Curriculum Overview
Clinical Training and Mentorship
Learn first-hand about the Clinical Training and Mentorship of the Cardiovascular Medicine Fellowship program.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.
1st year | 2nd year | 3rd year | |
Cardiology Continuity Clinic | weekly | weekly | weekly |
Inpatient Cardiovascular Medicine | 1-2 (Ward) | 1 (Ward) | 2-3 (CCU) |
Cardiac Catheterization Laboratory | 1.5 | 2 | 2-3 |
Nuclear Cardiology (VA) | 2 | 2 | 0 |
Echocardiography Laboratory | 1.5 | 2 | 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 | 2-3 |
Each rotation provides an opportunity for the fellow to be exposed to a variety of clinical settings, consult services andlabs. The clinical training is balanced by the opportunity to participate in research and learn from primarily researchfaculty 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
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 volume. In 2019, our catherization lab performed over 3000 diagnostic cases, over 1100 PCI and mechanical support device insertions, and over 250 structural interventions (TAVR, MitraClip, PFO/ASD closure, left atrial appendage closure). We perform cutting-edge interventional procedures including catheter-directed therapy for pulmonary embolism, aortic interventions, and Angiovac for endocarditis. The general fellow spends approximately 6-7 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 six to eight months in the echocardiography lab, where over 35,000 TTE and 1000 TEE examinations were performed in 2019. 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 substantial time with the hands-on performance of TTE and 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 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. For fellows with an interest in adult congenital heart disease, we have two board-certified faculty to supervise additional training in adult congenital echocardiography.
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.
Nuclear Cardiology/CT/MRI
Fellows will have five to seven months of supervised training in cardiovascular imaging, which will include CT and MRI at Wake Forest Baptist Medical Center; with additional nuclear training at the VA Medical Centers in Kernersville and Salisbury, NC. Additionally dedicated didactics and reading sessions will be held at the Wake Forest Campus. Over 1500 nuclear cardiology studies are performed at the VA. Over 1000 cardiac CT and 700 cardiac MRI are performed at Wake Forest each year.
Fellows participate in:
- Pretest patient evaluation
- Supervision of the study
- Data processing and analysis
- Study interpretation
- Clinical report generation
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 faculty mentor. There are approximately 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 Consult/Electrophysiology
General 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 condition. Fellows are also invited to participate in EP lab procedures. During the 2019 fiscal year, our EP lab implanted over 650 pacemakers and ICDs, performed over 100 laser lead extractions, and performed approximately 1000 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
At the VA Kernersville location, cardiology fellows will perform and interpret nuclear cardiology studies as noted above. 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, the fellow will perform and interpret nuclear cardiology studies as noted above.
In addition to providing well rounded training in all aspects of general cardiology, several of our faculty practice in niche areas such as cardio-oncology, geriatric cardiology, pulmonary hypertension, HFPEF clinic, preventive cardiology, amyloid clinic, congenital cardiology. In addition to didactic series in these topics, these faculties are open to interested fellows rotating in these clinics to increase clinical exposure to these patient populations.
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).
Volumes in each subsection:
Cath | EP | Imaging | Clinic visits |
Diagnostic:3000 PCI:1100 Structural (TAVR, Mitraclip, PFO, ASD closure):250 | PPM/ICD: 650+ Ablation (SVT, VT, AF, etc): ~1000 Lead extraction:100+ Watchman: 27 | TTE:35,000 TEE:1000 (including ~300 structural) Stress tests:5000 Nuclear at VA: 1560 Nuclear at Main campus: 1040 Cardiac CT: 1060 Cardiac MRI: 780 | 62, 710 |
Monday
- AM Clinical Case conference
Tuesday
- AM: Multimodality Imaging (CT and MRI)
- PM: Multimodality Imaging (Echo)
Wednesday
- AM: Cath Conference EP: Devices and EGM
- PM: Multimodality Imaging (Nuclear, Weeks 2 and 4)
Thursday
- AM: EKG Conference
- PM: Journal Club, Board Review, Special topics (weeks 1,3, and 4)
Friday
- AM: Research Conference
- PM: EKG Board Review (week 1)
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.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 our regional ACC meeting (held in alternate years in Asheville, NC or Kiawah, SC) and other subspecialty meetings such as HRS.
Learn more about highlighted current projects, research publications on our fellows profiles.