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.
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, iFR, FFR, IVUS 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 ensure that fellows will be readily able to achieve the required minimum of 100 right and left heart catheterizations, and most certainly many more.
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.