Echocardiography Fellowship

Overview

The Echocardiography Fellowship Program is a two-year non-ACGME training program that involves time performing and reporting all modes of echocardiography and time doing ongoing and new clinical research.

Mission Statement

The Massachusetts General Hospital Cardiac Ultrasound Fellowship Program is designed to train independent investigators and directors of echocardiography laboratories. The program includes the requisite clinical training required to perform, interpret and teach echocardiography at an academic level, and to engage in clinical and experimental research studies.

The clinical training program includes supervised performance by the fellow of enough echocardiograms to satisfy professional certification requirements for laboratory director; interpretation of routine clinical studies; and performance of transesophageal, contrast, stress echo and emergency studies. The fellow will become conversant with the latest technology and develop an integrated appreciation of cardiac pathophysiology from the combined clinical and research program. Cross modality exposure to Cardiac CT and MRI is available during this fellowship for interested individuals.

Objectives of Training

• Develop clinical expertise in the performance and interpretation of echocardiograms (transthoracic (rest and stress) and transesophageal
• Achieve level III training in echocardiography
• Develop research skills for clinical and experimental investigation with implementation and completion of a successful research plan
• Learn to effectively communicate results of investigations in echocardiography through publications and invited presentations
• Learn basics of grant writing

Requirements

To apply to the Echocardiography Fellowship, the following is required:

• Completion and passing of all three USMLE steps
• ABIM board certified or board eligible
• The accepted applicant must obtain a full Massachusetts license (limited license if on visa)
• A valid ECFMG certificate for all foreign medical graduates
• Only J1 visas accepted
• For all subspecialty programs in cardiology, completion of previous cardiology fellowship training
• Level I training in echocardiography

Curriculum

Transthoracic Echo (TTE)

The fellow will develop expertise in all areas of transthoracic echocardiography, including 2D, M-mode, Doppler and color Doppler. This will include recent advances such as contrast imaging, harmonic imaging, tissue Doppler, strain imaging and three dimensional imaging.

Other Forms of Echocardiography

Transesophageal echo (TEE) and its particular role in the diagnosis of specific disease entities including:

• Valve pathology with particular focus on aortic and mitral valve diseases
• Aortic pathology, including aortic dissection, ulceration, hematoma (cause, location, severity and extent) and aortic trauma (transection, rupture)
• Cardiac source of embolus
• Prosthetic valve function/dysfunction
• Infective endocarditis and its complications
• Complex congenital heart disease
• Intraoperative echo

Stress echocardiography:

• Exercise and pharmacological
• The fellow will become proficient in performing and reporting stress echocardiography

Contrast echocardiography:

The fellow will become experienced in the use of contrast echocardiography for LV opacification, myocardial perfusion and as a diagnostic adjunct in patients undergoing stress echocardiography.

Core Clinical Competencies

• Transthoracic echocardiogram
• transesophageal echocardiogram
• Stress echocardiograms.

Ability to interpret:

• Transthoracic echocardiogram

• Transesophageal echocardiogram

• Stress echocardiogram

• Contrast echocardiograms

Benchmarks of Clinical Competence

• Achieving level III training as outlined by the CoCATS
• Passing of National Board of Echocardiography examination
• Achieving comprehensive or transthoracic/transesophageal certification from the National Board of Echocardiography

Core Research Competencies

• Ability to design and carry out research project
• Publication results of investigation
• Ability to present and defend results of investigations
• Ability to write grant proposal

Benchmarks of Research Competence

• Complete research study
• Present abstracts at national cardiology meetings
• Publish results of work in peer reviewed journals
• Submit proposal for funding

Duration

The standard fellowship will be two years in duration.

Specifics

Formal Lectures

• Introduction to Echocardiography Fellowship - Dr. Picard
• Physics and Instrumentation - Dr. Weyman
• Transesophageal Echo I - Dr. Isselbacher
• Transesophageal Echo II - Dr. Januzzi
• Exercise Echocardiography - Dr. Hung
• Dobutamine Echocardiography - Dr. Picard
• Congenital Heart Disease - Dr. King, Dr. Hung
• Statistical Methods in Echo Research

Selected Topics

• LV Remodeling - Dr. Picard
• MV Prolapse - Dr. Levine
• Myocardial Contrast Imaging - Dr. Picard
• Noninvasive Assessment of Valvular Lesions - Dr. Levine

Handouts

• How to perform an echo, understanding instrumentation
• Bibliography of suggested readings in echocardiography

Conferences

• Clinical cardiology conference - weekly clinical conference focusing on several cases. Echo fellows present and interpret appropriate echocardiographic data.
• Clinical echocardiography conference - weekly conference where fellows present important echocardiographic topics with a mix of lecture and case interpretation
• Echo lecture series (see above)
• Congenital heart disease - pediatric cardiology conference
• Back Bay Echo Society - quarterly meeting in Boston where fellows present interesting cases from Mass General Hospital
• Combined Echo-cMR-cCT conference - once per month case based conference discussing various clinical applications of the 3 noninvasive cardiac imaging modalities. Staff and fellows of all three services attend

Clinical Experience

The fellow is expected to spend approximately 50% of time in clinical activities within the echo lab including performance and interpreting all modes of echocardiography. In addition, on-call responsibilities will include performance of emergency transesophageal echocardiograms and initial review of complicated transthoracic echocardiograms performed by on-call cardiovascular disease fellow.

Research Experience

Approximately 50% of the fellow's time will be spent doing clinical and/or experimental research including design, implementation and publication of new echocardiographic research.

Research Resources

The inpatient and outpatient echocardiography laboratories with an annual volume of approximately 22,000 echocardiograms. This is a combined working space of approximately 10,000 square ft and includes all the necessary computers for data base analysis, offline review of images, image processing and analysis of studies.

• Three-dimensional echo research center with a full-time senior programmer and analyst
• Cardiac Surgery/Cardiology Animal Research Center, a space with approximately 500 square foot animal laboratory and two full time technicians experienced in the creation of small and large animal models of cardiac disease, open-heart surgery and cardiopulmonary bypass.
• Cardiology Laboratory in Integrative Physiology, an area equipped with cardiac MRI system dedicated for research
• Active collaborations with Molecular Genetics, Cardiac Gene Therapy Center and Molecular Cardiology groups at the CVRC in Charlestown
• Cardiac Computer Center (Laboratory of Computer Sciences), including staff available for echo database searches

How to Apply

Positions are filled at least one year in advance, and prior cardiology fellowship training is required.

Interested applicants should send their CV, personal statement, and three letters of recommendation by e-mail to jhung@partners.org.