knowledge gaps in implantable cardioverter defibrillator therapy: a survey of trainees in internal medicine and cardiology

Background: knowledge of clinical practice guidelines for implantable cardioverter defibrillator (icd) therapy is a pre-requisite for effective application of this life-saving technology. the level of trainee familiarity with these guidelines is unknown. the objective of this study was to assess trainee familiarity with clinical practice guidelines for icd therapy. methods: this study surveyed 32 clinicians of varying training levels in internal medicine and cardiology at a large va medical center. this is a survey study conducted from a population of all trainees in internal medicine at the medical center; the sample included trainees from pgy-1 through pgy-7 as well as attending physicians in internal medicine. analysis of the collected survey data was performed using either chi-square tests for comparison of categorical variables or unpaired t-tests for comparison of means. results: of all respondents, 69% reported that they were familiar with published guidelines, and consistent with previously published data. cardiologists were significantly more likely to report familiarity than internists (85% vs 42%, p=0.01). most respondents (75%) reported satisfactory or better knowledge of published guidelines, though only 34% self-reported their knowledge as good or very good. the majority of respondents (86%) underestimated the usual cost of icd implantation, while most respondents (78%) agreed that implantation of an icd was cost-effective for secondary prevention, cardiologists were far more likely to agree than internists (95% vs. 50%, p<0.03). conclusion: there are considerable knowledge gaps evident among trainees with regard to clinical practice guidelines for icd therapy. this likely represents a modifiable barrier to icd implantation. structured education for medical trainees on the appropriate use and referral practices consistent with practice guidelines may reduce knowledge gaps and increase appropriate icd implantation.