Cardiology Fellowship Program
Fellowship curricula:
Cardiovascular Disease, Interventional Cardiology and Clinical
Cardiac Electrophysiology Fellowships
Cardiovascular Disease Fellowship (3 year program)
Cardiology Basic Program: 1st Year
The first year of the basic program consists of 12 months of clinical
cardiology. Six fellows are selected each year.
Clinical campuses used during this year are the Milwaukee Heart
Institute, Aurora Sinai Medical Center, and St. Luke's Medical Center.
Any animal laboratory research is conducted in the Winter Research
Building on the Aurora Sinai Medical Center campus, whereas clinical
research may be conducted at any of the clinical areas.
Critical Care Cardiology
This clinical assignment is two months each at Aurora Sinai and Aurora St. Luke's Medical
Centers. Critical care experience focuses on arrhythmia
management, hemodynamics, the use of pharmacologic therapy, and
management of all acute cardiac disorders. Fellows are responsible for
all critical care cardiology consults and management, along with
temporary transvenous pacemaker placement, Swan-Ganz catheter
insertions, and resuscitation. They will also serve as backup/teaching
resources for the internal medicine teaching service. Attendance is
expected at daily rounds in the Coronary Critical Care Unit.
Noninvasive Cardiology, Rami Gal, MD, ASMC Rotation Director, Steve
Port, MD, and Kiran Sagar, MD, ASLMC Rotation Directors
This rotation involves four months in the cardiac echocardiography lab,
stress lab, nuclear cardiology lab, and EKG interpretation. Instruction
is provided by the assigned attendings, more senior-level fellows, and
each lab's technician.
Echo Lab Techniques
Transthoracic echo
Stress echo
Transesophageal echo
Noninvasive Peripheral Vascular Lab, Rami Gal, MD, ASMC Rotation
Director
In this lab, fellows have the opportunity to observe performance of
noninvasive peripheral ultrasound studies in the echocardiography
laboratory. They learn to interpret non-invasive peripheral vascular
studies under the supervision of one of the cardiovascular attendings.
Studies
Carotid duplex
Venous duplex
ABI and extremity arterial duplex
EKG Interpretation (Electrophysiology Faculty) Fellows on the
noninvasive rotation are responsible for reading hospital
electrocardiograms at the Aurora Sinai Medical Center campus each
morning. All EKGs are over-read by the assigned attending faculty
reader.
Studies
12-lead EKG
Rhythm Strip
Stress Testing: Fellows assigned to the stress laboratory
learn monitoring and interpreting of exercise and pharmacologic stress
studies.
Studies
Treadmill
Bicycle
Pharmacologic stress
Nuclear Cardiology
Fellows read nuclear cardiology studies daily, along with more
senior-level fellows and the assigned attending for that day.
Outpatient Clinics
Each fellow spends the equivalent of one half-day per week in a general
cardiology consultation clinic during the first year at either Aurora St.
Luke's Medical Center or Aurora Sinai Medical Center.
Research, Neil Oldridge, PhD, Basic Research Director and Suhail
Allaqaband, ND, Clinical Research Director of Cardiology and
Interventional Cardiology Fellowship Programs
Each first-year fellow selects a faculty mentor and initiates a research
project. A project should be well under way by the completion of the
first year. Fellows' research efforts, activities and times are designed
to run concurrent with clinical experience throughout the fellow's
training.
Cardiology Basic Program: 2nd Year
The second year of the Cardiovascular Fellowship Program provides
rotations to: 1 month rotation at Children's Hospital of Wisconsin for training in congenital
heart disease diagnosis and management, 4-6 months in the Cardiac
Catheterization Laboratory at the Aurora Sinai Medical Center and Aurora
St. Luke's Medical Center campus,
2-4 months on the electrophysiology service.
Congenital Heart Disease, Michael Earing, MD, Pediatric Cardiology
Director
Faculty physicians of the Pediatric Cardiology Section of the Medical
College of Wisconsin supervise fellows in this 4-week inpatient and
outpatient rotation at Children's Hospital of Wisconsin. Located 6 miles
west of downtown, Children's Hospital of Wisconsin houses 7 inpatient
units including a 24-bed Pediatric Intensive Care Unit, 22-bed Neonatal
Care Unit, 24-bed Hematology/Oncology/Transplant Unit, and Emergency
Department/Trauma Center. Experience in
assessment, diagnosis, management, and treatment of congenital heart
disease is gained by attendance in outpatient clinics, in
echocardiography and catheterization laboratories, and in the inpatient
areas. Training includes a variety of patient care management and
didactic conferences.
