Cardiovascular Disease Fellowship Program Structure
The three years of cardiology fellowship at the University of Vermont are a time of intense personal and professional development. We respect our fellows as adult learners who enter as Board Eligible Internists and will be exposed to the depth and breadth of cardiovascular medicine during their training here. We aim to equip them with a core set of skills while helping them develop and pursue their own career goals. The fellows who graduate from our program are well-prepared to contribute to the field of cardiovascular medicine.
Learning and Teaching
The University of Vermont Cardiovascular Fellowship curriculum includes interactive conferences that complement the intensive clinical learning experience. The curriculum is dynamic and ever-changing, and it is characteristic of the UVM environment that our fellows are always involved in shaping it.
Fellows are learners – they attend weekly interventional, electrophysiology and imaging conferences, as well as case discussions, hemodynamic sessions, ECG hours, congenital series, journal clubs, cath film review, and many more. Fellows are contributors – they participate in Interventional QA sessions, lead research seminars, host interdisciplinary MICU/CCU conferences, revise the curriculum through QI initiatives, and more. Fellows are educators – in addition to teaching peers, residents, and medical students during clinical rotations, they can develop lecture series for their peers, become members of the UVM Larner College of Medicine Teaching Academy, or serve as instructors at the College of Medicine.
All fellows complete their core clinical training during the first 24 months. Every clinical rotation takes place at the University of Vermont Medical Center, the academic center of the University of Vermont Health Network. During our unique Third Year, fellows can opt to begin subspecializing in noninvasive cardiology, interventional cardiology, or electrophysiology, focus on research, or explore other career objectives. In addition, fellows complete an advanced heart failure / transplant rotation at Massachusetts General Hospital. The site for the weekly outpatient continuity clinic is the UVM Medical Center Cardiology outpatient practice. This outpatient experience can be supplemented by participation in specialty clinics.
Fellows engage in bench, translational, and clinical cardiovascular research under the guidance of our nationally acclaimed faculty. The Cardiovascular Research Institute of Vermont (CVRI) provides additional mentorship and resources such as project support, networking events, and travel awards to trainees. Scholarly quality projects are supported with divisional and departmental resources. A range of funding opportunities are available through the CVRI and the Department of Medicine. Our fellows present at the local and national level and are mentored and sponsored to succeed during and after fellowship.
Fellows are assigned an academic advisor at the beginning of their fellowship. That faculty member will serve as a general resource to guide integration into fellowship and academic development during the first year. Thereafter, fellow subspecialty interests will drive the choice of a mentor. Faculty mentors represent a broad spectrum of academic physicians with interests ranging from translational research to innovation.
First and Second Year Rotations
Cardiac Catheterization: Our cardiac catheterization laboratory is the quarternary referral center for the region. We are the only center in Vermont that performs structural procedures and complex PCI with hemodynamic support. First and Second Year Fellows are trained to independently perform diagnostic coronary angiography and left and right heart catheterization with hemodynamics. They are also exposed to percutaneous coronary interventions, structural procedures (TAVR, mitral valve repair, valve-in-valve procedures, PFO closure, left atrial appendage occlusion, and more), intracoronary diagnostics (FFR/DFR, IVUS, OCT), and complex interventions with and without hemodynamic support. Fellows who intend to subspecialize in Interventional Cardiology begin focused training in interventional procedures during their Third Year. Overall, approximately 2500 diagnostic coronary angiographies are performed at UVMMC per year, 1000 PCI, and 350 structural procedures.
CCU Rotation: The busy inpatient Cardiology service is fellow-led at UVMMC and comprises all levels of acuity, from acute STEMI care and decompensated heart failure to chest pain. Fellows drive the care of all patients admitted to the cardiology service, from ED to discharge. Most patients are admitted to the CVCU, a mixed-intensity unit providing all levels of care from chest pain to STEMI. Teams include a cardiology faculty member, one or two fellows, four residents, a midlevel provider, and medical students. Fellows become comfortable managing and directing the care of patients with coronary syndromes, acute valvular disease, acute heart failure, pericardial disease, pulmonary hypertension, and adult congenital heart disease.
