Enhancing specialist competence in clinical pathways for left ventricular hypertrophy: design and evaluation of a competency-based curriculum.

BACKGROUND

Left ventricular hypertrophy (LVH) is a frequent clinical phenotype with diverse etiologies, including hypertensive heart disease, hypertrophic cardiomyopathy, and infiltrative or metabolic disorders. Despite the availability of disease-specific therapies, diagnostic delays and misclassifications remain prevalent. From a health services perspective, these diagnostic gaps are often driven by significant variability in specialist-level diagnostic reasoning and the inconsistent implementation of clinical pathways. To design and evaluate the feasibility of a competency-based curriculum aimed at standardizing specialist-level clinical pathways for LVH-related diseases, and to assess its immediate impact on physician knowledge acquisition, diagnostic reasoning, and clinical confidence.

METHODS

A structured curriculum was developed following principles of patient-centered care and multidisciplinary collaboration. The program, delivered as a continuing medical education (CME) initiative for 45 cardiologists, incorporated guideline reinforcement, genetics-oriented learning, case-based discussions, and pathway design exercises via a blended learning format. Outcomes were assessed through pre- and post-training knowledge tests, structured case-based evaluations, and self-reported confidence and satisfaction surveys.

RESULTS

Forty-five cardiologists from secondary and tertiary centers completed the program. Mean knowledge test scores significantly improved from 62% ± 12% pre-training to 86% ± 8% post-training (p < 0.001). The correct identification of rare LVH etiologies (e.g., Fabry disease, cardiac amyloidosis) in structured cases rose from 35% to 78%. Participants reported significantly higher diagnostic confidence for both common and rare etiologies, and overall course satisfaction was high (92% rating ≥ 4/5).

CONCLUSION

This competency-based curriculum was associated with short-term improvements in specialist-level knowledge and diagnostic reasoning for LVH-related diseases. This program shows potential to assist in reducing variability in specialist practice and establishing standardized clinical pathways, serving as a preliminary health services intervention that may enhance downstream referral consistency and inter-provider care coordination.

CLINICAL TRIAL NUMBER: Not applicable.