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The Interventional Cardiology Fellowship at Massachusetts General Hospital is a one-year ACGME-approved program, organized under the directorship of Igor Palacios, MD, and Douglas Drachman, MD. The fellowship functions as an integral component of the subspecialty residency in cardiology and the categorical residency program in internal medicine. During the year of interventional training, fellows are expected to master the techniques involved in coronary intervention, while developing perspective on procedural risk and benefit, patient selection and clinical decision-making in cardiovascular patient care. At the end of the year, fellows should function as independent operators during interventional procedures. The program adheres to the tenets outlined in the ACC COCATS guidelines document and the AHA statement on clinical competency in interventional cardiology.
The primary goal of the Interventional Cardiology Fellowship is to provide comprehensive training in the diagnosis, care and endovascular treatment of patients with cardiovascular disease. Fellows graduating from Mass General's program will be poised to assume positions of leadership in the field of Interventional Cardiology. The fellowship program provides the opportunity to acquire procedural expertise including but not limited to:
In additional to learning techniques for percutaneous coronary intervention, fellows will be exposed to non-coronary cardiac interventions and management of peripheral vascular disease.
Non-coronary interventions include:
Peripheral evaluations and intervention include percutaneous treatment of arterial disease in the following distributions:
Clinical investigations include the use of novel devices for percutaneous treatment of coronary artery disease, non-coronary cardiac interventions such as percutaneous valve replacement, drug-eluting stent studies, stem cell and angiogenesis factor treatment for patients with end-stage coronary and peripheral arterial disease and novel imaging technologies.
The clinical fellows are responsible for seeing patients pre- and post-cath. They are involved in the daily care of these patients, including their pre-catheterization evaluation. The clinical fellow participates in daily rounds on these patients. All cases are discussed in the morning prior to the day’s procedures. There is a comprehensive core curriculum lecture series that includes didactic presentations, as well as a journal club and an intensive morbidity and mortality review.
Those graduating from the one-year program will easily exceed the minimum ACGME requirement of 250 coronary interventions, where a single coronary intervention is defined as all coronary interventions performed during one hospitalization. The ACC recommends a maximum participation level at 600 procedures per year. We anticipate that each fellow will perform between 300 to 350 coronary interventions during the one-year program. Fellows will be the primary operator on the majority of these cases. Our curriculum meets the requirements specified by the American College of Cardiology for interventionalists; our high volume and high level of case complexity provide an excellent foundation to develop expertise as an independent operator.
The Interventional Cardiology Fellowship Program allows fellows the opportunity to work with a variety of highly-qualified invasive cardiologists in the setting of an extremely active program which performs approximately 6,000 cases per year. The case material is varied and challenging, as Massachusetts General Hospital serves both as the primary hospital for the local neighborhood as well as a tertiary referral center which draws patients from affiliated hospitals and health centers throughout Massachusetts. Massachusetts General Hospital also attracts patients from across the United States and internationally. Furthermore, the Interventional Program is academically based and has approximately 20 active research protocols including multicenter and investigator-driven trials. This provides ample opportunity for fellows to pursue their research interests. Additionally, there is ample faculty mentorship and animal facility access for fellows who wish to focus on translational research.
The Knight Cardiac Catheterization Laboratory is located on the 9th floor of the Blake building on Mass General's main campus. The laboratory is comprised of six state-of-the-art, high-resolution digital fluoroscopy units, which are networked throughout the hospital. A wide variety of diagnostic and interventional procedures are performed in these laboratories, with approximately 6,000 cases done per year, approximately 1,400 of which are coronary interventions. While patients from throughout the hospital may be referred to the Cardiac Catheterization Laboratory for invasive assessment, the majority of patients with acute cardiovascular illness are managed on Ellison 9, Ellison 10 or Ellison 11. Ellison 9 is the Cardiac Intensive Care Unit (CICU); Ellison 10 is the Stepdown Unit (SDU); and Ellison 11 is the “Access” unit. Outpatient care for patients of the Interventional Cardiology Associates’ practice is provided on the 8th floor of the Gray-Bigelow building.
