Coronary heart disease
Congestive heart failure
Arrhythmias
Acute myocardial infarction
Lipid disorders
Hypertension
Cardiomyopathy
Valvular heart disease
Pulmonary heart disease
Peripheral vascular disease
Infections and inflammatory heart disease
Adult congenital heart disease
- Upon completion of the program, the fellow will have acquired the expertise to be a consultant in cardiology.
- The curriculum will ensure the opportunity for fellows to achieve the cognitive knowledge, psychomotor skills, interpersonal skills, professional attitudes, and practical experience required to be a cardiologist.
- The program will emphasize scholarship and self-instruction while assisting fellows in the development of expertise required for critical analysis of clinical problems and for appropriate decision-making in cardiology.
- Fellows will be given increasing responsibility for patient care and procedures while adequately supervised.
- The program will provide sufficient supervised procedural experience to the fellow, so he/she can become adept at skills required by a cardiologist.
- There will be meaningful, supervised research experience with protected time. The fellow should identify a research mentor early in his/her fellowship. The goal is for the fellow to write at least one publishable paper during training and become accomplished at interpretation of the literature and familiar with study design.
- The fellow will be given the opportunity to individualize his/her third and fourth year curriculum to satisfy his/her own professional interests and to develop expertise in one or more areas of cardiology subspecialization.
- The fellow will be proficient in performing skills necessary to become a cardiologist: EKG and holter monitor analysis, stress testing, echocardiography, nuclear cardiology, cardiac catheterization, and electrophysiology.
- The fellow will fulfill the criteria set by the ACGME, Residency Review Committee, and the American College of Cardiology.
- Fellows will be exposed to ethical, medical / legal, cost-containment issues during daily teaching sessions, patient care rounds, and lecture series.
- Fellows will be taught communication skills during the fellowship. Fellows will be critiqued on patient history presentations, both inpatient and outpatient settings.
- Fellows will present original research as well as topics for discussion at numerous conferences during their fellowship (Cardiology Division Conference, fellows' conference, echocardiography conference, nuclear correlation conference, EKG conference). In addition, prior to large national cardiology meetings, fellows will present their research findings to the Division for critique. Fellows will be taught research design in formal lectures by the staff. In addition, fellows will meet with research mentors to design research topics and protocols.
- Fellows will be exposed to medical statistics in various research endeavors. Some fellows may chose to attend courses offered in the Clinical Care Research Program or work with statistical experts at Tufts University School of Medicine.
- Fellows will read independently and actively pursue the current literature. Fellows will meet weekly to discuss relevant journal articles. In addition, fellows will be encouraged to attend local and national cardiology meetings. Fellows will also encouraged to become members of local and national organizations related to the field.
- Fellows will teach medical students and housestaff, including EKG interpretation, physical diagnosis, and cardiac pathophysiology. Teaching skills will be taught by the attending staff.
A full range of inpatient, outpatient, clinical and research laboratory facilities are available to the cardiology fellows. In addition, a complete medical library is available at Tufts University School of Medicine. The heart station has a library with a variety of textbooks and bound journals as well as computer equipment.
In addition to the individualized instruction received on various rotations as indicated in the curriculum, fellows are taught through didactic sessions, interactive conferences, and self study. All fellows are provided with a syllabus of required reading and goals are discussed prior to each rotation.
Each year, the Program Director appoints an incoming second year fellow to the position of Chief Cardiology Fellow. The Chief fellow acts as a liaison between the fellows and the staff. Other duties include assisting the Program Director in setting up rotation schedules and conferences as well as other administrative duties.
Fellows spend approximately 50 hours in the hospital per week. Fellows are instructed not to be on clinical duty for more than 80 hours per week, including moonlighting hours. Averaged over a four-week period, fellows have at least one full day (consecutive 24-hour period) per week free of all clinical responsibilities.
