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Interventional Cardiology

Curriculum


The Interventional Cardiology Fellow is a fourth year Cardiology Fellow who has completed an Accreditation Council for Graduate Medical Education (ACGME) accredited cardiovascular disease program, or it's equivalent. The Interventional Cardiology Fellow acts as a senior Fellow working with the Clinical Cardiology Fellows under supervision of the Attending Interventional Cardiologist assigned to the Catheterization Laboratory.

The Interventional Cardiology Fellow will proceed through a rotation designed to enable them to become a competent Interventional Cardiologist and to achieve increasing levels of performance in all aspects of interventional cardiology. The Interventional Cardiology Fellow will be provided Clinical experience to acquire knowledge of the indications, contraindications, risks, limitations, sensitivity, specificity, predictive accuracy and appropriate techniques for evaluating patients with a wide variety of cardiac disease disorders- such as chronic ischemic heart disease, acute ischemic syndromes and valvular heart disease. In addition, they will also have opportunity to acquire experience in management of bleeding complications.

The Interventional Cardiology Fellow will be provided sufficient experience to acquire knowledge in clinical decision making to include the role of randomized clinical trials, clinical importance of complete versus incomplete revascularization, strengths and limitations of differing percutaneous approaches, the role of emergency coronary bypass surgery, the use and limitations of intra-aortic balloon counterpulsation, strengths and weaknesses of mechanical vs. lytic approach for patients with acute myocardial infarction, the use of pharmacological agents appropriate in the post- interventional management of patients, strengths and limitations of both noninvasive and invasive coronary evaluation during the recovery phase after acute myocardial infarction. The Interventional Cardiology Fellow will be instructed in invasive diagnostic and treatment methods used to treat critically ill cardiac patients such as coronary angiograms, ventriculography, hemodynamics, intravascular ultrasound, femoral and brachial cannulation, application and use of balloon angioplasty, stents and other commonly used interventional devices.

The Interventional Cardiology Fellow, as part of the Interventional Cardiology Team, will care for these patients in various settings as appropriate: the General Cardiology Clinic, Operating Room, Interventional Cardiology Laboratory, Cardiac Catheterization Laboratory, Coronary Care Unit, Intensive Care Unit and the Emergency Room during the evaluation, treatment and follow-up processes. In the context of this training, the Interventional Cardiology Fellow will continue to gain extensive experience in associated specialized skills (use of antiarrhythmic drugs, cardiopulmonary resuscitation, cardioversion and defibrillation, cannulation (arterial and venous), use of thrombolytic and antithrombolytic agents, use of vasoactive agents for epicardial and microvascular spasm and advanced cardiac life support procedures.

Invasive Diagnostic and Treatment Modalities:
The Interventional Cardiology Fellow will participate in the care of patients undergoing interventional cardiology procedures. This experience will be structured so that the Interventional Cardiology Fellow will perform a minimum of at least 250 coronary interventional cardiology procedures, although a recommended amount is 400 coronary interventional. The ACGME defines one coronary interventional case as all coronary interventional procedures performed during a single hospitalization (i.e. staged procedures or emergent repeat procedures are counted as a single case).

These procedures will be completed during the rotation through the Interventional Cath Lab either as the primary physician or as an assistant actively involved in collecting and analyzing the data. The Interventional Cardiology Fellow will gain the necessary knowledge of the technology used in interventional cardiology (e.g. intravascular ultrasound, cannulation, catheters, stents, balloons, angiojet and rotoblader) measuring and analyzing data and providing follow-up care to the patient.

The Interventional Cardiology Fellow is responsible to maintain detailed records in the form of a logbook that contains clinical information for each patient studied and/or treated in the laboratory. Documentation is to include the patient medical record number, the procedure performed, assisting physicians and procedure outcomes including any complications encountered. To claim credit for a case the following elements must be included:1) Pre-procedural evaluation to assess appropriateness and to plan procedure strategy; 2) Personal performance by the trainee of the case's critical manipulations under the direct supervision of a scrubbed Interventional Cardiology faculty member. The faculty member, who takes overall responsibility to supervise the trainee's actions and to take over the performance of the case at any time that it is in the best interest of the patient; 3) Active involvement in post-procedural management both in the catheterization laboratory at the conclusion of the case and on the inpatient unit afterwards. This includes experience in managing vascular access sites and anticoagulation.

The Interventional Cardiology Fellow will also be involved in procedure reporting and the quality assurance process.

The Interventional Cardiology Fellow will attend the Cardiology Clinic or clinic equivalent. He or she will be exposed to and gain experience in interventional follow up treatment. The Interventional Cardiology fellow will be carefully trained to evaluate the patient's overall quality of life in the context of this therapy and assisting the patient when necessary to improve his or her condition.

ROTATION SCHEDULE

Cardiac Catheterization Laboratory with Director 8 months
Cardiac Catheterization Laboratory with other faculty 2 months
Julio Sosa, MD learning the brachial approach how to decipher data 1 month
National Conferences 1 week
Vacation 3 weeks


The responsibilities of the Interventional Cardiology Fellow's respective rotation service are:

Clinical Consultation: 
The Interventional Cardiology Fellow will act as a Senior Resident working with the second year Clinical Cardiology Fellows rotating through the Interventional Cardiology Service in their respective month. The interventional Cardiology fellow is expected to see patients who present with need for interventional cardiology.