Requirements of the Interventional Cardiology Fellowship include:
Five fellows are selected from a highly competitive field of applicants for the training program. Fellows are selected from among eligible applicants on the basis of their ability, academic credentials, aptitude, communication skills, intellectual and humanistic qualities, personal attributes (such as motivation and integrity), preparedness and their ability to benefit from the program. These qualities may be assessed through review of academic records, letters of recommendation, standardized test scores, and other means, including interviews. Selection of fellows will not discriminate with regard to age, gender, nation of origin, race, religion, sexual orientation, disability or veteran status. Fellows must have completed three years of General Cardiology training prior to entering the program.
Fellows spend 12 months assigned to the cardiac catheterization laboratory at Mass General. Prior to a procedure, the fellow sees and examines the patient, explains the procedure to be performed and obtains informed consent. The fellow reviews the case and discusses pertinent issues with the faculty attending before the patient is taken into the laboratory. The attending is scrubbed during every interventional procedure. As the fellow develops his or her skills, he or she progressively performs more of the procedures in a primary role. Advancement of responsibility is at the discretion of the faculty attending until the fellow is capable of performing cases as primary operator. Over the course of the year, the attending may assist or stand aside to observe, giving verbal instructions and feedback as necessary. The fellow reviews pressure tracings, ultrasound recordings and angiography data with the attending, completes the procedure note, writes the post-procedural orders and procedure report, then follows the patient post-procedurally. The patient is seen again the following morning and daily thereafter until discharge, during which time the fellow writes progress notes detailing the apparent results of the procedure and records any interim complications. On call weekends, fellows will assist the on-call interventional attending with rounds on the inpatient service.
Fellows rotate in the outpatient clinics of the Interventional Cardiology staff physicians half day per week over the course of the one-year training program. Patients seen in the outpatient clinic include patients undergoing pre-procedural evaluation as well as follow-up after interventional procedures for coronary, non-coronary cardiac, and peripheral interventions. The fellow follows their course, and under the supervision of the preceptor, orders medications and diagnostic testing as clinically indicated. Patients referred to the preceptor for consideration of revascularization will be scheduled as new patients for the fellow. These new patients provide the fellow with consultative experience in the outpatient setting. Pre-procedure evaluation patients provide the fellow with consultative experience in the outpatient setting. Pre-procedure evaluation patients provide the fellow with consultative experience. Fellow and preceptor discuss the indications, if any, for percutaneous revascularization and anatomical or clinical characteristics which would favor coronary artery bypass grafting surgery as an alternative.
Due to the diverse teaching activities conducted at Mass General, fellows have the opportunity to participate in training medical students as well as residents from various GME training programs (e.g., internal medicine residents, cardiothoracic surgery residents, cardiology residents). In conjunction with Dr. Drachman, the interventional fellow helps to orient and educate the cardiology residents rotating through the catheterization laboratory. The interventional fellow may provide insight into angiographic anatomy, equipment and supplies used during invasive procedures and to the correct interpretation of pressure tracings. He or she serves as a resource person for these individuals throughout the year. Additionally, fellows are active presenters in the Cardiology Division conference schedule.
There is a research requirement for all interventional cardiology fellows, which includes the full scope of project involvement (e.g. enrollment of patients, data analysis, presentation or publication of results including in abstract form and complete manuscripts). The program directors facilitate a connection between the interventional fellows and potential faculty research mentors before the fellows arrive; in this fashion, fellows may maximize their academic productivity during the one-year program. Approximately 20 percent of the year is protected for academic research.
The interventional cardiology fellows prepare and present at the three cardiology conferences each week. These include the presentation of patients including strategy and review of interventional outcome as well as pertinent literature. They are also expected to participate in a variety of conferences, including:
Journal club is scheduled once per month; staff facilitator, article and fellow discussant will be scheduled and posted in New Innovations. Morbidity and Mortality conference (second Thursday of the month at 7:15 am) is also held on a monthly basis; fellows’ attendance and participation is mandatory.
It is our intention to have all fellows eligible for the Interventional Cardiology Boards upon completion of this program.
Applicants interested in a position starting July 2017 need to apply through ERAS. Completed applications must be submitted by January 4, 2016. Interviews will be held on in either late January or early February 2015. We require the following information (via ERAS):
Requests for a second year of advanced training in either Structural Heart Disease or Vascular Diagnostic and Intervention will be considered during the interventional fellowship interview process.
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