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Cardiology Fellowship

Brief Description of Program

The Parkview Medical Center Cardiology Fellowship program focuses on training fellows to become expert clinicians, with a strong fund of clinical knowledge, well developed clinical judgment maintaining a professional and compassionate approach to patient care. Our clinical staff primarily are made of full-time attendings who have made a commitment to academic careers and aspire to help our fellows develop interest and capability in becoming future excellently trained cardiologists. 

Part of our mission is to create a program with flexibility to meet our fellows’ needs.  We concentrate most of our fellows’ clinical rotations into the first two years of the Fellowship training program. Clinical, consultative and procedural skills are all emphasized during this time, but we also seek to expose our fellows to our academic pursuits so that by their third year of fellowship they are also engaged in meaningful academic pursuits or focused training in any given sub-specialty area. A continuity outpatient clinic experience is maintained with one afternoon per week throughout the fellowship training period. During the third year, the Fellows’ schedule is elective for 4 months, which is planned in conjunction with the Program Director and one or more mentors that each fellow may select within the Parkview Medical Center Division of Cardiology.  The goals of the third year elective time are completely driven by the career path of each Fellow. In fact, if a fellow so desires, one may spend essentially the 4 months on research endeavors, provided that all COCATs requirements have been met.

In fostering these goals, we are highly committed to fostering our fellows’ competency in the Six General Competencies and have revised our goals and objectives to reflect this commitment:

  1. Patient care competency
  2. Knowledge base
  3. Practice base learning and Improvement (PBLI)
  4. Interpersonal and communication skills
  5. Professionalism
  6. Systems based practice

These competencies have been adopted by accreditation committees of hospitals across the country, so that a graduating fellow must now be certified in each of these competencies in order to gain attending privileges. Indeed, hospitals have adopted the ACGME’s mandate that physician competency be defined as competency in the Six General Competencies.

Faculty

Dr. Garcia

Dr. Berarducci

Dr. Gibson

Dr. Aruni

Dr. Albashaireh

Dr. Brown

Dr. Lee

Dr. Stout

Dr. Mackerrow

Dr. Strunk

Dr. Vashistha

Dr. Alattar

Clinical Schedule for Cardiology Fellows

The training program is designed to meet all of the COCATS 4 requirements within the first two +/- half years of the fellowship training program. The general distribution of rotations is listed below. 

First year fellows:

  • 3 months  - consultative service
  • 3 months - CCU
  • 2 months - echo/ Nuclear
  • 2 months - cath
  • 1 month - arrhythmia service (consults, EP lab, device clinic)
  • 1 month  - vacation

Second year fellows

  • 1 month – consultative service
  • 1 month – CCU
  • 2 months - cath
  • 2 months - echo/nuclear
  • 3 months - arrhythmia service (consults, EP lab, device clinic).
  • 1 month – advanced HF (University of Colorado)
  • 0.5 month – MRI, CTA
  • 0.5 month – Cardiovascular Prevention
  • 1 month - vacation

Third year fellows

  • 1 month- consultative service
  • 1 month – CCU
  • 2 months – cath
  • 2 months – echo/Nuc
  • 0.5 month – vascular
  • 0.5 month – CTS
  • 1 month – vacation.
  • 4 months – elective.

On Call:

A designated cardiology fellow is on-call to cover Parkview Medical Center between 5:00 p.m. the following to 8:00 a.m. on weekdays and from 8:00 a.m. to the following 8:00 a.m. on Saturdays and Sundays, until Monday 8:00 am. 

Procedural Expectations 

The focus and scope of required clinical experiences are guided by COCATS 4, ABIM and ACGME requirements and recommendations. The clinical experience is complemented by an extensive didactic program.

Based on these requirements, during the course of their training fellows gain formal instruction and gain clinical experience designed to develop competence in the evaluation and management (and prevention, when applicable) of both inpatients and outpatients with the following disorders:

    1. Chronic coronary heart disease (stable chronic coronary artery disease)
    2. Congestive heart failure – Acute, Chronic and Advanced Cardiac t( herapies.
    3. Arrhythmias and ablation
    4. Device therapy
    5. Acute myocardial infarction and other acute ischemic syndromes (Acute Coronary
      Syndrome)
    6. Lipid disorders
    7. Hypertension
    8. Cardiomyopathy
    9. Valvular heart disease
    10. Pulmonary heart disease (Pulmonary Hypertension) and pulmonary embolism
    11. Peripheral vascular disease
    12. Infections and inflammatory heart disease
    13. Cardiovascular rehabilitation
    14. Adult congenital heart disease
    15. Pericardial diseases
    16. Cardiovascular trauma
    17. Cardiology anatomy, physiology and pathophysiology
    18. Cardiac disease and pregnancy
    19. Cardiac pharmacology
    20. Cardiac disease in women, elderly population and minorities
    21. Hemodynamics
    22. Cardiac masses
    23. Cardiac statistics
    24. Molecular and genetics cardiology
      In addition, our program is designed to meet the requirements for our fellows to gain formal instruction and experience in the following technical skills:
    25. Elective and acute cardioversion;
    26. Insertion and management of temporary pacemakers, including transvenous and transcutaneous;
    27. Programming and follow-up surveillance of permanent pacemakers;
    28. Right heart catheterization and vasodilator testing;
    29. Left heart catheterization including coronary arteriography and ventriculogram;
    30. Exercise and pharmacological Nuclear and Echo stress testing ;
    31. Echocardiography (including transesophageal, complete 2D and color/flow Doppler, contrast, strain, 3D);
    32. Cardiac MRI basic sequences, acquisition and pharmacological stress testing;
    33. Cardiac CTA basic sequences and acquisition;

Fellows will also be expected to gain interpretive skills in the following areas:

  1. Chest x-rays;
  2. Electrocardiograms; a minimum of 3500 electrocardiograms;
  3. Ambulatory ECG recordings; a minimum of 150 ambulatory ECG recordings;
  4. Interpretation of intra-cardiac electrophysiology studies and Tilt Table tests
  5. Radionuclide studies of myocardial function and perfusion ( Nuclear stress test);
  6. Echocardiography (including transesophageal, complete 2D and color/flow Doppler, 
    contrast, strain, 3D);
  7. Exercise and pharmacological echo stress tests;
  8. Cardiac MRI basic interpretation;
  9. Cardiac CTA basic interpretation;

    Finally, fellows are expected to enhance their training through their participation or exposure to the following procedures:
  • Intra-cardiac electrophysiologic studies;
  • Electrophysiology different ablation procedures;
  • Left atrial appendage closure with Watchman  device placement;
  • Internal Loop Recorder placement and interpretation;
  • Pacemakers and ICD placement (including Biventricular devices);
  • Programming and follow-up surveillance of ICDs;
  • Hemodynamic support with Intra-aortic balloon counterpulsation and Impella;
  • Percutaneous transluminal coronary angioplasty and other interventional procedures;
  • Pericardiocentesis;
  • Transcatheter Aortic Valve Replacement (TAVR) and Balloon Valvuloplasthy;
  • Basic understanding of function and programing of Left Ventricular Assistance Device (LVADs);

Clinic Experience

The Cardiology Fellows at Parkview Medical Center rotate on a weekly basis through their “continuity cardiac clinic”. This takes place once afternoon per week. This is a great opportunity to the cardiology fellows to foster a better relationship with their patients, whilst having the opportunity to follow them through their 3 years of fellowship. First year fellows are assigned patients previously followed by our graduating third year fellows.

  • Fellows are evaluated semi-annually by their assigned attendings

Fellows also participate in the pacemaker and defibrillator follow-up clinics as part of their electrophysiology rotation. Finally, fellows also participate in the outpatient Heart Failure Clinic, as an attempt to bridge the gap between acute and chronic heart failure treatment.

  • Fellows are formally evaluated by our clinic faculty bi-annually. Also, fellows should meet with their clinic attendings personally to obtain formal feedback

The goal of the faculty is to teach our fellows how to develop and apply the full range of their growing fund of medical knowledge and experience to clinical problems

Teaching Methods

The Cardiology Fellowship program at Parkview Medical Center is committed to teaching and academics. This is accomplished through a wide variety of teaching methods. Through bedside rounds, formal lectures and research, the fellows are exposed to an extensive Cardiology curriculum. These may include:

  • Standard clinical teaching rounds, supervised by our attending faculty in the CCU, EP and consult services, and faculty supervision and mentoring of fellows’ ambulatory clinic experience.
  • Sub-specialty weekly teaching conferences (e.g., Cath, EP, Echo and Nuclear Cardiology conference).
  • Didactic sub-specialty morning conferences, including:
      • attending lectures,
      • fellow presentations,
      • clinical case presentations,
      • group discussions.
  • Supervision of technical procedures.
  • Core curriculum lectures.
  • Monthly Journal club, with appropriate rotating faculty participation.
  • Cases Review and Morbidity and Mortality Conference with Pueblo Cardiology Associates
  • Medicine Grand Rounds.
  • EKG sessions.
  • Supervised Research projects.
  • Board review sessions.
  • Review of video presentations and web based material.
  • Attendance at outside conferences (e.g. AHA & ACC).
  • Assessment tools and projects (used particularly to foster learning in the six general competencies

Teaching Conferences

Fellows are required to attend all morning conferences, which are held from 7 to 8 AM on Mondays and Wednesdays, and from 12:00 – 1:00 pm on Tuesdays, Wednesday, Thursday and Fridays. These conferences are briefly discussed below:

Day

Topic/Description

MONDAY

7-8 A.M.

