Cardiovascular Disease Fellowship

Program Overview

The Cardiovascular Disease Fellowship at Penn State Health Milton S. Hershey Medical Center is a three-year, ACGME-approved program that admits five fellows per year.

Program Details

The Cardiovascular Disease Fellowship is a well-established program, providing fellows with state-of-the-art training in all aspects of cardiology.

To be a candidate for this ACGME-approved training position, the qualified candidate will be completing (or already has completed) a three- year ACGME-accredited Internal Medicine Residency. It is expected that the candidate be board-eligible for Internal Medicine by the start of the training program.

Our program is designed to meet all of the requirements for board eligibility in Cardiovascular Disease upon completion of the fellowship.

The program is clinically well-rounded, with an excellent balance of invasive and noninvasive cardiology experience and training in all subspecialty areas of cardiology.

Fellows also have the opportunity to work with physicians in an established adult congenital heart disease program, an active heart transplant program, vascular surgery, cardiac surgery and interventional radiology. At the end of cardiovascular disease training, opportunities are available at Hershey Medical Center for subspecialty training in clinical cardiac electrophysiology and interventional cardiology, both ACGME-accredited programs as well.

Fellows also have the opportunity to participate in a few unique experiences to expand their educational training. These include an annual pig heart dissection, weekly EKG challenges and volunteer opportunities at the Bethesda Mission cardiology clinic, targeting the underserved population in downtown Harrisburg, PA.

The cardiology division is part of the Heart and Vascular Institute. Integration of some conferences and rotations provide important education in areas of cardiovascular pathophysiology not always covered in traditional cardiology training programs.

Penn State Health Milton S. Hershey Medical Center has a Heart and Vascular Institute Intensive Care Unit. Fellows gain experience with the use of LVADs and ECMO and caring for patients after cardiothoracic surgery.

The medical center, although located in a small community, is a quaternary care institute that cares for patients with a broad spectrum of pathology similar to that seen at any large city hospital. Learn more about life in Hershey, PA, here.

Our Team

Curriculum

The curriculum for the Cardiovascular Disease Fellowship at Penn State Health Milton S. Hershey Medical Center is divided into 14 components.

Detailed descriptions for some of these components appear below. Other components include ACHD, Acute Service, Ambulatory Clinic and Consults. Information on those components is available by contacting program coordinator Mandi Smith at asmith5@pennstatehealth.psu.edu.

Cardiac Catheterization

The goal of the cardiac catheterization laboratory rotation is to provide the general cardiology fellow with the requisite cognitive and technical knowledge of invasive cardiology. This will include pre-procedural, procedural, and post-procedural planning and management, including the appropriateness of the planned procedure. The general fellow will learn to perform venous and arterial puncture and sheath placement, coronary angiography, ventriculography, and right heart catheterization. Furthermore, they will learn the interpretation of hemodynamic data, angiographic data and the appropriateness for diagnostic catheterization and coronary revascularization. Fellows will learn the fundamentals of radiation safety as it pertains to the catheterization laboratory. Finally, the fellows will participate in the post-procedure management of the patients, particularly management of complications. Ultimately the cardiac catheterization laboratory rotation provides a platform for teaching and learning the core knowledge base of cardiac anatomy, physiology, pathology and therapeutics that all cardiologists should possess regardless of whether they perform invasive cardiovascular procedures. The cardiac catheterization rotations are also a component of the fellows’ exposure to ECG interpretation with routine review of pre-procedure ECGs.

Clinical Experience

All fellows must have a minimum of four months of direct cardiac catheterization experience. Many fellows (who desire COCATS Level II training) will have six to eight months of direct cardiac catheterization experience.  Additional elective time for interested fellows is available.

Further exposure to cardiac catheterization content comprised of, but not limited to, performing arterial and/or venous access for bedside procedures; correlation of catheterization results with other multimodality imaging studies; as well as ordering, review, and clinical correlation of invasive cardiac procedures is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • CHF Service
  • CCU
  • Consults
  • Outpatient Continuity Clinics (HMC and VA)
  • Nuclear Cardiology
  • Echocardiography

Training Goals and Objectives

The cardiac catheterization rotation and associated training is designed to provide the fellow, within the standard three year program, two potential levels of COCATS training:

  • COCATS Level I: (four months experience minimum)
    • All fellows are expected to achieve COCATS Level I training during the fellowship.
    • Trainee should participate in minimum of 100 diagnostic procedures.
    • At least 50 of these should involve coronary angiography and 25 should involve hemodynamic assessment of valvular, myocardial, pericardial, or congenital disease.
  • COCATS Level II: (6 months experience minimum)
    • All fellows have the opportunity to achieve COCATS Level II training during the fellowship program.
    • Participation in the performance of 300 diagnostic catheterization procedures.

