Innovative Healthcare Today, Training the Physicians of Tomorrow
Cardiovascular Fellowship Rotations & Experience
Participants in the Cardiovascular Fellowship Program will have the opportunity to gain experience in a wide variety of rotations and clinic settings.
Inpatient Wards Rotation
This will serve as the core inpatient rotation for the cardiovascular fellowship which provides fellows with the opportunity to provide longitudinal care of a patient in the inpatient setting. The fellow will follow the patient through their journey in the hospital from the initial ER visit to any of the inpatient floors (ICU, telemetry, med/surg) all the way through to their discharge. They will be expected to be the main cardiologist providing medical care to the patient, providing communication to the patient’s family, and requesting diagnostic and therapeutic cardiac procedures as needed from their colleagues. These patients can then be referred to and followed in the ambulatory clinic after discharge for true longitudinal medical care. This will primarily be a consult service except for STEMI patients or those who were brought in specifically for an elective cardiovascular procedure. A team-based, patient-centered approach will be emphasized with additional teaching/learning while working with medical residents and students.
Cardiac Catheterization Lab Rotation
The objective is to develop skills required to perform diagnostic cardiac catheterization and selective angiography along with derivations and interpretations of hemodynamic data obtained in the cardiac catheterization laboratory. Additionally, this rotation will develop cognitive skills relative to indications for cardiac catheterization and angiography and planning management decisions after acquisition of clinical and laboratory data in adult patients with suspected heart disease. A unique characteristic of this rotation is the ability to perform more than just coronary angiograms but also perform right heart catheterizations, permanent pacemaker placements, and diagnostic and interventional peripheral angiograms of all extremities, renal arteries, and carotid arteries. The general cardiology fellows will also have the ability to assist in advanced structural heart procedures including TAVR, MitraClip, Watchman devices, PFO/ASD closures, paravalvular leak closures, and EVARs.
Echocardiography/Stress Laboratory Rotation
A specific objective of this rotation is to familiarize the cardiology trainee with interpretation as well as technical skills of echocardiography (both TTE and TEE) with emphasis on strengths and limitations of the procedure and application of appropriate use criteria. Additionally, fellows with perform and interpret a variety of cardiac stress tests including exercise, pharmacological, and vasodilator nuclear stress tests as well as tilt table tests.
Cardiac CT and MRI Rotation
This rotation will be offered at both Saint Bernardine Medical Center as well as the Loma Linda VA Medical Center. The specific objectives of this rotation is to familiarize the cardiology trainee with selecting patients for CMR and cardiac CT, understanding the strengths and limitations of CMR compared to other cardiac imaging techniques, technique of performing cardiac MRI and various CMR sequences, familiarity with interpretation of CMR images. This should amount to level I training in CMR and cardiac CT. There will also be opportunities to be more involved with performance and interpretation of Nuclear Stress Testing while at the VA during this rotation.
Cardiac Electrophysiology Rotation
This rotation is held both at St. Bernardine Medical Center as well as the Loma Linda VA Medical Center. Fellows will have the opportunity to rotate at both sites to gain a broad exposure to the field of electrophysiology. Specific objectives of this rotation are to learn about current management of refractory arrhythmias including EP testing and use of drugs and devices along with indications and management of patients who are candidates for EP ablations or pacemaker and ICD devices.
Research/Specialty Clinics Rotation
Research training and critical thinking are integral parts of fellowship training, irrespective of subsequent career plans. A good understanding of research methods is essential to continue self-education beyond the formal fellowship years. Each cardiology trainee will actively participate in research projects under faculty guidance and supervision. The fellows will also have opportunities to observe and assist with cardiothoracic surgeries in the OR, visit arrhythmia/device clinic, and visit adult congenital heart disease clinics.
Arrhythmia and Device Clinic
Under the supervision of Dr. Annahita Sarcon, M.D., the fellows will get insights into ambulatory management of all types of arrhythmias, including the management of complex atrial fibrillation. They will gain an understanding of ablation indications and options as well as their outcomes. There will also be extensive hands-on management of ICDs, pacemakers and loop recorders.
