Curriculum Overview
Clinical Training and Mentorship
Learn first-hand about the Clinical Training and Mentorship of the Cardiovascular Medicine Fellowship program.Harry Hicklin
We may spend a month on heart failure, treating LVAD and transplant patients, and then the next month, we're rotating on the Cardiology ward services teaching the residents and treating bread and butter heart failure exacerbations with the medical students and the residents. Additionally, we do the routine stuff that most any fellowship will do, cath, echo, rotating on CVICU. But we also have time to do lots of non-invasive imaging such as CT, MRI. Most all of our fellows now are becoming COCATS 2 in nuclear training. So, if you want to do something, it's available here.
Jonathan Mayl
Coming out with the competency, the skillset you need to succeed in private practice or academics, you couldn't ask for really a better setup.
Jordan Tannenbaum
It's really important to also have the infrastructure in the program to be able to feel supported, to feel challenged, and to be part of a team. And I think that Wake Forest has done a great job with that. We have a great group of fellows that I've become really close with.
Taylor Nipp
A lot of the difficulty of being a first year fellow is just the mechanics of the hospital, how to get things done. And I know from day one that there were upper level fellows who were really, I felt like, watching me, making sure that I was doing things correctly, and able to lend a guiding hand. So professionally, there's a ton of comradery.
Garrett Snipes
You've got a wonderful relationship with your faculty members, you've got opportunities to grow, to tailor your interests and training. So really, it's been a wonderful year.
Harry Hicklin
What I really cherish about the program is the fellowship leadership's willingness to make changes, listen to fellows, listen to fellow's feedback about conferences and rotations, and really be always willing to implement changes wherever they see appropriate.
Jonathan Mayl
When you're on call, you have plenty of support. Attendants are always ready and end at the helm to guide you in any important decision-making you have any doubts about. And that's been a really great benefit of the program.
Taylor Nipp
You always want to feel like you've got backup, especially as a trainee, when sometimes you'll find your back against the wall a little bit. And it's good to know that the attending that's backing you up is always there to take your call and help you when you need help.
Garrett Snipes
Well, it's hard to say what my one favorite part about Winston-Salem is. It's really an incredible city.
Jordan Tannenbaum
I feel like every week there's a newsletter and there are 15 things to do. So, even though it's a relatively smaller city, we never feel like we're bored. It's a place that you can actually lead a full life outside of the hospital, and I really appreciate that.
Harry Hicklin
I can say that I've seen Winston-Salem change after being here for five years, many more restaurants, many more breweries. And if there's not something in Winston-Salem, then Greensboro is a half hour, and Charlotte's an hour and a half.
Jonathan Mayl
As far as a well-rounded fellow goes, this program really does give you the skills and competency to come out, be confident in your decision-making, and have the tools in your toolbox necessary to treat complex cardiac disease, and feel confident, and comfortable, and safe doing so.
Rotational Structure
Each fellow in the Cardiovascular Medicine Fellowship program completes 13 four-week rotation blocks per year over three years. We aim to provide robust clinical training to enable all graduates to excel in their chosen field. Below is the approximate breakdown of rotations by year of fellowship.
Individuals' rotations may vary based on interests and desired COCATS levels of training.
VA | Cath | Inpatient wards | Research | Echo |
VAS | EP consults | General consults | HF | General |
Our academic year is divided into 13 four-week blocks. An example of a typical first year fellow’s schedule is shown below. All fellows have two research blocks each year. However, fellows in the T-32 research program have 6 blocks of research during the first clinical year. The second year is very similar to the first year, but usually with only 2 months of consults, 1 month of heart failure and additional echo and cath lab time. Third year fellows have at least 2 months of imaging (CT and MRI) with the option to achieve COCATS level 2 and elective time in addition to research time.
