NYMC > Departments > Academic Departments > School of Medicine > Medicine > Divisions > Cardiology > Cardiology Fellowship > Clinical Training

Clinical Training

Cardiology Consultation

The consult service is a busy rotation where the fellow gains knowledge in both “bread-and-butter cardiology” (e.g. afib, supraventricular tachycardias, acute coronary syndromes, CHF, peri-operative management, pericarditis/pericardial effusions) and less-common cardiac disease processes (e.g. cardiac amyloidosis, cardiac tumors, rheumatic valve disease, hypertrophic cardiomyopathy). The fellow is also responsible for teaching medical residents and students on the consult team.

Coronary Care Unit (CCU)
The Coronary Care Unit provides a challenging and rewarding learning environment for the cardiology fellows.  The CCU is an 8-bed unit, caring for patients with all forms of cardiac critical illness including acute coronary syndromes, advanced heart failure, cardiogenic shock, complex arrhythmias, and structural heart disease.  The CCU medical team consists of a dedicated cardiac intensivist, the cardiology fellow, and internal medicine house staff.  The CCU fellow is responsible for all aspects of patient care, and for supervising and teaching the house staff, and they will gain extensive experience with invasive hemodynamic monitoring and mechanical circulatory support.  Graduated responsibilities will be granted throughout the 3-year fellowship experience.

General Inpatient Cardiology Service
The general inpatient cardiology service is a core experience for the cardiology fellow. Under the supervision of an experienced cardiology attending, the fellow will lead a team of medicine house staff and advanced nurse practitioners in caring for patients on the cardiology step-down unit. Triage for cardiac patients in the ED is also provided by this fellow. This rotation serves to provide the fellow with exposure to a broad array of cardiac illnesses, as well as instill the vital skills of team leadership.

Catheterization Laboratory
Fellows have ample opportunity to participate in both right and left heart catheterizations as well as pericardiocentesis, intra-aortic balloon pump placement, femoral and radial artery access, percutaneous coronary intervention, intravascular ultrasound and fractional flow reserve measurements.  Additionally, we work closely with both our vascular surgery and pediatric cardiology colleagues, giving our fellows broad exposure to the catheter-based procedures in these arenas.  Most recently, we have developed a vigorous TAVR program in collaboration with our cardiac surgical colleagues.  This program is housed in a state-of-the-art hybrid lab.

CHF/Transplant/Pulmonary Hypertension
WMC has a very active Heart Failure and Transplant program, performing over 20 transplants each year. The cardiology fellow on the CHF team will follow and manage his or her own set of patients during their month-long rotation. They will learn the nuances of inotropy, mechanical support in intensive care units including LVAD and ECMO, and pre and post heart transplant care.  Weekly interdisciplinary cardiac transplant meetings will introduce the fellow to the team approach necessary for advanced heart failure care.   The fellow will also learn how to perform Swan-Ganz catheter insertion, right heart catheterization and endomyocardial biopsy.

Echocardiography Laboratory
The echocardiography rotation includes performance and interpretation of transthoracic and transesophageal echocardiograms under the supervision of an expert physician and technologist staff.  Studies are performed in various clinical settings, including the inpatient echo lab, intensive care units, and the Bradhurst outpatient center.  By offering these diverse venues, WMC affords the cardiology fellow a unique perspective on how echocardiograms can differ in style. The fellow is encouraged to do a “wet-read” of echocardiograms after they are done and then discuss their thought-process with attendings. In addition, fellows present these echocardiograms weekly at conference. Along with standard TTE and TEE, the WMC echo lab has significant expertise in the use of real-time 3-Dimensional echocardiography.

Electrophysiology
Our EP program has become a nationally recognized leader in the care of cardiac arrhythmia patients.  We have two state-of-the-art EP laboratories, in addition to a device implantation room, and access to the hybrid OR.  All types of ablations are performed, including those for atrial fibrillation, atrial tachycardia, and ventricular tachyarrhythmias, utilizing both endocardial and epicardial approaches, as well as “hybrid” ablations. Our device program is also quite robust; our faculty performs pacemaker and ICD implants, including cardiac resynchronization therapy devices, subcutaneous ICD implants, and laser lead extractions, as well as left atrial appendage occlusion devices, in collaboration with the cardiac catheterization lab.  Our cardiology fellows have the opportunity to provide consultations regarding complex arrhythmia issues, provide peri-procedural care, and to have hands-on experience during electrophysiology studies, catheter ablations and device implants. Training in pacemaker and ICD interrogation is provided as well.

