Literature & Learning Objectives Gap Analysis

PART 1: Missing Key Papers & Trials

Kawasaki Disease (Topic 1)

Currently Have: AHA 2024, RAISE Study, KIDCARE Missing: | Paper | Year | Significance | |-------|------|--------------| | Newburger JW - NEJM | 1986 | Original IVIG efficacy trial | | Newburger JW - NEJM | 1991 | Single vs divided IVIG dosing | | Tremoulet AH - Lancet Infect Dis | 2014 | IVIG resistance predictors | | Kobayashi Score Validation | 2006 | Risk stratification scoring | | McCrindle BW - Circulation | 2017 | Long-term outcomes review | | KAWARACE Trial | 2023 | Aspirin dose comparison |

Channelopathies (Topic 11)

Currently Have: ESC 2022 Missing: | Paper | Year | Significance | |-------|------|--------------| | Schwartz PJ - Circulation | 2001 | Genotype-phenotype LQTS | | Moss AJ - NEJM | 2000 | Beta-blocker efficacy LQT1 | | Priori SG - NEJM | 2013 | Implantable recorder data | | Watanabe H - Circulation | 2009 | Flecainide in CPVT | | Van der Werf C - Circulation | 2012 | CPVT natural history | | Nademanee K - Circulation | 2011 | Brugada ablation | | Mazzanti A - JACC | 2016 | Mexiletine in LQT3 | | Schwartz PJ - Lancet | 2004 | LCSD long-term outcomes |

HCM (Topic 3)

Currently Have: AHA/ACC 2024 Missing: | Paper | Year | Significance | |-------|------|--------------| | EXPLORER-HCM | 2020 | Mavacamten Phase 3 | | VALOR-HCM | 2023 | Mavacamten reduces surgery | | Maron BJ - JACC | 2003 | Natural history pediatric HCM | | Maron MS - Circulation | 2013 | MRI risk stratification | | O'Mahony C - Eur Heart J | 2014 | Risk-SCD calculator validation | | Norrish G - Eur Heart J | 2019 | Pediatric risk model | | LIVE-HCM Registry | ongoing | Real-world pediatric data |

Myocarditis (Topic 9)

Currently Have: AHA 2021 Missing: | Paper | Year | Significance | |-------|------|--------------| | Caforio AL - Eur Heart J | 2013 | ESC position statement | | Ammirati E - JACC | 2018 | Fulminant myocarditis outcomes | | Felker GM - NEJM | 2000 | Myocarditis outcomes | | Cooper LT - NEJM | 1997 | Giant cell myocarditis | | TIMIC Trial | 2009 | Immunosuppression trial | | Tschöpe C - Circulation | 2019 | Management update | | Aquaro GD - JACC | 2017 | CMR prognostic markers |

Pulmonary Hypertension (Topic 6)

Currently Have: AHA/ATS 2015, ESC/ERS 2022 Missing: | Paper | Year | Significance | |-------|------|--------------| | Barst RJ - NEJM | 1996 | Epoprostenol landmark | | Galiè N - NEJM | 2005 | SUPER-1 (sildenafil) | | STARTS-1 & 2 | 2012/2014 | Pediatric sildenafil | | EARLY Trial | 2008 | Early combination therapy | | AMBITION Trial | 2015 | Initial combination therapy | | Ivy DD - Circulation | 2013 | Pediatric PH treatment algorithm | | Abman SH - Circulation | 2015 | Pediatric-specific PH statement |

Fontan/Single Ventricle (Topic 23)

Currently Have: AHA 2019 Missing: | Paper | Year | Significance | |-------|------|--------------| | Fontan F - Thorax | 1971 | Original Fontan description | | de Leval MR - J Thorac Cardiovasc Surg | 1988 | TCPC technique | | Rychik J - Circulation | 2019 | Fontan outcomes meta-analysis | | Goldberg DJ - Circulation | 2020 | Fontan-associated liver disease | | Pundi KN - Circulation | 2015 | 40-year Fontan outcomes | | Ridderbos FJ - Int J Cardiol | 2019 | PLE management review | | Deal BJ - Circulation | 2017 | Arrhythmias in Fontan |

PDA in Preterms (Topic 24)