1st year |
2nd year |
3rd year |
|
Outpatient Cardiology Clinic |
weekly |
weekly |
weekly |
Inpatient Cardiovascular Medicine |
1-2 (Ward) |
1 (Ward) |
2-3 (CVICU) |
Cardiac Catheterization Laboratory |
1 |
2-3 |
2-3 |
Nuclear Cardiology (VA) |
2-3 |
2 |
0 |
Echocardiography Laboratory |
1-2 |
2-3 |
3-3 |
CT-MRI |
0 |
0 |
2-3 |
General Cardiology Consults |
1-2 |
1 |
0 |
Arrhythmia Consults |
1-2 |
1 |
0 |
Advanced Heart Failure/Transplant |
1-2 |
1 |
0 |
Research/Elective |
2 |
2 |
3 |
Call Overview
Call is covered by first and second year fellows. Overnight call in our fellowship program is on a 24 hour or 24+4 hour (weekends) system. Call on Monday through Friday nights begins at 5 p.m. and lasts until 8 a.m. the following morning. Saturday and Sunday call begins at 8 a.m. and lasts until 8 a.m. the following morning. On Saturday and Sunday mornings, the post-call fellow rounds with either the CV-ICU or cardiology floor team and is finished no later than 11 a.m. We have recently implemented a change to post-call days during the week; the post-call fellow is relieved of all duties at noon on the post-call day and their pager is handed off to a fellow on a consult rotation. Additionally, the post-call fellow does not have afternoon clinic. This has been particularly well received by everyone.
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 research opportunities, in addition to clinical rotations.
Cardiology Continuity Clinic
Each fellow is assigned a weekly, half-day outpatient clinic in which he or she is the primary cardiologist. 1 to 3 new patients and 3 to 5 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.
Wake Forest Cardiology clinic sites include:
- Country Club Road* (Winston-Salem)
- Janeway Tower* (Winston-Salem, Main Campus)
- Davie Medical Center
- Elkin, NC
- High Point, NC
- Lexington, NC
- Wilkesboro, NC
*Fellow clinic locations
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 2 to 3 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 II).
Cardiac Catheterization Laboratory
Wake Forest Baptist’s cardiac catheterization laboratory specializes in diagnostic and therapeutic interventions for patients with conditions that include:
- Coronary artery disease
- Peripheral vascular disease
- Valvular heart disease
- Structural heart disease interventions (includes ASD, PFO and TAVR)
- Advanced heart failure and cardiac transplantation
- Pulmonary Embolism
We take pride in our high clinical volumes. In 2022, our catheterization lab performed over 3,300 diagnostic catheterizations, approximately 1,700 PCI and mechanical support device insertions, and over 400 structural interventions (TAVR, MitraClip, PFO/ASD closure, left atrial appendage closure). We perform cutting-edge interventional procedures including catheter-directed therapies for pulmonary embolism, aortic interventions and Angiovac for endocarditis. The general fellow spends approximately 6 to 7 total months on this rotation during the fellowship and is expected to have performed over 400 diagnostic catheterizations during that time. The fellow receives training on the performance, interpretation and indications of 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 COCATS level II in invasive cardiology.
Echocardiography Laboratory
Each fellow spends 6 to 8 months in the echocardiography lab, where over 33,000 transthoracic and over 1,300 transesophageal echocardiography studies were performed in 2022. This rotation provides intensive exposure to the performance and interpretation of:
- Transthoracic echocardiography
- Doppler echocardiography
- Transesophageal echocardiography
- Stress echocardiography
- Tissue Doppler imaging
- Strain imaging
- 3-D echocardiography
- Contrast echocardiography
- Congenital echocardiography
First year fellows spend most of their time in the echocardiography lab performing and interpreting transthoracic echocardiograms, 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 and further hone advanced imaging skills such as structural TEE in support of interventional procedures such as MitraClip and TAVR. By the end of fellowship, a fellow will have personally performed over 150 and interpreted 600-1000 transthoracic examinations, interpreted more than 150 stress echocardiography studies and performed over 150 TEE examinations under faculty supervision. Because we do not have an advanced imaging fellow, the general fellows perform a high volume of TEEs.
Educational purpose: To master the understanding and performance of transthoracic, transesophageal and stress echocardiography in a system of graduated responsibility meeting COCATS Level II requirements for echocardiography and preparing the fellow to sit for echocardiography boards if desired.
Imaging (Nuclear Cardiology/CT/MRI)
Fellows will have 5 to 7 months of supervised training in cardiovascular imaging, which will include CT and MRI at Atrium Health Wake Forest Baptist Medical Center, as well as nuclear cardiology training at the VA Medical Centers in Kernersville and Salisbury, NC. Our program is one of the few programs that enables fellows to achieve COCATS level II CT training within a two-year training span. Beginning with the 2023 graduating class, the fellowship gives the opportunity for fellows to achieve COCATS level II in CT, so that fellows pursuing Interventional and EP fellowships can graduate with level II training if so desired.
