Department of Internal Medicine Division of Cardiology
             The Brody School of Medicine
             Pitt County ...
Adult Cardiology Fellowship
              Division of Cardiology
              Department of Internal Medicine
           ...
Brody School of Medicine at East Carolina University
                              Pitt County Memorial Hospital
         ...
East Carolina University Brody School of Medicine
                                         Division of Cardiology
        ...
Prerequisites: I have passed the following examinations (give date and score). Please forward copies of
appropriate certif...
Record of Licensure. A license to Practice in North Carolina, either temporary or permanent, is mandatory.
Are you license...
References: List below the names and positions of those whom you have requested to write in your behalf.
We require origin...
Upcoming SlideShare
Loading in...5
×

Department of Internal Medicine Division of Cardiology

408

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
408
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Department of Internal Medicine Division of Cardiology"

  1. 1. Department of Internal Medicine Division of Cardiology The Brody School of Medicine Pitt County Memorial Hospital Teaching Annex, Room 378 Greenville, NC 27858-4354 252.744.4651 Office 252.752.4163 evenings and weekends 252.744.5884 Fax 1.800.775.4651 Dear Applicant: Thank you for your interest in the Cardiovascular Fellowship Program at East Carolina University School of Medicine. Enclosed please find a fellowship application as well as information about ECU, the Division of Cardiology and the Fellowship Program. Please complete the enclosed application and return to the address below no later than January 31, 2005. Also, with your application please include a non-returnable photograph, a copy of your driver’s license and a copy of your social security card. Applications, letters of recommendation and other correspondence should be mailed to: Mardie Bullock, Fellowship Coordinator ECU Brody School of Medicine Division of Cardiology PCMH Room 378TA Greenville, NC 27858-4354 If you have any questions, you may contact Mardie Bullock at 252.744.5964 or by email at cardiologyfellowship@mail.ecu.edu or visit our web site at www.ecu.edu/cardiologyfellowship. Should you be chosen for an interview, you will be contacted in February or early March. Please ensure that your phone numbers and email addresses are correct. Again, thank you for your interest in East Carolina University and best of luck to you in your educational endeavors. Sincerely, John D. Rose, MD Cardiology Fellowship Program Director Professor of Medicine
  2. 2. Adult Cardiology Fellowship Division of Cardiology Department of Internal Medicine Brody School of Medicine at East Carolina University Greenville, NC 27858-4354 The Brody School of Medicine at East Carolina University is located in Greenville, North Carolina, a charming college town of 60,000 situated halfway between the beautiful coast of North Carolina and Raleigh/Durham. The climate here is excellent with mild, comfortable winters and moderately warm summers. With more than 18,000 students, East Carolina has the second largest enrollment in the state. In addition to a young and growing medical community, we also boast a Division I sports program and an exciting liberal arts school with theatre, musicals and symphonic orchestral presentations throughout the year. Our cardiology fellowship program began in 1990. We accept two fellows in the general cardiology program each year and one per year for interventional cardiology and echocardiography. We are a fully accredited fellowship with a three year (maximum) accreditation from the ACGME. The Division of Cardiology offers all aspects of cardiovascular diagnosis and treatment, and our faculty includes specialists in invasive/interventional cardiology, nuclear cardiology, electrophysiology, cardiac rehabilitation and echocardiography, including transesophageal, stress echocardiography, and three dimensional echocardiography. There is an active cardiac catheterization program which serves Eastern North Carolina. The catheterization laboratories perform 6,000 catheterizations per year and approximately 2,000 angioplasties, including atherectomies, rotational atherectomy, and stent placements. The 750-bed hospital has a 24-bed coronary care unit and 40-bed telemetry unit housed in our Heart Center. The Heart Center has five state-of-the-art cardiac catheterization laboratories. Over 600 electrophysiology (EP) procedures will be performed this year, including the implantation of ICD devices and RF ablations. Permanent pacemakers are implanted and followed in a pacemaker clinic. The noninvasive laboratory is equipped with state-of-the-art Hewlett-Packard two-dimensional, transesophageal, and color flow Doppler echocardiography equipment. Two Quiniton Q5000 treadmill systems and a full disclosure Holter system are present as well as cardiopulmonary stress testing. A multidisciplinary, full-service cardiac rehabilitation program is in place. Approximately 1,200 open-heart surgeries will be performed this year by the full-time university cardiovascular surgeons. The surgery service performs adult and pediatric cardiac surgery. There is an active pediatric cardiology service at the university. Opportunities for research are available including collaborative work with basic scientists, as well as opportunities for research with clinical faculty. Our outpatient facility is located in a private practice setting adjacent to the medical center. This outpatient center provides efficient patient care in a comfortable setting and allows the opportunity for high-quality training in a relaxed atmosphere. Specialty clinics in arrhythmias, anticoagulation, and heart failure are present at this site. If you are interested in more information, please call us. Application deadline is January 31, 2005. Cardiology Fellowship Application 2 7/22/2004
