For each four-week block, a cardiovascular disease fellow is assigned different supervising cardiology attending each week to allow for a broad exposure of practice pattern and choices. The fellow serves as a consultant for assigned general medical and surgical consult inpatients with a variety of diagnoses (chest pain, refractory heart failure, management of arrhythmias, preoperative evaluation, and postoperative management of cardiac disorders). They also serve as primary admitting service for a portion of the patients. Expected daily census is approximately 15 patients (5 new consults; 10-15 follow-ups).
Coronary Care Unit
Cardiovascular fellows supervise the resident team in the Coronary Care Unit (CCU). They are assigned to follow an average of 8-12 teaching patients with myocardial infarction, unstable angina, arrhythmias, pericardial diseases, valve disease and heart failure. Dedicated CICU faculty rounds. In conjunction with CICU faculty, rounding with cardiovascular surgical team and providing team-based post op care. High acuity service with mechanical support and shock patients.
Peripheral vascular disease
Fellows work one-on-one with attending cardiologists with special knowledge and expertise in peripheral vascular disease and follow patients in a consultative, advisory capacity. Fellows perform and interpret Doppler arterial studies (carotid and extremity) and duplex ultrasound studies of lower extremities.
A minimum of four rotations is required, usually with one, or a maximum of two, fellows per four-week rotation. Responsibilities include performance and interpretation of echocardiographic studies, performance of transthoracic and transesophageal echoes and supervision of treadmill and dobutamine echoes.
Outpatient and inpatient electrophysiology consults include programming and follow-up surveillance of pacemakers, evaluation of patients with unexplained syncope or arrhythmias, and evaluation of patients with heart failure who require prophylactic placement of an ICD and/or biventricular pacemakers. Fellows will be supervised in the performance of electrical conversion, temporary pacemaker insertion and device follow-ups.
Nuclear cardiology/stress tests/ECG
During the three-month nuclear medicine rotation, cardiovascular disease fellows have the opportunity to interpret 10-15 myocardial imaging studies per day. They are supervised in the performance and/or interpretation of studies that include radionuclide stress tests; ECG; exercise and pharmacologic stress testing; cardiolite imaging and MUGA.
Cardiac catheterization laboratory
During Cardiac Catheterization rotations, fellows perform four to six catheterizations per day. Supervised incremental experience will cover both left and right heart catheterizations. Fellows will also receive an introduction to PCI and other procedures such as PFO closure, TAVR, Impella, FFR and Watchman. ChristianaCare has five busy catheterization laboratories on campus. At any one time, there usually will be only one fellow (and a maximum of two) assigned to the Cath Lab. This will insure that fellows will be readily able to achieve the required minimum of 100 right and left heart catheterizations, and most certainly many more.
Cardiac rehabilitation/preventive medicine/screening
This two-week rotation offers the opportunity to work one-on-one with the director of cardiac rehabilitation and with a designated cardiologist who has special interest and expertise in lipid disorders.
Fellows spend two weeks working with an attending cardiologist or radiologist with additional training in Cardiac MRI and CT. At the conclusion of the rotation, fellows will have knowledge of the role of cardiac MRI and CT in the diagnosis of cardiovascular disease.
Congenital heart disease
Each fellow spends four weeks on the Congenital Heart Disease rotation at Alfred I. duPont Hospital for Children. Two weeks are spent in the outpatient clinic where the fellow will examine patients (ages 16-21 and younger) with congenital heart diseases, both preoperatively and postoperatively, as well as those in long-term follow-up. Fellows also rotate one week in the Pediatric Cardiac/Cardiovascular Surgery Unit, and one week in the Intermediate Care Unit.
Outpatient continuity experience
Fellows’ outpatient continuity clinic is a set half day a week for all three years of their training with a panel of patients, both acquired from graduating fellows and accrued from inpatient experience/rotations. Cardiology attendings are present for supervision and co-management. Longitudinal care and decisions are the primary responsibility of the fellow with faculty supervision.
The three-year cardiovascular medicine fellowship includes didactic training (lectures, conferences, class work, assigned study, etc.) and clinical experience that is carefully structured to provide a balance between inpatient and outpatient management.
Required rotations are Consult, Coronary Care/Intermediate Care, Cardiac Catheterization, Nuclear Cardiology, Echocardiography, Electrophysiology, Peripheral Vascular Disease, Cardiac Rehabilitation/ Preventive Cardiology, Congenital Heart Disease and Research.
The program is structured to offer a maximum degree of flexibility to allow fellows to pursue either clinical or research areas of interest. Each fellow will have the opportunity to do electives in all required rotations, as well as in interventional catheterization and MICU. The program supports up to two away electives, guided by ACGME requirements, which may include a Cardiac Transplant rotation.
Throughout the course of their training, cardiovascular disease fellows are supervised by designated cardiovascular disease attendings during all education experiences. Performance evaluations cover patient care, medical knowledge, practice-based learning, systems based practice, professionalism, and interpersonal communication. Although all fellows are required and are given ample opportunity to achieve and show competence in the procedures specified by the RRC Program Requirements, the large number of electives ensures that fellows have the opportunity, if they so desire, to achieve the numbers specified for Level 2 certification in some areas, as described in the ACC Revised Recommendations for Training in Adult Cardiovascular Medicine Core Cardiology Training II (COCATS 4).