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The training goal of Massachusetts General Hospital Cardiovascular Disease Fellowship is to prepare and nurture innovators in cardiovascular medicine and science who are committed to scholarship and proud of their clinical acumen. The fellows are an essential part of the division, and our faculty is firmly committed to training the academic leaders of tomorrow.
The first two years of fellowship training are devoted to full-time clinical activities. This typically occurs during PGY4 and PGY5. During this time, with close staff mentoring, fellows serve as cardiology consultants for acutely ill medical and surgical patients, provide ongoing, outpatient care for their own patients and perform and interpret both invasive and noninvasive diagnostic procedures. Fellows participate in didactic sessions, some of which are designed for them as a core curriculum. Other conferences are division-wide and are designed for clinical care review or as a forum for invited external experts.
Research begins with the development of a focused plan during the first year in concert with an identified mentor. Although only one full-time research year is required, typically during PGY6, we believe this to be insufficient preparation to propel a subsequent career in academic cardiology. Therefore, we encourage fellows to commit two to four years to their research training. The expectation is that this training will be at Massachusetts General Hospital and under the supervision of a member of Mass General staff, although short components might be taken elsewhere. It is also expected that fellows complete one year of research training prior to pursuing advanced subspecialty training in such areas as interventional cardiology, echocardiography and electrophysiology.
Beginning in July 2000, the clinical training programs in cardiology at Brigham and Women's Hospital and Mass General formed a partnership, with four rotations at sister institutions during the first year and two during the second year. This has increased the breadth of experiences for the fellows by exposing them to the best clinical training experiences at the two institutions.
Requirements for the Cardiovascular Disease Fellowship Program include:
The curriculum for the Cardiovascular Disease Fellowship Program is a three-year ACGME training program that includes:
This rotation forms a core portion of learning during the first year. One of the strengths of clinical training at Massachusetts General Hospital is the remarkable variety and complexity of patients seen during this rotation. Fellows serve as the primary cardiologists on new hospital-wide cardiology consultations and admissions to the dedicated cardiac step-down unit. Although senior staff supervise through daily rounds, the fellow is the main provider and decision maker for patient care. The patients seen while on service are followed as outpatients and form the bulk of each fellow’s practice in the Paul Dudley White associates clinic.
In the first year, fellows develop a proficiency in the performance of diagnostic ultrasound, understanding of basic principles and competence in study interpretation. A particular strength is the direct instruction fellows receive from senior sonographers in the performance of the echocardiographic examination during their first rotation. In addition to performing and interpreting their own studies, fellows also attend daily reading sessions in the laboratory. For second-year fellows, emphasis is placed on interpretive skills and advanced procedures, such as stress echo studies and transesophageal echocardiography. Fellows developing interest in the research aspects of diagnostic cardiac ultrasound are encouraged to pursue projects under supervision of the laboratory staff.
Nuclear cardiology at the Massachusetts General Hospital Corrigan Minehan Heart Center is a joint effort between the cardiology and radiology departments and provides various types of cardiac stress tests that help to identify and diagnose heart disease. The laboratory has six SPECT cameras and two PET cameras and performs over 7,500 imaging procedures per year. Fellows learn the integral role of cardiac stress testing in the practice of clinical cardiology, as well as its limitations, by performing and interpreting studies. From a research perspective, the laboratory is involved in several multi- and single-center trials, including, for example, the evaluation of new myocardial tracers, the usage of PET for quantitative coronary physiology and nuclear studies of peripheral vascular disease and plaque inflammation.
Fellows are lead operators on diagnostic procedures in the Knight Cardiac Catheterization Laboratory, a state-of-the-art suite of six rooms with high-resolution digital fluoroscopy units. A wide variety of diagnostic and interventional procedures are performed, with approximately 6,000 cases done per year, approximately 1,400 of which are coronary interventions. Since Mass General serves as the primary hospital for the local neighborhood as well as a tertiary referral center for high-risk patients from state, nation and worldwide health centers, cases are varied and challenging. Fellows gain a strong foundation in appropriateness and indications for catheterization, protocols for venous and arterial access, the hemodynamic assessment of cardiac, valvular and coronary function, angiography of coronary and bypass vessels, and post-procedural management. Furthermore, the laboratory is academically-based and has approximately 20 active research protocols. This provides ample opportunity for fellows to pursue their research interests.