Advanced Cardiac Imaging (CT/MRI)
The Cardiac MRI and CT rotation serves as an introduction to these advanced imaging techniques. The fellow will learn the pertinent safety issues (provider and patient) for both modalities, basics of acquisition and post-processing, and an introduction to certain common disease states. A basic understanding of the interpretation of delayed hyper-enhancement imaging and coronary CTA will also be covered.  Clinical cases will be supplemented with a library of hundreds of interesting cases, and a syllabus of the seminal papers for both modalities.  Additional elective rotations are available for fellows interested in a more in-depth imaging experience.

Nuclear Cardiology
Fellows will participate in at least 2 months of nuclear cardiology during their training.  Stress modalities include treadmill, regadenoson, and (occasionally) dobutamine.  They include EKG and nuclear imaging.  The fellow will decide if the ordered test is indicated and, if so, which modality of stress test should be used. The fellow will work closely with the attending in nuclear imaging interpretation. On a weekly basis, the fellow will rotate through an outpatient teaching practice for nuclear stress imaging interpretation as well as for stress echocardiography.

Vascular Medicine
Fellows will be exposed to many aspects of vascular medicine throughout their training.  Clinical exposure will be complemented by a series of didactic lectures provided by vascular surgery attendings.  Fellows will become facile with vascular imaging, and elective time can be utilized to develop sufficient experience to sit for the vascular imaging certification exam.

Rotations offered as Electives
Research
Congenital Heart Disease
Cardiothoracic Surgery

Outpatient Continuity Practice
The outpatient continuity practice is a key component of the education of our cardiology fellows.  Fellows spend one half day per week caring for a panel of outpatients that they will see throughout their fellowship training.  The fellows see patients under the supervision of an attending cardiologist, in the same world-class private office facility and within the same practice structure as the attending cardiologists.  One-on-one mentoring in a superb environment allows our fellows to develop the skills they will need to practice outstanding patient-centered outpatient cardiology.

Vacation
Each fellow is allotted 4 weeks of annual vacation, plus holidays.

Sample Rotation Schedule

First Year Rotations:

 

CCU

4 Weeks

Consult

6 Weeks

General Inpatient

8 Weeks

CHF/Transplant

4 Weeks

EP

4 Weeks

Cath

6 Weeks

TTE

6 Weeks

Nuclear

4 Weeks

Night Float (see below)

6 Weeks

Vacation

4 Weeks

 

Second Year Rotations:

 

CCU                                       

4 Weeks

Consult                                   

4 Weeks

General Inpatient

1 Week

CHF/Transplant

5 Weeks

EP

4 Weeks

Cath

6 Weeks

TEE/TTE

8 Weeks

Nuclear

6 Weeks

Advanced Cardiac Imaging

2 Weeks

Night Float

4 Weeks

Vacation

4 Weeks

Elective

4 Weeks

 

Third Year Rotations:

 

CCU

3 Weeks

CHF/Transplant

2 Weeks

EP 

3 Weeks

Cath

8 Weeks

TEE

10 Weeks

Nuclear

4 Weeks

Advanced Cardiac Imaging

2 Weeks

Elective

16 Weeks

Vacation

4 Weeks


TEE= Transesophageal Echocardiography
TTE= Transthoracic Echocardiography
CCU= Coronary Care Unit
Cath = Cardiac Catheterization
EP= Electrophysiology
CHF= Congestive Heart Failure
Electives: Research, Congenital Heart Disease, Cardiothoracic Surgery, or more of the aforementioned rotations.

Conferences:

Mondays:  
Morning Report 7:30-8:30am
Core Curriculum/Board Review (alternate weeks) 12:30-1:30pm
   
Tuesdays: 8:00-9:00am
1st – Imaging Conference  
2nd & 4th – CHF Conference  
3rd – Adult Congenital Heart Disease Conference  
   
Wednesdays:  
Cath and Cardiothoracic Surgery Conference 7:30-8:30am
   
Thursdays:  
Transplant Conference 7:00-8:00am
Nuclear Conference/Echo Conference (alternate weeks) 8:00-9:00am
Cardiology Grand Rounds 12:00-1:30pm
   
Fridays:  
Vascular Conference 7:00-8:00am
EP Conference/Cath Image Review (alternate weeks) 8:00-9:00am
EKG Workshop 12:00-1:00pm

Other: Journal Club, Morbidity & Mortality (“M & M”), Research Conference

On-Call

Night Float
We have recently inaugurated a night float call system.  The night float fellows work in 2-week blocks, arriving at 6:30pm and staying through 7:30am, Sunday-Friday.

Saturday Night Call
Saturday night call is a traditional 24-hour call which is front-loaded (i.e. decreases in frequency as you become more senior). 

Call Rooms
Our recently renovated fellows lounge is home to a private call room with a private bathroom, carpeting, desk, chair, phone, Wi-Fi, and computer along with a large common area.

At all times, cardiology faculty members are available for phone or in-person support.

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