All right, let me thank you so there's already been a number of questions in the chat. And I know that fellows will perseverate on this. And then numbers will be counted differently in different programs at the discretion of the PD but here are our examples that were vetted by our, our training program directors, and others that we've discussed this with so for example. Intravascular imaging or assessment of coronary physiology for procedure followed by a PCI to PCI is more or less, any case in which a balloon is inflated to perform an intervention. So if, if a patient gets an IBIS, followed by an image by an intervention. And even if they get a post intervention IBIS, it's one imaging and one PCI. A patient who gets multi vessel PCI in a single procedure is counted as one PCI patient who gets a coronary and peripheral vascular intervention in the same episode of care is one procedure you can call it what you'd like. But again, given the way we have laid out the foundation 200 minimum coronary interventions are part of your minimum training. For those who get coronary and structural heart interventions in the same episode of care for example a PCI followed by tab or in the same setting. That's still one procedure with the same analogy, as if it was done with a vascular intervention. And finally, any structural heart or peripheral intervention, done as a primary operator during the fellowship can only be counted toward procedural competency if an IC fellowship is completed with 250 CV interventions, plus the 25 imaging and physiology procedures. So, these are some of the permutations. I'm sure there will be unique circumstances in which we as a as a writing committee would refer all fellows to their program directors for adjudication of how this should count. We did want to make the additional point that simulation training has been mentioned in the document and is included as both the teaching and evaluation tool. I do want to reiterate that some low frequency procedures such as managing rare complications or less common conditions, or for the development of procedural skills that may be supplementary to clinical experience simulation training may be available on site, or through interventional courses or industry sponsored programs, but these do not supplant the numbers that have been laid out in the document. With respect to transitioning to practice I think it's important and we all feel strongly that a major mission of training is to provide the foundational cognitive and technical skills that will later be followed by experience during clinical practice that will lead to expertise and mastery of the field over time. It's important that the fellowship be viewed as, as the ground floor with the minimum foundational experience. We recognize as the college and the society both are strongly endorsing that lifelong learning facilitates expansion of knowledge and skills beyond this initial training period, and includes broadening competencies as new technologies and practice patterns emerge following training the last document was published over a decade ago, and so much has changed in the field in that interval, and we expect the same to be true for the next interval. Companies are guided to practice within the scope of their personal expertise, training and technical skills, and to see guidance mentoring assistance as needed as they enter the profession. And we expect that, you know competency also includes the recognition of one's limitations, and that this is an important part of your professional development during your training.

procedural counts

training programs

interventional cardiology

intravascular imaging

coronary interventions