The training program is structured according to guidelines recommended by the American College of Cardiology. It meets all the requirements of the Subspecialty Board in Cardiovascular Disease of the American Board of Internal Medicine and includes clinical and laboratory experiences in each of the three years of training.
Fellows participate in research activities concurrent with clinical involvement and are also provided block time for their own approved projects. Fellows are actively involved in the teaching of medical residents and medical students on the inpatient and consult services, and they provide continuing education programs for nursing and technical staff.
Clinical experience is organized as block rotations through the cardiology consult service, the inpatient services, the catheterization laboratory, the electrophysiology laboratory, the noninvasive laboratories, congenital cardiology, and research or elective rotations.
The fellow is responsible for leading work rounds with a team composed of a cardiology attending, a critical care attending, residents, interns, medical students, ICU nursing, and pharmacy. Our CICU includes patients with complicated STEMI/ACS, cardiogenic shock, LVADs, VT storm and complex arrhythmias, complex valvular heart disease, as well as adult congenital heart disease. The fellow performs or supervises procedures on the unit including placement of central lines, arterial lines, PA lines, transvenous pacemakers, emergent pericardiocentesis, as well as adjustment of intra-aortic balloon pumps and assessment of Impella left ventricular assist devices.
The fellow serves as the consultant for our inpatient services and leads a team consisting of a cardiology attending, advanced practice provider, resident, and medical student. We provide consultative care to the general medical services, surgical services, medical and surgical intensive care units, the Emergency Department, and Ob/Gyn.
Each fellow manages a panel of outpatients in a longitudinal clinic that meets one half day a week throughout the year. Fellows see patients with a diverse case mix in consultation and in follow-up under the supervision of a faculty preceptor. The clinic is fully supported by nurses and medical assistants. Registered nurses are available to help cover calls from patients when the fellow is not in clinic and to see patients in conjunction with the fellow.
Fellows receive comprehensive training in electrocardiogram interpretation and multi-modality imaging including echocardiography, cardiac CT, cardiac MRI and nuclear cardiology (PET and SPECT). There is a robust curriculum including didactics, case conferences, and journal club led by the non-invasive imaging faculty.
Training in echocardiographic imaging includes the performance and interpretation of transthoracic and transesophageal echocardiography. Given the clinical volume (inpatient and outpatient) our fellows exceed the training recommendations from COCATS and the National Board of Echocardiography.
As required by the Nuclear Regulatory Commission, all fellows participate in a radiation physics course. It is essential for fellows who wish to supervise nuclear cardiology studies as part of their practice and is provided without cost. Studies in nuclear cardiology (PET and SPECT) are performed and interpreted under the supervision of an attending nuclear cardiologist.
The cardiac catheterization experience includes experience with diagnostic right and left heart cath hemodynamic assessment, coronary angiography, transvenous pacemaker placement, pericardiocentesis and drain placement, endomyocardial biopsy, IABP, and Impella. In addition to the procedures skills there is an emphasis on the interpretation of hemodynamics, coronary and graft angiography, and clinical reasoning.
Fellows rotate on the EP service, participate in inpatient consultations and have the opportunity to participate in the EP lab including EP studies and device implantation. Fellows receive training and experience in device interrogation and programming.
Fellows rotate on the adult congenital heart disease service with both an inpatient and outpatient experience with Board-certified pediatric and adult congenital cardiologists. These experiences expose fellows to a wide spectrum of congenital heart disease, including uncorrected and corrected disease in selected adolescent and adult patients.
Fellows participate in inpatient heart failure consultation (SHOCK consults, ECMO consults, and advanced therapies consult). Fellows also rotate on the primary heart failure service where patients with HFrEF, HFpEF, LVAD, and heart transplant are followed. Outpatient experiences include LVAD, transplant, infiltrative cardiomyopathy and LVAD clinic. Fellows get experience in CPET lab during this rotation.
Fellows have the opportunity to participate in electives aligned with their career path including our multidisciplinary programs: Advanced Heart Valve (TAVR, mitra-clip), Advanced heart failure, Prevention, Cardiovascular Genetics, Vascular Medicine, Cardio-Oncology, Complex Lipid Disorder, Sports Cardiology, Cardiac Pacemaker and Defibrillator Device Clinic, Watchman and PFO closure programs, Advanced Cardiac Imaging (CT, MR, PET, TEE), Hypertrophic Cardiomyopathy, Infiltrative Cardiomyopathy and Chronic Total Occlusion clinics.
Our fellowship program provides a variety of conferences, meetings, presentations, and didactic lectures. Fellows are expected to attend the following:
7-8 AM: GME Institutional Fellows Didactics – once a month
12-1 pm Echo/Multimodality Imaging Conference
Thursday – On Thursdays at 7 am, there is a rotating series of conferences/meetings
- Clinical Case Conference (fellow-led)
- Grand Rounds
- Research Meeting
- Departmental Meeting
- Morbidity and Mortality Conference (quarterly)
Thursday Protected Didactic (once a month). 10 am – noon
Didactics are dedicated to simulation sessions, ECG conference, High yield board review
7-8 am – Core Fellowship Didactics/ Board Review (faculty-led)
12-1 pm – Clinical Conference/Journal Club (fellow-led)
There are also several other sessions that the fellows may attend, depending on rotation or interest:
- ECMO Conference – Monthly
- SHOCK Team Meeting – Monthly
- Valve Team Meeting – Weekly
- LVAD Multidisciplinary Team Meeting- weekly
- Cardiac MRI Conference – Monthly
- Board Review (Program Director/Faculty) – Monthly
- ECG session (Program Director/Faculty) – Monthly