During the CCU month, under the supervision and guidance of the attending cardiologist, the fellow leads a team of residents and medical students whose primary objective is to care for patients with acute cardiovascular illnesses. The CCU month is an immersion into cardiac critical care where fellows are involved in all aspects of care including management of acute coronary syndromes, decompensated heart failure, severe valvular disease and unstable arrhythmias. Fellows are responsible for evaluation and triage of acute unstable cardiac conditions in the emergency room as well as the bedside procedural needs of CCU patients (placement of transvenous pacemakers, PA catheters and management of hemodynamic support devices including intra-aortic balloon pumps and Impellas).

Fellows in the nuclear cardiology lab begin by gaining familiarity with stress testing indications/contraindications and stress testing protocols. The majority of clinical time is spent interpreting cardiac nuclear studies alongside attending physicians. Fellows receive training in SPECT and PET camera design and operation, radiation safety, pharmacologic stress agents, metabolic and amyloid imaging, and integration of nuclear imaging results with clinical data to guide clinical decision making.

During the cardiology consultative months, the fellow leads a team of residents and medical students, under the supervision of the attending cardiologist, to provide cardiac consultations on inpatients admitted to general medical, surgical and subspecialty services. Fellows are exposed and gain experience managing a diverse range of cardiac conditions. Fellows are also responsible for cardiac consultative services at neighboring Women and Infants’ Hospital, providing exposure to the field of cardio-obstetrics.

The cardiac catheterization labs at both RIH and TMH see high volumes of cases, providing general fellows with ample opportunities to gain experience in all aspects of interventional cardiology. General fellows participate in acquiring, interpreting and reporting results from invasive hemodynamic and angiographic assessments, as well as therapeutic interventions. Fellows play a key role in the care of cardiac patients before, during and after procedures as dictated by their level of experience, including case selection and procedural planning.

The echo rotation is a lab-based rotation that involves all aspects of acquiring and interpreting echocardiographic studies. First year fellows begin with gaining hands-on experience, learning to perform complete transthoracic studies under the guidance of our experienced technicians. Subsequent rotations focus on interpretation of transthoracic studies followed by triage, performance and interpretation of transesophageal studies. Fellows who choose to pursue advanced training in echocardiography during their third year of fellowship (achieving COCATS level 3) participate as members of our structural heart team, gaining the interventional echocardiographic skills necessary to guide an array of catheter-based structural heart procedures including TAVR, MitraClip, Watchman, ASD, PFO and PVL closures.

The non-invasive month at the VA provides fellows the opportunity to perform and interpret a wide range of cardiac testing and procedures. Fellows responsibilities include weekly supervision of treadmill stress testing, EKG and Holter monitor interpretation, and interpretation of nuclear stress tests and echocardiograms. They perform transesophageal echocardiograms, cardioversions and outpatient right heart catheterizations.

Under the supervision of the attending electrophysiologist, the general fellow runs the EP inpatient consultative service, providing consults for patients on the cardiology services as well as non-cardiac inpatient services. Fellows are trained in pacemaker and ICD indications and interrogation, complex arrhythmia assessment and management ,and placement of temporary transvenous pacemakers. They have the opportunity to spend time in the EP lab gaining exposure to device placement and ablation procedures.

During the heart failure month, fellows gain experience in inpatient consultative management of patients with advanced heart failure. Patients seen by this service include acutely ill patients in the intensive care units on inotropic and mechanical support, all patients with LVADs or prior heart transplants, new heart failure with severely reduced systolic function and patients with frequent readmissions for heart failure. Fellows also attend weekly clinic sessions in our advanced heart failure center.

Whether a fellow chooses to pursue a career in academic or clinical medicine, familiarity and experience with research methods and analysis is essential for fostering intellectual inquisitiveness and critical thinking – both of which are essential characteristics of master clinicians. For this reason, fellows in the general cardiology fellowship program are expected to participate in cardiovascular research during their 3-year program. One month during the first year of training is set aside for identifying faculty mentors and developing research questions and goals.

During the first two years, fellows attend a general cardiology continuity clinic, under the supervision of our faculty, averaging one half-day per week. Continuity clinics are located at out faculty office site in East Providence or at the Providence VA Medical Center. During the third year, fellows have the option of continuing their general cardiology clinics or transitioning to one of our subspecialty cardiac clinics. Subspecialty cardiac clinics include advanced heart failure, structural/interventional cardiology, cardio-oncology, women’s cardiology, congenital heart disease, electrophysiology, lipids, and cardio-genetics.

Conferences and lectures are an integral part of the cariology fellowship and are attended by fellows and faculty. Our faculty provides a core didactic lecture series which spans the academic year. Cardiology Grand Rounds take place on a weekly basis and are comprised of nationally-recognized invited speakers, M&M cases, and senior fellow presentations. Technical conferences for ECG interpretation, echocardiography, and catheterization, in addition to journal club and subspecialty conferences complement the core curriculum throughout year.