Cardiovascular Fellowship Curriculum

Training and Curriculum

A combination of clinical rotations, simulation, didactics, procedures, mentored research and self-directed learning prepare fellows to be future leaders in Cardiovascular Medicine. Fellows participate in the following activities during the cardiovascular fellowship program:

Clinical Rotations

Our clinical rotations emphasize fellow autonomy and clinical decision-making with direct faculty supervision. Fellows in our program gain independence in clinical judgment and procedural skills with this interaction, which is bolstered by outstanding clinical volume and diversity, as well as numerous core curriculum and sub-specialty conferences.

The clinical curriculum in our program is designed to meet COCATS 4 recommendations by the American College of Cardiology for both procedural volume and training time for competency in Cardiovascular Disease. Specific rotation requirements include:

  • Cardiac Catheterization Laboratory
  • Coronary Care Unit
  • Valvular/Congenital Heart Disease
  • Echocardiography
  • Electrophysiology Inpatient and Consults
  • Heart Failure/Transplant

MRI

  • Nuclear Cardiology
  • Magnetic Resonance Imaging
  • Vascular Medicine/Prevention Cardiology
  • Outpatient Continuity Clinic

Didactics

Weekly educational conferences throughout the Division of Cardiology and Heart Center are available for fellows. Conferences cover topics in general cardiology as well as sub-specialties. For fellows, three weekly conferences offer a core didactic curriculum: Cardiology Grand Rounds, Core Curriculum Conference, and Clinical Case Conference. Other conferences are optional but highly recommended, especially on specific rotations or based on the fellow's own interest, to increase knowledge in the sub-specialties. Link to conference schedule

Travel

First- and second-year fellows are supported to attend one major, national scientific conference per academic year, such as the AHA, ACC Scientific Sessions, Heart Failure Society of America, or Heart Rhythm Society. Fellows generally receive support from their faculty mentors to attend meetings during their research year(s) or advanced training.

Cardiac Catheterization Rotation

Rotation Overview

The cardiac catheterization rotation and associated training is designed to provide the fellow, within the standard three-year program, two potential levels of COCATS training:

COCATS Level I:

  • All fellows are expected to achieve COCATS Level I training during the fellowship.
  • Trainee should participate in minimum of 100 diagnostic procedures.
  • At least 50 of these should involve coronary angiography and 25 should involve hemodynamic assessment of valvular, myocardial, pericardial, or congenital disease.

COCATS Level II:

  • All fellows have the opportunity to achieve COCATS Level II training during the fellowship program.
  • Participation in the performance of 300 diagnostic catheterization procedures.

The cardiovascular fellow on the cardiac catheterization laboratory rotation will be responsible for evaluating patients for, assisting in the performance of, and interpreting the results of, cardiac catheterizations. Specific responsibilities include:

  • Seeing the patient prior to cardiac catheterization.
  • Documenting the indication for the cardiac catheterization.
  • Completing of an appropriate history and physical (H&P) examination.
  • Writing a brief note that includes:
  • Pertinent history, including indication for the test, presence or absence of contrast allergy and results of previous cardiac catheterizations
  • Pertinent physical examination data
  • Pertinent laboratory data (hemogram, electrolytes, renal function, clotting parameters)
  • Documentation that the patient and as appropriate the patient’s family understands the risks and benefits of the planned procedure and that informed consent has been obtained
  • Discussing the planned procedure with the patient, outlining risks and benefits, and obtaining informed consent
  • Understanding recommendations for testing consistent with the ACC/AHA guidelines.
  • Performing/assisting with the catheterization procedure under the supervision of the attending physician in the laboratory
  • Interpreting the results of the procedure, including hemodynamic tracings and video images
  • Communicating to the patient the results of the study
  • Assessing the patient after the procedure, including assessing the patient for any complications related to the procedure
  • Education of the patient - Fellows on this rotation become integral members of the Arrhythmia Service and are exposed to complex ablation, cardiac resynchronization therapy, consultative electrophysiology and interpretation of electrocardiograms. At the end of the rotation fellows become proficient in device interrogation and reprogramming, cardioversion, tilt table testing, understanding arrhythmia mechanisms and guideline-based therapy for various arrhythmias.

Rotation Goal

  1. Be competent in the provision of comprehensive care in patients diagnosed with coronary artery disease, structural heart disease, pulmonary vascular disease and peripheral vascular disease requiring angiography and intervention.
  2. Understand the usefulness and limitations of angiography procedures.
  3. Learn how to apply evidence-based, cost conscious strategies to diagnose and manage patients undergoing cardiac catheterization procedures.
  4. Learn to function as a member of a multidisciplinary team treating patients undergoing interventional cardiac procedures.
  5. Be able to participate in family meetings and be an effective communicator
  6. Have an understanding of utilization of resources and appropriate levels of care in patients with coronary disease, valvular heart disease and atrial septal defect; and peripheral vascular disease undergoing interventions.

Objectives

  1. Function as effective team leaders and teachers in caring for patients undergoing procedures in the cardiac catheterization lab.
  2. Demonstrate competency in history and physical examination of patients undergoing coronary angiograph.
  3. Discuss the diagnosis and management of patients with the cardiac conditions requiring invasive procedures and angiography.
  4. Demonstrate the organizational skills necessary to supervise the care of patients in the cardiac catheterization laboratory.
  5. Effectively cross-cover for patients undergoing angiography when other team members are not available
  6. Function effectively as a member of a multidisciplinary team
  7. Demonstrate effective communication with patients, families, colleagues and staff
  8. Demonstrate ability to oversee effective discharge planning for patients who underwent angiography and revascularization.
  9. Demonstrate an understanding of the indications and contraindications for various types of procedures, including hemodynamic invasive monitoring with Swan-Ganz catheters, arterial catheter monitoring, intra-aortic balloon pump, percutaneous and surgical revascularization.