Cardiac Catheterization and Peripheral Vascular Laboratory, Tanvir
Bajwa, MD, ASMC Rotation Director and ASLMC Cardiac Catheterization
Laboratory, Anjan Gupta, MD, ASLMC Rotation Director
During this 6 months rotation, fellows are responsible for pre-procedure
assessment, participating in the procedure, interpretation of studies,
and post-procedure patient management. During assignment in this area,
fellows present selected cases at the weekly Cardiac Catheterization
conference.
Techniques
Diagnostic heart catheterization
Management/intervention in acute MI
Device and pharmaceutical trials
Pericardiocentesis
Endocardial biopsy
Second assist in interventional procedures
Peripheral vascular angiography
Intra-aortic balloon pumps
Thrombolytic and IIb/IIIa therapies
Heart Failure, Transplant, Jose Mendez, MD, Rotation Director
Fellows spend two months at St. Luke's Medical Center working with Dr.
Mendez and Dr. Pisani. Activities include inpatient and outpatient consultations,
introduction to the catheterization laboratory, and care of
post-transplantation patients.
ASLMC Pulmonary Hypertension Rotation, Dianne Zwicke, MD, Rotation
Director
Fellows spend one month at St. Luke's Medical Center working with Dr.
Zwicke. Activities include inpatient and outpatient consultations,
introduction to the catheterization laboratory and care of post
catheterization patients.
ASLMC Electrophysiology, Anwar Dhala, MD, ASLMC Rotation Director
During their 3 month assignment on the electrophysiology service,
fellows develop a basic understanding of management and treatment of
arrhythmias, as well as appropriate use of noninvasive and invasive
electrophysiology techniques. Under the supervision of the
electrophysiology faculty, fellows attend outpatient clinics,
participate in and interpret studies, participate in pacemaker
management, inpatient consultations and management, and interpret
surveillance and ambulatory devices.
Studies
Cardioverter-defibrillator implantation and maintenance
Clinical EP consultation (inpatient and office)
Comprehensive invasive EP testing
Advanced intracardiac mapping
Tilt-table testing
Catheter and intraoperative ablation
Transtelephonic monitoring for PM and loop recorders
Pacemaker implantation, testing and follow-up
Clinical trials for drugs and devices
Holter monitoring
Intracardiac ultrasound
Signal-averaged EKG interpretation
Outpatient Clinic Assignment
Each fellow is assigned to a cardiology teaching physician's
clinic for one half-day per week.
Clinics are held at all campus sites: the Milwaukee Heart Institute on
the Aurora Sinai campus, and the Professional Office Building on the
Aurora St.
Luke's campus.
Research
Protocols designed in the first year are implemented throughout the
course of the second year. Faculty mentoring begun in the first year
continues during this phase of research development. It is expected that
these projects will be presented at a national or international meeting
or submitted to a refereed journal. Fellows' research efforts,
activities and times are designed to run concurrent with clinical
experience throughout the fellow's training.
Cardiology Basic Program: 3rd Year
Third-year rotations are individually designed by the trainee and the
program director. Typically, this 12-month period is devoted to
additional time in the Cardiac Catheterization Laboratory and the
Noninvasive Laboratory, elective rotations, as well as ongoing research.
Interventional Cardiovascular Lab, Tanvir Bajwa, MD, Director
Individual fellows spend differing amounts of time in this laboratory (a
minimum of four months). Third-year fellows typically spend 50% of this
year in the Cardiac Catheterization Laboratory. Participation in
research involving investigational devices and drug trials will be part
of this rotation.
Techniques
All procedures previously listed, plus . . .
Percutaneous transluminal coronary angioplasty (PTCA) and stenting
Exposure to transseptal catheterization and valvuloplasty
Peripheral vascular angiography and intervention
Endomyocardial biopsy
Limb salvage
Pharmacologic management with thrombolytics and IIb/IIIa inhibitors
Noninvasive Cardiology, Rami Gal, MD, ASMC Rotation Director and
Steve Port, MD, and Kiran Sagar, MD, ASLMC Rotation Directors
A fellow who chooses additional experience in the noninvasive
laboratories is expected to spend at least five months during the third
year. The goal is to prepare the third-year fellow to function on the
same level clinically as would a junior attending. If the laboratory's
director determines the fellow to be adequately trained, he may grant
permission for the trainee to attend a course for licensing in nuclear
cardiology and participation in performing transesophageal
echocardiography. Cardiac CT experience and setting takes place in an
office-base practice non-invasive lab located on Aurora St. Luke's
Campus.
