Heart Failure and Transplant Fellowship

Overview

The Heart Failure and Transplant Fellowship provides inpatient and outpatient training in evaluating and treating patients with advanced heart disease, and follow-up of patients after cardiac transplant. This is a one-year ACGME Accredited Fellowship Program.

History

Our primary training facility is the Massachusetts General Hospital, a teaching hospital affiliated with Harvard Medical School. The Mass General Heart Failure and Cardiac Transplant Service was founded in 1985 and serves as a national and international resource for patients with advanced heart disease. The Mass General Heart Failure and Transplant Fellowship Program was established in 1988 with the goal of training future leaders of academic cardiology in the increasingly demanding need of cardiologists in this specialty. 

Requirements

Requirements of the Heart Failure and Cardiac Transplant Fellowship include:

• 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 sub-specialty programs in cardiology, completion of previous cardiology fellowship training is required. 

Curriculum

It is anticipated that the fellow will acquire expert knowledge in the following areas:

• Broad expertise in preoperative evaluation of potential heart transplant candidates including those with heart failure, cardiac tumors, end-stage ischemic heart disease.
• Ability to manage post-transplant patients. Specifics will include common medical problems, drug-drug interactions, immunosuppressive protocols, and their complications.
• Expertise in evaluation and management of donors. At least three donors must be managed in collaboration with the transplant cardiologist or surgeon. At least five cardiac transplants must be witnessed, and early management decisions made in conjunction with the transplant cardiologist.
• Expertise in the evaluation of patients with new onset dilated cardiomyopathy.
• Expertise in the diagnosis and management of patients with hypertrophic and restrictive cardiomyopathies.
• Broad understanding of the principals, pathophysiology, and management strategies for patients with moderate to severe heart failure. This will include the use of inotropic agents, beta blockers, ACE inhibitors, angiotensin II receptor blockers, and new agents including endothelin antagonists and aldosterone antagonists.
• Understanding and participation in the management of patients with mechanical circulatory support including intra-aortic balloon counter pulsation and the TCI HeartMate left ventricular assist device.
• Participation in recruitment and management of patients in heart failure clinical trials.
• Expertise in the performance of endomyocardial biopsies. Fellows should perform at least 20 right ventricular biopsies under supervision of a transplant cardiologist.
• Expertise in the evaluation of transplant rejection and other common findings, such as "quilty B lesions" should be developed.

A core curriculum has been developed and is updated yearly. This reviews key articles in the area of cardiomyopathy, heart failure diagnosis and management, and transplantation medicine. In addition, several textbooks are utilized for didactic instruction. These include Heart Failure (editors Poole, Wilson, Colucci, Massie, ChatterJee, and Coats), Thoracic Transplantation (editors Shumway and Shumway), Transplantation (editors Cosimi, Ginns, and Morris), and Congestive Heart Failure (editors Hosenpud and Greenberg).

Evaluation

Dr. Coglianese, director of the program, reviews each fellow's performance on a quarterly basis. Feedback will be provided to them regarding their strengths and areas in need of improvement. Written evaluations are given to the fellow with a copy stored on file in the Transplant Director's office. Career counseling for the fellow is available from the entire faculty of the program, and research mentoring is also provided by the faculty based on the fellow's skills and interests.

The fellow is asked to provide the director with a written evaluation of the fellowship at the conclusion of the year, including comments on the faculty, the structure, and organization of the fellowship, and the degree to which the objectives of the fellowship have been met. 

Clinical Experience

Inpatient Clinical Experience

Fellows will spend the majority of their effort on the inpatient Heart Failure Service, where they have responsibility for diagnostic and treatment planning for patients with advanced heart disease, and for the care of patients after cardiac transplant or mechanical circulatory support surgery. They will be expected to be thoughtful and independent in their approach to patient care, working closely with the supervision of the attending physician.

Outpatient Clinical Experience

Outpatient evaluation of patients with advanced heart disease will occur in the Heart Failure Center. This will include the initial evaluation and design of a treatment plan for patients with advanced heart disease, as well as the follow-up care of patients that have received cardiac transplants.  Experience in the outpatient management of patients receiving mechanical circulatory assistance is also included. The fellow is expected to round on the service's patients on ten weekends over the year.  No coverage of private patients is expected of the fellow.

Procedures

Fellows will receive training in the performance and interpretation of right and left ventricular endomyocardial biopsy.  

Education & Training

Fellows are closely supervised in their clinical work by the faculty. Inpatients being followed by the fellow are reviewed with the faculty at least twice a day, with at least one of these rounds occurring at the bedside. All outpatient visits in which the fellow participates are supervised, in person, by a faculty member.

The fellow is also responsible for the weekly Heart Transplant/Heart failure Research Conference. This conference includes: a journal club discussion of the recent literature by the fellow, presentation of research by the fellow, presentations by the Mass General Hospital faculty of their ongoing research projects, and presentation by extramural speakers concerning basic and clinical research in heart failure.

Attendance at Cardiac Grand Rounds, Heart Failure/Transplant Research Conference, and other didactic conferences of the Division (morning report, catheterization report, etc.) are required. Attendance at the monthly meetings of the New England Consortium for Heart Transplantation is also required of the fellow.

Sample Rotation

Nine Months Per Year

• 7:30 am to 8:30 am: Round with attending on critically ill patients, recent transplant recipients. Review overnight events
• 8:30 am to 4:30 pm: See follow-up patients, new consults.
• 4:30 pm to 6:00 pm: Round on all patients with attending physician

Three Months Per Year

• 7:30 am to 10:00 am: Attend outpatient transplant clinic
• 10:00 am to 4:30 pm: Research and literature review
• 4:30 pm to 5:30 pm: Review of patient data with attending physician, RN coordinators

Research Experience

A research mentor is assigned to each fellow. This individual will review their progress and academic development in the field. In particular, emphasis will be placed on the development of abstracts and original publications based on ongoing projects within the section.

Fellows are encouraged to participate in the ongoing clinical research projects or basic science projects under the direction of the faculty of the section. They are encouraged to utilize this preliminary data for the writing of a grant proposal, and several fellows have been successful in obtaining support from national organizations such as the ACC or AHA and the NIH for their proposals.

Teaching Responsibilities

The fellow is responsible for journal club presentations at the Friday Heart Failure Conference. They are also expected to educate the medical and surgical house staff participating in the care of the patients on the service as to the appropriate diagnostic tests and treatments of heart failure patients.

How to Apply

Applicants interested in the program must submit their applications by September 4, 2020 via ERAS. Our program ID# is 1592414014.

A completed application should include the following:

• CV
• Personal statement
• Three letters of reference
• USMLE transcripts
• ECFMG certificate (if applicable)
• Photo