Cardiovascular Disease Fellowship

Curriculum

    The Cardiology Fellowship Program at VCU Medical Center and McGuire V.A. Medical Center is a 3 year program designed to provide comprehensive clinical cardiology training, to foster the development of investigative skills in basic science and patient oriented research, and to encourage and facilitate careers in either academic medicine or clinical practice.

    The goals of our clinical training program are to provide ample exposure to the many complex areas within our subspecialty, to teach the principles and practice of consultative cardiology, and to transmit the skills required to properly utilize, perform, and interpret the variety of noninvasive and invasive methods available in cardiovascular medicine.

    The goals of our research program are to assist in the development of research projects, to provide faculty supervision and protected time for investigation, and to guide interested fellows through the initial stages of research career development. 

    Responsibility for the management of the Cardiology Fellowship Program, and for the successful completion of appropriate training for each fellow, resides in the the Division Chief, Dr.Kenneth Ellenbogen, and the Program Director, Dr. Gautham Kalahasty.    Major determinants of the structure of the Fellowship Program are the American Board of Internal Medicine subspecialty requirements for Cardiovascular Disease, and the American College of Cardiology/American Heart Association Bethesda Conference on Adult Cardiology Training.  Additional determinants of program contents include the career plans and special needs of individual fellows, the requirements for adequate clinical exposure to ensure clinical excellence, and the needs of the Fellowship program and the Division of Cardiology.

    Ordinarily, fellows are accepted for combined clinical and research training for a period of three or more years.  However, the backgrounds, previous training, and career plans of our fellows are diverse, and their individual needs may be met by tailoring the fellowship experience. Based upon these factors and the needs of the MCV program, fellows may be accepted for any period of clinical, research, and/or advanced subspecialty training.

    The Fellowship Program includes major involvement at both the VCU Medical Center (VCU) and the McGuire V.A. Medical Center (MVA). In general, about 60% of clinical rotations are at VCU, but this may vary according to sources of funding, institutional needs, and fellows’ preference for specific rotations. The VCU and McGuire MVA faculties are equally involved with, and equally available to, the cardiology fellows. Research opportunities are available at both institutions, which together present broad and complementary clinical and research faculties.

    Tracks

    The complexity of our subspecialty requires extensive experience to ensure clinical excellence.  For this reason, and because it is an ABIM requirement in order to sit for the subspecialty board exam in Cardiovascular Disease, a minimum of 24 months of clinical training will be performed.  In some situations, overall clinical training, and particularly the distribution of clinical rotations, may be modified as appropriate for the previous training and career plans of individual fellows.  Clinical training will include all areas of adult critical care, cardiac catheterization and interventional cardiology, consultative cardiology, electrophysiology and pacemakers, cardiac transplantation, inpatient and outpatient cardiology, and all aspects of noninvasive cardiology.

    Typical Schedule



    Possible electives:

    • Pediatric Cardiology—Institution 1
    • Non-Invasive Vascular Lab—Institution 1
    • Heart Failure—Institution 1
    • EP—Institution 1 or 2
    • Cardiac MR/CT—Institution 1

    Institution Key:
    Institution 1 - Medical College of Virginia Hospitals
    Institution 2 - Hunter Holmes McGuire VA Medical Center (Richmond)

    Rotations

    ACE: The ACE service is the inpatient cardiology service at the VA medical center. The service consists of a fellow, an attending, and 3 or 4 residents. You are responsible for the cardiology patients on the floor as well as in the CCU. The CCU is an open unit at the VA so you will follow the patients until discharge. You also run the consult service with the help of 1 or 2 additional residents. You are on 24 hour call for 6 days at a time. This is the only service that we cover that does not have a night float system. However, there is always a resident at the hospital so you only have to come in overnight if there is an emergency that cannot be handled by the resident.

