The Emergency Room of Rhode Island Hospital is one of the busiest emergency rooms in the Northeast with over 150,000 patient visits/year and over 500 patients admitted with confirmed myocardial infarction. We are a center of referral for patients with shock or who have failed lytic therapy at other medical centers. Rhode Island has a cardiac catheterization lab within the emergency room, a 10 bed CCU and a 24 bed intermediate coronary unit. It is home to busy cardiac surgical and structural heart programs. The Miriam Hospital is a 247 bed facility with a busy cardiac cath lab and a large cardiac rehab program. Both RIH and TMH have 24/7 primary PCI programs for ST elevation myocardial infarction. The volume of patients coupled with multiple protocols for acute myocardial infarction provides Interventional fellows with a unique experience of emergency cardiac catheterization and intervention in unstable patients with coronary disease. Each fellow participates in the cognitive and procedural aspects of managing such patients including the use of percutaneous mechanical circulatory support, emergency cardiac care and primary and rescue percutaneous coronary intervention.

Interventional fellows attend and participate in several conferences. Weekly conferences include the interventional didactic curriculum conference, the peripheral clinical conference, the cardiac catheterization and intervention clinical conference, as well as the Division of Cardiology Grand Rounds. Interventional fellows present cases at the clinical conferences and are asked to discuss patient selection, procedural strategy and patient management. Interventional fellows will be expected to review topics and make formal presentations at the didactic conference and the Division grands rounds. Fellows have a quality improvement (QI) curriculum and carry out a QI project over the course of the year. The fellows are also responsible for preparing the monthly Cath Lab Morbidity and Mortality Conference, and an Interventional Journal Club which is held quarterly. Fellows are assigned a faculty mentor for presentations and journal clubs.

• Vascular biology including the process of plaque formation, vascular injury, vasoreactivity, vascular healing and restenosis
• Hematology including the clotting cascade, platelet function, thrombolysis and methods for altering clot formation
• Coronary anatomy and physiology including location and distribution of vascular segments, lesion features and their significance to intervention, alterations in coronary flow due to obstruction, assessment of flow dynamics, function of the collateral circulation and the effects of arterial spasm or microembolization

• Biologic effects and appropriate use of vasoactive agents, antiplatelet drugs, thrombolytics, anticoagulants and antiarrhythmics
• Biologic effects and appropriate use of angiographic contrast agents

• Indications for angioplasty and related catheter-based interventions in ischemic heart disease including factors that differentiate patients who require interventional procedures rather than coronary bypass surgery or medical therapy
• Indications for catheterization on intervention for patient having acute myocardial infarction
• Indications for mitral, aortic and pulmonary balloon valvuloplasty in the management of valvular heart disease including factors that differentiate patients needing valvuloplasty from those who need surgical valve repair or replacement
• Indications for catheter-based intervention for patients with congenital heart disease
• Indications for interventional approaches to patients with acute coronary syndromes who are hemodynamically compromised including the use of pharmacologic agents, balloon counterpulsation, emergency pacing and stent placement

• Planning and conduct of interventional procedures including knowledge of options, limitations, outcomes and complications
• Selection and use of guiding catheters, guidewires, balloon catheters, ultrasound catheters, stents and atherectomy devices
• Knowledge of intravascular catheter techniques and their risks
• Use of antithrombotic agents during interventional procedures
• Management of hemorrhagic complications
• Management of hemodynamic complications

• Identification of anatomic features and visualization of lesion morphologies by angiography and intravascular ultrasonography
• Radiation physics, radiation risks and injury and radiation safety including methods t control radiation exposure for patients, physicians and staff

• Designing and investigation to test a research hypothesis in interventional cardiology
• Creation of a database for data entry and analysis
• Interpretation of scientific data
• Understanding and application of statistical techniques

• Ethical issues and risks associated with diagnostic and therapeutic techniques
• Obtaining proper informed consent for clinical and research purposes

A required component of the curriculum is for fellows to identify a research theme and to complete at least one research project from beginning to end. There are faculty members at the Rhode Island Hospital and Miriam Hospital campuses that can serve as mentors for these efforts. Resources to support research include a fully equipped and staffed animal lab experienced in the porcine model, an angiographic core laboratory with a large database derived from multiple clinical trials, information technology support to assist in the creation of computer databases, support for statistical analyses, equipment in the adult cath lab for measuring coronary flow and fractional flow reserve, quantitative coronary angiography and digital subtraction angiography. The objective of the research experience is to promote lifelong involvement in scientific research and to begin preparing fellows to become capable independent investigators should they choose a career in academic medicine. A monthly Interventional research conference is held at RIH with the program director and faculty research mentors. Interventional fellows also attend a monthly Division of Cardiology Research Conference.

The Interventional Cardiology programs at Rhode Island Hospital and The Miriam Hospital have a long history of participation in clinical trials of new interventional therapies. Both sites have a cardiac research office staffed with research nurses and support personnel. Many trials enroll at both sites. Fellows are exposed to the issues of study design, trial conduct, data collection, analysis, presentation and manuscript preparation. In addition, fellows may have the opportunity to participate in the evaluation of new devices prior to clinical release. These have included directional atherectomy, perfusion balloon catheters, local delivery devices, rotational atherectomy devices, brachytherapy devices, endomyocardial laser devices and second and third generation stents. These activities expose fellows to new therapies and instruct them in techniques for objective evaluation.

The Interventional Program curriculum is structured to permit fellows adequate time to read, complete research assignments and perform other scholarly activities. The Hospitals support Physicians Assistants for the Cath Labs. Physicians Assistants can work-up patients, assist in procedures and perform post-procedural care thus allowing fellows protected time free of clinical obligations.