INTERVENTIONAL CARDIOLOGY FELLOWSHIP
                EMORY UNIVERSITY SCHOOL OF MEDICINE
The fellowship program in Interve...
Emory University School of Medicine
                            Division of Cardiology
               2009 Interventional ...
EMORY UNIVERSITY SCHOOL OF MEDICINE
 APPLICATION FOR INTERVENTIONAL (PTCA) 2009 CARDIOLOGY FELLOWSHIP

Return this applica...
EDUCATION                                                          List degrees, honors,
                                 ...
Other Post-Graduate Training:
___________________________________________________________________________________
________...
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INTERVENTIONAL CARDIOLOGY FELLOWSHIP EMORY UNIVERSITY SCHOOL ...

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INTERVENTIONAL CARDIOLOGY FELLOWSHIP EMORY UNIVERSITY SCHOOL ...

  1. 1. INTERVENTIONAL CARDIOLOGY FELLOWSHIP EMORY UNIVERSITY SCHOOL OF MEDICINE The fellowship program in Interventional Cardiology, first started by Andreas Gruentzig in 1981, is a one-year program which continues to accept applications from highly qualified physicians who have completed their board eligibility in Internal Medicine and Cardiology. Basic requirements are the completion of a three-year Cardiology fellowship program and full training in cardiac catheterization and coronary angiography. Selections are made in October. Currently, six fellows are accepted each year for this one-year fellowship. Responsibilities of clinical interventional cardiology fellows include the evaluation and care of all patients referred for interventional procedures and the direct participation in all of those procedures under the supervision of the senior interventional cardiologist. Fellows can anticipate participation in 400 or more procedures including new devices, valvular and peripheral interventions. Fellows will be expected to actively participate in clinical trials of devices and therapy for restenosis as well as data collection for prospective evaluation of patients and for comparison to other forms of therapy. Fellows will be expected to review incoming requests for referral to evaluate and make judgments on indication and selection for patients and to become expert in the performance and interpretation of procedures. Fellows are also expected to complete a research project suitable for publication in a peer review journal. The experience in the fellowship program is acquired in the Interventional Cardiology section of the Division of Cardiology at Emory University Hospital, at Crawford W. Long Hospital of Emory University and at the Veterans Administration Medical Center of Emory University. At the conclusion of the training fellows are expected to become board eligible for the American Board of Internal Medicine, Interventional Cardiology certifying examination.
  2. 2. Emory University School of Medicine Division of Cardiology 2009 Interventional Fellowship Training Program Application Instruction Sheet Please use this sheet as a “checklist” for application requirements! I. Please send the following letters of recommendation and have them addressed to Ziyad Ghazzal, M.D., Director of Fellowship Training in Interventional Cardiology. The address is the same as listed on the application. 1. Chief of Service or Director during Fellowship. 2. Two other physicians who are qualified to evaluate your ability and qualifications for the specific fellowship. 3. Copies of official scores from all exams attempted since your matriculation into medical school. ______ ABIM ______ USMLE ______ FLEX ______ NBME 4. Curriculum Vitae. 5. Personal Statement. 6. If you are a graduate of a medical school outside the United Stated or Canada, please send a copy of your ECFMG certificate. 7. Please attach a photo of yourself to the application. THE DEADLINE FOR RECEIVING YOUR APPLICATION MATERIAL IS SEPTEMBER 1, 2008
  3. 3. EMORY UNIVERSITY SCHOOL OF MEDICINE APPLICATION FOR INTERVENTIONAL (PTCA) 2009 CARDIOLOGY FELLOWSHIP Return this application and all necessary documents (by September 1, 2008) to: Ziyad Ghazzal, M.D., FACC Director, Fellowship Training Interventional Cardiology Emory University Hospital 1364 Clifton Road, Room F606 Attach Recent Photograph Here Atlanta, Georgia 30322 Phone: (404) 712-7424 Fax: (404) 712-5622 PERSONAL DATA Name in Full:________________________________________________________________________ Last First Middle Home Address:______________________________________________________________________ Street Address ________________________________________________________________________ City State Zip Code Country Telephone:_________________________________ _____________________________ Home Telephone Number Work Telephone Number E-mail:_____________________________________ _____________________________ Cell phone Work Address:_______________________________________________________________________ Street Address ________________________________________________________________________ City State Zip Code Country Social Security Number:____________________________________ Birthdate:____/____/____ (optional) (optional) Citizenship: ___________________________________________________________________ If not a citizen of the United States please check: Permanent Resident: _____ J-I Visa: _____ Other: ________________ Please enclose a copy of your immigration visa together with the date and results of the Foreign Medical Graduate test.
  4. 4. EDUCATION List degrees, honors, majors, minors: ______to______ College:_____________________________________________ ______________ (mo/yr) (mo/yr) Name Degree _____________________________________________________________ City State Country Medical ______to______ School: ______________________________________________ _____________ (mo/yr) (mo/yr) Name Degree _____________________________________________________________ City State Country Graduate ______to______ School: ______________________________________________ _____________ (mo/yr) (mo/yr) Name Degree _____________________________________________________________ City State Country POST-GRADUATE MEDICAL TRAINING ______to______ Internship:_________________________________________________________ (mo/yr) (mo/yr) Hospital Name ________________________________ _______________________ Type Chief/Department Chairman ______to_____ Residency:_________________________________________________________ (mo/yr) (mo/yr) Hospital Name _________________________________ _______________________ Type Chief/Department Chairman ______to_____ Fellowship:_________________________________________________________ (mo/yr) (mo/yr) Hospital Name _________________________________ _______________________ Type Chief/Department Chairman Present ______to_____ Position:___________________________________________________________ (mo/yr) (mo/yr) Hospital Name _________________________________ _______________________ Type Chief/Department Chairman
  5. 5. Other Post-Graduate Training: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Post Graduate Research Training: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Previous Research Experience (as a student or house officer): ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ OFFICIAL SCORES: List all (post-matriculation) examinations you have taken, scores and dates (ABIM, USMLE, NBME, FLEX, etc.): EXAM SCORES DATE ABIM Internal Medicine _______ _______ Cardiovascular Disease _______ _______ USMLE I _______ _______ USMLE II _______ _______ USMLE III _______ _______ FLEX _______ _______ NBME _______ _______ Honors, Awards: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ List states licenced to practice:__________________________________________________________ Bibliography: List articles that have been published or accepted for publication in peer review journals One reprint of each article should be included with the application. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Medical and scientific affiliations: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Applicant Signature:_______________________________________________Date:____________________

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