The Interventional Cardiology Fellow will perform a complete work-up (including a detailed history and physical exam), review the medical records, conceptualize the problem and establish a plan for the appropriate diagnostic approaches to follow.  the Interventional Cardiology Fellow would determine whether non-invasive or invasive cardiology testing is appropriate and/or whether urgent antiarrhythmic medication treatment should be initiated.

All consults must be presented to the Interventional Cardiology Attending.  It is expected that the Interventional Cardiology Fellow would play an active role in organizing the presentation, formulating the thought and explaining the rationale for her or his given therapeutic approach, which would be discussed with the Attending. 
 
Interventional Cardiology Catheterization Laboratory:
During rotation in the Interventional Cardiology Lab, the Interventional Cardiology Fellow will gain clinical experience in acquiring knowledge of the indications, contraindications. risks and limitations of Interventional Cardiology. The Interventional Cardiology Fellow will learn the basic skills needed to do coronary interventions.

Radiation Safety:
In addition, the Interventional Cardiology Fellow must learn the appropriate radiation safety levels, since it will be necessary for him or her to successfully pass a radiation safety examination in order to qualify as a fluoroscopic examination operator. All Interventional Cardiology Fellows must pass the advanced cardiac life-support exam.

Outpatient Interventional Clinics:
The Interventional Cardiology Fellow is required to attend the Cardiology Clinic once a week. The clinic experience provides him or her training in performing outpatient consultations of patients who require interventional cardiology care as well as giving long-term follow-up treatment (pharmacologic or non-pharmacologic).

Research Program:
Clinical research is considered an integral component of achieving competence in Interventional Cardiology. This educational development would evolve from determining key questions to investigate, formulating significant hypothesis, designing significant and well-organized research protocols (based on sound scientific methodologies and data analyses) for grant and IRB submission, as well as preparing the data for abstract and manuscript formulation, preparation, publication and presentation. The Interventional Cardiology fellow will also be enrolling patients in the clinical trials, collaborating in research protocols, data analysis and presentations.  Support staff is available and includes staff (faculty, nursing, technical and ancillary), space and equipment resources, computer resources (including database, networking and analyses) and library, statistical, editorial and computer consulting support staff.

CONFERENCES
The objectives of the Cardiac Catheterization Conference are to promote the education’s and intellectual interaction among the Interventional Cardiology Fellow, Fellows, Cardiologists, Thoracic Surgeons, Attending Physicians and the lab technical staff. The Interventional Cardiology Fellow will gain knowledge and understanding of all basic areas of interventional cardiology, thereby gaining a fundamental foundation for ongoing growth and experience in interventional cardiology. Our conferences generally aim to stimulate creative and critical thinking, specifically encouraging the Interventional Cardiology Fellow to formulate and address key research and clinical relevant questions. Each type of conference addresses a different issue: a description of each type of conference follows:
 
Cardiac Catheterization Conference:
The purposes of the cardiac catheterization conference is to 1) review and critique both diagnostic and interventional cases with respect to case selection, procedure conduct and outcome. This conference is to review and discuss all adverse outcomes, which occur during the training program; and 2) Present and discuss the cognitive interventional cardiology curriculum subject matter. The Cardiac Catheterization Conference is held once a week, on Friday at 12:00 noon in D105. 

The Interventional Cardiology Fellow will be responsible for bringing interesting, salient interventional cardiology cases from current cases to present to the group for discussion and comment. This conference aims to improve the Interventional Cardiology Fellow's interpretive skills for interventional cardiology. The Cath Conference promotes stimulating discussion of a wide range of interventional cardiology maneuvers.

This Conference serves also as a forum for the Interventional Cardiology fellow to expand her or his ability to recognize the characteristics of interventional cardiology procedures. In this conference, relevant radiographic, angiographic and echographic findings relevant to the cases will be presented.

This conference also will discuss many representative cases and in so doing provide a discussion of diagnosis and how to best treat each patient.

Cardiac Catheterization Morbidity and Mortality Conference:
This conference is designed as a quality assurance as pertinent cases regarding deaths and serious complications are thoroughly discussed among peers. Each month one of the Attending Cardiologists acts as a narrator at the conference and can be contacted should a particular case be requested to be presented. Interventional Cardiology Fellows should attend this conference as a learning experience. This conference is held once a month on the third Thursday at 7:00 AM in D105.

Research Conference:
The Research Conference is held once a month. These conferences are used to teach research methodology including determining key questions to investigate, formulating significant hypothesis, designing significant and well-organized research protocols (based on sound scientific methodologies and data analyses) for grand and IRB submission, as well as preparing the data for abstract and manuscript formulation, preparation, and publication and presentation. Also working with the Albany Medical Center Study Coordinator to prepare the CRF (Case Report Forms) for the FDA and Pharmaceutical Sponsors.

Journal Club:
A Journal Club conference will be designed to teach the Interventional Cardiology Fellow how to read, interpret and apply data from the appropriate articles in cardiology and interventional cardiology. The Journal Club will be established to sharpen the acumen of the Interventional Cardiology Fellow in critically analyzing the methodology, results and data presented in selected articles in order to formulate her or his interpretation of the strength, weakness , as well as the clinical applications and implications of the given text. The Journal Club should meet at least once a month.