal and manages
interest in relationships industry relationships with industry relationships with
with industry and other and other entities to industry and other
entities minimize bias and undue entities to minimize bias
influence in practice and undue influence in
practice
Comments:
Not Yet Completed Level 1
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18Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Professionalism 3: Self-Awareness and Well-Being
Level 1 Level 2 Level 3 Level 4 Level 5
Recognizes the Independently recognizes With assistance, Independently develops Participates in a system
importance of personal status of personal and proposes a plan to a plan to optimize change to improve well-
and professional well- professional well-being optimize personal and personal and being in self and others
being professional well-being professional well-being
Comments:
Not Yet Completed Level 1
This subcompetency is not intended to evaluate a fellow’s well-being, but to ensure each fellow has the fundamental knowledge of factors that impact well-
being, the mechanisms by which those factors impact well-being, and available resources and tools to improve well-being.
Professionalism
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
©2021 Accreditation Council for Graduate Medical Education (ACGME)
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for educational purposes.
19Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
Level 1 Level 2 Level 3 Level 4 Level 5
Demonstrates respect Establishes a therapeutic With guidance, Independently Mentors others in
and establishes rapport relationship in routine establishes a therapeutic establishes a situational awareness and
in patient encounters patient encounters relationship therapeutic relationship critical self-reflection to
in challenging patient in challenging patient consistently develop
encounters encounters positive therapeutic
relationships
Knows barriers to Identifies barriers to Proactively minimizes Role models self-
effective communication effective communication Attempts to minimize communication barriers awareness to minimize
(e.g., language, in patient encounters communication barriers, and independently communication barriers
disability, health literacy, including reflection on any manages personal
cultural, personal bias) personal biases biases
Identifies the need to Organizes and initiates Independently uses Role models shared
adjust communication communication with With guidance, uses shared decision making decision making
strategies to achieve patient/patient’s family to shared decision making to to implement a
shared decision making facilitate shared decision implement a personalized personalized care plan
making care plan
Comments:
Not Yet Completed Level 1
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.
20Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Interpersonal and Communication Skills 2: Interprofessional and Team Communication
Level 1 Level 2 Level 3 Level 4 Level 5
Respectfully receives a With direct supervision, With indirect supervision, Completes
consultation request respectfully and completes consultations consultations with
thoroughly completes with effective effective documentation
consultations with documentation and and communication in
effective documentation communication in complex cases
and communication in common cases
common cases
Uses language that Communicates Adapts communication Coordinates Role models flexible
values all members of information effectively style to fit team needs recommendations from communication strategies
the health care team with all health care team different members of that value input from all
members the health care team to health care team
optimize patient care members, resolving
conflict when needed
Participates in team- Initiates team-based Facilitates team-based Facilitates regular health
based discussions to discussions to optimize discussions to optimize care team-based
optimize team team performance team performance feedback in complex
performance situations
Comments:
Not Yet Completed Level 1
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.
21Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Interpersonal and Communication Skills 3: Communication within Health Care Systems
Level 1 Level 2 Level 3 Level 4 Level 5
Accurately records Demonstrates organized Concisely reports Independently Models written
information in the patient diagnostic and diagnostic and communicates timely communication to
record and safeguards therapeutic reasoning therapeutic reasoning in information in a written improve others’
patient personal health through notes in the the patient record format and verbally performance
information patient record when appropriate
Identifies appropriate Respectfully Uses appropriate Guides departmental or
communication channels communicates concerns channels to offer clear institutional
(e.g., cell phone/pager about the system and constructive communication around
usage, medical record, suggestions to improve policies and procedures
email) as required by the system
institutional policy
Comments:
Not Yet Completed Level 1
Interpersonal and Communication Skills
The fellow is demonstrating satisfactory development of the knowledge, skill, and attitudes/behaviors needed to advance in the training
program. He or she is demonstrating a learning trajectory that anticipates the achievement of competency for unsupervised practice that
includes the delivery of safe, effective, patient-centered, timely, efficient, and equitable care.
_____ Yes _____ No _____ Conditional on Improvement
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.
22Version 2 Advanced Heart Failure and Transplant Cardiology, ACGME Report Worksheet
Overall Clinical Competence
This rating represents the assessment of the fellow's development of overall clinical competence during this year of training:
____Superior: Far exceeds the expected level of development for this year of training
____Satisfactory: Always meets and occasionally exceeds the expected level of development for this year of training
____Conditional on Improvement: Meets some developmental milestones but occasionally falls short of the expected level of development for
this year of training. An improvement plan is in place to facilitate achievement of competence appropriate to the level of training.
____Unsatisfactory: Consistently falls short of the expected level of development for this year of training.
©2021 Accreditation Council for Graduate Medical Education (ACGME)
All rights reserved except the copyright owners grant third parties the right to use the Advanced Heart Failure and Transplant Cardiology Milestones on a non-exclusive basis
for educational purposes.
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