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Cardiology Fellowship Training Program

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  • 1. Cardiology Fellowship Training Program M E T R O H E A LT H M E D I C A L C E N T E R CLEVELAND, OHIO
  • 2. Contact Kara Quan, M.D., program director or Audrey Patterson, program coordinator at (216) 778-2130 for further information.
  • 3. Hello, This brochure is provided to help answer the most important questions of the prospective Cardiovascular Fellowship applicant. We hope that we have succeeded in answering the following questions. What’s special about MetroHealth? 2 A description of our best attributes What is expected of me? 9 A description of the various rotations and the fellow’s responsibilities What conferences will I attend? 14 A schedule and description of the conferences With whom will I work? 15 The faculty and staff pictures How will my time be divided? 16 A break down of the yearly schedule What about Cleveland? 17 Information about Cleveland and the surrounding area
  • 4. What’s special about MetroHealth? MISSION STATEMENT The MetroHealth System commits to leadership in providing outstanding health care services which continually improve the health of the people in our community. We offer an integrated program of services provided through a system that encompasses a partnership between management and physicians and reflects excellence in patient care supported by superior education and research programs. We are committed to responding to community needs, improving the health status of our region and controlling health care costs. We hold as a core value the provision of service to any resident of Cuyahoga County regardless of ability to pay. T H E H I S T O RY O F M E T R O H E A LT H MetroHealth Medical Center was founded in 1837. Its first internship started in 1892, and in 1914, affiliation with Case Western Reserve University began. The first research building was completed in 1953 raising the standard of medical care and attracting prominent scien- tists to the hospital. Rammelkamp Center for Education and Research Center was opened in 1992. Through many years and many advances, it is now a 731-bed facility that stands as the center of The MetroHealth System. Today, MetroHealth continues to be an academic insti- tution that is committed to excellence in patient care, which is supported by superior education and research programs. 2
  • 5. EDUCATIONAL AFFILIATIONS As a major teaching facility of the Case Western Reserve University School of Medicine, several hundreds of residents and medical students receive training in 18 fields of medicine and surgery each year. All hospital full-time staff physicians hold faculty appointments at Case Western Reserve University and have extensive teaching responsibilities throughout the medical school curriculum. In addition, MetroHealth has a formal educational relation- ship with the Cleveland Clinic Foundation that includes joint sections in Emergency Medicine, Cardiothoracic Surgery, and Neonatology. This strong relationship allows the opportunity for fellows to perform clinical rotations in nuclear medicine, cardiac transplant, and congenital heart disease at the Cleveland Clinic. 3
  • 6. Heart & Vascular Center MetroHealth’s Heart & Vascular Center provides comprehensive cardiovascular services to individuals throughout Northeast Ohio and is nationally recognized for its leadership in the diagnosis, treatment, and research of cardiovascular disease.The Center’s team includes 21 cardiologists, two cardiothoracic surgeons, and two vascular surgeons, who are supported by a staff of highly trained and skilled physi- cian assistants, nurse practitioners, registered and licensed practical nurses, and an array of technol- ogists. The Heart & Vascular Center celebrates the rich diversity of its patient population and focuses on pro- viding comprehensive care and treatment for both the patient and family. A multidisciplinary approach to the needs of patients is what makes MetroHealth’s Heart & Vascular Center unique. Together, physicians, nurses, technologists, and other support staff work to make the practice of medicine truly holistic in the following three key areas: Clinical Care: MetroHealth’s Heart & Vascular Center provides fully integrated, multidisciplinary, car- diovascular specialty care including invasive and noninvasive cardiology as well as cardiothoracic and vascular surgery. Research: MetroHealth is home to the Heart & Vascular Research Center, a state-of-the-art clinical and basic science cardiovascular research center. The research studies underway at the Heart & Vascular Research Center are collaborative in