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Cardiovascular Disease Fellowship Program Clinical Rotation

Cardiovascular Disease Fellowship Program Clinical Rotation

Clinical Experiences

Clinical experiences are divided into Clinical Cardiology, Non invasive cardiology, Invasive cardiology, Elective and Research time. 

Clinical Cardiology

Consultative Cardiology - Consult Service 

  • 5 months are allocated to noninvasive consultative and inpatient services under supervision of senior clinicians.
  • Inpatient consultative experience is also acquired on the Electrophysiology and Advanced Heart Failure services.

While on the consult service, fellows:

  • Function as a member of a team lead by the attending consultative cardiologist. 
  • Develop communication skills to interface with referring physicians and other members of the health care team. 
  • Plan the short and long-term care of patients with cardiovascular disease (CVD), assess the pre-operative risk of noncardiac surgery for patients with CVD, and care for post-operative cardiothoracic surgical patients.

 

Electrocardiography, Ambulatory Electrocardiography, Exercise Testing

  • Fellows interpret over 3500 ECGs during their 3 years and qualify to achieve Level 2 training.
  • Fellows  participate in the fortnightly ECG Conference sharing their experiences from interpreting ECG’s in ICU, ED and pacemaker/ defibrillation clinics.

 

Electrophysiology, Cardiac Pacing, and Arrhythmia Management

  • 3 months of EP core rotations leading to level 1 training in EP, along with option of additional elective time if interested to pursue level 2 training. During these blocks, fellows:
  • Recognize the indications, contraindications, complications, usage and management of temporary and permanent pacemakers, implantable defibrillators and tiered therapy devices. 
  • Become familiar with the basic elements of intracardiac electrophysiologic recordings, stimulation protocols for supraventricular and ventricular arrhythmias, catheter mapping and ablation. 
  • Demonstrate competence in clinical management of patients on a clinical electrophysiology service including the advanced usage of antiarrhythmic agents and performance of elective cardioversions.

 

Preventive Cardiovascular Medicine  

  • Longitudinal education and training offered in preventive cardiovascular medicine is primarily provided in the ambulatory setting by participating in the Outpatient Cardiology/Continuity Clinic.  Elective experience is also available at the Women’s Heart Center (Allegheny General Hospital and Health & Wellness Pavilion).
  • Specific topics covered include vascular biology, atherosclerosis, hypertension, disorders of lipid metabolism, obesity and weight management, diet and nutrition, smoking cessation, diabetes mellitus, thrombosis, clinical epidemiology, cardiac rehabilitation, clinical pharmacology, genetics, and the psychosocial aspects of cardiovascular disease. 
  • All fellows receive Level 1 training in Preventive Cardiovascular Medicine.

 

Outpatient Cardiology/Continuity Clinic

  • Each fellow follows their patients along with their clinic mentor, one half day per week or two full days a month at AGH outpatient cardiology clinic\
  • Fellows function as both primary cardiologists and consultants for a diverse patient population, following them over the course of time including admission to inpatient services when necessary. 

 
Heart Failure/Pulmonary Hypertension/Transplant 

  • Each fellow rotates through the  Advanced Heart Failure and Transplantation service for 2 months, functioning as an integral part of a multidisciplinary Cardiac Transplant Team and leading to attainment of Level I in heart failure.
  • The rotation typically exposes the fellow to inpatient consultative experiences, primary management of patients with advanced hearty failure, including the use of replacement therapies, hemodynamic evaluation of heart failure and transplant patients in the catheterization laboratory and outpatient evaluation and follow-up of these groups of patients.
  • Option of obtaining Level 2 training in heart failure and pulmonary hypertension is available for those interested by pursuing additional experiences in their elective time. 
  • Extensive outpatient and inpatient training enables fellows to be  trained in medical therapies, sophisticated diagnostic imaging tools, investigational, device and surgical therapies - at AGH’s Pulmonary Hypertension Center which is a hub of excellence in management of all aspects of pulmonary hypertension.  
  • While on the heart failure service, fellows participate in the multidisciplinary transplant conference learning from a wide variety of disciplines who are present at this bimonthly conference. the program’s required 

 

Coronary Intensive Care Unit  

  • Each fellow has at least 2 months of CICU- one each during the second and third year where, under the guidance of a supervising cardiologist, the fellow directs a team of residents and medical students in the management of patients with complex cardiovascular disease.
  • AGH is a tertiary care center, having a very busy CICU caring for critical patients with varied and complex cardiovascular pathologies. Rotating through the CICU, fellows become proficient in skills needed to competently manage such diseases.
  • Third-year fellows also spend a month in the SICU getting exposed to pre and post-operative cardiothoracic surgical patients, patients with percutaneous circulatory support devices, and patients with vascular surgical issues.

 

Pediatric Cardiology (elective)

  • A pediatric cardiology/ Adult Congenital Heart Disease elective is available as an outside rotation. 
  • Fellows in the previous years have done elective rotations at Cleveland Clinic and Children’s Hospital of Columbus, OH, or at the Children’s Hospital of Pittsburgh. 

