Curriculum

Electrophysiology
Electrophysiology Rotation Schedule and Responsibilities
The general responsibilities of the cardiology fellow are to evaluate and work up outpatients for procedures, assist on EP procedures, pacers, and implantable defibrillators. Daily arrhythmia rounds will be conducted where consults and intracardiac tracings will be discussed. Fellows will participate in ICD and pacer follow-up clinic.

1. Overview
   1. Meet COCATS guidelines for general EP
   2. Duration: One month
   3. Rotation Supervisor: Adam Strickberger, MD
2. Rotation Goals:
   1. Indications for an EP test
   2. Interpretation of basic intracardiac recordings
   3. Basic understanding of pacing and pacemaker follow-up
   4. Basic understanding of ICDs and ICD follow-up
   5. Understanding of evaluation and treatment of cardiac arrhythmias
3. Overview of Responsibilities
   Daily participation in all aspects of the arrhythmia service, including:
   1. Inpatient consults
   2. Pre-procedural evaluation to assess appropriateness & risks of procedure and to plan procedure strategy, including obtaining informed consent and writing a pre-procedural note including indications for, risks of, and alternatives to the procedure, for all inpatients and as many outpatients as possible.
   3. Performance of procedures by the trainee which are at a level appropriate to the trainee’s experience, and under the direct supervision of the faculty.
   4. Active involvement in post-procedural management both in and out of the catheterization laboratory, including a preliminary catheterization note, being available to respond to any adverse reactions or complications (hypotension, vascular complications, heart failure, renal failure, bleeding or myocardial infarction), and a post-procedural note, and participation in follow-up and management of complications.
   5. Daily arrhythmia rounds with Dr. Strickberger that will include consults, EP tracings, management issues, etc.

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Cardiac Catheterization
Training in Cardiac Catheterization for First Year Cardiology Fellows at the Washington Hospital Center

1. Overview
   Overall Goal: Meet ACC/AHA COCATS Guidelines for Level 1 Training (www.acc.org March 2002)
   Level 1 training is intended for Trainees who will practice noninvasive cardiology and whose invasive activities will be confined to critical care unit procedures (i.e. all cardiologists).
   (Level 2 training is intended for Trainees who will practice diagnostic but not interventional cardiac catheterization, while Level 3 training is intended for Trainees who will practice diagnostic and interventional cardiac catheterization.)
    
   Duration of Level 1 Training is a minimum of 4 months, during which time the trainee should participate in a minimum of 100 diagnostic cardiac catheterization procedures.
   (Level 2 Training requires a minimum of 8 months total, including Level 1 training time, over the course of 3 years, and the performance of at least 300 diagnostic cardiac catheterization procedures.)
    
   Duration of First Year Cardiac Cath Training: 3 months of first year.
   Rotation Supervisors: Elizabeth Ross, MD; Ken Lee, MD
    
2. Rotation Goals
   1. To provide for all trainees didactic and practical training and experience in cardiac catheterization as outlined for Level 1 by the Core Cardiology Training Symposium (COCATS) published on the ACC Website (www.acc.org) in March 2002.
   2. To provide the groundwork for attaining Level 2 training for those trainees who wish to do so provided they have demonstrated appropriate skills during Level 1 training.
       
