Current status of cardiology fellow training based on COCATS-4 framework: A cross-sectional study from three tertiary care institutes across India

Background: The Core Cardiology Training Symposium (COCATS) guidelines, endorsed by the American College of Cardiology (ACC) emphasize competency-based training and establish milestones to be met during cardiology training. However, India lacks such guidelines for training cardiology fellows. Objectives: The study aimed to evaluate the self-declared competencies of cardiology fellows across multiple preselected domains as per the COCATS-4 recommendations. Methods: The study was conducted at three premier institutions across India between June 2022 and December 2024. A total of 52 cardiology fellows who had recently completed their 3-year core cardiology training course were included in the study. These candidates completed a questionnaire that included a checklist assessing different levels of competency in various preselected aspects of cardiovascular medicine. Candidates were also asked about their awareness of COCATS-4 standards and cardiology training in India. Results: While all trainees reported Level 1 competency in cardiac catheterization, heart failure, and adult congenital heart disease, a significantly lower percentage of trainees achieved Level 1 competency in nuclear medicine (1.9 %), cardiac MRI (3.8 %), and cardiac CT (17.3 %). At Level 2, cardiac catheterization (73.1 %) and echocardiography (63.5 %) had the highest self-declared competencies, whereas nuclear medicine (3.8 %), cardiac MRI (0 %), and cardiac CT (0 %) had the lowest. Only 23.1 % of trainees were aware of COCATS-4, and 82.7 % believed that standardized guidelines would improve cardiology training in India. Conclusions: The results emphasize the wide variability in self-reported competencies of cardiology trainees across India and highlight the deficiencies in certain core areas like cardiovascular imaging.