Clinical and Research Components
Interventional cardiology fellows spend 12 months rotating on the interventional cardiology service at Cedars-Sinai. Time is distributed among well-defined experiences in a number of clinical settings (listed below), which are designed to assure that all the educational objectives are met:
- Catheterization laboratory
- Inpatient and outpatient consultations
- Intensive care units
- Longitudinal outpatient clinic
- Non-invasive testing
- Educational conferences
- Research experience
Supervisory and Patient Care Responsibilities
The following roles, responsibilities and patient-care activities for the IC physician-in-training are designed to develop, demonstrate and support the required ACGME general competencies of patient care; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; professionalism; and systems-based practice.
- Teaching (supervisory) responsibilities. Throughout supervision, interventional cardiology fellows are encouraged to assume progressively increasing responsibility (such as teaching cardiovascular disease fellows on IC rotations), according to their level of education and experience. This level is determined by the program director and adheres to guidelines written in the program policy.
- Patient responsibilities. These include outpatient clinical and consultation services and cardiac interventional procedures
- Rotating responsibilities. The fellow scrubs in on cases in the IC procedures lab. The fellow’s rotating responsibilities also include assignment and designation duties supervising the general cardiology fellows on inpatient IC service, including post-procedure checks, hospital discharge and rounding on all IC service patients.
- Team approach to clinical care. The IC program faculty (or attending staff) is ultimately responsible for patient care. However, the fellow serves as a team member for patient care. In addition to discussion with the individual supervising physician(s), fellows and faculty have the opportunity to discuss cases at the Wednesday catheterization lab review meeting.
- Patient consultation services (inpatient and out-patient scope of service responsibilities). The fellow may see the patient first, collect all clinically important data, and present the case to the attending physician. The attending physician then reviews findings with the fellow; provides a confirmatory or alternative finalized decision-care plan; and sees the patient to write confirmatory chart notes or review a dictated consult. IC consultation services are performed in the emergency room, intensive-care units, wards and preoperative areas, as well as the outpatient clinic and private appointments at the cardiac non-invasive facility.
- Follow-up and continuity of care responsibilities. The fellow is required to participate in faculty consultations in follow-up clinics at Cedars-Sinai. The fellow will be called upon to perform additional management for inpatients, such as in the emergency room and during consultations for device patients in the outpatient area.
- Practice and system-based management responsibilities. Orders may be written by the fellow after discussing the treatment plan with the attending physician. Appropriate system-based technology will be utilized. The fellow is expected to explain all testing, procedural and diagnostic interventions, and also therapeutic management, to patients and family members at any time before, during and following treatment. The fellow advocates for patient care in long-term follow-up, treatment and testing plans, in addition to considering the quality of care while managing the patient with attending physicians in a cost-effective manner.
Laboratory (Clinical) Procedural Requirements
Training includes clinical activity as a primary physician or patient consultant to establish indications for coronary interventional procedures. The fellow’s clinical activity is supervised by a qualified interventional cardiology specialist and provides balanced experience in a variety of clinical settings, including the following:
- Catheterization lab
- Emergency department
- Coronary care and observation units
- Operating room
- Echocardiographic laboratory
- Imaging department
- Ambulatory clinic
Fellows should engage in clinical activities that provide opportunities to acquire knowledge in the evaluation of the following:
- Chronic and acute ischemic heart disease
- Valvular heart disease
Fellows should also have clinical experience in the prevention and management of bleeding complications secondary to thrombolytic agents and antithrombotic and antiplatelet drugs.
Fellows should develop clinical experience involving the following:
- Evaluation and management of patients in the intensive care unit and emergency department
- Pre- and post-procedure management of patients
- Outpatient evaluation and follow-up of patients for pre- and post-cardiac intervention procedures
The program is structured to develop the procedural and technical skills (learned manual skills and associated technical aspects) necessary to perform diagnostic and therapeutic procedures. Successful mastery of these essential skills also includes an understanding of indicators for cardiovascular interventional procedures, contraindications and complications, as well as the ability to monitor and interpret results.
To assure credible confirmation of proficiency in specified procedural techniques, fellows need to perform and demonstrate competence as the primary operator of the following:
- Right and left heart catheterization including coronary arteriography, ventriculography, and hemodynamic measurements
- Intravascular ultrasound
- Doppler flow, intracoronary pressure measurement and monitoring, and coronary flow deserve
- Minimum of 250 coronary interventions, including complex coronary interventional procedures and devices
- Femoral and brachial/radial cannulation of normal and abnormally located coronary ostia
- Intracardiac and transesophageal echocardiographic diagnosis and guidance of structural heart disease interventions
- Minimum of 50 structural heart disease interventions, including but not limited to: vavulplasty, valve replacement, valve repair, closure of cardiac defects and transseptal catheterization
In addition, the fellows have the opportunity to perform at least 10 valvuloplasty procedures and 10 adult congenital interventional procedures. They should acquire skills in the management of mechanical complications or percutaneous interventions.
- IC Catheterization Lab Conference. This case review conference occurs each Wednesday. The fellow is expected to present clinical cases for review during these conferences and develop interactive discussion with faculty and fellows on complex cases. Attendance is mandatory.
- IC Fellows Core Curriculum Lecture. Educational lecture presentations occur every other Tuesday morning. IC faculty and guest faculty are invited to give comprehensive didactic lectures covering current topics in clinical, diagnostic, and procedural IC. Attendance is mandatory.
- IC Journal Club / Research Conference. The conference is conducted on the second Tuesday of every month and is a combined conference of the cardiovascular and interventional cardiology fellowships. It represents a review of currently published articles from scholarly journals. Fellows are responsible for presenting IC Journal Club. Fellows establish and maintain an environment of inquiry and scholarship with presentations of peer-reviewed publications from leading medical journals. Attendance at Journal Club is mandatory.