Fellows participate in:
- Pretest patient evaluation
- Supervision of the study
- Data processing and analysis
- Study interpretation
- Clinical report generation
Nuclear: In addition to Cadmium Zinc Telluride (CZT) cameras, most systems are equipped with CT attenuation, including both VA locations. At the main campus, myocardial PET perfusion is also available. Fellows typically meet their requirements within 3 to 4 months at the VA. Didactic lectures are given by both VA faculty and Dr. Madigan from the Wake Forest Cardiology section.
Cardiac CT: At Wake Forest Baptist, we use both Dual Source 128- slice FLASH (Siemens) and 256 row Revolution (GE) systems. These systems have access to multiple image processing software programs (GE AW server, Siemens Syngo Via, TeraRecon). Remote access is also available. Fractional Flow Reserve (FFR) CT will be available beginning Fall 2023.
Cardiac MRI: A Siemens 1.5T scanner is available with an entire package of T2/T1 mapping sequences. Image processing systems include Circle and Webpax. A research agreement with Siemens is in process and access to dark blood sequences along with improved delayed enhancement sequences in patients with implanted devices will soon be available.
CT/MRI | Echo | Structural Echo Core | Nuclear |
Dr. Brandon Stacey | Dr. Karl Richardson | Dr. Karl Richardson | Dr. Karl Richardson (VA) |
Dr. Suji Vasu | Dr. Brandon Stacey | Dr. Suji Vasu | Dr. Michael Madigan |
Dr. Yashu Pokharel | Dr. Dalane Kitzman | Dr. Carolyn Park | |
Dr. Carolyn Part | Dr. Suji Vasu | ||
Dr. Joseph Yeboah | |||
Dr. Octavia Rangel | |||
Dr. Carolyn Park | |||
Dr. Michael Madigan |
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 in nuclear and MRI.
Research
Cardiology fellows will select a project by identifying an interest and will then select a faculty mentor. There are 6 months of protected research time during the fellowship. Fellows will present their research at the Cardiovascular Medicine Research Conference in the spring. Please see our “Research and Academics” page for further details.
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 Consults/Electrophysiology
General cardiology fellows will spend 2 to 3 months on the Arrhythmia Consult Service. Fellows evaluate and treat patients with a wide variety of arrhythmia/EP pathology, including diagnosis and treatment of atrial and ventricular arrhythmias, need for temporary and permanent pacing, ICDs, cardiac resynchronization therapy and much more. Fellows are also invited to participate in EP lab procedures. During the 2022 fiscal year, our EP lab implanted over 700 pacemakers and ICDs, performed over 160 laser lead extractions and performed approximately 1,150 ablations (SVT, VT/PVC, and atrial fibrillation).
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, and learn the appropriate use of pharmacologic and non-pharmacologic treatments of arrhythmias.
Advanced Heart Failure/VAD/Transplant
Fellows on this service will assist in management of a wide variety of patients including those with LVAD, cardiac transplantation, percutaneous mechanical support, cardiogenic shock, inotropic therapy, adult congenital heart disease, cardiac amyloid and pulmonary hypertension. We work closely with cardiac surgery and critical care anesthesia to ensure optimal multidisciplinary care for these complex patients. The fellow will also participate in didactic sessions and VAD/Transplant selection committee meetings.
Educational Purpose: To acquire skills in the medical management of patients with advanced heart failure and cardiogenic shock. The fellow will have the appropriate training to become a competitive applicant to match for an advanced fellowship in heart failure and transplant cardiology.
VA Rotation
Fellows spend time at the Kernersville, NC, VA Health Care Center and the Salisbury, NC, VA Medical Center during their first and second years. The Kernersville VA Health Care Center is a unique VA facility. In addition to having an active outpatient cardiology clinic, this location has an outpatient cardiac catheterization laboratory, an EP lab, and a busy device clinic in addition to facilities for echocardiography, exercise stress testing and nuclear stress testing. At the VA Kernersville location, cardiology fellows will perform and interpret nuclear cardiology studies. Additionally, the fellow will assist with consults in the clinic and participate in outpatient diagnostic cardiac catheterization procedures, TEE and cardioversions. At the VA Salisbury location, fellows will perform and interpret nuclear cardiology studies as noted above.