3. Objectives
   1. Overview of Conduct of Training – Participation Expected from the Cardiology Fellow in the Daily Life of the Cath Lab – from COCATS
      1. On all inpatients and as many outpatients as possible: preprocedural evaluation to assess appropriateness & risks of procedure and to plan procedure strategy, including obtaining informed consent and writing a preprocedural note including indications for, risks of, and alternatives to the procedure.
      2. Performance of the procedure by the trainee at a level appropriate to experience under direct supervision of the faculty.
      3. Active involvement in postprocedural management both in and out of the catheterization laboratory, including a preliminary catheterization note, being available to respond to any adverse reactions or complications (hypotension, vascular complications, heart failure, renal failure, bleeding or myocardial infarction), and a postprocedural note, and participation in follow-up and management of complications.
   2. Level 1 Cognitive Knowledge Objectives from COCATS
      1. Understand the indications for cardiac catheterization.
      2. Understand coronary anatomy, its variations, and congenital abnormalities.
      3. Understand coronary physiology
      4. Understand the complications of the procedure and their management, such as hypotension, acute myocardial ischemia, congestive heart failure, renal failure, vascular complications, contrast reactions, retroperitoneal bleeding, and cardiac tamponade.
      5. Select the optimal treatment modality, including medical therapy, percutaneous coronary intervention, or surgical therapy, with understanding of the indications for and risks of each revascularization strategy.
      6. Understand cardiac hemodynamics, including the measurement and interpretation of pressure, flow, resistance, and cardiac output.
      7. Interpret hemodynamic findings in a variety of cardiac conditions, including various forms of myocardial disease, pericardial disease, valvular stenosis and regurgitation, congenital heart disease, and pulmonary vascular disease.
      8. Understand the indications for and complications of temporary transvenous pacing.
      9. Understand the indications for and complications of pericardiocentesis and recognize tamponade physiology.
      10. Understand the indications for and complications of other laboratory procedures, such as endomyocardial biopsy, intra-aortic balloon counterpulsation, and retrieval of foreign bodies.
      11. Understand basic principles of X-ray imaging, radiation protection, and radiation safety.
      12. Understand the anatomy of and methods to access cardiac chambers and coronary arteries via the femoral, brachial, and radial access sites.
      13. Interpret coronary, ventricular, atrial, and aortic angiography and determine left ventricular ejection fraction.
      14. Understand the indications for and complications of contrast agents and drugs commonly used for invasive procedures, such as heparin, low-molecular-weight heparin, glycoprotein Iib/IIIa receptor antagonists, other antiplatelet drugs, thrombolytic drugs, vasopressors, vasodilators, and antiarrythmic drugs.
   3. Level 1 Technical Skills Objectives from COCATS
      1. Perform percutaneous vascular access from the femoral artery and vein and subclavian or internal jugular vein.
      2. Perform right heart catheterization using a balloon flotation catheter.
      3. Perform temporary right ventricular pacemaker insertion.
      4. Perform left heart catheterization and coronary angiography (of native arteries) under supervision.
          

Conferences
Attend weekly Cardiac Cath Conference (Wednesdays 7:30 am). This is a combined medical/surgical conference. Fellows are invited to present cases at this conference which should include hemodynamic and angiographic data discussed in the context of patient history, physical examination, and noninvasive findings. Indications, complications, and management strategies should also be discussed. This conference also serves as our morbidity and mortality conference for the Section of Cardiology.
 
In addition, there is a monthly Fellow's Hemodynamics Conference in which the Fellow on the Cardiac Cath rotation is expected to prepare, present and discuss the diagnosis and differential diagnosis of the hemodynamics of valvular and pericardial heart disease and cardiomyopathy. This should also be done in the context of a brief patient history and physical exam and any noninvasive findings.

Suggested Curriculum

1. Overview
   1. The first two weeks of the first month of cath rotation are spent with the cardiovascular technicians for training in sterile technique, preparation of the patient, and the preparation and use of the equipment in the lab.
   2. Following this the trainee will participate in the catheterization procedures of at least two to three patients per day. Cardiac caths should be preceded by a patient evaluation, and followed by a patient follow-up, as described in Objectives above. As often as possible, noninvasive data should be reviewed beforehand. This will require knowing what cases will be scheduled with your attending 1-2 days in advance. The cardiology fellow on Clinical service is also a good source of patients scheduled for upcoming cath's.
   3. Meet with Dr. Ross or Dr. Lee for didactic instruction (patient cases).
   4. Collect interesting cases (history, exam findings, noninvasive data, and angiography “burned” on a CD-ROM) for presentation at either the monthly Fellows Cath Conference (Fridays), or the weekly WHC Cath Coference (Wednesdays).
       