nature and promote interaction between clinicians, clin- ical investigators, biologists, and biomedical engineers. This collaboration ensures that new diagnos- tic techniques, treatments, and medical discoveries transition efficiently and effectively from the lab- oratory to the bedside. Specific areas of excellence in basic cardiovascular research include mecha- nisms and prevention of sudden cardiac death, Long QT Syndrome, and genetic susceptibility to heart disease, heart failure, and arrhythmias. Education: As a campus of the Case Western Reserve University School of Medicine, MetroHealth offers comprehensive training programs aimed at developing the next generation of cardiovascular physicians and scientists. In addition, the Heart & Vascular Research Center has developed a unique Cardiovascular Scholars Program to train future physician scientists by providing selected cardiology trainees with 2-3 years of additional dedicated research experience in one of MetroHealth’s cardio- vascular laboratories. 4
  • 7. THE FACULTY The faculty of the Heart & Vascular Center is committed to the training of cardiovascular physicians who strive to achieve the highest standards of academic excellence as clinicians, educators, and physician/scientists. Each member of the department has a full-time academic appointment at the Case Western Reserve University School of Medicine. RAKITA CARDIAC INTENSIVE CARE UNIT The Rakita Cardiac Intensive Care Unit is a busy, high-turnover, tertiary care unit. This unit is named for Louis Rakita, M.D., who is a pioneer in cardiovascular disease and is a former chief of cardiology at MetroHealth. The unit is equipped with a state-of-the-art, integrated Hewlett Packard monitoring system. Physicians working in the 12-bed acute care unit gain experience in the acute evaluation and treatment of patients requiring critical care monitoring, mechanical ventilation, and intra-aortic balloon pump support. Fellows will be exposed to patients with very diverse pathophysiology of cardiac diseases. ECHOCARDIOGRAPHY LABORATORY The echocardiography laboratory at MetroHealth is the only adult echocardiography lab in Cuyahoga County to be certified by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories. The laboratory performs approximately 10,000 studies per year, which include 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 & Vascular Center. 5
  • 8. CARDIAC CATHETERIZATION LABORATORY The cardiac catheterization laboratories at MetroHealth are both state-of-the-art General Electric imaging suites. One is outfitted for peripheral imaging and revascularization pro- cedures. The other employs a unique digital detector that offers enhanced image quali- ty and reduced radiation dosage for patients, physicians, and nursing staff. Intravascular ultrasound and intracoronary physiologic studies are routinely used in decision making prior to interventional procedures. The laboratory is staffed 24 hours a day for emergen- cies, and the interventional staff is committed to direct angioplasty for all acute myocar- dial infarctions. ELECTROPHYSIOLOGY LABORATORY There are seven faculty in the electrophysiology section. The electrophysiology labora- tory encompasses both the invasive diagnostic and therapeutic procedures performed for cardiac arrhythmias. The Siemens and General Electric imaging suites are outfitted for ablation, intracardiac device implantation, lead extraction (Excimer laser) and intrac- ardiac mapping (Biosense). Noninvasive electrophysiologic testing includes tilt-table testing, Holter / event monitoring, and T-wave alternans testing. HEART & VASCULAR RESEARCH CENTER The Heart & Vascular Research Center at MetroHealth provides an outstanding cross-disciplinary training environment to develop novel insights into the mecha- nisms, diagnosis, and a bench to bedside approach to the treatment of cardiovas- cular disease. Integrating outstanding talent with state-of-the-art facilities from both the Rammelkamp Center for Education and Research and Case Western Reserve University, the Heart & Vascular Research Center strives for excellence in cardiovascular investigation. A clinical trials committee and the General Clinical Research Center provide guidance and support for faculty and fellows interested in clinical trials. For further information, contact www.metrohealthresearch.org. 6
