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.
Ambulatory, Outpatient Consultative and Continuity Care Clinics
Ambulatory experience will obtained through continuity and specialized clinics. The specialized clinics include: arrhythmia, cardiac device, vascular, heart failure, aortic/marfan, valvular, structural heart disease, VAD/transplant, pre-op, cardio-oncology and device optimization clinics. Most of the clinics will be in the ambulatory building adjacent to the hospital.
Heart Failure Clinic
Supervised by Issa Alesh, M.D, the goal is to provide experience in post hospital management of HF patients, optimizing medical management per guidelines, patient education, minimizing hospital admissions, decisions on device therapies, hospice referral, referral for heart transplant or LVAD as destination therapy as appropriate.
Heart Transplant and LVAD Clinics
We do not have a separate program, but elective time will be offered to gain experience in this at Cedars Sinai Medical Center in Los Angeles.
Under the supervision of Ravi Sureddi, M.D. and Edward Abdalla, M.D. Goal is to get insights into ambulatory management of all types arrhythmias, understand indications for ablation, ablation options and their outcomes. The fellows will also get insights into complex management of afib including ablation and appendage closure.
Under the supervision of Ravi Sureddi, M.D. and Edward Abdalla, M.D. The fellows get experience in the management of ICD, pace makers and loop recorders.
Adult Congenital Heart Disease Clinic
Under the supervision of Mohammad Kanakriyeh, M.D. There will also be an option to gain experience at UCLA’s ACHD program.
Pulomary Hypertension Clinic
Under the supervision of Issa Alesh, M.D. The fellows will learn work up of patients with pulmonary hypertension and various therapeutic options available.
Valve and Structural Heart Disease Clinic/Program
This is a multidisciplinary clinical management program including surgeons, cardiologists, anesthesiologists and nursing professionals to manage complex valvular and structural heart disease problems with or without surgery or devices.
Echo-Guided Devise Optimization Clinic
Managed by Ramdas Pai, M.D. and the goal is to optimize hemodynamics by adjusting AV and VV delays under echoguidance.
Vascular and Aortic Clinic and Program
This is under the supervision of Ashish Mukherjee, M.D. and Prabhdeeb 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. John Kearney, M.D. (vascular surgeon) will help in mentoring for surgical exposure of the arteries and arteriotomy. Continuity of experience from clinic to interventions in cath lab (arterial interventions) and clinic (venous ablation) to back in the clinic for follow-up and secondary prevention.
Under various cardiologists. The goal is to perform cardiac risk stratification and risk reduction based on ACC/AHA guidelines. At the same time the fellows are encouraged to learn other perspectives for surgeon’s point of view and discuss and reconcile with referring physicians. One example is evaluation of patients for renal and liver transplant. Fellows are expected to evaluate literature and guidelines from transplant and renal literature and reconcile how to risk stratify these patients as their guidelines are at variance with ACC/AHA preop guidelines which does not specifically address transplant population undergoing a high risk procedure utilizing a valuable organ from a live or deceased donor with the highest moral obligation to make best use of the organ.
Critical Care and Cardiac Consultation Rotation (St. Bernardine Medical Center)
A specific objective of this rotation is to make a cardiology trainee knowledgeable in the management of acute cardiac illnesses requiring admission into the Intensive Care Unit. Also the resident will learn consultative cardiology for in-hospital patients.
ER Consultation / STEMI/ Emergency Cath Rotation (St. Bernardine Medical Center)
A specific objective of this rotation is to make a cardiology trainee knowledgeable in the management of acute cardiac illnesses that are initially seen in ER, rather than in the wards, and follow them up through cath lab or procedures or wards. This provides short-term continuity in critically sick patients to out of the hospital door. Trainee gets experience in STEMI, NSTEMI and cardiac catheterization (urgent and emergent) etc. Gives experience in all aspects of cardiac emergencies.
Cardiac Cath Lab Rotation
Objective is to develop the skills required to perform diagnostic cardiac catheterization and selective angiography. To learn derivations and interpretations of hemodynamic data obtained in the cardiac catheterization laboratory. To 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.
Cardiac Electrophysiology Rotation
Specific objectives of this rotation are to learn about (a) current management of refractory arrhythmias including EP testing and use of drugs and devices, (b) indications and management of patients who are candidates for EP ablations or pacer and ICD devices.
Echocardiography 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 use of appropriateness criteria.
Nuclear Cardiology Rotation
An average of 25-30 nuclear cardiology studies will be performed at St. Bernardine Medical Center on a weekly basis. The cardiology trainee, in the morning session, will review the patient's chart, investigations, and indications for the nuclear study. He/she will explain to each patient the indications and potential complications of the study, and obtain a written informed consent. He/she will actively participate in the resting portion of the nuclear study. The exercise provocative portion of the nuclear study will be done in the cardiology department starting at noon. The cardiology trainee will actively participate in the exercise test, adenosine or Lexiscan nuclear studies. After completion of the studies, the cardiology trainee will interpret the nuclear studies and generate a report under the supervision. During this rotation there will be specific readings in nuclear cardiology that will be recommended. The cardiology trainees will also be encouraged to read the regular American College of Cardiology Hot Topics in nuclear cardiology.
Cardiac CT and MRI Rotations
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.
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 and monthly research conferences under faculty guidance and supervision.
The cardiology trainee must be within beeper range from the hospital at all times, when on call. The cardiology trainee does not need to stay on hospital premises but must be available to come in at short notice (<30 minutes). The evening calls, from Monday through Thursday, will be shared between all the cardiology trainees through the year.
The on-call hours are between 5 p.m. to 8 a.m. the next morning. Friday on-call hours start at 5 p.m. and the weekend on call finishes at 8:00 a.m. on Monday. The on-call cardiology trainee will supervise CCU care, including procedures and respond to all urgent or emergency cardiology consultations throughout the hospital and respond to emergency procedures such as cardiac catheterization, TEE and temporary pacemaker insertion.
The cardiology trainee is required to come and review each sick admission with intern/resident on call during the night hours and discuss it with the attending cardiologist whenever appropriate. During the week and before going home, between 5 and 9 p.m., it is expected that the cardiology trainee will be in CCU/emergency room, reviewing and rounding on the new admissions with intern/resident. During this time, it is expected that he/she teach clinical cardiology to the internal medicine intern/resident.
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 based in the Coronary Care Unit, Consultation Service, and STEMI from ER: such as pericardiocentesis, invasive lines for monitoring purposes, cardioversions, or administration of restricted medications, there are graded levels of supervision.
During the first year, the attendings will scrub and perform the procedure with the resident observing or participating in a minor role.
During the second year the resident will assume more of the role of actual performance of the procedure, with direct supervision of a faculty member that is scrubbed with them.
During the third year the resident will be expected to perform a majority of the actual procedure with direct supervision of a faculty member that may or may not be scrubbed with them.