During the first 24 clinical months, call averages to approximately 1 of every 8 weekdays and 1 of every 8 weekends with even distribution of holidays amongst the fellows. If the fellow is not on-call on a given weekend, then two days each week are considered free. On-call, the fellow is responsible for consultations and procedures, including echocardiograms, right and left heart catheterizations, and placement of temporary pacing wires. Technical skills of echocardiography and catheterization are required for prior to taking call. Each case is discussed with the attending cardiologist on call. Fellows are not required to spend call nights in the hospital.
Fellows are evaluated at the completion of each monthly rotation. On-line evaluation forms include a rating of clinical judgment, medical knowledge, clinical skills, humanistic qualities, judgment, professional attitudes, ethical and professional conduct, medical care, and overall clinical competence. Staff are encouraged to sit down with the fellow to review their performance and discuss the rotation. Fellows are also asked to evaluate the rotation and staff. Both the staff and fellows review the evaluation forms and sign them. The evaluation form then becomes part of the fellow's folder. In addition, the Program Director and/or the Division Chief interviews and evaluates each fellow every six months. This comprehensive review is meant to discuss in detail all aspects of the fellowship program and the training environment. Fellows are also evaluated at monthly staff meetings. An annual report is placed in each fellow's folder at the completion of the academic year. In addition, evaluation forms for each fellow are forwarded to the American Board of Internal Medicine. If any issues or concerns arise between evaluations, the fellows meet with the Program Director and /or the Division Chief.
Fellows are also encouraged to evaluate the program, including faculty and staff, by means of an annual, anonymous evaluation form. The Program Director reads these evaluations and attempts to determine specific needs for change that require implementation. In addition, fellows regularly meet with the Program Director and Division Chief to maintain an ongoing dialogue. Fellows' comments remain confidential and they are encouraged to be forthright in their concerns.
The Program Director provides ongoing counseling to fellows regarding their performance in the program. Any fellow whose performance is assessed to be less than satisfactory by the Program Director may be placed on a remedial training status for a specified period of time. The Program Director will inform the fellow of the deficiencies noted in academic, clinical and/or professional performance, and will outline a program of remediation, including criteria for successful completion. Documentation of the remedial training program and outcome will be maintained in the fellow's program file. If a fellow develops medical or mental health issues, a meeting will take place to clearly define the fellow's issue(s) and attempt to find a proper solution. Recommendations for evaluation via the Employee Assistance Program are made if deemed necessary.
Tufts Medical Center cardiology faculty are full-time academic staff dedicated to teaching fellows. Every patient examined and all procedures performed by fellows in the Division of Cardiology are supervised by an attending cardiologist. Attendings are responsible for the care provided to each patient and are familiar with each patient for whom they are responsible. Faculty are intimately involved in teaching fellows while supervising. Cases are discussed and a plan is formulated. Both the fellow and attending write notes in the chart. Faculty are on-call each night to provide support for fellows on call. Throughout all clinic hours, there is a staff cardiologist immediately available to the fellow. The training program is structured to encourage and permit fellows to assume increasing levels of responsibility commensurate with their individual progress in experience, skill, knowledge and judgment. Fellows complete evaluation forms on the educational experience and to evaluate the quality of supervision. All written evaluations will be kept on file in an appropriate location.
Each fellow is entitled to three weeks of vacation per year. All vacation requests need to be approved by the Program Director prior to the fellow leaving. Fellows must arrange for appropriate coverage while on vacation. An effort is made to have only one fellow on vacation at any given time.
Fellows will be paid in accordance with the annual Graduate Medical Education stipend schedule set for each Post-Graduate Year (PGY) level in effect for the current academic year. All fellows will be paid according to the terms and conditions of a signed contract. All fellows at NEMC at the assigned PGY Level receive the same annual stipend. An internal medicine resident who completes a chief resident year after graduating from a three year internal medicine residency program is appointed as a first-year cardiology fellow and will be paid at the PGY4 level.
ACC revised recommendations for in training adult cardiovascular medicine core cardiology training II (COCATS 2). J. Amer. Coll Cardiol. April 2002.