Curriculum Overview

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:

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)