COCATS Level III training requires experience beyond a 3-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease.  Penn State Health offers a subspecialty Level III training program which can be applied for following general cardiology fellowship.

Specific curricular milestones for cardiac catheterization, as they relate to the Core Competencies promulgated by the ACGME, are adopted as outlined in the COCATS 4 Task Force 10 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend the Cardiac Catheterization conferences throughout the year.
    • When assigned, prepare a topic or case review for presentation during Cardiac Cath conference.
  • Track participation in performing cardiac catheterization procedures.
  • Participate in the weekly Structural Heart Disease (SHD) multidisciplinary meetings.
  • Observe five (5) each of TAVR and Mitraclip cases in second and/or third year of training.
  • The following specific responsibilities pertain to all fellows during the rotation:
    • See and evaluate the patient prior to the planned procedure.
    • Review and understand the indication for each planned procedure.
    • Complete the History and Physical (H&P) note for the first patient of the day.
      • Subsequent H&Ps may be written by the CRNP or PA, but the fellow is expected to help with additional review, examination, and documentation when available or necessary.
      • Know pertinent details of each patient on whom you expect to perform a procedure regardless of who completed the H&P.
    • Obtain informed consent from the patient or their designated representative.
      • Review the procedure along with its indication, risks, benefits, and alternatives.
    • Discuss the indications, history, examination, prior cardiac work-up, and planned procedure strategy with the designated faculty prior to each case.
    • Discuss appropriate use criteria (AUC) for diagnostic catheterization, pertaining to the case.
      • When indicated, discuss the AUC for coronary revascularization.
    • Participate in the planned procedure in a manner commensurate with the fellow’s current level of experience under the direct guidance of the involved faculty.
    • Participate in analyzing the angiographic and hemodynamic data obtained during the procedure.
    • Participate in discussion on formulation of treatment plan.
    • Preparation and completion of the procedure report.
      • To be completed as timely as possible, no later than the end of the day.
    • Communicate procedural findings and/or testing results to the referring team.
    • Explain procedural findings and/or testing results, along with any new recommendations or plans to the patient or their designated representative.
    • Assess the patient post procedure, including evaluation and treatment of any complications related to the procedure.

Critical Care

The cardiac critical care rotation, in conjunction with other inpatient cardiology rotations, provides direct exposure to the essentials of evaluation and management of patients with acute, life-threatening cardiovascular disease and conditions.  This rotation places an emphasis on, and provides the opportunity for, the cardiology trainee to participate in interdisciplinary care teams in the critical care environment. The fellow will also achieve competency in appropriate and safe transitions of care out of the critical care environment to other care teams. The cardiac critical care rotation is also a component of the fellows’ exposure to ECG interpretation with routine and urgent evaluation of ECGs across a variety of scenarios.

Clinical Experience

All fellows will have a minimum of one month of direct Cardiac Critical Care experience. Cardiac Critical Care rounds will also occur routinely on all inpatient services. Additional elective time for interested fellows is available.

Further exposure and overlap experience to Cardiac Critical Care content is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • Heart Failure Service
  • Inpatient Consults
  • Cardiac Catheterization
  • Echocardiography
  • Electrophysiology

Training Goals and Objectives

The cardiac critical care rotation is designed to provide the trainee, within the standard three year program, training that meets or exceeds COCATS Level I expectations.

  • COCATS Level I (two months experience minimum)
    • All fellows are expected to achieve COCATS Level I training during the fellowship.
    • Experience will come during dedicated rotation and frequent ICU level rounds while on all inpatient service rotations.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease. At the present time, Penn State Health does not offer subspecialty training in Cardiac Critical Care.

Specific curricular milestones for cardiac critical care as they relate to the Core Competencies promulgated by the ACGME are adopted from the ACC COCATS 4 Task Force 13 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Five consecutive weekdays, 12-hour shifts.
  • Attend 7 a.m. and 7 p.m. ICU handoff rounds.
  • Round with Intensivist team and act as a liaison between the Cardiology and Intensivist teams and assist in decision-making.
  • Provide cardiology consultation on patients in the ICU, as requested.
  • Responsible for consult note on cardiology consult patients and rounding with appropriate cardiology attending.
  • Assist in the scheduling of cardiac procedures in HVICU patients (cath lab, TEE).
  • Teach the ICU staff about cardiology topics.
  • Assist in procedures performed in the HVICU (PA catheter and art line placements, IABP placement, TEE, ECMO).
  • Participate in end-of-life issues, family discussions and meetings.