2. Goals of First Month
   1. Week One: Indications & Contraindications for Cardiac Catheterization, Complications of Cardiac Cath, Pre- and Post-Cath Patient Evaluation
   2. Week Two: Radiation Safety, Principles of Fluoroscopic Imaging, Contrast Agents
   3. Week Three: Coronary Anatomy & Anomalies; Coronary Physiology; Vascular Access and Coronary & Graft Angiography; Ventriculography and Other Angiography
   4. Week Four: Right Heart Catheterization & PCWP; Cath Lab Meds; Cardiac Output; Coronary Flow; Shunts
       
3. c. Goals of Second Month
   1. Week One: Interpretation of Angiograms; IVUS
   2. Week Two: Valvular Heart Disease
   3. Week Three: Pericardial Disease
   4. Week Four: Cardiomyopathies
       
4. Goals of Third Month
   1. Week One through Four: Focus on Workup, Analysis, & Presentation of Cases and Evidence Based Management of Coronary Artery Disease

Resources for Reading

The three most commonly used references for cardiac cath & angiography are

1. Grossman’s Cardiac Catheterization, Angiography, and Intervention Donald S Baim, William Grossman (eds) 6th ed. 2000.
2. Diagnostic and Therapeutic Cardiac Catheterization Carl J Pepine (ed) 3rd ed. 1998.
3. The Cardiac Catheterization Handbook Morton J. Kern (ed) 3rd ed. 1999.

Two other important resources are the ACC/AHA Guidelines

1. Guidelines for Coronary Angiography
2. Guidelines for Coronary Artery Bypass Surgery

Both are available on-line at the ACC’s Website.

Below is a compilation of chapters and page numbers from the three texts mentioned above which may be useful in helping you to find pertinent reading, listed according to the curriculum timetable. This is merely an index. You are not required to read 11 pages about contrast agents in Pepine, but if you want to, this tells you where to find it.

Month One:

Month Two:

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Clinical Consult Service
During this rotation the trainee gains experience with the practice of inpatient cardiology. He/she leads a team of internal medicine residents and medical students to whom requests for cardiology consultations for the “staff service” are directed. Patients are seen initially by a resident or student team member and reviewed with the fellow prior to presentation of the case to the supervising attending at daily rounds. The fellow should regard these patients as his/her responsibility and should, as a principle, participate in any procedure they require. The fellow shares with the supervising attending responsibility for appropriate didactic instruction for the medical team. Trainees are assigned to this service for two months in the first year and one month in each of the second and third years.

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Critical Care Unit
Fellows’ Curriculum for the Coronary Care Unit at the Washington Hospital Center

Overview: The Coronary Care Unit rotation is designed to be both challenging and gratifying for the cardiology fellows. Under the close supervision of a dedicated cardiology attending, fellows will be directly responsible for the care of the most critically ill cardiology patients, for assisting and teaching the CCU housestaff, and for performing and supervising numerous invasive procedures. The goal of the CCU rotation is to provide an environment in which cardiology fellows become comfortable in caring for critically ill cardiac patients as well as in leading a multifaceted team of health care providers.

Rotation Supervisor: Julio A. Panza, MD (CCU Director)

Attending Staff:
Julio A. Panza, MD
Zuyue Wang, MD
Howard Cooper, MD
Thippeswamy Murthy, MD
Rajnish Prasad, MD (weekend coverage)

Head Nurse: Heather Russell, R.N.

Rotation Goals:

1. Understand the pathophysiology, diagnosis, and treatment of the following common CCU conditions (among others):
a. Acute coronary syndromes, including acute myocardial infarction and unstable angina
b. Decompensated congestive heart failure and cardiogenic shock
c. Tachyarrhythmias and bradyarrhythmias
d. Aortic dissection
e. Bacterial endocarditis
f. Acute valvular heart disease
g. Pulmonary embolism

2. Enhance knowledge of ventilator management

3. Gain/refine competence in the following procedural skills:
a. Pulmonary artery catheterization (insertion and interpretation)
b. Temporary transvenous pacing
c. Central venous line placement
d. Arterial line placement
e. Intraaortic balloon counterpulsation
f. Emergency transthoracic echocardiography

4. Develop skills for supervising an inter-disciplinary team of health care professionals

5. Develop knowledge and skills regarding end-of-life issues

Overview of Fellow Responsibilities:

