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Cardiovascular Fellowship Curriculum

New York Methodist Hospital Cardiovascular Disease Fellowship Program is a three-year ACGME accredited training program that provides a rigorous academic and clinical experience in various areas of cardiovascular disease. The curriculum of fellowship training is in full compliance with ACGME requirements as described in 2008 Task Force 1: Training in Clinical Cardiology Statement.

CONTENT:

Coronary Care Unit and Telemetry
During this rotation fellows begin to understand the pathophysiology, diagnosis and treatment of the basic cardiac conditions such as acute coronary syndromes, medically-refractory ischemia, decompensated heart failure and cardiogenic shock, tachy- and bradyarrhythmias, as well as patients with various hemodynamic instabilities. In addition to perfecting their physical examination skills, fellows become proficient in performing insertion and interpretation of Swan-Ganz catheters, temporary transvenous pacemakers, arterial line placement and intra-aortic balloon counterpulsation. They also lead the team of medical residents and students in directing patients’ care and overall management of patients from admission to discharge.
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Consult Service
The consultation service at New York Methodist Hospital provides an ample opportunity for the fellows to be involved in the care of patients with an extraordinary diversity of cardiovascular diseases. During this rotation the fellows will not only develop the medical knowledge base and cognitive abilities necessary to offer the diagnostic and management support, but master basic skills required for effective consultation as well. These include the ability to determine the question being asked, communicate effectively with the requesting physician, make specific and accurate recommendations, define contingency plans, offer appropriate educational information and, when appropriate, provide follow-up care.
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Catheterization Lab
New York Methodist Hospital has a very active cardiac catheterization laboratory, which consists of 4 adult catheterization suites equipped with state-of-the-art digital x-ray systems. Each year, over 3500 diagnostic angiograms and 1500 interventional procedures are performed. The procedures offered include diagnostic left and right heart catheterizations with coronary angiography, balloon angioplasty, coronary stent placement, various atherectomy procedures, and structural and valvular heart disease repair. All complex revascularization procedures, including primary PCI for STEMI, unprotected left main coronary stenting and chronic total occlusion recanalization are performed on routine basis, with or without ventricular assist devices, such as intra-aortic balloon counterpulsation or the Impella. Patients are evaluated for pulmonary arterial hypertension and are studied for response to therapeutic agents. Fellows become proficient in pre- and post-catheterization management, arterial cannulation, performance of right heart and left heart catheterizations with coronary angiograms, advanced image interpretation including bypass grafts, understanding of coronary physiology using fractional flow reserve, intravascular ultrasound and OCT. New York Methodist fellows participate in the cardiac catheterization laboratory at Interfaith Medical Center, which performs the largest volume of catheterizations via the radial approach. In addition, clinical fellows have an opportunity to participate in research activities in the laboratory. There is an extensive patient database that can be used for clinical research. All graduating fellows acquire level II training in diagnostic cardiac catheterization as outlined in the 2008 COCATS 3 Training Statement: Task Force 3. New York Methodist Hospital also offers 2 ACGME accredited fourth-year positions dedicated to training in interventional cardiology.
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Electrophysiology
The Section of Cardiac Electrophysiology is staffed by three dedicated faculty members and a large number of health care professionals. Two positions for a 1-year EP Fellowship are ACGME accredited. There are two dedicated electrophysiology laboratories with state of the art equipment, consisting of a biplane x-ray suite, intracardiac echocardiography, and magnetic mapping systems. A full range of electrophysiology procedures is performed in these laboratories, including complex ablations for SVT, VT and AF, and device insertion. A busy Arrhythmia and Device Clinic is held weekly. Opportunities for clinical research are available.
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Echocardiography
New York Methodist Hospital has a very busy echocardiography laboratory that performs more than 11,000 transthoracic echocardiograms and over 500 transesophageal echocardiograms annually. The Echocardiography Laboratory is equipped with state-of-the-art Phillips and GE equipment. Training includes hands-on acquisition and interpretation of transthoracic and transesophageal images with all digital storage and retrieval technology. Every fellow will learn the basic aspects of cardiac ultrasound, including physical principles, “knobology”, instrumentation, cardiovascular anatomy, cardiovascular physiology, and cardiovascular pathophysiology. Fellows will also become adept at performance and interpretation of transesophageal echocardiograms and understand the basics of conscious sedation administration. Given the high expertise of our noninvasive faculty and the high volume of the procedures, all our fellows graduate with level II training in echocardiography as outlined in the 2003 ACC/AHA Clinical Competence Statement on Echocardiography. Majority of our fellows become board certified by the National Board of Echocardiography prior to their graduation from the program.
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Nuclear Cardiology