 

Noninvasive Cardiology

Echocardiography 

  • 6 core rotation months in transthoracic, trans-esophageal, and stress echocardiography is provided and ensures level 2 training in echocardiography for all fellows. Options for additional elective time are available for those interested in achieving Level 3 training in echocardiography.
  • Through extensive training each fellow becomes competent in performing and interpreting transthoracic echocardiography for evaluation of all of the forms of heart disease. 

 

Nuclear Cardiology and Stress Testing

  •  At least 4 months of core rotations leading to a level 2 in nuclear cardiology for all fellows.  Advanced elective options to achieve further training available.
  • Each fellow becomes proficient in understanding the indications, contraindications and performing and interpreting all forms of stress testing.

 

Magnetic Resonance Imaging (MRI) (Elective)

  • Those choosing to pursue the elective will receive a minimum of Level 1 training rotating through the cardiac MRI laboratory at AGH. Option of further level 2 training with additional elective time is available for those interested. 
  • Fellows become familiar with the essentials of cardiac MRI, indications, contraindications and potential patient risks through didactic sessions and rotation in the CVMRI Lab.
  • Additionally, a cardiac MRI/CT monthly case conference provides further instruction in these modalities.

 

Noninvasive Vascular Ultrasound Laboratory (elective) 

  • This is a one month elective that provides the opportunity to understand basic vascular image acquisition and interpretation.  Additionally, vascular image interpretation can be integrated with the cath lab rotation to obtain the required numbers for certification.  
  • Fellows perform and interpret vascular duplex ultrasound studies involving the cervical, carotid, vertebral circulation as well as venous and arterial circulation (PVR) with and without stress testing.

 

Cardiac Computed Tomography (elective)

  • Fellows are encouraged to pursue this rotation in the third year as an independent elective or in combination with MRI or nuclear cardiology.
  • Fellows are able to achieve Level 1 training based on the number of studies they are involved in.

 

Invasive Cardiology

  • Invasive cardiology involves a minimum of 4 months of core rotations with additional elective time and options for pursuing a 4th year of interventional cardiac catheterization fellowship available. During the core rotations fellows:
    • Become familiar with diagnostic coronary angiography, indications and basic techniques for coronary angioplasty and stenting. Fellows are also exposed to percutaneous valve implantation, including TAVR and Mitral-clip, trans-septal catheterization, balloon valvuloplasty, and percutaneous circulatory support devices.
    • Gain extensive experience in the spectrum of cardiac invasive procedures, coronary angiography and procedures like Swan-Ganz catheter, pacemaker, intra-aortic balloon pump placement, etc, required for management of acute coronary conditions.
    • Train in the invasive assessment of right and left heart hemodynamics and ventricular function, assessment of common forms of valvular stenosis and insufficiency, shunt lesions and other common forms of adult congenital heart disease, pericardial disease. 

 

Diagnostic Catheterization

  • Fellows have 2 months of cardiac catheterization in the first year and 2-3 months in the second year leading to level 1 training in invasive cardiology (4 months minimum).
  • Those choosing to obtain level 2 training can use their elective time to obtain the total of 8 months and 300 procedures to fulfill the training requirements. Interventional training is available in an optional fourth year interventional fellowship.
  • A clinical volume of 8,500 procedures a year provides ample opportunity for fellows to become proficient in diagnostic angiography and hemodynamic assessment, as well as preliminary exposure to percutaneous coronary intervention.
  • Fellows interested in Level 3 training are required to train for an additional year as an Interventional cardiology fellow.

 

Elective Time

  • Elective time is available in the second year and third years of the program. 
  • Each fellow is expected to develop a carefully thought-out, well integrated training plan for elective rotations, working closely with the Fellowship Director. 
  • Fellows use the elective time in a coherent fashion to obtain advanced training and experience in one or two aspects of clinical cardiology. The program permits each trainee to develop a unique training pathway once they have achieved the basic requirements.  This allows each graduating fellow to achieve a highly individualized set of objectives, preparing each trainee for a clinical or academic career.

 

Sample Block Schedule

      Consults  CCU    Cath Lab Echo Lab        Electives       Night Float        Nuclear Lab     Research    Vacation
1st year 3 months  - 2 months 3 months - 5-6 weeks 2 months 1 month 3 weeks
2nd year 3 months       1 or 2 months 2 months 2 months 1 month 2 weeks 1 month 1 month 3 weeks
3rd year 2 months 1 month 1-2 months 5-6 months 1 week 1 month 3 weeks

 

Didactic Experiences
A wide array of conferences complements the clinical rotations. In the first two months of each academic year, a series of core curriculum lectures is  provided four to five mornings a week.  Didactic sessions continue throughout the year along with Imaging conferences, Board review sessions, and Morbidity and Mortality reports.
 

Call Schedule
We utilize a night float call system that begins Sunday nights and runs through Saturday nights; one week at a time per fellow.  First year fellows each have 5-6 weeks of night float, second year fellows do 2 weeks of night float, and third year fellows do 1 week each. Fellows with more night float weeks are compensated in the 2nd or 3rd year of fellowship by having one less week of night float.  Throughout the year and especially in the first half of the year, there is a backup senior fellow on call to assist the first year fellows when they take call.