Interventional Cardiology Fellowship Curriculum

Clinical rotations and training takes place at Allegheny General Hospital.

The general purpose of the interventional cardiology fellowship curriculum is derived from the Accreditation Council for Graduate Medical Education Program Requirements for Residency Education in the Subspecialties of Internal Medicine, the Program Requirements for Residency Education in Interventional Cardiology (Internal Medicine) in conjunction with the experience and training requirements for certification in interventional cardiology established by the American Board of Internal Medicine Committee on Interventional Cardiology. The interventional cardiology curriculum integrates cognitive and procedural experiences to prepare fellows to successfully complete the certification examination. 

The fellows’ education in interventional cardiology will be conducted in clinical inpatient and ambulatory settings. AGH has four integrated catheterization suites and a hybrid OR/Cath lab with digitally enhanced imaging and computerized post-processing, with support by cardiac surgeons 24-hours a day.  The program exceeds the established requirements for the primary catheterization lab of an annual minimum of 400 interventional procedures including percutaneous coronary angioplasty, coronary stenting, atherectomy, thrombectomy, distal protection devices, intravascular ultrasound, and coronary flow reserve/fractional flow reserve.  The interventional cardiology fellows have exposure to and participate in all structural cardiovascular disease procedures as well as percutaneous devices for cardiogenic shock. The hospital facilities include cardiac fluoroscopic equipment and devices, and radiographic equipment consisting of a single-plane cineradiographic unit with digital video imaging.  Fellows will also provide care for patients in the cardiac intensive care unit, cardiac surgical intensive care unit, and a variety of outpatient settings.  AGH has an active cardiothoracic surgery department that performs approximately 600 cases annually.

The goals of this fellowship program are to educate and train fellows in a specialized cardiovascular disease area requiring technical, educational and research skills involved in interventional cardiology.  The knowledge base for interventional cardiology has become increasingly well-defined because of unparalleled programs in basic and clinical research in atherosclerosis, coronary disease, cardiomyopathy and structural cardiovascular disease.  Our educational goals for training in interventional cardiology are aligned with and guided by the recommendations of the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, the American Heart Association, and the ACC 2015 Core Cardiovascular Training Statement (COCATS 4, Task Force 10: Training in Cardiac Catheterization, and Task Force 14: Training in the Care of Adult Patients with Congenital Heart Disease, and the  Evolution of Training Recommendations for Specialists in Adult Cardiovascular Medicine, and the Core Curriculum for Interventional Fellowship in Structural and Congenital Heart Disease for Adults.

The one-year Interventional Cardiology Fellowship at AGH provides Level 3 training in which each fellow will exceed the minimum requirement of participating in 250 PCI procedures.  Fellows will also obtain Level 3 cognitive knowledge.  Fellows are expected to progress in a graduated fashion and will be evaluated quarterly to ensure appropriate progression and attainment of each levels’ goals. Requisite participation in a procedure includes the following elements:

1. Pre-procedural evaluation to assess appropriateness and to plan procedure strategy. Before the procedure, it is expected that the fellow will review the patient’s medical record and obtain a confirmatory history and physical examination, with specific attention given to factors known to increase the risk of the procedure, such as vascular disease, renal failure, history of contrast reaction, congestive heart failure, anemia, active infection, and conditions known to increase the risk of bleeding. The trainee should also obtain informed consent and document a pre-procedural note that includes indications for the procedure, risks of the procedure, and alternatives to the procedure.
2. Performance of the procedure by the fellow at a level appropriate to experience, always under the direct supervision of a program faculty member. Fellows will assume progressive responsibility for the performance of interventional procedures as they acquire skills.
   
3. Participation in the analysis of the hemodynamic and angiographic data obtained during the procedure and preparation of the procedure report as well as formulation of treatment plans and relevant communication back to the referring doctors.
   
4. Active involvement in post-procedural management both in and out of the catheterization laboratory. After the procedure, a preliminary catheterization report or note should be placed in the patient’s file. The fellow should monitor the patient’s status and be available to respond to any adverse reactions or complications that may arise, such as hypotension, vascular complications, heart failure, renal failure, bleeding, or myocardial ischemia. A post-procedural note should be completed before hospital discharge. If a complication occurs, the fellow should participate in the follow-up and management of the complication.
   
5. Clinic – Fellow must attend an outpatient clinic to provide follow-up care for patients. Fellow’s continuity care experience for outpatient cardiovascular management and consultation will be obtained one-half day per week for 12 months at Allegheny General Hospital. Fellows will develop communication skills that stress discussion of matters of importance to the patient in comprehensible terms. Utilization of the proper communication skills should include the capacity to transmit discouraging as well as favorable information to the patient, the former with appropriate sensitivity and understanding.