Clinical Vascular Medicine Fellowship

Fellowship Overview

The Clinical Vascular Medicine Fellowship Program at Massachusetts General Hospital is a one-year non-ACGME training program.

The Vascular Medicine Fellowship program is concentrated on diagnosis and management of patients with various aspects of vascular disease. Vascular Medicine is a section within the Division of Cardiology at Mass General. 

The clinical service of the cardiac division performs over 4,000 hospital admissions, 15,000 outpatient visits and 5,000 invasive cardiovascular procedures annually (of these, roughly 400 are dedicated peripheral procedures). The Mass General Vascular Diagnostic Laboratory performs over 11,000 examinations annually across the broad spectrum of vascular non-invasive tests.

Program Director
Ido Weinberg, MD

Program Description

The goal of this Vascular Medicine Fellowship is to provide integrated training in the diagnosis and clinical management of patients with non-cardiac vascular disease and to allow fellows to assume positions of academic leadership in the field of vascular medicine. This fellowship provides the opportunity to gain knowledge in the evaluation and management of patients with a wide variety of vascular diseases including:

• Acute and chronic arterial occlusion of the lower extremities
• Thoracic and abdominal aortic diseases
• Atherosclerotic renal artery disease
• Atherosclerotic disease of the brachiocephalic vessels including the extracranial carotid and vertebrobasilar arteries
• Acute and chronic venous disease including superficial and deep vein thrombosis, pulmonary embolus, and manifestations of chronic venous insufficiency
• Systemic vasculitis
• Genetic vascular diseases
• Uncommon vascular diseases (e.g. fibromuscular dysplasia; environmental/occupational vascular diseases)
• Evaluation and management of prothrombotic states
• Limb edema of all etiologies (i.e. dependency, venous, lipidema, lymphedema, tumors)
• Wound evaluation
• Expertise in performance and interpretation of non-invasive vascular diagnostic tests
• Exposure to performance and interpretation of vascular axial imaging (i.e. computerized tomography, magnetic resonance arteriography)

Requirements

Requirements for the Clinical Vascular Medicine Fellowship include:

• Completion and passing of all three USMLE steps
• Completion of prior internal medicine residency training
• Eligible for a Full or Limited Massachusetts License
• Valid ECFMG certificate for all foreign medical graduates
• Only ECMFG J1 visas will be sponsored (if applicable)

Curriculum

The program design of the Clinical Vascular Medicine Fellowship follows the recommendation of the Society for Vascular Medicine training guidelines. (Creager et al., JACC 2015). 

The training year will include:

• Inpatient consultations
• Longitudinal outpatient consultation and care
• Formal training in the performance and interpretation of vascular non-invasive diagnostic tests
• Training in the methods of image acquisition and interpretation of advanced contrast-enhanced magnetic resonance arteriography and multidetector computerized tomographic arteriography
• Participation in the performance and interpretation of catheter-based arteriography and endovascular interventional procedures as well as open surgical procedures and comprehensive exposure to the evaluation and management of vascular wounds
• Indications for requesting and interpretation of hypercoagulable laboratory tests in patients with thromboembolic disorders
• Guidance on approaches to uncommon and unusual vascular disorders

The fellow will be actively involved in both outpatient and inpatient management of vascular disease patients, including patients in the intensive care unit and Emergency Department.

Inpatient Clinical Consultation

The fellow will participate in the inpatient consultation service. Responding to vascular medicine consultations, the fellow will see and evaluate inpatients for vascular medicine consultations for a variety of vascular diseases. The fellow will obtain a history of the patient’s presentation, perform a physical examination and actively participate in the interpretation of the non-invasive test data, including ankle brachial index and duplex ultrasound studies. The case will be discussed, and pertinent physical examination, laboratory and non-invasive study data reviewed together by an attending staff physician and the fellow. The fellow will be trained to integrate the patient’s entire medical/clinical presentation and non-invasive study data to make accurate diagnoses and appropriate clinical decisions with respect to further invasive evaluation of the patient and therapeutic interventions. The strengths of medical vs. percutaneous vs. surgical therapy will be discussed for each case by the attending and the fellow. Written consultation will be provided addressing the pertinent issues relevant to the patient.

Outpatient Service

The fellow will see new patients with a vascular medicine attending in the outpatient setting. As described in the inpatient consultation section above, the fellow will be involved in the evaluation and management of patients. These patients will become the primary responsibility of the fellow throughout the academic year.  Outpatient longitudinal follow-up will be performed for all the patient groups outlined above, and the fellow will be expected to communicate to their patients between office visits and see their patient in hospital when relevant.

Non-invasive Laboratory

The fellow will be scheduled to spend a minimum of eight weeks in the vascular non-invasive laboratory. They will be expected to shadow technologists in order to learn how to perform non-invasive examinations of each vascular bed as described. The fellow will also be expected to visit the non-invasive vascular laboratory periodically while on other rotations (e.g. Friday when there is no clinic, but the fellow is in the outpatient clinic rotation) in order to further advance their manual skills of performing these studies.

Interpretation of Non-invasive Studies

The fellow will be provided a series of cases to review in the vascular laboratory. The fellow is encouraged to review these cases blindly and then compare their reviews to the formal interpretation. Afterward, any questions will be reviewed with a staff member. Fellows are also encouraged to schedule ad-hoc sessions with staff members reading non-invasive studies in order to review ongoing clinical studies with them. Fellows must document their formal interpretation before reviewing cases with the attending physician.  Finally, fellows are expected to review all studies pertaining to in- and outpatients they see with the staffing physicians. Fellows should maintain a record of the studies that they have reviewed.

Clinical Rotations

Fellows will be scheduled to participate in multiple clinical rotations including radiology, vascular surgery, peripheral intervention laboratory, hematology, dermatology and rheumatology. During these rotations, fellows are expected to join house staff in their responsibilities. Fellows will be expected to maintain their own vascular clinical patient responsibilities during this time.

Clinical Opportunities

Fellows will have various clinical opportunities that will not be formal rotations. These opportunities include exposure to the wound care clinic and hypercoagulable testing interpretation. These opportunities are scheduled ad-hoc with the relevant services.

Education/Training

The fellow will attend and actively participate in the following regularly scheduled teaching programs including:

• Cardiovascular Grand Rounds - A weekly scheduled combined lecture-seminar presentation
• Pulmonary Embolism Response Team Educational Meeting – A bi-monthly multidisciplinary educational meeting to review technique and literature on the topic
• Carotid Conference – A monthly multidisciplinary meeting pertaining to carotid artery diagnosis and treatment
• Venous Conference - A monthly multidisciplinary meeting pertaining to venous disease diagnosis and treatment
• Thoracic Aortic Conference- A monthly multidisciplinary meeting to review the presentation and management of thoracic aortic disease

How to Apply

The Clinical Vascular Medicine Fellowship begins each year in July. Applications will be reviewing on a rolling basis until the position is filled.

To submit an application, please submit the following documents in one PDF file to the Dropbox Application Portal:

• CV
• Personal statement
• 3 letters of reference
• ECFMG certificate, if applicable
• Visa status, if applicable
• Photocopy of USMLE exams

Once submitted, please email Valerie DiStefano for confirmation of receipt. Christina Alva is available to answer any questions or concerns at vdistefano@mgh.harvard.edu. We look forward to reviewing your application!

Meet Our Current Fellows

Seanna R. Daves, MD

Prior Training: Internal Medicine at Lahey Hospital and Medical Center