Life as a Fellow

 

General Fellowship Rotation Schedule

All fellows aim to achieve COCATS II training in echocardiography. Fellows who desire additional fellowship training in Electrophysiology will also aim for COCATS II in electrophysiology and cardiac catheterization. Fellows who desire additional fellowship training in Intervenional Cardiology will not only achieve COCATS II in cardiac catheterizaiton, but aim for 9 months in the cardiac cathterization laboratory. Fellows who desire training in non-invasive diagnostic modalities will aim for COCATS II in Nuclear Cardiology and either COCATS II in cardiac CT or COCATS III in echocardiography.

The following table is a sample schedule based on the aggregate desires of our fellows the past several years

  THIRD YEARS SECOND YEARS FIRST YEARS
INPATIENT CONSULTS 8 weeks 10 weeks 10 weeks
CCU 4 weeks 4 weeks 2 weeks
NIGHT FLOAT NONE 4 weeks 6 weeks
ELECTROPHYSIOLOGY 4 weeks 4 weeks 6 weeks
CARDIAC CATHETERIZATION 4 weeks 6 weeks 10 weeks
ECHOCARDIOGRAPHY 8 weeks 8 weeks 8 weeks
NUCLEAR CARDIOLOGY 4 weeks 4 weeks 4 weeks
AMBULATORY 4 weeks 4 weeks NONE
RESERACH/ELECTIVES 12 weeks 4 weeks 2 weeks

 

A Day in the Life of a Cardiovascular Disease Fellow

7:00 – 8:00 AM: Academic Conference
MONDAY   TUESDAY        WEDNESDAY       THURSDAY        FRIDAY

Cath/

Interventional cases

Echo conferences

  • Clinical case presentations (EP, shock/HF)

  • Practicums (echo/cath)

  • ECG conferences

  • Journal Clubs

  • Multimodality imaging

  • Self-Directed Learning*

  • Jeopardy

  • Meet with Grand Round’s Speakers¥
*Self-Directed Learning is a study period over a few weeks where fellows explore an assigned topic and compile questions for Jeopardy at the end of the block. Topics include Cardio-Oncology, Cardio-Obstetrics, Vascular Medicine, etc.
¥This is an opportunity for fellows to meet with the Grand Rounds speaker over breakfast but during our regularly scheduled conference time. It is an excellent chance for networking and mentorship, and previous fellows have used it to gain research, job, and academic connections that last an entire career.

 

8:00 AM - 5:00 PM: MONDAY - FRIDAY

Tucson VA Medical Center:

  • Consults: Work closely with faculty and residents to care for floor- and ICU-level patients. We are not a primary service at the VA. There are opportunities to perform some procedures on these patients.
  • Cath: The cath fellow is responsible for performing cardiac catheterizations (diagnostic and interventional) on scheduled outpatient, including pre- and post-care. This fellow works with the inpatient teams to preop and perform catheterizations on inpatients.
  • EP: The EP fellow splits time between the EP lab and the clinic. In the lab, the EP fellow will have the opportunity to perform ablations (atrial, SVT, ventricular, accessory pathway), device implants (pacemaker, ICD, loop recorder), and cardioversions. In the clinic, the fellow preops patients for procedures, reads event monitors, and performs device interrogations.
  • Echo: The echo fellow is responsible for reading and performing all stress echoes, TEEs, and stress tests (pharmacological and exercise) in addition to reading transthoracic echocardiograms with attendings. While it may on-paper seem like a lot of work, the case load is very balanced, and fellows leave on time every day. This is the hospital that has the most non-TEE stress tests and procedures, and it is also a great place to learn hands-on transthoracic echocardiography.
  • Nuclear: The Nuclear fellow is responsible for reading nuclear studies as part of a combined “reading rounds” session with the Radiology department.

Banner University Medical Center – Tucson Campus:

  • CCU (7 AM- 7 PM): Cardiac ICU rotation with exposure to a wide variety of cardiac pathologies and devices, including all types of mechanical circulatory support (ECMO, IABP, Impella, Impella-RP, Tandem Heart, CentriMag). The fellow is engaged in teaching residents on the service and working closely with the CVICU Team that co-manages patients.
  • Advanced Heart Failure & Transplant: The fellow works closely with an interdisciplinary transplant team (including a social worker, psychologist, coordinator, nurse practitioner, and pharmacist) to manage transplant and LVAD patients at all stages of their workup and post-transplant process.
  • Night Float (7 PM – 7 AM): A fellow/resident team cares for overnight admissions from floor to ICU level as well as consults. The team is responsible for procedures overnight. Calls from South Campus and the VA are triaged by this fellow to determine acuity and need for a second, “home call” fellow to go to the respective site for urgent patient matters.
  • Cath: One to 2 general fellows work closely with the interventional fellows to perform cardiac catheterizations (diagnostic and interventional) on scheduled outpatient, including pre- and post-care. This fellow works with the inpatient teams to preop and perform catheterizations on inpatients. This rotation may run later than 5 PM.
  • EP: The general cardiology fellow on EP splits time between the lab and consults. In the lab, the fellow assists on complex procedures, including ablation of atrial, supraventricular, accessory pathway, and ventricular arrhythmias and device implantation. The fellow also performs cardioversions. As consults arise, the fellow works closely with the EP fellow and attendings to manage patients in the hospital.
  • Echo: This rotation is a TEE-heavy rotation, with fellows gaining upwards of 150 TEEs by graduation. The responsibility of this fellow is to perform and interpret stress echoes as well as triage, perform, and interpret TEEs. This rotation may run later than 5 PM.
  • Advanced Imaging Elective (CT, MRI): This is the opportunity for fellows to get in-depth training in Coronary CT, CTA, and Cardiac MRI. This is a customizable rotation, and many fellows go on to take either CT or MRI boards in their third year.
  • Nuclear: The Nuclear fellow is responsible for performing and interpreting nuclear studies. Reading is split between Cardiology and Radiology, depending on the day. Fellows with at least 4 months of Nuclear (who also satisfy the reading requirements as delineated by the boarding body) may sit for boards.

Banner University Medical Center – South Campus:

  • Consults: Cardiology is not a primary service at South Campus. The fellow is responsible for the consults at South campus, often with a resident and medical student on the team and is thus engaged in teaching activities. The fellow is additionally responsible for inpatient TEEs and is optionally able to perform and interpret the inpatient and outpatient stress tests.

Banner University Medical Center – North Campus:

  • Ambulatory: Divided into 10 half-day sessions, fellows rotate through clinics in electrophysiology, hypertrophic cardiomyopathy, interdisciplinary heart failure, pulmonary hypertension, cardio-obstetrics, cardio-oncology, and adult-congenital cardiology. This is also a great rotation to get transthoracic and stress echocardiography reading time. Fellows spend one half day per week learning about cardiac rehabilitation.

 

12:00 PM – 5:00 PM: Continuity Clinic Half-Days

Fellows are assigned to either facility for a half-day per week continuity clinic. Depending on the assigned location, the fellow is excused from their regularly scheduled rotation to attend clinic.

  • Banner University Medical Center – North Campus: Wednesday, Thursday or Friday

  • Tucson VA Medical Center: Tuesday only

 

5:00 PM – 7:00 AM: MONDAY - FRIDAY
  • If you are not on call, this is personal time. Be ready to rinse and repeat the next day.