General Cardiology Fellowship – Education – Cardiovascular …

Fellowship in Cardiovascular Diseases

Our mission is to train leaders in academic cardiology for the 21st century. In accord with this mission, the cardiovascular medicine training program at Stanford University has been developed to offer a wide range of opportunities leading to a career in academic cardiology. Emphasis is placed on selection of applicants with strong clinical and research backgrounds. The training program is of three years duration, with many opportunities for additional years of research training dependent on fellow accomplishments and stipend availability. We also offer a "short track" option for residents with well-defined investigative backgrounds referred to as the Stanford Clinical Investigator Pathway (SCRP). For all of our Training Programs, we seek fellows who are dedicated to excellence and the advancement of clinical medicine.

The primary purpose of the postdoctoral training program in cardiovascular medicine at Stanford is to prepare physicians for careers in academic cardiology. We are assured of the clinical excellence of our fellows by providing an intensive experience in clinical cardiology rotations. In addition, 14 to 24 months of the program (depending on whether 3 or 4 years) are devoted to research, either basic or clinical. Our belief is that no one type of research is a priority, more desirable than another. Therefore, the only requirement is that all research activities be of high quality. Research activities may be supervised and directed by members of the Cardiovascular Medicine faculty and/or any of the collaborating Divisions and Departments at Stanford.

Research and clinical training time may be interspersed or clustered together. For individuals with focused research interests and pre-established affinity with a specific faculty preceptor, we encourage full-time investigation usually after two years of clinical training. However, in some circumstances, initiating fellowship with research is desirable. Alternative sequences that initiate fellowship with clinical training during the first year are possible. Clinical training in areas of special certification (electrophysiology, interventional) is accorded on a selective basis during either a fourth or a fifth year of training depending upon academic career goals. It is our intent that clinical and investigative programs should be integrated and of sufficient duration that the trainee will acquire the skills necessary to begin a career in academic cardiology.

The Stanford training program seeks to provide a rich educational environment. This includes weekly conferences on: basic science research, electrophysiology and EKG, interventional cardiology, interventional vascular radiology, cardiac transplantation, vascular medicine, pediatric cardiology and cardiac catheterization. In addition, the Division sponsors cardiovascular research conferences and clinical conferences on a weekly basis. A major forum of interaction is provided by a joint clinical conference with cardiovascular surgery. Tutorial lectures are provided each year to provide fellows with basic concepts in clinical cardiology, biostatistics and clinical epidemiology as well as cellular and molecular biology. The fellows are afforded opportunities to present seminars on clinical or basic research topics as well as to participate in monthly journal clubs held in the homes of faculty members. In addition to these opportunities, fellows can elect to audit courses offered within the Stanford University community.

Each fellow will have the opportunity to participate in a number of clinical rotations, with 22 to 24 months devoted to clinical training. Clinical rotations at Stanford University Hospital and the Palo Alto VA are of 1 month duration. The number of rotations on a particular service is adjusted to meet all guidelines as well as individual career goals.

Stanford Cath/Angio Laboratory: Cardiovascular Medicine trainees evaluate and carry out procedures on patients having a variety of different types of catheterization procedures. In an average month, this laboratory performs 300 coronary diagnostic and interventional procedures, 100 myocardial biopsies, 30 pediatric catheterizations, 50 peripheral vascular procedures and a variety of other specialized procedures, including valvuloplasty, atherectomy, intracoronary ultrasound recordings, coronary and peripheral stent placements and a variety of investigational protocols. Advanced catheterization techniques such as coronary angioplasty are performed by interventional cardiology fellows (4th or 5th year).

Inpatient Consultation: This clinical service evaluates 50 patients/month with a variety of cardiovascular disorders on the non-cardiology inpatient wards. The fellow is responsible for providing the first-line consultation care, and reviewing computer-generated ECG reports. This rotation includes supervision of medical students and housestaff.

Cardiac Arrhythmia and Electrophysiology Service: This service performs an average of 150 procedures per month and is responsible for an inpatient service that averages 6 to 10 patients at any time, in addition to an active outpatient and consultative program. This dedicated service also includes participation in pacemaker activities and interpretation of ambulatory ECG's. Fellows will evaluate and treat arrhythmia problems and assist in electrophysiology procedures. Advanced skills in cardiac pacemakers, ICD implantations (Implantable-Cardioverter-Defibrillator devices) implants, mapping, and electrosurgery are generally deferred until a fourth year of training. Our attendings are the only ones to implant ICD at Stanford. Our fellows assist with the implantations, generator changes, and follow-up of these devices as well.