Fellows spend a month rotating through the cardiac CT and cardiac MRI facilities at Mass General. Two new features have been recently added to this rotation. One is a full day of cardiac imaging teaching by Dr. Marcelo DiCarli at Brigham and Women's Hospital. The second is a half day in the vascular laboratory at Brigham and Women's Hospital with Dr. Marie Gerhard-Herman.
This is a 16-bed unit serving critically-ill patients requiring acute care for advanced heart failure (including those awaiting transplant), periprocedural management of high-risk coronary disease, malignant arrhythmias and cardiac arrest and mechanical ventricular support. Due to the complexity of the cases and the strong leadership role they play, Fellows are assigned to this rotation only during their second year.
Preventive cardiology and cardiac rehabilitation was an innovation at Mass General in 2002. This rotation offers a suite of primary and secondary prevention services including the heart attack primary prevention clinic, cardiac metabolic syndrome program and cardiac rehabilitation program. Fellows participate in intake sessions, exercise sessions, nutrition visits and team meetings.
The management of patients with advanced heart failure at Mass General is a multidisciplinary effort with input from physicians and non-physicians alike. Fellows are integrated into a team consisting of members of the heart failure, electrophysiology and cardiac surgery services by caring for patients with advanced disease and participating in meetings discussing transplant status. Fellows should gain a solid grasp of management of chronic severe heart failure and pulmonary hypertension, assessment of candidates for transplantation and left ventricular mechanical circulatory support.
In this rotation fellows will become familiar with the anatomy and physiology and current therapies of patients with congenital heart disease or pulmonary hypertension. The multidisciplinary group at Mass General is dedicated to the advancement of care for adolescents and adults born with heart disease.
Second-year fellows spend one month becoming familiar with the evaluation and management of patients with peripheral vascular disease, including cerebrovascular disease, peripheral arterial disease, renal artery stenosis, complications of venous thromboembolism, and others.
The Mass General Cardiac Arrhythmia Service was founded in 1978 and was one of the first clinical subspecialty services in United States specifically dedicated to the care of patients with cardiac arrhythmias. The cardiac electrophysiology laboratory comprises a state-of-the-art facility constructed in 2000 and fully renovated in 2004, equipped with new X-ray imaging, mapping systems and a robotic catheter navigation system. Second-year fellows on the electrophysiology rotation gain competence in the interpretation of commonly performed electrophysiology studies, manage inpatients with arrhythmias or dyssynchrony, learn indications for pacemaker and ICD implementation and become experienced in programming and interrogation of devices.
Fellows rotating on the cardiac surgical intensive care unit gain further experience in the postoperative care of cardiac surgical patients. Patients on the surgical service often undergo complex procedures with significant comorbidities, so fellows learn the ramifications of the technical and anatomic problems tackled during the operation. Fellows participate in daily morning rounds, working with the surgical intensivist, Dr. Hoffman. There is also the opportunity to attend surgical cases in the operating room, to gain an appreciation of the complexity of cardiac bypass pump physiology and intraoperative management.
One month of the second year may be spent on, either at Mass General or Brigham and Women's Hospital. These have proven to be popular and educationally valuable experiences for fellows in past years.
One of the most valuable aspects of the cardiology program is the opportunity to be the primary outpatient cardiologist for patients across the three years of training. Many of the first encounters a fellow has with these patients will be during their initial inpatient stay, after which they are enrolled in that fellows clinic. It is an opportunity to learn the fine points of the longitudinal management of a range of cardiac problems in ambulatory patients. Added to this is the challenge of evaluating new patients referred to the clinic by other providers.
The first-year fellows are responsible for the interpretation of all tracings performed on clinic patients and on Bigelow service patients. These are taken on the patient-care floors and processed in the laboratory.
Noon - 1 pm Monthly Journal Club
Noon - 1 pmFellows journal club (monthly)
12:30 pm - 1:30 pm – Cardiology Grand Rounds
Noon - 1 pm Dr. Dec conference (monthly); Dr. Fifer conference (monthly)
12:30 pm - 1:30 pm - Echo Clinical Conference
The following are descriptions of conferences geared towards or of particular interest to cardiology fellows. Additional conferences focused on particular subspecialties, such as echocardiography, electrophysiology, cardiac imaging and cardiac catheterization, also occur throughout the week and are open to interested Fellows.
