Since its introduction in 1999 as a new test of competency, the Interventional Cardiology Board Examination has been met with alarm and consternation, some applause, and, mostly, fear of the unknown. Undoubtedly, every interventional cardiologist has wondered how a written test can measure competence in a specialty that is dependent on manual dexterity. Indeed, the mastery of physical skills is of central importance during training. An individual's understanding of the sometimes counter-intuitive maneuvers required to manipulate guide catheters, wires, or balloons cannot really be tested in a written format.
Of equal importance, however, are the often-ignored cognitive skills required of interventional cardiologists. These specialists should have thorough knowledge of coronary anatomy and imaging techniques, the basic pathophysiology of common clinical situations such as acute myocardial infarction, the pharmacology of anticoagulant and antiplatelet drugs, and the manipulation of hemodynamics. Most importantly, the practitioner of interventional cardiology must be familiar with results of clinical trials that influence the clinical, drug, device, and procedural choices.
The need for some form of self-assessment during preparation for the new Board Exam has spawned a number of study guides and “pre-tests,” the most prominent of which is the Catheterization Self-assessment Program (CathSAP), published by the American College of Cardiology. The present title by Drs. Grines, Savu, and Tejada joins this list of preparatory guides. The text consists of multiple-choice questions organized into 8 chapters, each covering a specific category such as anatomy and physiology, pathophysiology, pharmacology, and so on. Most of the questions have a single best answer. The remainder are predominantly of the matching type. Answers are supplied at the end of each chapter, along with a brief explanation and a reprint of the question for the reader's convenience. Many of the answers are accompanied by references for further review.
The difficulty level of the questions varies widely. Some questions, such as the one that requires matching the blood test with the coagulation scheme, are incredibly simple. Other questions—for example, the list of true-false statements concerning cost-effectiveness ratios—seem too tightly focused. Generally, however, the questions are fair, well-written, and thought-provoking. The discussion and references provided with the answers are clear and helpful.
Errors are few, but they are present. One question that concerns the risks of dye nephropathy, for example, is worded as follows: “All of these are risk factors for the development of dye nephropathy except.” Diabetes mellitus is given as the correct answer, along with a reference to the New England Journal of Medicine. Technically, this is not an error because the referenced study does contain this information. However, the ACC/AHA guidelines for coronary angiography, as well as other references in the literature, list diabetes mellitus as a risk factor. While this discrepancy causes a little confusion, it also prompts a search of the guidelines, in order to be certain of the information.
The final section of the book contains a series of bite-sized morsels offered as clinical pearls. These are mostly, to borrow a term from CNN, factoids that digest information from clinical trials into a one-line statement. Some of these are more opinion than pearl: for example, the indication for intravascular ultrasound (IVUS) in a post-transplant patient and the use of pacemakers in rotablation.
Do we really need a book like this? The answer is yes. While most of us have acquired the knowledge that is tested by the board examination, we may not have organized it in such a fashion as to enable good performance on a standardized test. The goals of a book like this are to expose the reader's weaknesses in knowledge, to promote further reading, and to clarify certain concepts that are perhaps remembered but not well understood. The questions and answers in this book meet those goals as they cover the scope of concepts and principles that are tested by the Interventional Cardiology Board Examination. Interventional cardiology fellowship trainees who are preparing for the certification examination, as well as practicing physicians who wish to review and test their knowledge, will find this book useful.