Echocardiography: The fellow acquires basic and advanced methods of diagnosis, including M-mode, two-dimensional, Doppler, transesophageal and stress echocardiography. There is, in an average month, approximately 450 transthoracic echocardiograms, 40 transesophageal echoes and 170 stress echocardiograms performed.

Advanced Cardiac Imaging Rotation: Senior cardiology fellows will dedicate 4 weeks to obtaining increased exposure to the acquisition and reading of CMR, CCT, and Echo studies. The period of July-December: will train 3rd and 4th year fellows (CMR/CCT/Echo mix tailored to each fellows interests) and January-June will train 2nd year fellows.

Course Objectives:

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Coronary Care Unit: The fellow consults daily, supervises housestaff and writes notes on all patients in the CCU, and conducts daily CCU rounds.

Veterans Administration Medical Center: The junior fellow will have an integrated experience in outpatient and inpatient cardiology evaluations with participation in exercise tests, echocardiography, and catheterization. In an average month, there are 200 patient visits to the outpatient clinic, 120 patients for whom consultation is provided on the inpatient services, 120 patients having echocardiography and 45 patients having cardiac catheterization procedures.

Inpatient Fellow, Veterans Administration Medical Center: The fellow rounds rounds on patients on the heart failure and cardiac transplant service. In addition, he or she participates in the inpatient care of post-cardiac surgery patients, in conjunction with the cardiothoracic surgery residents and attendings. The inpatient fellow also assists with percutaneous coronary interventions, electrophysiologic testing, and device implantation.

Consult Fellow, Veterans Administration Medical Center: The fellow has considerable responsibility in housestaff and student teaching and patient care decisions in the CCU. The fellow also oversees the Cardiology consult team, reviews ECG's, participates in complicated echo cases, and attends Cardiology Clinic once a week.

Noninvasive (Elective): The senior rotation continues to amplify fellow skills in advanced methods of Doppler, esophageal echocardiography, by performing procedures and participating in daily morning reading sessions. Participation in daily afternoon nuclear medicine reading sessions provides experience in this important technology.

Noninvasive Stress Testing and Nuclear Medicine: The nuclear medicine department at the Veterans Affairs Medical Center is a very active laboratory and performs an average of 7-10 myocardial perfusion studies per day, including exercise and pharmacologic perfusion studies as well as viability studies (thallium, PET scans). During this rotation, the fellow supervises exercise treadmill testing and participates in the supervision and interpretation of nuclear myocardial perfusion studies.

Continuity Clinics: All fellows are assigned one cardiology clinic per week throughout their 3 years of training, where they examine and discuss patients referred to Stanford Cardiovascular Medicine. Continuity of care is emphasized. In addition to general cardiology, the Stanford Program offers subspecialty clinic experience in: electrophysiology, end-stage heart failure, post-cardiac transplantation, pacemakers, Marfan syndrome and vascular medicine.

The research interests of the members of the Division of Cardiovascular Medicine and affiliated faculty in other Divisions and Departments are broad, and include both clinical and laboratory studies. Research funding, including stipend support, is available from multiple sources. Individual applications for NIH National Research Service Awards, AHA California Affiliate Fellowships and other corporate and foundation sponsored programs are encouraged. Available to the Cardiovascular Medicine Division are multiple research grants (including a Program Project Grant in vascular disease) and training grant funds through an NIH vascular biology and medicine training grant, and a preventive medicine training grant. These training programs link clinicians and basic scientists within the Division with investigators throughout the University community and provide a forum for intellectual interchange.

The postdoctoral training program in Cardiovascular Medicine at Stanford is a multi-faceted experience, designed for those individuals with an interest in developing an academic career. Intensive training in invasive and noninvasive clinical cardiologic techniques, and in basic and clinical cardiovascular research, individually tailored, prepares each fellow to pursue his/her career at the forefront of cardiology.

For further information, contact our fellowship coordinator Laura Dodera at (650) 725-4177.

Our fax number is (650) 725-1599.

E-mail inquiries should be sent to CVMedFellowship@stanford.edu.

Postal Address: Falk Cardiovascular Research Center Stanford University Medical Center 870 Quarry Road Stanford, CA 94305-5406

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