Subspecialty Conference:

The first and second Mondays of the month is devoted to review the literature on different modalities of Echocardiography and areas will range from basic ECHO physics to new technology and developments. It will include topics such as: assessment of cardiac size and function, hemodynamics, valvular heart disease, coronary artery disease and stress testing, diastolic and systolic assessment, pericardial diseases, cardiomyopathies, aortic diseases, congenital heart disease, TEE, echo physics, contrast, cardiac masses and systemic diseases. Cardiology fellows, attendings and echo technologists will be participating.

The third Monday of the week is focused in reviewing the literature on Nuclear, Cardiac CT and Cardiac MRI. Emphasis are in reviewing the physics, indications, acquisition, performance and interpretation of these different imaging modalities.

Arrhythmia Service Conference:

This conference happens every fourth Monday of the month and includes didactic EP lectures, especially in the first few months and presentation of EP case presentations (and other teaching formats). EP Journal Club once/month as well as case presentations may occur if desired.  The complexity of clinical case presentations increase as the academic year progresses.

TUESDAY

12 – 1:00 P.M.

EKG:

A series of EKGs are presented and discussed on the first, second and third Tuesday of the month. Review of electrocardiography focuses primarily on the interpretation of the EKG 12-lead tracings but Ambulatory monitors results should also be interpreted. 

 

Journal Club

This is intended occur once a month, on the fourth Tuesday of the Monday.   Fellows should select important articles from the literature, with input from the supervising attending staff, and preferentially from areas not covered within the context of subspecialty conferences.

WED.

7 -8 A.M.

 Cases Review, Morbidity and Mortality and Cardiac Catheterization

During the first, second and third Wednesdays of the month, one or two review cases are presented each session. Cases are selected and prepared by the Cardiology Fellow rotating through the CCU and consultative service.  The cases are presented with all relevant imaging data. (e.g., cath films, echoes) and is followed by a literature review. A morbidity and mortality conferences is included in the same format. This is presented in a multidisciplinary approach amongst cardiology attending, cardiothoracic surgeons and fellows. A cardiac catheterization conference happens every fourth Wednesday of the month in a similar format, focused on structural, peripheral and coronary interventions.

THURS.

12 – 1 P.M.

 Basic Curriculum:

This is covered through a master core curriculum list, involving 13 areas, as enclosed in this document. The basic topic areas will be covered on a yearly basis, but all enclosed topics will be covered at least once during each fellow cycle throughout 2 years of training.

FRID             12 – 1 P.M.          







Board Review and Research Project discussion.

Happens 1st and 3rd week of the month

Research Requirements 

Our program is committed to ensuring an environment that fosters meaningful, supervised research experiences with appropriate protected time for each fellow who so desires – either in blocks (elective time) or concurrent with clinical rotations. The fellows’ research experience is bolstered by an attending staff. At Parkview Medical Center Cardiology Fellowship, the required clinical experiences are concentrated into the first 2 +/- half years so that fellows have the option to use any number of months, as research electives if they so desire later in his third year of training. Thus, fellows have the opportunity to develop the basis for fostering a future academic career if they so desire.  

Even for those who do not seek academic careers, we hold that as clinical cardiologists, they should be exposed to research endeavor in order to help them develop skills to understand the results of clinical investigation, while fostering habits of self -education for the rapidly evolving knowledge base.

By the end of their fellowship training, each fellow must demonstrate evidence of recent research productivity through one or more of the following:

  1. Publication (manuscripts or abstracts) in peer-viewed journals;
  2. Abstracts presented at national specialty meetings;
  3. Book chapters
  4. Preparation of a research-grade review topic, with a write-up of the material and presentation of the material at one of our didactic formats (e.g., core curriculum). This project must have the approval of the Program Director

Wallacy S. Garcia, MD

Dr. Garcia

Program Director Cardiology Fellowship
Office Phone:719-562-2900
Fax: 719-924-1592

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400 West 16th Street, Pueblo, CO 81003

719.584.4000