    CICU: The CICU is a traditional cardiac ICU service. It is a closed unit and you are only responsible for the ICU patients as well as the ICU consults. The service consists of a fellow, an attending, an NP, and 4 residents. There is a night float system in place so the day shifts are from 7a-6p with night float coverage from 6p-7a.

    NF: On night float you are responsible for covering the CCU as well as any ICU consults or urgent general cardiology consults. You also perform any stat echo’s that are needed after 11pm. The service consists of the fellow and 2 residents.

    Consults: The consult service consists of the fellow, an attending, and typically 4-6 residents and medical students. You will be responsible for all non-ICU cardiology consults. You will supervise the residents and medical students as they present to the attending.

    Echo: During the echo rotation you will be taught to perform echocardiograms. You will typically do several echo’s in the morning and early afternoon and then read those echo’s with the attending’s. You will then read the sonographer echo’s with the attending as well.

    EP: While on the EP service you will do the majority of the EP consults. When it gets busy the EP fellows will also help with consults. You are also encouraged to scrub in for any EP cases that you would like. Lastly, you will attend 1 or 2 half day clinics to see EP patients in the outpatient setting.

    HF: Heart failure is usually a 2 block rotation with one week being inpatient and one week being outpatient. The inpatient service consists of the fellow, 2 NPs, and a heart failure attending. The NPs will write the notes and do admissions and discharges and you function as a junior attending. The service is for advanced heart failure patients on inotropic drips or undergoing LVAD/TAH/transplant evaluation. You will also round on all of the VAD patients and attend transplant rounds. The outpatient week consists of seeing the advance heart failure and post-transplant patients in the outpatient setting.

    MRI: The MRI rotation consists of reviewing all of the cardiac MRIs with Dr. Grizzard. We also have an extensive electronic database with teaching cases that you will review while on MRI.

    Peds: While on the pediatric rotation you will work with the pediatric cardiology fellows and attending’s. You will see inpatient consults and work in the outpatient pediatric cardiology clinic. While in the clinic you will see mostly adult patients with congenital cardiac disorders. You will also become familiar with many of the congenital surgeries and repair techniques.

    Research: You will have approximately 12 weeks of dedicated research time during your second year of fellowship. You will also have significant amount of elective time your third year that can be used for further research. We have robust research opportunities at VCU. Many of our fellows work with our primary investigators on ongoing projects but you also have the support to create your own bench or clinical projects.

    Stress: During the stress rotation you spend the mornings at the VA medical center and the afternoons at VCU. It is only about a 10 minute drive so going back and forth is not an issue. You will be responsible for supervising the stress tests at both locations. The VA does mostly stress echo’s and VCU does primarily stress nuclear’s so you will have plenty of experience with both imaging modalities.

    TEE: During the TEE rotation you will be responsible for performing the TEEs at VCU. You will perform and read about 4-5 TEEs daily while on the rotation.

    Team B: Team B is the inpatient cardiology rotation at VCU. The team consists of one fellow, an attending and 2-3 NPs. The NPs do the admissions and discharges. Your role is that of a junior attending and you will be responsible for the day to day management of the patients. There is a hospitalist service that manages the low level chest pain rule outs at VCU which allows the Team B service to care for the higher level cardiac patients.

    VA cath: Second and third year fellows do their cardiac cath rotations at the VA.

    VCU cath: First year fellows do their cardiac cath rotations at VCU.

    Conferences

    Fellows are required to attend all conferences.

      EKG Conference
      Cath Conference
      CICU Conference
      Echo Conference
      Heart Failure Conference
      Journal Club
      Ground Rounds

    Unique Learning Opportunities

    Other important components of the clinical training program include instruction in ECG interpretation, and participation in cardiology ambulatory care clinics. ECG training occurs as part of the Cardiology Consultation rotations and by means of biweekly ECG reading sessions with cardiology faculty members.

    All fellows attend Cardiology Clinic one-half day per week. First year fellows have clinic at VCU and second and third year fellows have clinic at MVA.