1. Meet with on-call fellow and house staff prior to a.m. rounds to discuss new admissions and other overnight issues
2. Meet with resource nurse prior to a.m. rounds to review probable transfers out of the CCU
3. Actively participate in daily a.m. rounds (8:30-12:00) and evening rounds (5:00-5:30) with the CCU attending and house staff
4. Attend, whenever possible, CCU noon lecture series
5. Present one interesting/informative case per month at the CCU conference, including a brief didactic talk on the pertinent issue.
6. Assess all new admissions to the CCU immediately upon their arrival to the unit
7. Supervise and assist house staff with management of all patients in the CCU
8. Perform and/or supervise invasive procedures in the CCU
9. Discuss and coordinate with primary attending, consultants, nursing staff, respiratory therapy staff, nutrition staff, and others as required to maximize patient care quality and efficiency
10. Coordinate all admissions and discharges from the CCU (see below)

Bed Management:

Fellows are primarily responsible for bed management for the CCU. The fellow will carry the dedicated cell phone through which all transfers to the CCU must be coordinated. The fellow must respond to all calls immediately in order to preserve the integrity of this system. The following procedures should be followed:

1. In consultation with the CCU attending, the fellow will determine which patients are appropriate for transfer out of the CCU. Decisions regarding transfers out of the CCU should be communicated to the resource nurse on an ongoing basis so that arrangements can be made to transfer the patient. The appropriate house staff should be instructed to complete transfer orders as soon as possible.

2. The fellow should keep a list of available beds to assign to new admissions.

3. The fellow will immediately answer all incoming calls on the CCU phone (877-7228) or pager (474-7228). Basic information regarding the incoming patient should be obtained and recorded, such as name, MR number, diagnosis, hemodynamic status, ventilator status, vasoactive medications, and accepting cardiologist. An available bed should be assigned to the patient immediately (it may be necessary to check with the resource nurse regarding bed assignments).

4. Every patient admitted to the CCU must have an accepting cardiologist (not the CCU attending). The fellow should not accept transfers from outside hospitals until a WHC cardiologist has agreed to accept the patient in transfer.

5. In general, any cardiology patient about whom the fellow is contacted should be immediately accepted to the CCU. If the fellow feels strongly that the patient would be adequately served on the floor, this can be suggested to the referring physician, but in no case should the fellow “refuse” admission to the CCU.

6. If the fellow is contacted regarding a medical (non-cardiac) patient, the fellow should refer the caller to the MICU (2G) resident. If the MICU does not have any vacant beds and the patient requires an intensive care bed, the fellow should accept the patient to the CCU if a bed is available.

7. In the event that no beds are available in the CCU and a cardiology patient requires a CCU bed, the following steps should be followed:

a. Contact the MICU (2G). If a bed is available, the MICU will accept the most stable “medical” patient in transfer from the CCU, and the new cardiology patient can then be admitted to the CCU. If there are no “medical” patients in the CCU, the MICU will accept the new cardiology patient and care for them. It is important to remember that the CCU and MICU staffs always work as a team in order to provide patients with needed care.

b. If the MICU does not have an available bed, contact the 3G attending and request that the CCU team board a patient in one of the surgical units. In this case, the CCU team will care for the patient in the surgical unit.

Suggested Reading Materials:

1. AHA/ACC Guidelines for the care of patients with acute myocardial infarction (available at americanheart.org and acc.org)
2. Cardiovascular Therapeutics. 2002. Antman (editor)
3. Cardiac Intensive Care. 1998. Brown (editor)

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Echocardiology / Noninvasive Laboratory
Fellows’ Curriculum for the Echocardiography Rotation

Goals

1. To provide for all trainees didactic and practical training and experience in the performance and interpretation of M-mode and 2-dimensional ultrasound imaging as well as pulsed, continuous wave, and color flow Doppler echocardiography to meet the requirements for level 1 competency as outlined in the COCATS statement.

Beller GA, Bonow RO, Fuster V, et al. ACC revised Recommendations for Training in Adult Cardiovascular Medicine Core Cardiology Training II (COCATS 2) (Revision of the 1995 COCATS Training Statement). 2002. American College of Cardiology Web site. Available at
http: //www.acc.org/clinical/training/cocats2.pdf.