  • 9. Basic Science Research The basic science research section focuses on molecular, ion channel and cellular mecha- nisms of cardiac physiology. Novel techniques include optical mapping, as well as confocal and fluorescent microscopy. The expression of genes that regulate cardiac electrophysiol- ogy and hemodynamics are explored using transgenics and mutagenesis. Animal models of heart failure, cardiac remodeling, and re-entrant arrhythmias are other ongoing research ini- tiatives. Clinical Research Clinical studies initiated by Heart & Vascular Center physicians include the evaluation of nerve stimulation to reduce arrhythmia vulnerability, genetic and epidemiological studies of the Long QT Syndrome, T-wave alternans / heart rate variability for the prediction of sudden death, intravascular ultrasound and fractional flow reserve in acute coronary syndromes, mechanisms of human repolarization, minimally invasive robot-assisted cardiac surgical pro- cedures, and the assessment of novel echocardiographic indices of various disease states. The Heart & Vascular Center is actively involved in many multi-center clinical trials and is proud to be the coordinating center for a national multi-center trial designed to evaluate arrhythmia risk stratification by ECG T-wave alternans (ABCD Trial). CARDIAC REHABILITATION The beautifully remodeled Lifestyle, Fitness, and Rehabilitation Center provides the facilities for comprehensive Cardiac Rehabilitation, Pulmonary Rehabilitation, Smoking Cessation, and the Weigh to Wellness (physician supervised weight loss) pro- grams. 7
  • 10. What are my options? Fellowship Tracks The Cardiology Training Program at MetroHealth Medical Center offers three tracks that are tailored to the future interests and needs of fellows in training. Standard Track This is a three-year program comprised of two clinical years and one research year, with an optional additional year for research. Most fellows place in this track. Often fellows opt to have their research year during the second year, in order to allow them to com- plete their research project during the remainder of their fellowship. Subspecialty Short Track This is a four-year program comprised of two clinical years followed by two years in a subspecialty area. The fellow performs a long-term research project during the sub- specialty training years. Cardiovascular Scholar Program This four to five-year program begins with two to three years of basic research followed by two clinical years. This track is designed for selected fellows, who plan to have future careers in basic research and become academic leaders in their field. Summary of available tracks Year One Year Two Year Three Year Four Standard Track Clinical Clinical Research Subspecialty Short Track Clinical Clinical Subspecialty Subspecialty Clinical and Clinical and Research Research Cardiovascular Scholar Program Research Research Clinical Clinical 8
  • 11. What is expected of me? INPATIENT EXPERIENCE The “inpatient” experience includes month-long rotations in the Rakita Cardiac Intensive Care Unit, general cardiology consultation, and arrhythmia consultation serv- ices. The level of responsibility increases with each of these rotations, as the fellow advances through the fellowship program. In addition, a one-month heart failure/heart transplantation rotation is done at the Cleveland Clinic Foundation. General Cardiology Consultation Service The cardiology consultation service is a busy month for the fellow, who acts as the “point person” for both emergent and routine consultations throughout the institution. The fellow, along with the medical residents and students, evaluates, prepares initial plans, and devises a strategy for further management of patients. The entire team rounds each day with the attending physician to finalize these plans. The fellow is responsible for supervising and providing direct teaching and appropriate literature to the medical residents and students rotating on the consultation service. 9
  • 12. THE RAKITA CARDIAC INTENSIVE CARE UNIT The fellow is an integral part of the CICU team, acting as the primary liai- son between the medical residents, patients, families, and nursing staff. After evaluation of each new admis- sion, the fellow is responsible for for- mulating an initial plan of care and then refining that plan after discussion with the cardiology attending. The fellow rounds each weekday and Saturday with the team and has an every third day call schedule while in the CICU. Other responsibilities include didactic lectures for the students and medical resi- dents rotating in the cardiology department for that month. ARRHYTHMIA CONSULTATION SERVICE The arrhythmia consultation service is staffed by one of the cardiac electrophysiologists. Fellows assigned to the Arrhythmia Service assist with consultations and participate in the daily management of patients on the service. The fellow participates in the interrogation of both pacemakers and Internal Cardioverter-Defibrillators. He/she gains experience in interpreting Holter and event monitors and per- forming supervised cardioversions. Lastly, fellows participate in a weekly outpatient clinic for the fol- low-up of patients with pacemakers or Internal Cardioverter-Defibrillators. 10
