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Curriculum

Clinical experiences for the Cardiovascular Disease Fellowship Program at Allegheny Health Network (AHN) include:

  • Clinical cardiology
  • Non-invasive cardiology
  • Invasive cardiology
  • Electives
  • Didactic experiences
  • Call schedule

Clinical cardiology

The clinical cardiology rotation includes:

  • Consultative cardiology
  • Electrocardiography, ambulatory electrocardiography, and exercise testing
  • Electrophysiology, cardiac pacing, and arrhythmia management
  • Preventive cardiovascular medicine
  • Outpatient cardiology and continuity clinic
  • Heart failure, pulmonary hypertension, left ventricular assist devices, and heart transplant
  • Coronary intensive care unit
  • Pediatric cardiology elective

Consultative cardiology

While on the consultative cardiology service, fellows:

  • Participate in five months of supervised noninvasive consultative and inpatient services
  • Get inpatient consultative experience in electrophysiology and advanced heart failure
  • Function as a member of a team led by the attending consultative cardiologist
  • Develop skills for communicating with referring physicians and members of the health care team
  • Plan the short- and long-term care of patients with cardiovascular disease, including assessing the preoperative risk of non-cardiac surgery, and caring for postoperative cardiothoracic surgical patients

Electrocardiography, ambulatory electrocardiography, and exercise testing

During this rotation, trainees:

  • Interpret more than 3,500 electrocardiograms (ECGs) over three years to qualify for level 2 training
  • Participate in ECG conferences every two weeks, sharing experiences from interpreting ECGs in the intensive care unit, emergency department, and heart device clinics

Electrophysiology, cardiac pacing, and arrhythmia management


Fellows participate in three months of electrophysiology (EP) core rotations leading to level 1 training in EP with the option of additional elective time to pursue level 2 training. During these blocks, fellows:

  • Learn 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 EP recordings, stimulation protocols for supraventricular and ventricular arrhythmias, catheter mappings, and ablation
  • Demonstrate competence in clinical management of patients on a clinical EP service including the advanced usage of antiarrhythmic agents and performance of elective cardioversions

Preventive cardiovascular medicine

We provide level 1 training in preventive cardiovascular medicine, including:

  • Ambulatory setting participation in the outpatient cardiology and continuity clinic
  • Elective experience in the Women’s Heart Center

Outpatient cardiology and continuity clinic

Alongside clinic mentors, fellows care for patients at the outpatient cardiology clinic at Allegheny General Hospital. Fellows:

  • Serve as both primary cardiologists and consultants for a diverse patient population
  • Follow patients over time and oversee admission to inpatient services, when necessary

Heart failure, pulmonary hypertension, and heart transplant

Fellows participate in a two-month rotation in the advanced heart failure and heart transplant service. They function as an integral part of a multidisciplinary cardiac transplant team. Fellows achieve:

  • Level 1 training in heart failure
  • Option of obtaining level 2 training in heart failure and pulmonary hypertension during elective time
  • Extensive outpatient and inpatient pulmonary hypertension training in medical therapies; sophisticated diagnostic imaging tools; investigational, device, and surgical therapies at the Pulmonary Hypertension Center at Allegheny General Hospital
  • Participation in a bimonthly multidisciplinary transplant conference

Coronary Intensive Care Unit (CICU)

Fellows participate in a one-month CICU rotation during the second and third years directing a team of residents and medical students (under the guidance of a supervising cardiologist) in the management of patients with complex cardiovascular disease.

Fellows also spend one month in the surgical ICU during the third year caring for preoperative and postoperative cardiothoracic surgical patients, patients with percutaneous circulatory support devices, and patients with vascular surgical issues.

Pediatric cardiology elective

In previous years, fellows have completed elective rotations at the Cleveland Clinic, Nationwide Children’s Hospital in Columbus, Ohio, and Children’s Hospital of Pittsburgh of UPMC.

Non-invasive cardiology

Noninvasive cardiology rotations include:

  • Echocardiography
  • Nuclear cardiology and stress testing
  • Magnetic resonance imaging (MRI) elective
  • Non-invasive vascular ultrasound laboratory elective
  • Cardiac computed tomography elective

Echocardiography

Fellows participate in six core rotation months in transthoracic, transesophageal, and stress echocardiography. This participation includes:

  • Level 2 training in echocardiography with options for achieving level 3 training
  • Competency in performing and interpreting transthoracic echocardiography and transesophageal echocardiography including 3D-echocardiography for evaluation of all forms of heart disease
  • Exposure to performance of echocardiography for evaluation and percutaneous management of structural heart disease.
  • Additional training to attain Level 3 in echocardiography is also available.