2. To provide for those trainees who wish to attain Level 2 proficiency (and thus to be qualified to read echocardiograms independently) an opportunity to do so provided they have demonstrated appropriate skills during Level 1 training.

3. To provide for those trainees who wish to attain Level 3 proficiency (and thus to be qualified to function as director of an echocardiography laboratory) an opportunity to do so provided they have demonstrated appropriate skills during level 2 training.

Orientation to Non-Invasive Lab Rotations(s)

A. Conventional (Transthoracic) Echo (TTE)
1. Performance of Echocardiograms
    a) Suggest minimum of 2 to 4 per day (keep a log)
2. Interpretation of Echocardiograms
3. Examine patients when appropriate
4. Hours of Operation
    a) Expected to be in the lab 8 AM to 5 PM (or last patient)

B. Stress Echocardiography
1. Fellow assigned certain days
2. Responsible for brief history, determining appropriateness of test, presenting a summary to attending. Determine pre-test probability
3. Refer to “Fellows’ Guide to Stress Testing”

C. Echocardiography Conference
1. Every Thursday 7:45 AM to 9 AM (5th floor conference room)
2. Fellow expected to actively participate in case presentations during the conference
3. Fellow expected to present a weekly topic, 10 minutes
4. Review topic with attending 1 or 2 days prior to conference

D. On-Call
1. Remember to fill out logbook and appropriate paperwork
    a) Assign study number, tape number, etc.
    b) Write your preliminary interpretation on work-sheet
    c) Write down diagnoses for billing purposes
    d) Review studies with attending at earliest convenient time
2. Write brief “preliminary” note in the patient chart
3. Use your judgment regarding STAT requests
4. TEE
    a) Fellow will usually be called first
    b) Notify attending
    c) First and second year fellows do not need to come in for TEEs
    d) Third year fellows should come in and work with attending
5. Echo Laboratory is open Saturday, 8 AM – 12 Noon

E. Cleaning /handling of TEE probes
1. Occasional chore
2. “Training” provided by Dr. Sears-Rogan

F. Capitol Area Echocardiography Society Meetings
1. Generally 3 per semester
2. Fellows on echocardiography rotation expected to present cases/discussion

Goals for First Echocardiography Rotation (First two months)

1. Understand the physics of sound and ultrasound
2. Learn operation of the echo machine
3. Perform a complete echocardiography exam
4. Perform accurate measurements and calculations for 2D and Doppler echocardiography
5. Identify the standard imaging planes for 2D echocardiography
6. Explain the difference between Pulse-wave and Continuous-wave Doppler
7. Identify pericardial effusion and tamponade
8. Learn the potential bioeffects of ultrasound

Goals for Second Echocardiography Rotation (Second two months)

1. Debate the pros and cons of various formulae for ejection fraction
2. Be able to perform and understand the accuracy, strengths, and limitations of :
    a. Pressure half-time method for MS
    b. Pressure half-time method for AI
    c. Cardiac output
    d. Regurgitant fraction (AI, MedStar Research )
    e. Continuity equation for AS
    f. Dimensionless index (AS, prosthetic aortic valves)
3. General principles for evaluating prosthetic valves
4. Fluid dynamics of regurgitant jets
5. Principles of diastolic function
6. Echocardiography and Doppler features of hypertrophic cardiomyopathy
7. Infective endocarditis
8. Constrictive vs. restrictive cardiomyopathy
9. Exam planes of the coronary arteries
10. Basics of congenital disease
11. Stress echocardiography (Refer to “Stress Echocardiography - A Guide for the Cardiology Fellow”)

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ECG/Holter

Training in ECG and Ambulatory ECG

Goal

To provide for all trainees didactic and practical training in electrocardiography in order that they become competent in the interpretation and clinical correlation of nearly all clinically encountered ECGs and ambulatory ECGs.

Objectives

1. All trainees must gain an understanding of the following didactic and intellectual matters:
    a. Fundamentals of cardiac electrophysiology.
    b. The principles underlying the generation and recording of clinical ECG.

Methods of Teaching (Curriculum):

Throughout the three year program the trainee will attend the monthly ECGs conference. In this conference recognition of the patterns of arrhythmias, conduction disturbances, and patterns of ischemia will be emphasized and special emphasis will be placed on clinical correlation with the patterns seen.
 

