For the first six months, the curriculum is largely fixed. However, there is the opportunity to personalize the curriculum over the second half of the year and tailor the experience to individual interests and/or anticipated job descriptions e.g., dedicating more time in the HLA and Histopathology lab during the non-clinical weeks if there is a particular interest toward Transplant Immunology/Pathology.
Our team cares for a large and remarkably diverse patient population not only from a socioeconomic and demographic standpoint but also from a pathology standpoint, thereby representing the full spectrum of advanced heart failure. The trainee will participate in both our outpatient and inpatient services. During the fellowship year, the trainee will always perform procedures with faculty supervision.
The outpatient service is located in the Center for Cardiovascular Medicine and comprised of patients with pulmonary hypertension, mechanical circulatory support devices, and cardiac transplant. The fellowship trainee will attend clinic two full days a week and see on average 5 new referrals and 15-20 return visits. In addition, clinical trial study visits afford an opportunity to gain exposure to clinical research and participate in study design and recruitment. During the outpatient block, fellows will have one day a week without clinical responsibility for independent learning and research.
Currently, the inpatient service comprises two separate services; a primary service and a consultative service together average 25+/-5 patients at any given time. The fellowship trainee rounds on a subset of the inpatients along with one of the two attendings assigned to the inpatient service on a daily basis. General cardiology fellows also rotate on the inpatient service. The fellowship trainee is expected to participate in the multi-disciplinary Cardiogenic Shock program.
Fellowship trainee is expected to teach both the house staff and advanced practice providers, including the review of all of the diagnostic studies such as echocardiograms, cath films and hemodynamic tracings, MRIs, etc.
The fellowship trainee spends two half days a week in the Cardiac Catheterization Laboratory performing right heart catheterizations and endomyocardial biopsies in patients with pulmonary hypertension as well as congestive heart failure, including those who have undergone cardiac transplantation and left ventricular assist device placement. By the completion of the fellowship training, the trainee should have gained adequate experience in performing these invasive procedures, independently. The trainee is also expected to develop expertise in histologic interpretation of the biopsy samples and have a full knowledge of both the Dallas criteria for the diagnosis of myocarditis and the ISHLT criteria for the diagnosis of acute cardiac rejection.
Trainees will also spend time in our exercise laboratory in which patients with congestive heart failure undergo cardiopulmonary exercise testing with online analysis of respiratory gas exchange. Approximately, 5-10 exercise studies are performed weekly in this laboratory. The fellowship trainee is expected to develop a full understanding of the indications for functional testing in congestive heart failure, interpretation of gas exchange data, and the relationship of functional capacity to prognosis in heart failure.
The fellowship trainee is also expected to attend a number of clinical and research conferences weekly. These conferences include Heart Failure didactics, Journal Club and Morbidity and Mortality (Tuesdays), the Cardiac Transplantation Candidate Selection Conference (Wednesday), Pulmonary Hypertension Conference (every other Thursdays) and Transplant Immunology/Therapeutics Conference (every other Thursdays). In addition, they also participate in other conferences that are scheduled during different days of the week including Cardiology Grand Rounds, Cardiovascular Research Conference, and the general fellowship’s Hemodynamic Conference.
It is expected that the Advanced Heart Failure and Transplant Cardiology Fellowship trainee writes at least one new clinical research protocol during the year of training. It is expected that the trainee completes the protocol, analyze the results and submit the data for presentation in a national cardiovascular meeting and publication.
Opportunities in basic cardiovascular research are also available at the Cardiovascular Research Institute should any of the trainees be interested.
Trainees will be provided the opportunity to attend at least one national meeting over the course of the year.