Nuclear cardiology and stress testing

Fellows participate in a minimum of four months of core rotations leading to level 2 training in nuclear cardiology. In addition, fellows:

  • Achieve proficiency in understanding the indications and contraindications for stress testing, as well as performing and interpreting all forms of stress testing
  • Achieve proficiency in appropriate use and interpretation of myocardial perfusion imaging including SPECT and PET in the evaluation of coronary artery disease.
  • Exposure to advanced PET and SPECT imaging including viability imaging and testing for cardiac sarcoidosis and amyloidosis.
  • Participate in advanced elective options to achieve further training, if interested

Magnetic Resonance Imaging (MRI) elective

All fellows achieve a minimum of level 1 training with rotations throughout the cardiac MRI laboratory. In addition, fellows:

  • May acquire level 2 training with additional elective time
  • Become familiar with the essentials of cardiac MRI, indications, contraindications, and potential patient risks
  • Attend monthly cardiac MRI/CT case conferences

Non-invasive vascular ultrasound laboratory elective

This one-month elective promotes the understanding of basic vascular image acquisition and interpretation. During this rotation, fellows:

  • Perform and interpret vascular duplex ultrasound studies involving the cervical, carotid, and vertebral circulation, as well as venous and arterial circulation, with and without stress testing
  • May choose to integrate vascular image interpretation with catheterization lab rotation to obtain required certification hours

Cardiac computed tomography elective

  • All fellows are exposed to Cardiac CT and MRI in their first year as a required elective
  • Third-year fellows may choose this independent elective, which may be taken in combination with MRI or nuclear cardiology. Depending on how many studies a fellow participates in, there’s potential for level 2 training.

Invasive Cardiology

Invasive cardiology involves a minimum of four months of core rotations with additional elective time. Fellows may choose to pursue a fourth year of interventional cardiaology fellowship. During the core rotations, fellows:

  • Become familiar with diagnostic coronary angiography, indications, and basic techniques for coronary angioplasty and stenting
  • Receive exposure to percutaneous valve implantation, including transcatheter aortic valve replacement (TAVR), MitraClip®, trans-septal catheterization, balloon valvuloplasty, and percutaneous circulatory support devices
  • Gain extensive experience in the spectrum of cardiac invasive procedures required for management of acute coronary conditions, including coronary angiography, Swan-Ganz catheter, pacemakers, and intra-aortic balloon pump placements
  • Train in diagnostic catheterization
  • Train in the invasive assessment of:
    • Right- and left-heart hemodynamics and ventricular function
    • Common forms of valvular stenosis and insufficiency
    • Shunt lesions
    • Common forms of adult congenital heart disease
    • Pericardial disease

Diagnostic catheterization

During the first year, fellows participate in two months of cardiac catheterization training. Second-year fellows have two to three months of cardiac catheterization training. Combined, this training time leads to level 1 training in invasive cardiology (four-month minimum). Fellows also may:

  • Obtain level 2 training using elective time to fulfill training requirements
  • Participate in interventional training (for fourth-year interventional cardiology fellows)
  • Become proficient in diagnostic angiography and hemodynamic assessment
  • Receive exposure to percutaneous coronary intervention
  • Train for an additional year to achieve level 3 training

Electives

All cardiovascular fellows must work closely with the fellowship director to develop a carefully thought-out, well-integrated training plan for elective rotations. We offer:

  • Advanced training in one or two aspects of clinical cardiology during the second and third years
  • Opportunity to develop a unique training pathway after achieving basic requirements
  • Potential to achieve a highly individualized set of objectives in preparation for a clinical or academic career
cardiovascular disease fellowship elective chart

 

Didactic experiences

A wide array of conferences complements the clinical rotations. In the first two months of each academic year, we hold a series of core curriculum lectures four to five days a week. Throughout the year, we hold educational sessions, including imaging conferences, case-conference, board review sessions, and morbidity and mortality reports.

Call schedule

We use a night float call system that begins Sunday nights and runs through Friday nights, one week at a time per fellow. Fellows who have more night float weeks are compensated in the second or third year of fellowship by having one less week of night float. A backup senior fellow is always on call to assist first-year fellows.

  • First-year fellows have five to six weeks of night float
  • Second-year fellows complete two-3 weeks of night float
  • Third-year fellows usually have no night float

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