In addition, fellows are expected to attend the Tuesday morning Teaching Conference presided over by the Chief of Cardiology. This conference is a case-based clinical conference where fellows are expected to bring examples of unusual arrhythmias or unusual manifestations of more common arrhythmias from the preceding week for review by the group.
 

Evaluation:

Specific evaluation of the knowledge and skills of the trainee in ECG interpretation will be provided by the attending involved with the supervised experience on an ongoing basis.

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Nuclear Cardiology

Division of Nuclear Medicine
Section of Nuclear Cardiology
Washington Hospital Center

NUCLEAR CARDIOLOGY ROTATION CARDIOLOGY FELLOW TRAINING (LEVEL 2: 4 MONTHS)

Learning Objectives:

1) Learn the indications, advantages and limitations of nuclear cardiac imaging.
2) Learn the indications, contraindications, and limitations of pharmacologic vasodilator stress testing.
3) Learn to interpret myocardial perfusion images (SPECT and planar), gated SPECT images, and radionuclide angiographic images (MUGA and 1st-Pass).
4) Understand nuclear cardiology technology (image acquisition, image processing and quantitation) and radiation safety.

Rotation Requirements:

1) Perform one or more complete patient work-up (*) per day which consists of the following:
    a) Isotope preparation and use of dose calibrator
    b) Dose administration
    c) Image acquisition
    d) Image processing

[*Refer to Rotation TasksTimetable]

2) Select and organize 2 (or more) cases per week for cardiac cath correlation.(*) Organize each case in the Cath Correlation binder and include the following:
    a) Copy of nuclear SPECT perfusion images
    b) Copy of nuclear cardiology report
    c) Copy of stress report
    d) Copy of cath image showing abnormal (or normal) coronary

[*Refer to Rotation Tasks Timetable]

3) Select and organize 2 (or more) interesting cases per week. (*) Organize each case in the Interesting Case binder and include the following:
    a) Copy of nuclear image(s) demonstrating subject of interest
    b) Brief patient history and other information pertinent to interesting case
    c) Other correlative image(s), if any

[*Refer to Rotation Tasks Timetable]

4) Prepare daily studies for reading session
    a) Periodically check throughout the day for studies that are ready for review.
    b) Prompt each study as an icon on the computer monitor for viewing
    c) Compile stress data for each patient in the patient’s jacket
    d) Perform preliminary reading and record your own observations and interpretation for each study

5) Reading session format:
    a) Present patient history, stress protocol, stress data (i.e. exercise workload achieved [METS, HR in
       % of MPHR, hemodynamic response [for vasodilator pharmacologic stress], ECG findings)
    b) Describe your findings in images.
    c) Render your conclusions
    d) Discuss case with attending
    e) Dictate study. Use the dictation format from the attached sample dictations for normal and
       abnormal studies.
    f) Periodically check for completion of your transcribed reports throughout the day. Upon completion,
       proof-read and make appropriate corrections as needed.

6) Complete your daily log for the following:
    a) Number of cardiac perfusion (SPECT) and functional studies (i.e. Gated SPECT, MUGA’s) read with
       attending.
    b) Number of dose administrations performed
    c) Number of image acquisitions performed
    d) Number of image processing performed

7) You will be given a reading assignment from a “Self-Study Program in Nuclear Cardiology” for each month of your rotation. You are required to complete this reading assignment and complete a written exam by the end of your month’s rotation.

8) End of month topic presentation:
    a) Select a nuclear cardiology topic for presentation to Nuclear Medicine/Nuclear Cardiology
        attendings at the end of your monthly rotation.
    b) Topics can be clinical and/or technical in context.
    c) Submit a printed copy of your presentation.

9) 3rd and 4th – month rotations:

Cardiology fellow will manage all aspects of the Nuclear Cardiology section in collaboration with Dr. Acio and Adrian Mishoe, CNMT (Section Lead-Technologist).

