Curriculum

The Cardiovascular Fellowship Program is designed to enhance your ability to both understand and treat a variety of cardiovascular illnesses.

Sample Schedule

Our program is personalized, but understanding what a standard schedule looks like could help you to determine what you will be expected to do during your time as a fellow. This is a sample schedule of a standard track. Each number represents a 4-week block.

More detail about each item on this schedule, along with other electives available, is below. 

Arrhythmia consultation service, which is staffed by cardiac electrophysiologists, allows fellows to assist with consultations and participate in the daily management of patients. You will also participate in the interrogation of both pacemakers and Internal Cardioverter-Defibrillators.

Cardiac Catheterization Laboratory, which will allow you to become knowledgeable in the many aspects of invasive cardiac evaluation and decision making, while focusing on the basics of diagnostic cardiac hemodynamics and imagining strategies. You will participate in all cardiac catheterization cases and have the option to assist in interventional procedures.

Responsibilities include pre-procedural evaluation as well as post-procedural care of patients referred for diagnostic cardiac catheterization. Along with the attending physician, you will review the hemodynamic and angiographic data after each case, and you will be expected to dictate the catheterization report. You will also prepare a weekly conference consisting of a didactic lecture and a presentation of interesting cases.

General cardiology/heart failure consultation service, in which the fellow acts as the ‘point person’ for both emergent and routine consultations in general cardiology or heart failure throughout the institution. You will be busy during this rotation. You will, along with the medical residents and students, evaluate, prepare initial plans and devise a strategy for further management of patients.

The entire team rounds each day with the attending physician to finalize these plans. You will be responsible for supervising and providing direct teaching and appropriate literature to the medical residents and students rotating on the consultation service.

Heart failure/cardiac transplantation rotation, which is based at the Cleveland Clinic, provides a unique opportunity for you to become acquainted with the issues crucial to those patients with advanced heart failure awaiting cardiac transplantation.

Pre-heart transplantation assessment is emphasized, and you will be exposed to both start and long-term mechanical assist devices. You will also follow patients in the immediate post-transplant period and can gain an appreciation of the special needs and long-term follow-up care that is necessary to the successful recovery of a heart transplant patient.

Inpatient experience includes 4-week rotations in the Rakita Cardiac Intensive Care Unit, general cardiology consultation, arrhythmia consultation services and heart failure consultation. The level of responsibility increases with each of these rotations, as the fellow advances through the fellowship program. In addition, a 1-month heart failure/heart transplant rotation is done at the Cleveland Clinic.

Noninvasive Echocardiography Laboratory stresses a ‘hands-on’ interactive learning process. You will have ample time to obtain practical experience and skill in performing and interpreting transesophageal echocardiograms. As an echocardiography fellow, you will be responsible for selection and presentation of interesting studies and a didactic presentation on a pertinent topic at the weekly echocardiography conference.

The echocardiography laboratory at MetroHealth is the first adult echocardiography laboratory in Cuyahoga County to be certified by the Intersocietal Accreditation Commission (IAC). The laboratory performs approximately 10,000 studies per year, which includes transthoracic and transesophageal echocardiograms and stress testing. The digital echocardiography system allows for immediate access to echocardiographic images at any time from many locations within the Heart and Vascular Center.

Fellows will be exposed to a variety of cardiovascular disease pathologies as well as more unusual disease patterns. The training in the echocardiography laboratory is diverse, many fellows take the National Board of Echocardiography examination.

Nuclear cardiology experience allows you to participate in the review and interpretation of gated blood pool scans and nuclear stress tests under the supervision of a nuclear medicine attending.

Outpatient experience, which is held in the Continuity Clinic, makes you responsible for a core group of patients seen during the general Cardiology Continuity Clinic located in the Heart and Vascular Center Outpatient Area. Fellow clinics are held one half day per week for the duration of training. The fellows at MetroHealth provide care for approximately 200 outpatients with a wide range of cardiovascular problems.

During a typical session, a fellow will see two new patients and four to six follow-up patients. Fellows also have the opportunity to supervise and teach medical students, who rotate through the clinic. Attending supervision is at a ratio of one or two fellows per attending physician during these sessions. While they are precepting, the attending physicians can devote their attention to their teaching responsibilities.

The Rakita Cardiac Intensive Care Unit (CICU) makes you an integral part of the CICU team. You will act as the primary liaison between the medical residents, patients, families and nursing staff. After evaluation of each new admission, you will be responsible for formulating an initial plan of care and then refining that plan of care after discussion with the cardiology attending.

Fellows round each weekday and Saturday with the team while in the CICU. Other responsibilities include didactic lectures for the students and medical residents rotating in the cardiology department for that month.

Vascular surgery, which is a rotation at Cleveland Clinic, provides you with the opportunity to attend vascular surgery clinic and vascular intervention procedures. You will also review vascular ultrasounds with vascular surgeons.