To achive international standard in the filed of interventional
Cardiology : What should we do
Patwary MS¹ , Karmaker kk²

Abstract
Bangladesh is highly dense populated area. We have many cardiac patients, deal with them with care to reduce cardiac burden in Bangladesh.  We have been doing a lot of work in different centres, arranging training and educating cardiologists also. There are enough cath labs in our country to perform interventional procedures. We may build up computer scoring systems to evaluate and to categorize the interventional cardiologists.  We already have been crossed knowledge acquisition phase and now we are entering into percutaneous coronary intervention development phase. Government already plays a tremendous role to highlight and to patronize the development of interventional cardiology in Bangladesh. In this article, we are trying to highlight the course and curriculum of interventional cardiology, to provide best service from cardiologists to the patients and way to achieve international standard. Thus it reflects authors view.

Key word
Interventional cardiology, international standard.

Introduction
We know that for manyyears, in different centres we have been doing a lot of work for the purpose of training, educating and developing skill of cardiologists. But question is- Are we now in international standard? What interventional cardiologists should to do from now to achieve international standard?
For this reason, we need firstly more systematic training in general cardiology and especially for interventional cardiology. Secondly, interventional cardiologists should offer therapeutic procedures to patients with appropriate clinical indications. Its aim is to be treating 'patients, not lesions'. Thirdly, we should have reliable long term follow up data to show that such procedures truly improve the survival rates or at least improving the quality of life. Fourthly, innovation and improvement of the devices and drugs which must be consistent with international research established clinical practice and quality manufacturing products; And with the exponential growth in the number of centres and of interventional procedures are performed in Bangladesh, it should be monitor regularly and the necessary steps would be taken to ensure the best and safest practice to the patients for receiving such therapies.

Finally, we should to share our knowledge with other cardiologists here and abroad, should be capable to accept modern technology and also should have urge to train new generation (cardiologists).In case of training, we may upgrade their knowledge in cardiology irrespective to their academic background and carrier. We may build up computerized scoring system to evaluate and categorize the interventional cardiologists.

We should keep respect for each others performance and should to create an unique forum to protects our colleagues.

Pyramidal approach of education
Medical advancement follows a pyramidal approach. The base of the pyramid is the knowledge and skill acquisition phase. The middle level is the update knowledge phase, where knowledge is obtained through original research. Finally the top level is the knowledge exchange phase, where ones knowledge is shared with others. It is through written (scientific publications) or oral communications.

Course and curriculum
How one becomes an interventional cardiologist. As there is no fixed curriculum or structural course, so opinion may defers from person to person. But from my point of view, I reflect my opinion here is based on developed country.

After graduation (MBBS) and completion of internship training, graduate doctors (candidates) are must be assessed by both clinically and theoretically to be a specialist physician in medicine, through a structural examination process without any biasness which would be specified by the Government approved system or by Board, off course with scoring system also. By the above way, we may find out professionally efficient doctors. Then according to the successful score of exam, they would be entitled to enter into the subspecialty course and training such as cardiology. These courses must be uniform and would be formulated to eliminate in different categories for subspecialty. This course curriculum or core training programme would also cover all the skills required for the practice of that subspecialty such as well as clinical training followed by training in non-invasive and invasive procedures. In the course, a minimum number of procedures must be recorded in a logbook and would be supervised by an accredited supervisor. After the successful completion of all steps of training and requirements, then the candidate would be issued a certificate of specialist cardiology by the Government which is off course approved by the tertiary education authority.

With this specialist cardiology certificate, the accreditation board of the health ministry that might be BMDC will then license the specialist in cardiology and issue him a registration number for practice as a cardiology specialist and would be charged as an independent cardiologist. After post graduation as a cardiology specialist, further four years fellowship training would to be chosen for super specialty such as interventional cardiology or electrophysiology or echocardiography. This fellowship training must to be undertaken at home or abroad which would be approved by government body and provide certificate as an interventional cardiologist before one commences his private practise.

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1. Dr. Mohammad Shafiqur Rahman Patwary , MBBS , MCPS
   (Medicine),FCPS(Medicine),MD(Cardiology),DSC(USA),FESC
   (Europe),Member of Asian Pacific Society of Interventional Cardiology,
   Member of European Association of Percutaneous Cardiovascular
   Inventions(EAPCI),Registrar Cardiology , Department of Cardiology ,
   National Institute of Cardiovascular Diseases and Hospital , Dhaka
   E-mail:dr_md_shafiqur_rahman@yahoo.com
2. Dr. Kajal Kumar Karmaker , MBBS , D-Card
   Assistant Professor cum Residential Physician of Cardiology
   Department of Cardiology
   National Institute of Cardiovascular Diseases and Hospital , Dhaka