The Cardiovascular Fellowship Program clinical curriculum was recently re-designed as a milestone, competency-based model to meet Core Cardiology Training Symposium (COCATS 4) recommendations of the American College of Cardiology. Core rotations include:
- Cardiac Intensive Care Unit
- Cardiac catheterization
- Cardiovascular Medicine Continuity Clinic
- Adult Congenital
- Vascular Rotation
- Ahuja Rotation
- Advanced Imaging Rotation
- Prevention Rotation
- Night Float
Procedure Volume Training in Cardiovascular Fellowship
The procedural volume meets previous training recommendations of the American College of Cardiology (COCATS3). Procedural volume is tracked throughout training by the specific laboratories (Syngo database) and by the maintenance of procedural/case logs. Procedures include:
- Ambulatory ECG recordings
- Bedside right heart catheterization
- Cardiac magnetic resonance imaging/computed tomography
- Echocardiography, including transesophageal, exercise and pharmacologic stress testing
- Exercise stress testing
- Insertion and management of temporary pacemakers including transvenous and transcutaneous
- Intra-aortic balloon counterpulsation (insertion and management)
- Programming and follow-up surveillance of implantable cardioverter-defibrillators (ICDs) and permanent pacemakers
- Radionuclide studies of myocardial function and perfusion
- Right and left heart catheterization including coronary arteriography
Mentored Research in Cardiovascular Medicine
One of the main strengths of the Cardiovascular Fellowship Program at University Hospitals Cleveland Medical Center is the opportunity for innovative basic, translational and clinical research. Fellows initially identify a faculty mentor and explore clinical, translational and basic science laboratories during the first two clinical years; one to three additional years of dedicated and protected research time are available during the fellowship for a mentored research project(s).
Throughout the clinical years of training, fellows are encouraged to initiate and develop plans for research years. This critically important component of fellowship training is strongly encouraged and emphasized in regular meetings with the program director and other key faculty members. Grant writing/submission is strongly encouraged for those seeking extended research training and mentors assist in targeting appropriate grants and agencies.
Cardiovascular Fellowship Program Evaluations
The Cardiovascular Fellowship Program uses MyEvaluationsTM, through which faculty evaluations are posted at the conclusion of each clinical assignment. Fellows also have a face-to-face meeting with the responsible faculty member. In addition, there is a twice yearly summative evaluation, in which fellows meet individually with the program director to review the following:
- Fellow's evaluations
- Individualized learning portfolios
- Lecture attendance
- Procedure logs
- Quality improvement project
- Research project progress
After one rotation, fellows evaluate faculty and at the end of the year, both fellows and faculty evaluate the program.
In addition to the above evaluations, fellows will participate in 360-degree evaluations, which incorporate feedback from nurses, laboratory staff and patients. This feedback provides the fellow with information about his/her performance from multiple perspectives, and in this manner, the fellow is able to set goals for self-development. These 360-degree evaluations occur in the following areas:
- Cardiac catheterization and echocardiography laboratories
- Cardiac intensive care unit (CICU)
- Continuity clinics
Evaluation of the mentored research portion of the fellowship occurs under the auspices of the designated mentor. This includes a description of a research plan prior to the initiation of research, as well as periodic evaluations of the progress in the research plan.
While the general responsibilities for all years of fellowship are the same, the expectations and independence increase with each successive year of training. Specific personal goals and expectations for further development are assessed before the rotation begins. These will be related to the fellows' learning portfolios and should take into account fellows' prior performance, degree of competence, comfort and experience.
First-year fellows are expected to discuss in detail consultations with an attending while patients are actively followed. Second-year fellows are expected to have a comfortable handle on management and discuss patients with an eye to subtleties of management and future plans. Senior fellows are expected to have facile handling of complex cases, as well as sophisticated and maturing clinical judgment. Thus, the expectation is that the leadership and teaching roles will progress during training.