Kernersville VA Weekly Schedule:
Monday | Tuesday | Wednesday | Thursday | Friday |
Morning: Clinic or echo or EKG reading |
Morning: Cath lab or EP lab or EP clinic (depends on schedule |
Morning: Cath lab |
Morning: EP lab or EP clinic (depends on schedule) |
Fellow's clinic |
Afternoon: Device clinic (Learn interrogation, programming, other) |
Afternoon: Nuclear stress reading |
Afternoon: Nuclear stress reading |
Afternoon: Noon- Nuclear case review conference (once/block) Nuclear stress reading |
Afternoon: Fellow's clinic |
Electives:
Fellows are welcome to allocate an elective during their third year to develop proficiency in specific skills, such as EP lab or additional imaging.
Volumes in each subsection:
Cath Lab |
EP Lab |
Imaging (Echo/Stress Lab, CT, MRI) |
Diagnostic: 3,400
PCI: 1,700 Watchman: 21 |
Ablations (SVT, VT, AF, etc.): 1,150
EP study: 250 ICD: 200 Lead extraction: 170 Watchman: 85 Other (cardioversions, etc.): 1,000 |
TTE: 33,500 TEE: 1,300 (including ~300 structural) Stress tests: 3,300 Nuclear at VA: 1,500 Nuclear at Main campus: 1,000 Cardiac CT: 1,060 Cardiac MRI: 780 |
Conference | Brief Description |
Clinical Cardiology (weekly) | Case-based presentation and discussion with faculty and fellows on a core clinical cardiology topic chosen and presented by the fellow |
Imaging (CT-MRI) (weekly) | Case-based conference covering topics relevant to multimodality imaging |
Echocardiography (weekly) | Didactic lectures and case discussions on topics pertaining to echocardiography and valvular heart disease |
Nuclear (monthly) | Didactic lectures and SPECT-MPI, PET case discussions |
Interventional (weekly) | Case-based presentation and discussion with faculty |
EP Conference (weekly) | Review of intracardiac electrograms and device reports (Presented by EP fellows; general fellows invited as well) |
ECG Conference (weekly) | Arrhythmia consult fellow presents ECGs from the consult service for interpretation with EP faculty |
Board Review (monthly) | Group board review session faculty preceptor |
Journal Club (monthly) | Fellow presents new literature for group discussion |
Valve (monthly Sept-Feb) | Didactic lectures and board review questions on the most important valvular cardiology topics |
Congenital (monthly) | Didactic lectures and case review with congenital heart disease faculty |
Ground Rounds/Research Conference (weekly, Sept-June) | Fellow, faculty and visiting professors present their research for discussion and feedback |
Spotlight on Heart Failure
Learn more about the scope of advanced heart failure and transplant at Wake Forest, see what you might experience as a fellow here at Wake Forest, and meet our advanced heart failure faculty and their varied clinical interests.Spotlight on Multimodality Imaging
Hear from our cardiovascular imaging faculty about the strength and breadth of multimodality imaging program at Wake Forest.Joseph Yeboah
... cardiovascular disease, and in anything, it's a form of apprenticeship. The more you see, the more you are thought what it is, the more you are able to practice on your own.
Carolyn Park
Imaging is fundamental to cardiology. What we do really depends on what we see in the heart, and what we don't see, and nowadays there's so many different modalities and different ways to visualize a heart.
Octavia Rangel
There is never a dull moment, and we're always bringing up, "Oh, so this patient also had a cardiac MRI and this is what we saw," or, "This patient had a CT scan," or compliment what we had seen in a TEE with the CT images, and having that going on live and that interaction between trainees and faculty is something that I really thrive on, and has been like that during my training and now as an attending.
Karl Richardson
The program can kind of both build this opportunity for strong mentorship and a career direction, whether that's in echo, whether you want to explore level three an interventional echo, or you wanted to go into EP and you want to spend time in the EP lab.
Sujethra Vasu
Our multimodality imaging program is a key pillar of strength for our fellowship training. Our fellows are able to get comprehensive level two training in all four modalities: echo, nuclear, cardiac MRI, and CT, thanks to our robust interventional and EP programs. The incredible volume of the imaging program puts our fellows in a position to be very proficient at the end of the second year in modalities like echo and nuclear. Consequently, when they start that third year, when they start doing cardiac CT and MR, they're able to develop a robust cross-modality correlation and a nuanced understanding of cardiac structure and function.
Carolyn Park
The vibe of the teamwork and just being able to be open, being able to rely on people, I think is unparalleled in terms of when I compare to other places that I've been at. I think Wake Forest really has something special, and especially in its imaging group.