Research
Prior to graduation, each fellow must complete the research project(s).
Fellows' research efforts, activities
and times are designed to run concurrent with clinical experience
throughout the fellow's training.
Preventive Cardiology, V. Shrinivas Murthy, MD, PhD, Director
The primary goal of preventive cardiology curriculum is to provide the
learner with the knowledge, skills and strategies for successfully
initiating a maintaining preventive care using a team approach in the
practice of clinical cardiology. The program provides additional
educational, clinical and research opportunities for fellows interested
in cardiology careers with an emphasis on prevention.
Our program utilizes the available resources to provide comprehensive
teaching and self-guided learning opportunities in cardiovascular
physiology, pathology, pharmacology and epidemiology related to the
following diseases with emphasis on prevention.
- Atherosclerosis: Ischemic heart disease, peripheral vascular
diseases and vascular aneurysms. These topics and related subjects
which have significant impact atherosclerosis such as tobacco abuse,
metabolic syndrome, insulin resistance, diabetes, obesity, exercise,
dyslipidemias and platelet function are covered.
- Hypertension: Topics include renin-angiotensin-aldosterone
system, sympatheric nervous system, endothelium function and related
peripheral humoral system, vascular smooth muscle function are
discussed.
- Heart failure: Left ventricular function and improvement of its
performance with various pharmacological modalities are covered.
Patients referred to Preventive Cardiology Clinic for the management
of dyslipidemia or hypertension are managed in collaboration with the
referring fellow so as to enhance the learning experience.
Cardiac Rehabilitation Didactic Sessions, Neil Oldridge, PhD,
Director
Dr. Oldridge teaches a regular research and conference series for
fellows with a focus on cardiovascular disease prevention and
rehabilitation.
Interventional Cardiology Fellowship (1 year
program)
Two candidates are selected for these positions that show a
high level of maturity and clinical acumen mixed with common sense and
demonstrated ability as a researcher. This candidate may already be in
our program or in one at a different institution.
The Interventional Program is an opportunity for participation and
skill enhancement in diagnostics, performance of advanced interventional
procedures, and post-procedure management of cardiac disorders.
The purpose of this fellowship year is to provide solid clinical
experience that includes consultations, diagnostics, management, and
research opportunities. At the end of this year of advanced training,
the fellow should be able to function at a very high level as a
consultant to cardiologists.
Techniques
Simple & complex angioplasty/stenting/rotablator
Valvuloplasty
Thrombolytic & IIb/IIIa inhibitor therapies
Partial cardiopulmonary bypass
Transseptal catheterization
Management of critically ill cardiac patients and those with acute
MIs
Device and pharmacologic trials
Pathophysiology related to CAD and interventional procedures
Pharmacology
Original research
Clinical Cardiac Electrophysiology Fellowship (1
year program)
These three advanced electrophysiology fellowship positions offer an
unparalleled opportunity for extensive training in cardiac
electrophysiology under the supervision of seven faculty
electrophysiologists. The scope of training is comprehensive in both
clinical electrophysiology and basic research, and the program strongly
emphasizes and supports independent research, mentored by the faculty.
It is expected that fellows not only contribute to ongoing clinical
projects, but develop their own projects to completion for presentation
at national meetings and eventual publication in peer-reviewed journals.
The clinical program is conducted at two sites: Aurora Sinai Medical
Center and Aurora St. Luke's Medical Center.
Fellows spend equal amount of time at Aurora Sinai and Aurora St.
Luke's sites during their
fellowship and participate in the management of patients referred for
tertiary care of cardiac rhythm disturbances, both in outpatient and
in-hospital settings. The Aurora Sinai Medical Center campus has a fully
equipped and staffed research laboratory (described below).
Both institutions offer training in simple and complex
electrophysiologic studies, tilt-table testing, ambulatory cardiac
rhythm monitoring, and catheter ablation. Electrophysiologic guided
intracardiac operative mapping and cryoablation therapy are also
performed in the cardiac surgical suites.