Currently Have: AAP 2025 Missing: | Paper | Year | Significance | |-------|------|--------------| | PDA-TOLERATE Trial | 2019 | Conservative management | | Hundscheid T - JAMA Pediatr | 2022 | Early treatment vs conservative | | Semberova J - Arch Dis Child | 2017 | Spontaneous closure rates | | Zahn EM - JACC Cardiovasc Interv | 2016 | Piccolo device outcomes | | Benitz WE - Pediatrics | 2016 | PDA management review | | Philip R - Circ Cardiovasc Interv | 2018 | Transcatheter PDA closure preterms |

Arrhythmias/Devices (Topic 5)

Currently Have: PACES/HRS 2023 Missing: | Paper | Year | Significance | |-------|------|--------------| | Perry JC - Pacing Clin Electrophysiol | 1990 | SVT in infants | | Salerno JC - Circulation | 2009 | Pediatric SVT management | | Van Hare GF - Heart Rhythm | 2015 | Pediatric ablation outcomes | | Khairy P - Circulation | 2008 | EP issues in ACHD | | Atallah J - Heart Rhythm | 2020 | Pediatric pacing outcomes | | PACES/HRS Pediatric Ablation Registry | ongoing | Real-world outcomes |

Sports Cardiology (Topic 12)

Currently Have: AHA/ACC 2025 Missing: | Paper | Year | Significance | |-------|------|--------------| | Maron BJ - NEJM | 2003 | Sudden death in athletes | | Corrado D - JAMA | 2006 | Italian screening effectiveness | | RACER Study | 2014 | Exercise risk in middle age | | Lampert R - Circulation | 2017 | ICDs in athletes | | Pelliccia A - Eur Heart J | 2021 | Athlete's heart vs cardiomyopathy | | PANORAMA Registry | ongoing | ICD-HCM athletes |

Heart Transplant (Topic 28)

Currently Have: ISHLT 2023, 2024 Missing: | Paper | Year | Significance | |-------|------|--------------| | Dipchand AI - JHLT | 2013 | Pediatric outcomes registry | | Rossano JW - Circulation | 2017 | Pediatric listing outcomes | | Conway J - Circulation | 2018 | Sensitization strategies | | Kindel SJ - Circulation | 2012 | Rejection surveillance | | Everitt MD - JHLT | 2020 | Pediatric retransplantation |

Pericarditis (Topic 26)

Currently Have: ESC 2015, ESC 2025 Missing: | Paper | Year | Significance | |-------|------|--------------| | COPE Trial | 2005 | Colchicine first episode | | CORE Trial | 2011 | Colchicine recurrent | | CORP/CORP-2 | 2014 | Colchicine prevention | | AIRTRIP | 2016 | Anakinra for refractory | | RHAPSODY | 2021 | Rilonacept FDA approval | | Imazio M - NEJM | 2013 | Colchicine meta-analysis |

Neuromuscular Disease (Topic 25)

Currently Have: AHA 2017, AAP 2018 Missing: | Paper | Year | Significance | |-------|------|--------------| | Duboc D - Eur Heart J | 2005 | Perindopril in DMD | | Duboc D - JACC | 2007 | Perindopril long-term | | Raman SV - Circ Cardiovasc Imaging | 2015 | CMR in DMD | | Mavrogeni S - Circulation | 2017 | CMR timing in DMD | | Birnkrant DJ - Lancet Neurol | 2018 | DMD care recommendations | | ACTION DMD cardiac papers | ongoing | Collaborative outcomes |

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PART 2: Learning Objectives Gap Analysis

Current State

• 115 total objectives across 34 topics
• Range: 3-4 objectives per topic
• All topics have objectives (none missing)

Gaps Identified

1. Bloom's Taxonomy Coverage

Current distribution (estimated): | Level | Current % | Target % | |-------|-----------|----------| | Remember | 20% | 10% | | Understand | 40% | 20% | | Apply | 30% | 35% | | Analyze | 8% | 20% | | Evaluate | 2% | 10% | | Create | 0% | 5% |

Missing Higher-Order Objectives: - "Analyze" and "Evaluate" verbs underrepresented - No "Create" objectives (develop care plan, design protocol) - Heavy on "Know" and "Recognize" (lower Bloom's levels)

2. Competency Domain Gaps

Current coverage: | Domain | Covered | Missing Examples | |--------|---------|-----------------| | Medical Knowledge | ✅ Strong | - | | Patient Care | 🟡 Partial | Procedural skills, acute management | | Communication | ❌ Weak | Family counseling, shared decision-making | | Systems-Based Practice | ❌ Weak | Care coordination, transition planning | | Practice-Based Learning | ❌ Weak | Literature appraisal, QI | | Professionalism | ❌ Absent | Ethical considerations, end-of-life | | Interpersonal Skills | ❌ Absent | Team communication, handoffs |