  • 13. HEART FAILURE/TRANSPLANTATION ROTATION The Congestive Heart Failure/Cardiac Transplantation Service, based at the Cleveland Clinic Foundation, provides a unique opportunity for the fellow to become acquainted with the issues crucial to those patients with advanced heart failure awaiting cardiac transplantation. Pre-heart transplantation assessment is emphasized and fellows are exposed to both short and long-term mechanical assist devices. The fellow also follows 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. CARDIOTHORACIC SURGERY AND CARDIAC REHABILITATION EXPERIENCE This is a combined cardiothoracic surgical and cardiac rehabilitation rotation. On the cardio- thoracic surgical rotation, the fellow assists in the management of patients after cardiac surgery. He/she learns to recognize and manage post-operative cardiac complications. During this combined rotation, time is spent in the cardiac rehabilitation pro- gram. The fellow learns the principles of lifestyle modification and the psychoso- cial issues that are important in the suc- cessful recovery of patients with heart disease. Under the supervision of the cardiac rehabilitation attending, the fel- low evaluates and manages any compli- cations that may occur during rehabilita- tion exercise sessions. 11
  • 14. OUTPATIENT EXPERIENCE Continuity Clinic Each fellow is responsible for a core group of patients seen during the general cardiology continuity clinic located in the Heart & Vascular Center outpatient area. Clinic for the fellow is 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 prob- lems. During a typical session, a fel- low 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 physi- cian during these sessions. While they are precepting, the attending physicians have no other clinical responsibilities, so that they can devote their attention to their teaching responsibilities. NUCLEAR AND PEDIATRIC CARDIOLOGY EXPERIENCE This is a combined rotation that is spent at the Cleveland Clinic Foundation. Mornings are spent evaluating patients along with a pediatric cardiology faculty member in the outpatient pediatric cardiology clinic at the Cleveland Clinic Foundation. The fellow gains knowledge of congenital heart disease through participation in daily clinics as well as the weekly pediatric cardiology conference. Afternoons are spent in the nuclear medicine department. The fellow participates in the review and interpretation of gated blood pool scans and nuclear stress tests under the supervision of a nuclear medicine attending physician. RESEARCH EXPERIENCE The fellow is expected to learn the essentials of the scientific method, including research design, statisti- cal analysis and the presentation of research results. As part of the standard three-year fellowship track, one month in the first year and seven months in the third year are dedicated to research. The goals are to identify a research interest, a specific hypothesis, and mentor early in the program. The fellow is expect- ed to complete an organized project and present the results of that research as a manuscript in a peer- reviewed journal by the end of fellowship. 12
  • 15. LABORATORY EXPERIENCE Noninvasive Laboratory The noninvasive echocardiography rotation stresses a “hands-on,” interactive learning process. The fellow has ample time to obtain practical experience and skill in performing and interpreting echocardiograms and stress tests. As the skill of the fellow improves, he/she also becomes involved in performing and interpreting transesophageal echocardiograms. The echocardiogra- phy fellow is responsible for selection and presentation of interesting studies and a didactic presentation on a pertinent topic at the weekly echocardiography conference. Cardiac Catheterization Laboratory The months spent in the Cardiac Catheterization Lab at MetroHealth allow the fellow to become knowl- edgeable in the many aspects of invasive cardiac evaluation and decision-making, while focusing on the basics of diagnostic cardiac hemodynamics and imaging strategies. Fellows participate in all cardiac catheterization cases of that month 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. The fellow, along with an attending physician, reviews the hemody- namic and angiographic data after each case and is expected to dictate the catheterization report. The fellow also prepares a weekly conference consisting of a didactic lecture as well as presentation of inter- esting cases. 13