Device evaluation and follow-up, including cardiac pacing and
implantable defibrillators, are performed daily. In-hospital
electrophysiologic consultative services create a unique opportunity for
evaluation and management of the patient with rhythm disturbances in the
acute care setting, often in a multispecialty environment.
Both sites also have full-service electrophysiology consultation
suites.
Didactic training sessions include two interactive weekly meetings
that discuss current patients and case reviews from teaching files. The
Cardiac Catheterization Conference at the Milwaukee Heart Institute (MHI)
is another forum for the integration of electrophysiology and cardiology
training.
The Electrophysiology Program, which began at Aurora Sinai Medical
Center as the first of its kind in Wisconsin over 20 years ago, has
achieved many “firsts” in the evolution of diagnostic and therapeutic
electrophysiology. There are two busy, full-time customized
electrophysiology laboratories, supported by highly trained nurses,
technicians, and bioengineering staff. In addition to conventional
equipment, the lab is equipped with advanced intracardiac mapping
capabilities. At MHI, diverse outpatient training is provided in the
Arrhythmia Clinic and the Pacemaker Clinic.
The Winter Research Building houses a fully funded basic research
laboratory where animal research in atrial fibrillation is currently
underway. This full-scale laboratory operates with conventional
electrophysiologic equipment, as well as with the Biosense Carto system
and intracardiac ultrasound, for experiments that will help translate
animal research findings into clinical applications for patients.
Fellows are encouraged to participate in these ongoing projects.
The Aurora St. Luke's Medical Center training site is the largest tertiary
cardiac referral center in the state of Wisconsin and offers a wealth of
clinical material.
Aurora St. Luke's Medical Center is considered a “center of excellence” for
its many developing cardiovascular technologies. Its five dedicated
high-volume electrophysiology laboratories are staffed by a highly
trained, strongly committed professional staff and serve as the core of
the program. Under the leadership of Dr. Masood Akhtar, St. Luke's
Institute for Cardiac Rhythms has been developed to provide public
education and awareness of cardiac rhythm disorders.
In addition to focus groups for patients, as part of a state-wide
network of patient and public education forums, electrophysiologists
have opportunities in telemedicine and outreach education. The
Arrhythmia Clinic in the Physician Office Building provides fellows with
office experience, including consultations and office visits, and
clinical experience with pacemaker and ICD patients seen in follow up.
For the past six years, at both training sites, we have used the
Biosense Carto system, and for the past two years, the Endocardial
Solutions mapping system. Both systems offer state-of-the-art
technologic enhancement for a variety of unique applications in
arrhythmia therapy, including focal ablation for atrial fibrillation.
Conferences, along with journal clubs and research conferences,
provide fellows with extensive resources for their learning experience.
Fellows required conferences
- Analysis of Intracardiac Electrograms (every Monday, Noon
- 1 p.m. Milwaukee Heart Institute, 1st Floor) Electrophysiology
and Cardiology Fellows
- Cath Conference (every Tuesday, 5 p.m. - 7 p.m.,
Milwaukee Heart Institute, Conference Room, 1st Floor)
Cardiology and Interventional Cardiology Fellows
- Cardiology Noon Conference (every Wednesday, Noon - 1
p.m. Aurora Sinai Medical Center, 5 North Conference Room)
Cardiology, Interventional Cardiology and Electrophysiology Fellows
- Fellow's Journal Club Conference (Thursday, Noon - 1
p.m., Milwaukee Heart Institute, Conference Room, 1st Floor) 2
Cardiology Fellows Journal Club presentations, 1 preventive
cardiology/clinical pharmacological conference and 1 research
conference, rotating presentations every 4 weeks
- Electrophysiology Case Report (every Friday, 7:30 a.m. - 9
a.m., St. Luke's, Ste. 777) 3 weeks of case presentations and 1 week
of Electrophysiology Journal Club, 1 week of research
Electrophysiology Fellows
- Cardiovascular Disease Board Review Sessions (every
Friday, Noon – 1 p.m., Aurora Sinai Medical Center, 5 North
Conference Room) Cardiology, Interventional Cardiology and
Electrophysiology Fellows
- Interventional Cardiology Cath Conference (every 3rd
Friday, 6 a.m. - 7 a.m.) Aurora St. Luke's Medical Center, Cath Lab
Conference Room Cardiology and Interventional Cardiology Fellows
Cardiology Fellowship Program links
|