  3. 3. Brody School of Medicine at East Carolina University Pitt County Memorial Hospital and Affiliated Graduate Medical School Education Programs Application Requirements Please read the attached application form carefully and provide the information and credentials requested. Only completed application forms can be processed for appropriate review and subsequent recommendations. 1. The following credentials are to be forwarded to this office as promptly as possible: • Complete transcripts of medical school records must be sent directly from the school. Notarized copies of complete transcripts from residency office of applicants from ECU are acceptable. • Two letters of recommendation addressed to the Adult Cardiology Fellowship Program Director should be from faculty or staff who are familiar with your performance record. If the latter are acquainted with the Program Director, they may prefer to write directly to him. Additional letters are required from the dean of your medical school and director(s) of all residency programs in which you served stating date(s) of training. • Copies of NBME scores, ECFMG scores, FEMGEM scores, FLEX scores. Copies of ECFMG certificate, FLEX certificate. • Curriculum vitae. • Personal Statement: This should include your professional interests, achievements, and plans for the future. Reference should be made to research experience and training, special projects or scientific work you have engaged in, and any notable professional accomplishments you have achieved. You may also wish to describe your personal interests, activities, and circumstances, including your family and household. • Foreign school graduates: Copies of ECFMG certificate, medical school diploma, and license to practice medicine in home country with certified translations of documents if they are not in English. Transcripts of medical school must be notarized if not original. References letter must be original and sent directly from the person writing in your behalf. 2. Personal interviews are required and are to be arranged directly with the Office of the Director. Program Director Adult Cardiology Fellowship Division of Cardiology Department of Internal Medicine East Carolina University Brody School of Medicine Greenville, NC 27858-4354 The East Carolina University School of Medicine policy is to be in full compliance with all federal and state nondiscrimination and equal opportunity laws, orders and regulations, and it will not discriminate against any person because of race, color, sex, religion, handicap, or national origin in any of its educational programs and activities. Cardiology Fellowship Application 3 7/22/2004
  4. 4. East Carolina University Brody School of Medicine Division of Cardiology Department of Internal Medicine Greenville, North Carolina 27585-4354 Application I hereby apply for clinical training in: at year level, to begin: I am participating in NRMP: Yes No NRMP No.: I am participating in another Matching Program (Specify): Name: Soc. Sec. No.: (Please Print) Last First Middle Mailing Address: Street: City: State/Country: Zip: Telephone: Home: Work: Permanent home address, if different from above: Street: City: State/Country: Zip: Citizenship: US Citizen Foreign Citizen Visa Status: Permanent Immigrant Temporary J1 H1 Place of Birth: Date of Birth Sex: State of Health: Ht.: Wt.: Do you have any condition which would preclude you from performing rational judgments, reacting quickly in emergent situations or working for an extended period of time (i.e., night call) under stressful conditions without interruption? If yes, attach a detailed explanation. Yes No Have you ever been convicted of any criminal offense in any state or federal court (other than minor traffic violations)? If yes, attach statement including state and place of conviction(s) and nature of such offense(s). Yes No Cardiology Fellowship Application 4 7/22/2004
  5. 5. Prerequisites: I have passed the following examinations (give date and score). Please forward copies of appropriate certification. Mo./Yr. Score Place Mo./Yr. Score National Board Part I State Lic. Exam National Board Part II Flex National Board Part III VQE ECFMG FEMGEM Date Served: Internship: Flexible Straight Specialty at in Hospital Location Residency or Fellowship in: Specialty at in Institution Location at in Institution Location at in Institution Location Research and Teaching Experience: at in Rank Field at in Institution Location Under direction of: Other medical experience: Scholarships, Prizes or Awards: Memberships in professional and/or honorary societies: American Board of Internal Medicine Certificate: Date Certificate No. Cardiology Fellowship Application 5 7/22/2004
  6. 6. Record of Licensure. A license to Practice in North Carolina, either temporary or permanent, is mandatory. Are you licensed to practice medicine in North Carolina: Yes* No** *If yes, submit copy of license **If no, you must be able to obtain full licensure Date of Certificate: Exp. Date: License No.: I have been licensed to practice medicine in the following states: State License No. Issue Date Exp. Date Original License: Original License: Original License: Original License: Have you ever been denied a license, permit or privilege of taking an exam by any licensing authority? If so, attach a detailed explanation. Yes No Have you ever had a license or permit encumbered in any way (revoked, suspended, surrendered, censured, restricted, limited, placed on probation)? If yes, attach a detailed explanation. Yes No Have you ever been named in a malpractice suite? If yes, attach a detailed explanation. Yes No Education College/University (Include graduate work) Degree/Field From To Medical or Osteopathic School From To Publications: Please submit a list or copy of each, if available. Cardiology Fellowship Application 6 7/22/2004
  7. 7. References: List below the names and positions of those whom you have requested to write in your behalf. We require original letters and do not accept Xerox copies. We require a letter from all program directors of any accredited United States residencies or fellowships in which you have served and from current or past medical employers and two other letters of recommendation from faculty and staff familiar with your clinical skills and/or from the dean of your medical school. Name: Position: Name: Position: Name: Position: Please check the appropriate box: I hereby waive access to the above letters and will so inform the authors. I desire access to the above letters and will so inform the authors I have read, and I understand the instructions for the completion of this application. I certify that the information submitted on these application materials is complete and correct to the best of my knowledge. I understand that any use or missing information may disqualify me for this position or be grounds for termination in case of employment. Signature of Applicant Date Note: The signature and date on each application must be original. Cardiology Fellowship Application 7 7/22/2004

×