Mahesh Chandrasekhar
I had an interest in a type of imaging called structural imaging, and many programs don't necessarily have that. There was a gentleman named Karl Richardson, who allowed me to really investigate things from a research side, and get more clinical expertise. Honestly, anything in imaging that you want to do at Wake Forest, you'll have the opportunity to do it.
Carolyn Park
I was very fortunate to be allowed to do an extra year of advanced imaging. We were allowed to go down to our sister campus at Charlotte, Sanger Heart and Vascular, and worked with some of the pioneers in the field: Marcus Shearer in CT, Dr. Mike Elliott in MRI, and I got to process things and work with high-end technologies that are probably the top of cutting edge in terms of what we can do for heart disease and heart imaging.
Karl Richardson
It's important for general cardiology fellows and those interested in imaging to gain experience with structural imaging because this will be a crucial piece of the future of multimodality imaging. Using not just CT, MRI and echo to understand structural abnormalities, the fellows also need to learn to use TEE to guide structural interventions, because this is becoming an increasingly crucial piece of cardiac interventions. So one of the cool opportunities for fellows that are interested in imaging at Wake Forest is the chance to come with me to the cath lab, or with one of our other advanced echocardiographers to the cath lab to do procedural imaging.
Joseph Yeboah
Imaging is the bread and butter of cardiovascular disease. It is an extension of the patient examination. Because without imaging, a lot of things will be missed, and most of the treatment is based on imaging. So a very broad and a very sound imaging background is always needed by any cardiac fellow or any cardiologist. Without that, you don't know what you're dealing with, and so it's very important.
Sujethra Vasu
You're well poised to tackle challenging structural cases within cardiac CT and MR. For me, it's a point of pride to see the evolution and to see how they translate their echo skills to become better CT imagers, and then to use their cross-modality knowledge from CT and MR to tackle structural and complex 3D TEEs as well. Beyond the structural space, our fellows will also have access to cardiac CTFFR, and given our robust heart failure program, they have a lot of access to challenging cardiac MRIs as well. And one of the key strengths of our program beyond the volumes are our dedicated faculty. Every single imaging faculty member is cross-modality trained, and this year we will have, for the first time in our institution, our fellows will have access to myocardial PET as well.
Joseph Yeboah
Our faculty is approachable. We are all in it together.
Octavia Rangel
It's a very collegial and good environment to work. We support each other and we share our knowledge with each other, and also learn.
Joseph Yeboah
You can meet me anywhere you want and can ask me any question or show me any imaging modality that I can explain to you, and then teach you what you need to know about.
Research Curriculum
Trainees develop skills in the critical assessment and interpretation of the scientific literature during didactic sessions with faculty including our journal clubs, research conference, and clinical cardiology conference. Approximately 6 months of the general cardiology fellowship consists of protected research time where the fellow is not assigned to another clinical rotation. Each fellow will present their research at Cardiology Grand Rounds. On the inpatient cardiology services, the fellow will develop skills teaching students and residents under the supervision of faculty. Please see faculty profiles for further details on faculty clinical and academic interests.Fellows planning a career as physician-scientists are encouraged to apply to our 4-year combined clinical and research program which includes a Masters Degree in Clinical and Population Translational Science. This program is funded by a NIH/NHLBI T32 research training grant. Please see the Cardiovascular Research Fellowship program for further details on the application process.
Research Mentorship
Learn more about how research mentorship plays a large roll in the Cardiovascular Fellowship program here at Wake ForestSpotlight on Prevention
Dr. Michael Shapiro and other faculty discuss the new Center for Preventive Cardiology and unique clinical and academic opportunities for our section and our cardiology fellows.Attendance at Cardiovascular Meetings
Fellows will receive departmental funding to attend one out-of-town meeting per year and the program arranges coverage for the AHA or ACC scientific sessions. Many fellows also present their work and participate in other meetings, such as:
- Regional ACC meeting (alternately held in Asheville, NC and Kiawah, SC)
- ACC CV Summit
- Edwards TAVR
- Epidemiology and Prevention of Cardiovascular Diseases and Stroke Tahoe (T-32 fellows only)
- HRS
- SCAI
- Southeast EP
In addition to a travel stipend, section funding also extends to the following supplementary educational resources:
- ACCSAP
- American Society of Nuclear Cardiology (ASNC) Board Review
- Mayo Clinic General Cardiology Board Review Course (3rd-year)
- EKG Board Review Resources
- Others
Learn more about highlighted current projects and research publications on our fellows’ profiles.