Methods for Evaluation of Fellows

Direct observation by the Cardiology attending.

  • New Innovations performance evaluation form completed by a Cardiology attending at the conclusion of the rotation.

Methods for Evaluation of Rotation/Attendings

  • Evaluations are completed in New Innovations anonymously by the fellows at the conclusion of the rotation.

Criteria for Advancement

Patient Care & Communication

  • Manages patients with progressive responsibility and independence
  • Manages patients with progressive responsibility and independence
  • Demonstrates skill in performing and interpreting invasive procedures

Medical Knowledge

  • Possess clinical knowledge
  • Knowledge of diagnostic testing and procedures

System Based Practice

  • Works effectively within an inter-professional team
  • Transitions patients effectively within and across health delivery systems

Practice Based Learning

  • Learns and improves at the point of care

Professionalism

  • Has professional and respectful interactions with patients, caregivers and members of the inter-professional team

Interpersonal and communication skills

  • Communicates effectively in inter-professional teams

Duties

First Year Fellow in Cardiovascular Medicine

Overall Focus: Vascular access; basic coronary angiography and hemodynamics

Number of months: 2

Objectives:

  1. Become familiar with operations of the Cath lab.
  2. Understand indications/contraindications for diagnostic and therapeutic cardiac catheterization.
  3. Learn standard views obtained during coronary angiography.
  4. Become proficient in vascular access and management of complications.
  5. Perform and interpret coronary angiography and hemodynamic assessment.

Clinical Responsibilities:

  1. Develop daily schedule with other fellows in the Cath lab that allows for:
  2. Equal exposure to a variety of cases and clinical indications during the month, as appropriate.

More senior fellows should focus on complex cases.

  1. Perform pre-Cath evaluations, including:
  2. A complete history and thorough physical examination.
  3. Pertinent pre-Cath laboratory testing.
  4. Pre-Cath non-invasive diagnostic testing.
  5. Perform and interpret comprehensive catheterization studies, providing preliminary interpretation with the digital reporting system. These reports need to be discussed with the supervising attending in a timely manner before they can be finalized.
  6. Perform post-Cath assessment of each patient, monitoring for common complications.

Didactic Responsibilities:

Each first-year fellow is required to present a case-based conference. These topics will be assigned by the chief fellow and should focus on a specific theme, with a brief review of guidelines and primary literature.

Second Year Fellow in Cardiovascular Medicine

Overall Focus: Continued development of catheterization technical skills; evaluation and management of patients with unstable coronary syndromes; incorporation of more advanced arterial access techniques and devices for hemodynamic support

Number of months:

Objectives:

  1. Continued development of catheterization performance and interpretation skills.
  2. Participate in more complex diagnostic cases.
  3. Assist in percutaneous interventional procedures when appropriate.

Clinical Responsibilities:

  1. Develop daily schedule with other fellows in the Cath lab that allows for:
  2. Equal exposure to a variety of cases and clinical indications during the month, as appropriate. More senior fellows should focus on complex cases.
  3. Perform pre-Cath evaluations, including:
  4. A complete history and thorough physical examination.
  5. Pertinent pre-Cath laboratory testing.
  6. Pre-Cath non-invasive diagnostic testing.
  7. Perform and interpret comprehensive catheterization studies, providing preliminary interpretation with the digital reporting system. These reports need to be discussed with the supervising attending in a timely manner before they can be finalized.
  8. Perform post-Cath assessment of each patient, monitoring for common complications.
  9. Participation in more complex and/or unstable diagnostic catheterizations, assisting in interventions when appropriate.
  10. Provide mentorship for junior fellows during their time in the Cath lab.

Didactic Responsibilities:

Each second-year fellow is required to present a case-based conference. These topics will be assigned by the chief fellow and should focus on a specific theme, with a brief review of guidelines and primary literature.

Third Year Fellow in Cardiovascular Medicine

Overall Focus: Continued development of catheterization skills and interventions; potential research, education and lab directorship.

Number of months:

Objectives:

  1. Continued development of catheterization performance and interpretation skills.
  2. Begin to perform select percutaneous interventional procedures when appropriate.

Clinical Responsibilities:

  1. Develop daily schedule with other fellows in the Cath lab that allows for:
  2. Equal exposure to a variety of cases and clinical indications during the month, as appropriate.

More senior fellows should focus on complex cases.

  1. Perform pre-Cath evaluations, including:
  2. A complete history and thorough physical examination.
  3. Pertinent pre-Cath laboratory testing.
  4. Pre-Cath non-invasive diagnostic testing.
  5. Perform and interpret comprehensive catheterization studies, providing preliminary interpretation with the digital reporting system. These reports need to be discussed with the supervising attending in a timely manner before they can be finalized.
  6. Perform post-Cath assessment of each patient, monitoring for common complications.
  7. Participation in more complex and/or unstable diagnostic catheterizations, assisting in interventions when appropriate.
  8. Perform select percutaneous interventional procedures when appropriate.
  9. Provide mentorship for junior fellows during their time in the Cath lab.

Didactic Responsibilities:

Each third-year fellow is required to present a case-based conference. These topics will be assigned by the chief fellow and should focus on a specific theme, with a brief review of guidelines and primary literature.