  • 16. What conferences will I attend? Monday 7:00 - 8:00 am Wednesday 7:00 - 8:00 am Core Curriculum Electrophysiology Conference This is a didactic conference covering all of the major topics This interactive conference emphasizes the evaluation and in the field of cardiovascular medicine and is presented by a management of complex arrhythmia cases. It is an oppor- tunity for fellows to gain knowledge in the interpretation of faculty member of the Heart & Vascular Center. intracardiac electrograms. It is presented by an electrophys- iology fellow and precepted by a member of the electro- Monday 5:00 - 6:00 pm physiology faculty. Chief/Program Director Rounds These bimonthly meetings are for “fellows only” time with Research Conference the chief and program director. Topics include selecting a This multidisciplinary conference reviews new research in research project, finding a research mentor, reviewing the field of cardiovascular medicine. Graduate students, fel- unknown cases, and discussing future plans. lows, and faculty present their ideas and review their research progress during these interactive sessions. Journal Club During journal club, current or classical research articles are presented by one of the fellows. Time is available in each session for lively discussion between the faculty preceptor, fellows, and local experts in the chosen topic. Thursday 7:00 - 8:00 am ECG Conference This bimonthly conference presented by one of the Heart & Cardiac Catheterization Conference Vascular faculty focuses on the review of basic topics in elec- This is a multidisciplinary conference that includes fellows, cardiologists, and cardiothoracic surgeons. Coronary trocardiogram interpretation and review of interesting electro- angiograms and hemodynamic tracings are discussed. A por- cardiograms. tion of the time is set aside each week for the catheterization fellow to review one of a series of topics pertaining to cardio- vascular physiology or coronary intervention. Tuesday 5:00 - 6:00 pm Friday 7:00 - 8:00 am Heart & Vascular Center Noninvasive Conference Grand Rounds This is an interactive conference designed to review inter- This conference allows time for the entire department to assem- esting cases from the echocardiography laboratory with the ble for presentations of current issues and new research in the noninvasive attendings. The noninvasive fellow presents field of cardiovascular medicine. It is presented by a combination the conference, and a portion of time is set aside for the fel- low to review one of a series of topics. of national speakers and local faculty. The visiting professor program is a vital component of the learn- ing experience of the fellows. Nationally recognized academic leaders of the field spend a day interacting with attendings, reviewing interesting cases with the fellows and faculty, and giv- ing a didactic session. Approximately 20% of grand rounds are part of the visiting professor program. 14
  • 17. With whom will I work? 15
  • 18. How will my time be divided? REPRESENTATIVE STANDARD TRACK Clinical year 1 Clinical year 2 Research year ECHO 2 2 1 CATH 1 2 1 CONSULT 2 1 1 CCU 2 2 1 ARRHYTHMIA 1 1 CT/REHAB 1 1 HEART FAILURE/ TRANSPLANT (CCF) 1 NUCLEAR CARDIOLGY (CCF) 1 PEDIATRIC CARDIOLOGY (CCF) 1 RESEARCH 1 7 VACATION 1 1 1 Summary of Fellowship Time 16
  • 19. What about Cleveland? MetroHealth Medical Center is located 10 minutes from the heart of downtown Cleveland. While Cleveland is nationally known as a center for medical education and health care, fel- lows can expect to find almost everything they seek in cul- tural activities, entertainment, sports, and nightlife. We have included a list of some of the attractions our fami- lies have enjoyed over the years: • Sightseeing at the Rock and Roll Hall of Fame and Museum • Watching Broadway shows at the beautifully restored Playhouse Square • Learning while having fun at the Great Lakes Science Center and Omnimax Movie Theatre • Enjoying an evening with the Cleveland Ballet • Shopping and dining downtown at Tower City Center, the Galleria, the “Warehouse District” and the “Flats” • Cheering at professional sporting events including the Browns, Indians, Cavaliers, Rockers, and the Force • Listening to concerts at Severence Hall (the home of the world renowned Cleveland Orchestra) or Blossom Music Center, Gund Arena, and the Convocation Center • Hiking and biking on the “tow path trail” or in the extensive Cleveland MetroParks - part of the “Emerald Necklace” • Spending a day with the family at nearby Six Flags and Cedar Point Amusement Parks or Dover Lake Park • Doing all of these activities in a safe place with a very reasonable cost of living 17