Cardiovascular Medicine Fellowship Curriculum

Each fellow in the Cardiovascular Medicine Fellowship program completes 13 four-week rotation blocks per year over three years.

1st Year

2nd Year

3rd Year

Cardiology Continuity Clinic

13

13

13

Inpatient Cardiovascular Medicine Service

0

2 or 3 (Blue Service)

2 or 3 (CV-ICU)

Cardiac Catheterization Laboratory

1.5

2

2 or 3

Echocardiography Laboratory

1.5

1 or 2

3

Nuclear Cardiology/CT/MRI

1

0 or 1

1 or 2

General Cardiology Consults

2

1

0

Arrhythmia Consult/Electrophysiology

1

1

0

VA Medical Center - Kernersville Consult

2

1

0

VA Medical Center - Salisbury Stress Tests

1

1

0

Advanced Heart Failure

1

1

0 or 1

Research

2

2

2

Rotations

Each rotation provides an opportunity for the fellow to be exposed to a variety of clinical settings, consult services and labs. The clinical training is balanced by the opportunity to participate in research and learn from primarily research faculty to build a foundation of excellence for the fellowship experience.

Cardiology Continuity Clinic

Each fellow is assigned a weekly, half-day outpatient clinic in which he or she is the primary cardiologist. One to three new patients, and five to eight established patients are seen per session. An attending cardiologist is assigned as the preceptor to whom all patients are presented for discussion and formulation of diagnostic and therapeutic plans.

Educational purpose: To master the diagnosis, evaluation and treatment of all common cardiovascular disorders in the ambulatory setting.

Inpatient Cardiovascular Medicine Service

Each fellow will rotate through the inpatient service for a total of three months as a first- and second-year fellow. The educational content of this rotation reflects the pathology encountered in a large tertiary hospital with both referral cases and cases admitted directly from the emergency room.

Pathology includes:

  • Coronary artery disease
  • Valvular heart disease
  • Congenital heart disease
  • Cardiac arrhythmias
  • Heart failure
  • Infective endocarditis
  • Peripheral vascular disease
  • Pericardial disease
  • Pulmonary heart disease

Educational purpose: To learn how to diagnose and care for a wide variety of cardiac diseases seen on a general cardiology inpatient service.

CV-ICU

Third-year fellows rotate through the CV-ICU for a total of three months during their third year. This rotation is driven by several parallel educational experiences:

  • Direct patient care
  • Review of diagnostic studies
  • Performing bedside procedures
  • Mentoring house staff and medical students

Educational purpose: To master the evaluation and management of cardiovascular critical care issues in the CV-ICU. Fellows are provided with the cognitive and technical skills necessary to achieve Level 2 (COCATS 2) skills of clinical cardiology in the care of critically ill patients.

Cardiac Catheterization Laboratory

Our cardiac catheterization laboratory specializes in diagnostic and therapeutic interventions for patients with conditions that include:

  • Coronary
  • Vascular
  • Structural heart disease (includes ASD, PFO and TAVR)
  • Advanced heart failure
  • Heart transplant

Each fellow spends seven total months on this rotation during the fellowship and is expected to have performed over 400 catheterizations during that time.

The fellow receives training in all aspects of invasive cardiology, including

  • Right and left heart catheterization
  • Ventriculography
  • Coronary angiography
  • Interpretation of hemodynamic recordings
  • Endomyocardial biopsy
  • Pericardiocentesis
  • Peripheral angiography
  • Acute mechanical circulatory support
  • Percutaneous coronary interventional techniques

Educational purpose: To provide the fellow with the technical and cognitive skills necessary to achieve Level 2 (COCATS 2) of invasive cardiology.

