| || 1st Year||2nd Year||3rd Year||Total to Complete|
| Rotation (4-week blocks)|
|VA / Nuclear||1||1||0||2|
|Arrhythmia / EP||1||1||0||2|
|CHF / Transplant||1||1||0||2|
| || || || || |
CARDIOLOGY CONTINUITY CLINIC
Fellows are assigned a weekly, half-day outpatient clinic in which he/she is the primary cardiologist. One to 3 new patients and 5 to 8 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 GENERAL CARDIOLOGY SERVICE ("FELLOW-PA SERVICE")
Each fellow will rotate through the inpatient service for a total of 3 months as a first- and second- year fellow. The educational content of this rotation will reflect 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, and pulmonary heart disease.
Educational Purpose: Fellows will learn the diagnosis and care of a wide variety of cardiac diseases seen on a general cardiology inpatient service.
CORONARY CARE UNIT (CCU)
Third-year fellows rotate through the CCU for a total of 3 months during his/her third year. This rotation is driven by several parallel educational experiences: direct patient care, review of diagnostic studies, performing bedside procedures, and mentoring house staff and medical students.
Educational Purpose: Third-year fellows will master the evaluation and management of cardiovascular critical care issues in the CCU. 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 coronary, vascular, structural heart disease (includes ASD, PFO, and TAVR), advanced heart failure, and heart transplant patients. In 2012, over 2600 diagnostic catheterizations, 800 coronary interventions, and 150 endomyocardial biopsies were performed. Since April of 2011, we have also performed more than 50 TAVRs. Our team is also heavily involved in research with an ongoing procedural and outcome database, participation in 17 DES clinical trials since 2001, and over 20 publications in the past 3 years.
Each fellow will spend 7 total months on this rotation during the fellowship, and is expected to have performed over 400 catheterizations during the fellowship. 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, and percutaneous coronary interventional techniques.
Educational Purpose: The ultimate goal of the cardiac catheterization laboratory rotation is to provide the fellow with the technical and cognitive skills necessary to achieve Level 2 (COCATS 2) of invasive cardiology.
Each fellow will spend 6 to 8 months in the echocardiography lab, where over 19,000 transthoracic and over 600 transesophageal echocardiography studies were performed in 2012. This rotation provides intense exposure to the performance and interpretation of TTE, Doppler echocardiography, TEE, stress echocardiography, in addition to emerging technologies such as tissue Doppler imaging, strain and strain rate imaging, and 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: Each fellow will master the understanding and performance of transthoracic, transesophageal, and stress echocardiography in a system of graduated responsibility as he/she rotates through the echocardiography laboratory in the clinical fellowship years.
Fellows will have 5-7 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 the pretest patient evaluation, supervision of the study, data processing and analysis, study interpretation, and clinical report generation. Travel to Salisbury is reimbursed.
Educational Purpose: Training provides an understanding of the indications for specific imaging modalities, the safe use of radionuclides, basics of instrumentation and 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 during fellowship.
GENERAL CARDIOLOGY CONSULTS
Each fellow will spend 2-3 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 assessment of patient's symptoms, physical examination findings, selection and interpretation of appropriate tests, and development of rational management strategies for inpatients.
Educational Purpose: Provide fellows with training and the technical and cognitive skills which are required to achieve independence in clinical assessment and appropriate management of patients whose primary problem is non-cardiac but in whom cardiac issues have been identified.
First- and second-year cardiology fellows will spend 2-3 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: Fellows will 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 EP studies, the appropriate use of pharmacologic and non-pharmacologic treatments of arrhythmias, the proper and appropriate use of anti-arrhythmic drugs.