NUCLEAR CARDIOLOGY ROTATION
CARDIOLOGY FELLOW TRAINING (LEVEL 2: 4 MONTHS)

POLICIES

1) Report to the Nuclear Cardiology section no later than 8:00 am on Monday, and 9:00 am Tuesday to Friday (normal laboratory working hours are from 7:00 am to 6:00 pm).
    a) Mondays - Prepare weekend nuclear cardiac studies for reading (as specified under Rotation
        Requirements #4)
    b) Check the patient schedule board in the Nuclear Cardiology section and select patients for your
        daily work-up. Coordinate your activities with the lead-technologist in nuclear cardiology*

*Refer to Rotation Tasks Timetable

2) At the start of your month’s rotation, inform Dr. Acio of your clinic day/times, scheduled days off from the rotation, and your pager number.

Important Notice: All scheduled vacations, conferences, or days off during the rotation requires no less than 2 weeks notice which must be submitted in writing and requires a signature of approval by Dr. Acio or Dr. Van Nostrand. No more than 2 weeks (non-consecutive) vacation will be permitted during your 4 months (total) rotation in nuclear cardiology.

3) If you are going to be unexpectedly absent for the day, you are required to notify Dr. Acio (leave voice mail message at 202-877-0009 or page at 8372) and also notify the reading desk physician, Drs. Yeganeh or Shankar, no later than 10:00 am that day.

4) You are expected to utilize your free time IN the laboratory for reading, completion of cardiac cath correlation and/or interesting cases, or other task(s) assigned by the attending. If you are away from the laboratory, please be available immediately when paged.

5) You are responsible for maintaining a log of the number of cases you read and procedures you perform throughout your 4-month rotation in Nuclear Cardiology. Daily log entries must be initialed by the attending reading the cases with you and by the technologist supervising your imaging activities. Submit copies of the log sheets to Dr. Acio at the end of each month of rotation. Be advised that future requests for verification of training in Nuclear Cardiology and documentation of studies performed will be based on these log sheets. There will be no credit given for cases that are not recorded.

NUCLEAR CARDIOLOGY ROTATION
CARDIOLOGY FELLOW TRAINING (LEVEL 2: 4 MONTHS)

TASK TIME-TABLE

1ST MONTH

1st Week

1st day: Orientation

2nd day:
  a) Be able to use Autoquant for display of myocardial tomographic slices, quantitation, and gated
      SPECT images.
  b) Be able to display MUGA images using ADAC display format.
  c) Be able to enter preliminary results in Insight.
  d) Observe reading, interpretation and dictation of studies.

3rd day: Read, interpret and begin dictatation of normal myocardial perfusion studies using “normal” template.

2nd Week Continue 1st week tasks

3rd Week
  a) Begin dictatation of abnormal perfusion studies using “abnormal” template.
  b) Perform one or more complete patient work-up per day as outlined in the rotation requirements.

1st day: Observe acquisition and processing
2nd day: Begin study acquisition and processing

4th Week Continue preceding weeks tasks

2ND MONTH

  a) Read and dictate all studies.
  b) 1st to 4th Week Select and organize 2 (or more) cases per week for cardiac cath correlation as
      outlined in the rotation requirements.
  c) 1st to 4th Week Select and organize 2 (or more) interesting cases per week as outlined in the
      rotation requirements.
  d) 3rd and 4th Week Perform one or more complete patient work-up per day as outlined in the
      rotation requirements.

3RD AND 4TH MONTHS

  a) Read and dictate all studies.
  b) 1st to 4th Week Select and organize 2 (or more) cases per week for cardiac cath correlation as
      outlined in the rotation requirements.
  c) 1st to 4th Week Select and organize 2 (or more) interesting cases per week as outlined in the
      rotation requirements.
  d) 3rd and 4th Weeks Perform one or more complete patient work-up per day as outlined in the
      rotation requirements.
  c) Manage all aspects of the Nuclear Cardiology section.

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Research

Washington Hospital Center Cardiology Fellows
Research ‘Block’ Curriculum

Purpose: To provide a fulfilling cardiovascular research experience during the clinical cardiology fellowship

Objectives:

• Obtain an appreciation for how to conduct cardiovascular research
  • Hypothesis generation
  • Critical literature review
  • Protocol development
  • Institutional review board submission and purpose