Echocardiography Laboratory

Each fellow spends six to eight months in the echocardiography lab, where over 19,000 transthoracic and over 600 transesophageal echocardiography studies were performed in 2012. This rotation provides intensive exposure to the performance and interpretation of:

  • Transthoracic echocardiography
  • Doppler echocardiography
  • Transesophageal echocardiography
  • Stress echocardiography
  • Tissue Doppler imaging
  • Strain and strain rate imaging
  • 3-D echocardiography

First-year fellows spend substantial time with the hands-on performance of TTE and basic TEE, working with skilled sonographers and faculty. During the second year, the fellow spends increasing amounts of time with more advanced procedures, such as TEE and stress echocardiography, while reading studies with faculty. A third-year fellow is expected to have developed the skills expected of an independent echocardiographer.

By the end of fellowship, a fellow will have personally performed over 50 and interpreted 300 to 600 transthoracic examinations, interpreted more than 150 stress echocardiography studies, and performed over 100 TEE examinations under supervision.

Educational purpose: To master the understanding and performance of transthoracic, transesophageal and stress echocardiography in a system of graduated responsibility.

Nuclear Cardiology/CT/MRI

Fellows will have five to seven months of supervised training in cardiovascular imaging, which will include nuclear, CT and MRI at Wake Forest Baptist Medical Center; with additional nuclear training at the VA Medical Center in Salisbury, NC. In 2012, there were over 450 nuclear, CT, and MRI studies performed at Wake Forest alone.

Fellows participate in:

  • Pretest patient evaluation
  • Supervision of the study
  • Data processing and analysis
  • Study interpretation
  • Clinical report generation

Travel to Salisbury is reimbursed.

Educational purpose: To understand the indications for specific imaging modalities, the safe use of radionuclides, basics of instrumentation, image processing, methods of quality control, image interpretation, integration of risk factors and clinical symptoms, and the appropriate application of the resultant diagnostic information for clinical management. Fellows will have the opportunity to achieve Level 2 (COCATS 2) in nuclear and MRI.

Research

Cardiology fellows will select a yearly project by identifying an interest and faculty mentor. They’ll conduct research throughout the year with dedicated weeks and present their project at the Cardiovascular Medicine Research Conference in the spring.

Training and Consults

General Cardiology Consults

Each fellow will spend two to three months on the consultation service during the first and second years of their fellowship. This rotation is designed to provide the fellow with comprehensive training in the assessment of:

  • Patient symptoms
  • Physical examination findings
  • Selection and interpretation of appropriate tests
  • Development of rational management strategies for inpatients

Educational purpose: To provide fellows with the technical and cognitive skills that are required to achieve independence in the clinical assessment and appropriate management of patients whose primary problem is non-cardiac, but in whom cardiac issues have been identified.

Arrhythmia Consult/Electrophysiology

First and second year cardiology fellows will spend two to three months on the Arrhythmia Consult Service. Fellows will see hospitalized patients with arrhythmias in consultation and follow the patient through the evaluation and treatment of their rhythm problems.

Educational purpose: To learn the indications for temporary and permanent pacing, participate in the evaluation and programming of pacemakers and defibrillators, learn the indications for and limitations of electrophysiology studies, learn the appropriate use of pharmacologic and non-pharmacologic treatments of arrhythmias, and learn the proper and appropriate use of anti-arrhythmic drugs

Advanced Heart Failure

Fellows in this rotation will participate in inpatient care, staff new heart failure consults and observe left ventricular assist device (LVAD) and transplant surgery.

Other Training and Consults

 

At the VA Kernersville location, cardiology fellows will consult on outpatient clinic patients and participate in select procedures and studies. At the VA Salisbury location, cardiology fellows will supervise and write reports on stress tests and interpret nuclear studies.

For a full detailed overview of the curriculum, please download the Cardiovascular Medicine Fellowship Curriculum Overview (PDF).

Conferences and Training

Heart Failure Conference

Monday

7:30 am

Clinical Cardiology

Conference

Monday

4 pm

Imaging (MRI)Conference

Tuesday

7:30 am

Echo Conference

Tuesday

12 pm

Interventional Conference

Wednesday

7 am

Arrhythmia Conference

Thursday

7:30 am

Core Curriculum/Board Review (Journal club once a month)

Thursday

12 pm

Cardiology Grand Rounds/Research Conference

Friday

7:30 am

There is also a monthly program director meeting.