Rotation Descriptions (in PDF Format)

• Echocardiography - RI Hospital
• Nuclear Cardiology/Cardiac CT - RI Hospital
• Non-invasive Cardiology Rotation - VA Medical Center
• Cardiac Catheterization Laboratory Rotation - RI Hospital
• Cardiac Catheterization Laboratory Rotation - Miriam Hospital
• Coronary Care Unit - RI Hospital
• Coronary Care Unit - Miriam Hospital
• Consultative Cardiology - RI Hospital
• Consultative Cardiology - Miriam Hospital
• Consultative Cardiology - VA Medical Center
• Electrophysiology - RI and Miriam Hospitals
• Multi-modality Noninvasive Imaging Elective - Miriam Hospital

Competency-Based Curriculum

The major goals for fellowship training in cardiology have been defined according to the competency-based structure recommended by the ACGME. For the Brown program, these major competencies and goals are listed below. Each rotation covers a different selection of these competency goals, as defined in each individual rotation description.

Competency Category	Specific Goals
Medical Knowledge	Demonstration of investigatory and analytical thinking relevant to the clinical rotation
	Acquisition the appropriate background relevant to specific rotations
	Application of basic and population science to practice
Patient Care	Develops effective interactions with patients and families
	Obtains appropriate information concerning the patient (history, past medical records, examination)
	Knowledge of the appropriate indications for diagnostic and therapeutic cardiology procedures
	Develops sound management plans and/or recommendations to consulting services
	Understands utilization of information technology as it relates to clinical care of patients
	Demonstration of a teamwork approach to patient care
	Procedures: ACLS
	Procedures: Cardioversion
	Procedures: ECG, Holter
	Procedures: Stress testing (level 1)
	Procedures: Echocardiography or Nuclear Imaging (level 1)
	Procedures: Arterial catheter insertion / Level 1 diagnostic catheterization
	Procedures: Right heart cath & temporary pacers
Practice-Based Learning & Improvement	Demonstration of self-critical thinking and motivation to improve
	Teaching skills: Participation in the teaching of students, residents, and others
	Learning from clinical cases through active participation or through speaking at lectures and conferences
	Demonstration of the ability to appraise and assimilate studies in the literature ("Evidence-based medicine")
Systems-Based Practice	Develop an understanding of the broad health care system (billing, insurers, ancillary staff)
	Develop an understanding of the practice cost-effective care
	Commitment to act as a patient advocate within the system to achieve optimal medical care and minimize medical error
Professionalism	Demonstration of respect and compassion for patients, including sensitivity to cultural and social issues
	Commitment to professional responsibilities and ethics
	Commitment to ongoing professional development
Interpersonal & Communication	Effective creation of therapeutic relationships with patients
	Effective communication of medical information by verbal and written means
	Commitment to developing effective relationships with referring clinicians, hospital services, and colleagues

Additional Areas of Training (not rotation-based)

1. Treadmill Exercise, Ambulatory ECG Monitoring, and ECG Interpretation

The goals of this experience include: 1) Understanding the physiology of exercise, recognition of the ischemic exercise response and the range of normal ECG findings during exercise and development of the ability to independently conduct treadmill exercise studies. 2) Appreciation of advanced diagnostic capabilities of cardiac arrhythmias on holter and transtelephonic monitoring systems. 3) Understanding of the methodology for computer-assisted analysis of holter recordings for detection of arrhythmias, heart block, and ST-segment deviations. 4) Development of a high level of expertise in the interpretation of 12-lead ECG's.

Fellows perform exercise studies on inpatients and outpatients for two half-days a week during the non-invasive rotations (echocardiography, nuclear cardiology); attending reading sessions are held at these times and are supplemented by readings from the exercise and physiology literature. Holter monitor interpretation with faculty members, and holter computer processing sessions with the holter nurse are held at selected intervals during this rotation. Interpretation sessions are held once weekly during the non invasive rotations.

2. Ambulatory Cardiology

Supervised care of ambulatory patients with cardiac disease is an integral part of the fellowship educational experience. Patients are seen in an outpatient office setting at either RIH, TMH, or VA hospitals, which function as a group practice for fellows and faculty. The practice serves as the primary point of ambulatory cardiology consultation and referral for the hospital and surrounding areas, and incorporates the hospital Cardiology Clinic. Patients previously seen in the in-patient services are also followed. Both private and service patients are seen. Each fellow attends the same clinic and is responsible for his/her own group of patients, including routine, urgent, and emergency care, for the three years of fellowship. The fellows are assigned office hours for one half day per week and work with faculty preceptors.

3. Heart Failure (elective)

The heart failure clinic is a multidisciplinary program. The goal of this program is to provide treatment for patients with congestive heart failure referred for either standard therapy, or augmented therapy through clinical research protocols. Patients are seen in an office setting and undergo metabolic stress testing at RIH. Attending physicians from Rhode Island Hospital and two clinical research nurses staff the clinic. Fellow participation involves outpatient evaluation and management. Fellows are expected to gain improved understanding of the management of advanced chronic heart failure and to become familiar with options available to those patients with end-stage disease. Fellows are also invited to use the heart failure faculty as a resource for difficult inpatient cases and to assist in identification and enrollment of inpatients into clinical trials. We work in close collaboration with the Heart Transplant Program at Tufts-New England Medical Center and several of our patients are transplanted each year through this affiliation. Fellows may participate in the conduct of a variety of ongoing clinical trials related to both inpatient and outpatient treatment for heart failure.

4. Adult Congenital Heart Disease (elective)

Familiarity with common and uncommon congenital heart defects and associated syndromes, coexistent medical and psychosocial issues, long-term sequelae, and the nature and residuae of cardiac surgical procedures for congenital heart disease are necessary components of the adult congenital heart disease knowledge base. The Rhode Island Adult Congenital Heart Program takes a multidisciplinary approach to the care of patients with congenital heart disease in our region. Participants in the Program include "adult" cardiologists, pediatric cardiologists, specially trained cardiac nurses and cardiac surgeons. The program also draws on other areas of expertise at our institutions including electrophysiology, echocardiography and diagnostic/interventional catheterization. Outpatients are evaluated and followed at our office site adjacent to Rhode Island and Hasbro Hospitals. Inpatients are seen for initial evaluation and follow-up as needed. Emphasis is placed on clinical assessment and management, with careful review of supporting testing modalities including echocardiography with Doppler, stress testing with and without metabolic measurements, and catheterization. Patients are followed closely through pregnancy, cardiac and non-cardiac surgery, and medical illnesses.