Adult Congenital Heart Disease Clinic
Under the supervision of Dr. Mohammad Kanakriyeh, M.D., the fellows will manage patients with complex congenital heart disease. Highlights include hands-on fetal echocardiograms, experience with pediatric patient populations, and robust learning with a wide variety of pathology.
VA Cardiovascular Critical Care Unit Rotation
A rotation offered at the Loma Linda VA Medical Center where the goal will be to manage critically ill patients with advanced cardiovascular pathology requiring ICU-level care. Led by an experienced and evidence-based faculty, the fellow will be given the opportunity to take charge of the service and steer the direction of cardiac care. The fellow will work closely with medical residents and students to develop teaching and leadership skills.
VA Heart Failure Rotation
A rotation offered at the Loma Linda VA Medical Center where fellows will manage patients with advanced stages of heart failure of various etiologies. Occurring in both the inpatient and outpatient settings, the goal of this rotation is to provide experience in both hospital and clinic management of HF patients, optimizing medical management per guidelines, patient education, minimizing hospital admissions, decisions on device therapies, hospice referral, and referral for heart transplant or LVAD as destination therapy as appropriate.
Ambulatory, Outpatient Consultative and Continuity Care Clinics
Ambulatory experience will be obtained through continuity clinics. Most of the clinics will be held either with the Pulse Cardiology group in the San Bernardino/Riverside locations or UCR Multispecialty Clinic at Citrus Tower in the downtown Riverside location. Specialized areas addressed in clinic will include: arrhythmia, vascular pathology, heart failure, valvular pathology, structural heart disease, pre-op, cardio-oncology, genetic disorders, and congenital disorders. In addition, the UCR Multispecialty Clinic has exposure specifically focused on: device optimization using echo guidance, cardio obstetrics, infiltrative diseases, and aortopathies.
Vascular and Aortic Clinic and Program
This is under the supervision of Dr. Ashis Mukherjee, M.D. and Dr. Prabhdeep Sethi, M.D. The goal is to learn vascular ultrasound, evaluation of peripheral vascular disease, carotid disease, aortic aneurysms, selection of appropriate therapies and hybrid approaches. There will be exposure to carotid and peripheral artery stenting, EVAR, etc. Dr. John Kearney, M.D. (vascular surgeon) will help in mentoring for surgical exposure of the arteries and arteriotomy. There is excellent continuity of experience from clinic visits to arterial interventions in the Cath lab and venous intervention in the clinic with thorough follow-up and secondary prevention.
The call is split between two teams – Team A and Team B – both of which are led by a separate fellow. The night call will be covered by a separate fellow who is required to be in house for the duration of the call. The schedule is as outlined in the table below:
(7 a.m to 7 p.m)
|Team A Fellow||Team B Fellow||Team A Fellow||Team B
|Team A Fellow||Team B Fellow||Team A Fellow|
(7 p.m. to 7 a.m. the following day)
|Night Fellow||Night Fellow||Night Fellow||Night Fellow||Night Fellow|
The on-call cardiology fellow will supervise care for the existing patients on their service, including performing bedside procedures, and respond to all cardiology consultations during the shift. This will be done as part of a teaching team with residents and medical students. The night fellow is likewise expected to respond to all consultations in the overnight hours and reach out to the on-call cardiology attending as needed to discuss the cases. A core expectation of this rotation will be a robust and thorough sign-out between fellows that allows for safe and effective transition of care.
For the on-call responsibilities, the level of supervision is graded for each year of training. Thus the resident will see the patients independently initially and then review every case with the attending faculty cardiologist on call. It is expected that the resident will gradually assume a larger role in initially formulating an assessment and plan and by the third year be able to independently come up with a complete independent assessment. However, even at that level this will be reviewed by an attending cardiologist including direct interaction with each patient. For procedures such as pericardiocentesis, invasive lines for monitoring purposes, cardioversions, or administration of restricted medications, there are graded levels of supervision.
For procedures, the attendings will initially scrub and perform the procedure with the fellows and then begin to allow for more independence and autonomy as the skills of the fellow grow to the goal of allowing the fellow to perform a majority of the actual procedure with direct supervision of a faculty member that may or may not be scrubbed with them.