Cardiology Fellowship Rotations & Schedule

This constitutes full coverage of patients in the coronary care unit and selected patients on telemetry floors. The team includes one cardiology fellow (for the month), internal medicine residents and medical students from Tufts University School of Medicine (for four weeks) and a cardiology faculty member for one week (including weekends).

This rotation provides an excellent training opportunity for fellows to acquire experience in the evaluation and management of a broad range of acute and chronic cardiovascular diseases, including myocardial infarction, unstable angina, chronic coronary artery disease, chest discomfort, congestive heart failure, cardiac arrhythmias, lipid disorders, hypertension, peripheral vascular disease, valvular heart disease, cardiomyopathy and pulmonary heart disease.

The strength of this rotation lies in the volume and diversity of pathology encountered. In a busy clinical environment, the cardiovascular fellow may be asked to handle several clinical activities simultaneously. Further, it puts the onus of advancing one’s academic pursuits, to some extent, on the trainee. Activities such as self-instruction, keeping up with the wide body of expanding cardiovascular literature, conference preparation, and conducting research projects require extra effort on the part of the fellow.

However, the familiarity gained from repeated exposure to day-to-day cardiac problems and the ability to efficiently triage multiple tasks, including academic activities, simulates the busy working environment a fellow is likely to encounter after completion of the training program as a cardiovascular consultant in an academic or private practice setting.

This includes a team of two fellows for the month-long rotation and one attending physician designated for one week at a time, including weekends. Often residents from the Lahey Internal Medicine Training Program and outside institutions rotate through this service. Fellows see consultations from:

• Ambulatory Surgery (for preoperative consultations)
• The Emergency Department
• General Medical and Surgical Services
• Medical/Surgical ICUs (Intensive Care Units)
• Recovery Room

In addition to mastering the clinical and technical skills, the fellow is expected to maintain strong values of professionalism, including placing the needs of one’s patients ahead of one’s self-interest, being responsive when called upon, and maintaining professional relationships with healthcare professionals who may fall above or below the trainee’s level of training.

The emphasis of this experience is “learning by doing”; by continuous hands-on exposure to an extremely wide variety of cardiovascular disorders. As the fellows gain insight and experience throughout their clinical rotations, they are expected to assume progressively increasing responsibility for the formulation of diagnostic and therapeutic decisions that is commensurate with their experience and ability at the time. As fellows advance toward attaining consultant level expertise, they play a greater role in the teaching of medical residents and medical students and provide appropriate references to the literature.

During your rotation in invasive cardiology, you’ll gain experience in our high-volume, state-of-the-art cardiac catheterization lab. You will:

• Develop a clear understanding of the indications for cardiac catheterization as well as its potential limitations and complications.
• Gain skill in interpreting hemodynamic findings.
• Learn the pathophysiologic basis of cardiovascular disorders.
• Understand the medical and surgical implications of angiographic and hemodynamic findings.

We operate under an apprenticeship model, where you’ll have one-on-one supervision from a staff member. You’ll first observe, then assist, then perform our various procedures. Expect to gain manual dexterity while at the same time enhancing your judgement and interpretative skills.

The echocardiography lab at Lahey plays a central role in diagnosing cardiovascular conditions in ambulatory, inpatient, critical care and intraoperative settings. During your fellowship you will:

• Develop an appreciation for the three-dimensional cardiac structural relationships and their depiction using two-dimensional imaging planes.
• Gain an integrated understanding of cardiovascular anatomy, physiology, pathophysiology and hemodynamics.
• Master skills of interpretation required for technically difficult studies, challenging hemodynamic problems and congenital heart disease cases.
• Receive hands-on training conducting and interpreting transthoracic, transesophageal, exercise and pharmacologic stress echocardiography tests.
• Recognize limitations of the technique and confounding artifacts and learn to derive appropriate qualitative and quantitative data to make an accurate diagnosis.

This is a combined rotation in which you’ll spend roughly half your time in our ECG (electrocardiography) and nuclear laboratories. You’ll interpret ECG tracings, exercise tests, ambulatory monitor studies and nuclear scans, which will then be reviewed by an attending cardiologist. Although you’ll supervise all pharmacologic nuclear scans, your presence will be required at only select exercise studies.

This rotation is designed to help you:

• Become proficient in interpreting exercise testing and develop an awareness of the sensitivity and specificity of test findings.
• Develop expertise in recognizing patterns and arrhythmias in common and uncommon types of cardiovascular disease.
• Familiarize yourself with specific characteristics, cost differences, and advantages and disadvantages of commonly used isotopes.
• Gain a basic understanding of nuclear imaging, including myocardial perfusion imaging and radionuclide angiography.
• Identify normal variants and abnormal findings of various tests and better understand the accuracy, limitations and clinical implications of these findings.
• Learn to correlate nuclear data with clinical information and coronary anatomic findings.
• Understand the principles of exercise physiology, expected heart rate and blood pressure response to exercise.

The electrophysiology rotation provides exposure to intracardiac electrophysiologic studies, catheter ablations for cardiac arrhythmias and implantation and follow-up of cardiac rhythm management devices (including pacemakers, defibrillators and loop recorders).

During your fellowship you will:

• Acquire the knowledge and expertise necessary to diagnose and manage cardiac arrhythmias.
• Develop a complete understanding of the indications and limitations of electrophysiology procedures.
• Gain firsthand experience as a consultant in arrhythmia management by seeing and following patients directed to our service.
• Increase your knowledge of ambulatory ECG monitoring, event recorders and exercise testing for arrhythmia management.
• Learn about nonpharmacologic and pharmacologic treatments for arrhythmias, as well as pharmacokinetics, drug interactions and side effects.

An obligatory month-long rotation during your third year at Tufts Medical Center helps you recognize when it’s appropriate to refer patients for cardiac transplantation and provides an opportunity to become familiar with long-term management of transplant patients.

During your fellowship, you will:

• Develop an understanding of appropriate patient selection criteria for transplantation.
• Expand your grasp of pathophysiological mechanisms in outpatient and inpatient management of advanced heart failure.
• Gain insight into cardiac transplant success rates, expected survival and anticipated short-term and long-term complications.
• Increase knowledge of standard and experimental cardiovascular drugs and various ventricular assist devices.
• Participate in preoperative testing and post-transplant patient care.

With advances in medical and surgical techniques, more patients are surviving into adulthood. These patients often present with unique problems that may be unfamiliar to the adult cardiologist. The small number of centers in the United States that deal with congenital heart disease patients with sufficient regularity makes it difficult for the fellow to gain enough experience during training to feel comfortable dealing with such cases.

To provide our fellows with exposure of sufficient intensity to patients with congenital heart disease, during their second year of the fellowship, they rotate for a month-long period with renowned experts in the field, including Dr. Doreen DeFaria-Yeh at Massachusetts General Hospital and Dr. Michael Landzberg at Boston Adult Congenital Heart and Pulmonary Hypertension program. Additionally, fellows can gain valuable experience working with Dr. Michael Singh (BWH and BACH) and Dr. Sourbha S Dani who provide care for adult patients living with congenital heart disease at Lahey Hospital and Medical Center. The focus of these unique rotations is to allow the fellows to gain the necessary experience in an organized, concentrated manner, in a setting enriched with a large volume of patients with congenital heart disease.