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Third-year fellows act as the obligatory cardiac consultant on the inpatient resident teaching service, supervising residents and third-year clerks and leading work and teaching rounds. The fellow is responsible for all procedures carried out on the service, including passage of catheters under fluoroscopic control, placement of transvenous pacemaker wires, and pericardiocentesis. The inpatient service also follows its patients who are referred to cardiac surgery.
Experience in postoperative care of patients undergoing cardiac surgery is also provided by a full month's inpatient service rotation on the Special Care Unit in the second or third year. The rotation is a concentrated experience in the care of ventilator patients and intra and postoperative cardiovascular surgery problems.
Experience in adult congenital heart disease is gained from didactic teaching in a monthly pediatric conference and a month-long inpatient and outpatient rotation. In addition, there is continued exposure through participation in the inpatient care of these patients. Board-certified pediatric cardiologists supervise fellow training and management with respect to adult congenital heart disease. These experiences expose fellows to a wide spectrum of congenital heart disease, including uncorrected and corrected disease in selected adolescent and adult patients.
Cardiology clinics provide experience in the diagnosis and management of outpatients. Fellows see new patients in consultation and follow their own patients by appointment in a supervised office practice setting. The clinic is fully supported by nurse practitioners, dietitians, social workers and secretarial staff. Notes can be dictated or directly entered into a computerized patient management system.
The Cardiology Fellowship Program Director personally supervises outpatient training. 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. Considerable emphasis is placed on preventive cardiology; especially through lifestyle counseling, nutritional assessment, and appropriate pharmacologic therapy.
Over the course of three years, the fellow spends a total of six months on the consult service, seeing patients referred to cardiology from the medical or surgical inpatient services. Fellows generally evaluate three new patients per day and follow 8-15 active consult patients, making daily rounds on these patients with the staff cardiologist. Fellows also assist medical residents in performing procedures, and teach medical residents and students taking elective on the consult service.
Fellows are trained extensively in electrocardiogram interpretation, stress testing, and multi-modality imaging including echocardiography, cardiac CT, cardiac MRI and nuclear cardiology. The division sponsors a biweekly conference for faculty and fellows to review and discuss unusual electrocardiograms. Fellows act as faculty for residents and students in electrocardiogram interpretation course work. Over the course of training fellows are able to progress from direct to indirect faculty supervision for stress testing. Fellow independently supervise approximately 600 studies over the next three years. A responsible faculty member reviews all interpretations. Available stress testing modalities include treadmill, recumbent bicycle and pharmacologic. Stress imaging options include echocardiography, nuclear perfusion and positron emission tomography.
Training in echocardiographic imaging includes a core curriculum and analysis and interpretation of studies. The fellow interprets approximately 400 transthoracic echocardiogram studies during five months of experience over the three years. Expertise in scanning and interpretation develops very quickly. Training in transesophageal echocardiography occurs during the second and third year.
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. Studies in nuclear cardiology are performed and interpreted under the supervision of an attending nuclear cardiologist. A didactic core curriculum is a required component of training.
There is a six-month core requirement in cardiac catheterization for all fellows. Procedure training includes experience with right heart catheterization or placement of Swan Ganz cannulas in over 50 patients, placement of over 20 temporary transvenous pacing wires and a cumulative experience of at least 300 cases of left heart catheterization and coronary angiography. Fellows also assist in the implantation of permanent pacemakers and defibrillators and are trained in the follow-up of pacemaker patients under the supervision of three faculty members trained in electrophysiology. They also participate in EP studies and ablations in the pediatric and adult population. There is a weekly, didactic core curriculum.