3. Specific Missing Objectives by Topic

Kawasaki (Topic 1): - Current: Diagnosis, treatment, risk stratification, IVIG resistance - Missing: - "Counsel families on long-term prognosis" - "Coordinate care for patients requiring anticoagulation" - "Develop surveillance plan based on coronary involvement"

HCM (Topic 3): - Current: Risk factors, screening, ICD, sports - Missing: - "Lead a shared decision-making discussion about sports participation" - "Interpret genetic test results for families" - "Evaluate appropriateness of septal reduction therapy"

Channelopathies (Topic 11): - Current: Diagnosis, treatment, recognition - Missing: - "Counsel families on inheritance patterns and cascade screening" - "Create emergency action plan for schools" - "Evaluate QT-prolonging medication lists"

Fontan (Topic 23): - Current: Physiology, surveillance, complications, transplant - Missing: - "Coordinate multidisciplinary care for Fontan patients" - "Counsel patients on pregnancy risks" - "Develop transition plan for ACHD transfer"

All Topics - Cross-Cutting Gaps: - Transition of care planning - Palliative care discussions - Interprofessional collaboration - Quality improvement participation - Cost-effective care principles - Health equity considerations

4. ACGME Milestone Alignment

Not Currently Mapped: - Objectives don't reference specific EPA (Entrustable Professional Activities) - No leveling of objectives (PGY-1 vs Fellow level) - Missing procedural milestone objectives - No systems-based practice objectives

5. Assessment Alignment

Gap: No clear connection between: - Learning objectives → Assessment methods - Objectives → Flashcard content - Objectives → Case-based learning - Objectives → Self-assessment questions

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PART 3: Recommended Enhancements

A. Literature Database Expansion

Add dedicated files:

/resources/landmark-papers/
├── kawasaki-key-papers.md
├── channelopathies-key-papers.md
├── hcm-key-papers.md
├── fontan-key-papers.md
├── pulmonary-hypertension-key-papers.md
└── ... (one per major topic)

Each file should include: - Paper citation with PMID - One-paragraph summary - "Why it matters" explanation - Board relevance rating

B. Learning Objectives Enhancement

For each topic, add:

1. Higher-order objectives:

   - Analyze [clinical scenario] to determine [decision]
   - Evaluate [treatment options] for [patient type]
   - Create [care plan/protocol] for [condition]
   

2. Communication objectives:

   - Counsel families on [prognosis/inheritance/risks]
   - Lead shared decision-making discussion regarding [topic]
   - Communicate effectively with [team members] about [handoff/transition]
   

3. Systems objectives:

   - Coordinate multidisciplinary care for [patient population]
   - Develop transition plan for [ACHD patients]
   - Apply cost-effective care principles when [ordering tests]
   

4. Level indicators:

   ## Learning Objectives
   
   ### PGY-1 Level (Foundation)
   - [ ] Recognize [basic finding]
   - [ ] Know [key facts]
   
   ### PGY-2/3 Level (Developing)
   - [ ] Apply [criteria/algorithm]
   - [ ] Interpret [test results]
   
   ### Fellow Level (Competent)
   - [ ] Analyze [complex cases]
   - [ ] Evaluate [treatment options]
   - [ ] Create [management plans]
   

C. Objective-Assessment Mapping

Create /resources/assessment-map.md:

Objective	Flashcards	Cases	Questions	Skills
KD diagnosis	KD deck #1-5	Case 004	AHD bank Q1-3	-
KD treatment	KD deck #6-12	Case 004	AHD bank Q4-6	-
Echo Z-scores	-	-	Imaging Q1-5	Echo lab

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Summary: Priority Actions

Immediate (Literature)

1. Add 50+ landmark papers with summaries
2. Create topic-specific "key papers" files
3. Add PMID links to all citations

Immediate (Objectives)

1. Add 2-3 higher-order objectives per topic
2. Add communication/counseling objectives
3. Add systems-based practice objectives

Short-term

1. Create ACGME milestone mapping
2. Level objectives by training year
3. Map objectives to assessments

Medium-term

1. Add procedural competencies
2. Create objective self-assessment rubrics
3. Develop faculty evaluation tools