Nuclear cardiology laboratory performs over 2600 nuclear procedures annually. The Nuclear Cardiology Laboratory includes two nuclear cameras and 2 treadmill exercise suites. Procedures include treadmill exercise tests, myocardial perfusion imaging (planar and SPECT) with ECG-gated imaging and radionuclide ventriculography (MUGA). The pharmacologic stress testing includes vasodilator stress with both dipyridamole and adenosine as well as inotropic stress with dobutamine. The goals of this rotation include becoming proficient in interpretation of stress tests and nuclear angiographic correlation, appropriate imaging modality selection, understanding of quality control issues in the “hot lab” and on cameras and becoming proficient in radiation safety, physics, pharmaceuticals and gamma camera technology. All fellows have the opportunity to receive level II training as described by 2008 Task Force 5: Training in Nuclear Cardiology. Most of the fellows become certified by the Certification Board of Nuclear Cardiology upon graduation from the fellowship.
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Cardiac Magnetic Resonance Imaging
Fellows also have the opportunity to spend significant amount of time in the CMR Center and become familiar with CMR rest and stress protocols. All fellows receive level I training in CMR, which provides basic background knowledge in CMR and is sufficient for the practice of adult cardiology and referral for CMR evaluation. Fellows who wish to practice the clinical subspecialty of CMR, including independent interpretation of CMR studies or pursue a career in CMR and to direct a CMR laboratory have the option of achieving level II or level III training, respectively. The specific requirements for the advanced training in CMR may be found in Task Force 12: Training in Advanced Cardiovascular Imaging (CMR) document. In addition to clinical imaging experience, fellows have the opportunity to get involved in one of the numerous ongoing clinical projects in cardiovascular imaging. There is an active patient database that can be used for research. These activities have resulted in a number of national presentations and publications by cardiology fellows.
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Cardiac Computed Tomography
Third year fellows will receive at least 1 month of one-on-one teaching from an experienced cardiac CT expert. This experience will include hands-on manipulation and reading of cardiac CT images, daily clinical read out sessions. A bank of existing studies and an active daily imaging schedule provide extensive and deep resources for learning. By the end of the rotation fellows will have a basic understanding of cardiac CT technology and become proficient in 3D and other post processing techniques. Requirements for certification in cardiac CT performance and interpretation can be found in the document by Task Force 13: Training in Advanced Cardiovascular Imaging (Computed Tomography).
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Advanced Heart Failure and Transplant
Third-year fellows will also spend 1 month on a very busy, yet tremendously academic, cardiac transplant service at Columbia University-Presbyterian Hospital. The fellows will learn about all aspects of managing advanced heart failure, pulmonary hypertension, complex congenital heart disease, and heart transplantation. The fellow will participate in the peri-operative preparation of patients, understand the physiology of denervation, primarily be responsible for postoperative management including selection of immunosuppressive therapy, learn post transplant complications including infectious and malignant disease. On leaving the clinical rotation, the fellow will possess a familiarity with advanced medical and surgical intervention for late stage heart failure, develop clinical judgment to independently recognize, manage and treat complications and become proficient in interpretation of diagnostic studies pertinent to advanced heart failure and transplantation.
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Vascular and Cardiothoracic Surgery
Third-year fellows will spend a total of 1 month in vascular and cardiothoracic surgery learning about pathophysiology of arterial atherosclerosis, surgical management of severe coronary and peripheral arterial disease not amendable to percutaneous therapy and will have an opportunity to not only take part in the management of patients in the preparation for surgical procedures and post-operatively, but also scrub in along with surgeons for elective and emergent cases in the operating room.
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Research
The division has a strong commitment to providing rewarding research experiences for cardiology fellows. There are a number of prospective data sets that fellows have access to which include follow up data on all patients who have undergone a cardiac MR, all patients who have had a cardiothoracic surgery performed, and finally with an integrated databank for all cardiac catheterizations, echocardiograms, and stress testing that have been performed at NYM since 2004. Fellows will start their research experience with the selection of a mentor and a project topic during their first year of fellowship. The fellows will be encouraged to initiate their projects in the beginning of the second year of fellowship. During the third year of fellowship, if the project has progressed, the fellow is encouraged to submit abstracts for oral or poster presentations to major national and international conferences. If accepted the fellow is expected to prepare the abstracts for presentation and move towards manuscript preparation. In addition, the division of cardiology is very heavily involved in the number of national multicenter trials. Fellows are welcome to submit queries and proposals for data analysis. The complete list of trials may be found here.
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