This series of introductory lectures, covering various areas of clinical cardiology, is given during the first few weeks of the fellowship. It is designed to provide a basis for dealing with the more common clinical problems and frequent on-call consult questions.
This series is consistently viewed as one of the most rewarding. First-year Fellows currently on the Consultation Rotation present one or two interesting cases to five senior staff members, Drs. DeSanctis, Hutter, Isselbacher, Januzzi and Dec. Management is discussed in detail from a diagnostic and therapeutic perspective, with particular focus on physical exam and EKG findings, as well as the appropriateness, timing, and interpretation of ancillary invasive and non-invasive studies. Attendance is restricted to cardiology fellows to encourage a frank and insightful discussion.
A didactic lecture series devoted to general cardiologic topics designed specifically for the cardiology fellows. The goal of this series is to focus on basic areas of cardiology, emphasizing physiology, pathophysiology, clinical practice and the supporting literature. This series is intended to be similar to a cardiology board review course, and is required for fellows in their first year.
One monthly case-based conference is led by Dr. Dec, Chief of Cardiology. It is an opportunity to explore the tools for diagnosis and management of critically-ill patients with rare diseases or unusual presentations. The second-year fellow on the CCU rotation selects and presents the case.
Another monthly case-based conference is led by Dr. Fifer, Director of the Catheterization Laboratory. It is an opportunity to gain a deeper understanding of the invasive and non-invasive hemodynamics in the assessment of cardiac function. The first-year fellow on the cardiac catheterization rotation selects and presents the case.
Twice a month, Dr. Milan, Associate Program Director, and other staff members present a series of lectures on electrocardiographic interpretation and the understanding of cardiac arrhythmias. The other two weeks, Dr. Philip Podrid leads EKG-interpretation sessions, drawing on his extensive collection of abnormal cardiograms to quiz each fellow.
Once a month, a speaker is invited to discuss her or his ongoing research activities and career path. The conference is helpful for fellows seeking out mentors for their research years, and also serves as a forum to obtain career advice in an informal setting.
Once a month, one of the fellows presents a brief outline of a major recent publication of general interest. This presentation serves as a starting point for a lively discussion, with input from the fellows, Dr. Dec, Dr. Drachman, and an invited senior staff member with expertise in that area.
Selected cases demonstrating exemplary or unusual angiographic or hemodynamic findings established at cardiac catheterization are presented by and discussed by members of the laboratory. These conferences are frequently multidisciplinary, establishing correlations between invasive and noninvasive modalities, and are attended by members of programs in interventional cardiology, peripheral vascular disease, cardiac imaging, cardiac electrophysiology and cardiac surgery.
This conference is a department-wide presentation by an invited speaker, often a nationally-recognized leader in their field. Speakers often survey the current state and latest research in their topic of interest.
Research training is a critical element of the cardiology fellowship at Mass General and usually is completed in the third year of cardiovascular fellowship training. All fellows are required to undertake research training for at least 12 months in order to be eligible for subspecialty board certification in cardiology by the American Board of Internal Medicine. The Cardiology Division also encourages its fellows to undertake longer periods of research training because it is generally agreed upon that 24 or more months of training are required for a successful career in academic cardiology.
There is a broad spectrum of research opportunities available at Mass General and across the Harvard and MIT community. Opportunities at Mass General are broadly grouped into three areas - the Cardiovascular Research Center (CVRC), the Cardiology Laboratory for Integrative Physiology and Imaging (CLIPI) and the Cardiovascular Clinical Research Program.
Early in their first year, fellows will meet individually with Dr. Drachman, Fellowship Program Director to begin to plan research programs tailored to the interests of each fellow. Dr. Drachman assists fellows with identifying outstanding mentors and excellent research programs. In addition, a monthly fellows research conference is geared towards allowing Fellows to interact with potential mentors.
It is critically important that research training plans be finalized in the early fall of the second fellowship year. Each fellow will be strongly encouraged to prepare applications for extramural funding for their training program. Research mentors will assist trainees in the preparation of these grant applications. Senior investigators in the Cardiology Division are available for advice and assistance.
How to Apply
Applicants interested in a position starting July 2017 need to apply through ERAS. Completed applications must be submitted by August 2, 2016. Interviews will be held on in September and October 2016. We require the following information via ERAS:
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