Inpatient Consultation: Fellows provide consultative services in conjunction with select faculty members, residents and students. A focus of this rotation is the care of the critically ill cardiac patient in the Intensive Care Unit. At UVMMC, patients with a primary cardiac diagnosis who require mechanical ventilation or advanced hemodynamic support are treated in the medical or surgical (CT) Intensive Care Units, and are co-managed by Intensivists and the Cardiology Consult Team.
Electrophysiology: Fellows evaluate and treat patients with the whole range of arrhythmia problems both on the electrophysiology inpatient service and as in-hospital consultants. Throughout fellowship, they are responsible for reading assigned ECGs and ambulatory arrhythmia monitoring. Fellows also take part in ambulatory device clinics. Our electrophysiology laboratory performs more than 1500 procedures a year, including ablations, diagnostic procedures, left atrial appendage occlusion, and devices.
Echocardiography: During dedicated echo rotations, fellows are trained in the performance and interpretation of transthoracic and transesophageal echocardiography, including 3D and strain imaging. This is a particularly high-volume service, offering our fellows ample opportunity to achieve COCATS Level 2 competency. Third-year fellows wishing to focus on noninvasive cardiology or imaging can obtain Level 3 training. Fellows can participate in imaging during structural procedures, such as mitral valve repair or left atrial appendage occlusion.
Cardiac Imaging: First-year fellows are initially trained in stress testing and nuclear myocardial perfusion imaging. Subsequent rotations add Cardiac CT and Cardiac MR exposure. A collaborative environment between Cardiology and Radiology creates optimal training conditions in all advanced cardiac imaging modalities. For example, at UVM, 75% to 80% of all nuclear studies are co-read by a nuclear cardiologist and a nuclear radiologist. A dedicated Nuclear Physics curriculum is offered biennially to fulfill Nuclear Cardiology Board eligibility requirements. Available technology includes SPECT and solid-state PET-CT, 265-detector CTA, and CMR with tissue characterization.
Night Float: Fellows direct the night resident on the inpatient cardiology service and direct care of admissions throughout the night. This 2-week rotation runs Sunday through Thursday from 7 pm to 7 am.
Continuity Clinics: All Fellows participate in weekly half-day continuity clinics at the UVM Cardiology outpatient practice. In addition, Fellows in their third year can choose to participate in specialized outpatient clinics in electrophysiology, heart failure, interventional/structural cardiology, adult congenital heart disease, and preventive cardiology.
Research/Reading: Four weeks are dedicated to exploring and initiating research projects and to focus on reviewing and reading during the first two years.
Third Year Rotations
Advanced Heart Failure/ Transplant: Fellows rotate to Massachusetts General Hospital, Boston, for a one-month inpatient rotation.
Vascular Medicine: All third-year fellows rotate with Vascular Surgery for 2 weeks to acquire skills in noninvasive vascular imaging and participate in vascular clinic.
Preventive Cardiology / Cardiac Rehabilitation: Fellows gain additional experience in preventive cardiology, lipid management, cardiac rehabilitation and cardiopulmonary exercise testing during this 2-week rotation
The Third Year: The remainder of the Third Year is customized according to the fellow’s preference and can include a mix of invasive/noninvasive cardiology or electrophysiology, a focus on research, a month-long external elective, a rotation with other specialties at UVMMC, or any other configuration. For example, fellows wishing to subspecialize in Interventional Cardiology generally do 6 months of Interventional training and participate in Interventional Call throughout the year.
Please contact us with any questions!
Fellowship Coordinator: Roberta Frohock, 802-847-2005
Email: Roberta [dot] Frohockuvmhealth [dot] org (subject: Cardiology%20Fellowship)
Address: Department of Medicine, UVM College of Medicine/UVM Medical Center
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