Cardiac CT Imaging

The cardiac CT portion of the Vascular/Imaging rotation exposes the fellow to the basics of cardiac CT. They will gain familiarity with clinical indications and appropriate use criteria for cardiac CT. They will also be involved with the manipulation, interpretation, and application of the data from a cardiac CT study.

Clinical Experience

All fellows will have one month of cardiac computed tomography experience. This will be obtained during the combined Vascular/Imaging rotation and in aggregate exposure on other rotations. Additional elective time for interested fellows is available.

Further exposure to cardiac computed tomography content comprised of, but not limited to, ordering, reviewing, and applying results from cardiac CT studies is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • Consult Service
  • Cath
  • Outpatient Continuity Clinics (HMC and VA)

Training Goals and Objectives

The cardiac CT portion of the Vascular/Imaging rotation and associated training are designed to provide the fellow, within the standard three year program, one potential level of COCATS training:

  • COCATS Level I: (one month experience minimum)
    • All fellows are expected to achieve COCATS Level I training within the first two years of fellowship.

COCATS Level II training requires a minimum of three months of dedicated training in cardiac CT. At the current time, Level II training is not available during the standard fellowship. Fellows who wish to achieve Level II in cardiac CT should discuss this with fellowship leadership to see if arrangements external to Penn State can be made.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease. Penn State Health does not offer subspecialty training in cardiac CT.

Specific curricular milestones for computed tomographic imaging, as they relate to the Core Competencies promulgated by the ACGME, are adopted as outlined in the COCATS 4 Task Force 7 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend and participate in the monthly Multimodality Imaging conferences throughout the year.
  • Discuss upcoming/planned cardiac CT cases with the responsible faculty member.
  • Review planned cardiac CT cases for clinical background and medical history prior to the cardiac CT study.
    • Evaluate the appropriateness of the study and anticipated clinical data.
    • Review prior CT studies and/or other imaging modalities.
    • Discuss planned protocol with the responsible faculty.
  • Attend planned cardiac CT studies when possible.
  • Observe and/or participate in the measurement and interpretation of the cardiac CT studies under the guidance of the interpreting faculty member.
  • Independent review of cardiac CT materials.
  • Refer to and follow the Vascular/Imaging Rotation Schedule for recommended schedules. Due to the current structure of cardiac CT at our institution, availability and timing of cardiac CT studies may not be predictable. Independent learning will comprise a significant portion of the fellows’ exposure to cardiac CT. Interested fellows are encouraged to proactively seek out hands-on opportunities.

Echocardiography

The echocardiography rotation is a comprehensive approach to learning the use of cardiac ultrasound imaging to diagnose and guide treatment of cardiovascular disease. The objective of this rotation is to provide a broad exposure to the field including an understanding of the fundamentals of cardiac ultrasound imaging and image acquisition, the approach to obtaining and optimizing images on different ultrasound systems, as well as accurate interpretation of transthoracic, transesophageal, and stress imaging. Fellows will be trained to perform transthoracic and transesophageal echocardiograms, learn appropriate supervision of stress echocardiography, and will gain improved understanding on the appropriate use of echocardiography to diagnose and guide therapy of cardiovascular diseases. The echocardiography rotations are also a component of the fellows’ exposure to ECG interpretation and stress testing (pharmacologic and exercise modalities) with routine review of rest and stress ECGs.

Clinical Experience

All fellows will have a minimum of six months of direct echocardiography experience. Additional elective time for interested fellows is available.

Further exposure to echocardiography content comprises, but is not limited to, the ordering, review, and clinical correlation of echocardiographic studies is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • Heart Failure Service
  • CCU
  • Consults
  • Outpatient Continuity Clinics (HMC and VA)

Training Goals and Objectives

The echocardiography rotation and associated training are designed to provide the trainee, within the standard three-year program, three potential levels of COCATS training:

  • COCATS Level I: (three months experience minimum)
    • All fellows are expected to achieve COCATS Level I training within the first 2 years of fellowship.
      • Minimum number of TTE examinations performed/interpreted: 75/150
  • COCATS Level II: (six months experience minimum)
    • Required to perform and interpret echocardiographic studies independently in practice.
    • All fellows are expected to achieve COCATS Level II training during the fellowship.
      • Minimum number of TTE examinations performed/interpreted: 150/300
      • Minimum number of SE/DSE examinations interpreted: 100
      • Minimum number of TEE examinations performed & interpreted: 50
        • A minimum of 100 TEEs is strongly recommended.
    • Many fellows will achieve this in time to take the NBE Certification Exam in their third year of fellowship.
  • COCATS Level III: (nine month experience minimum)
    • Interested fellows must discuss the opportunity to achieve COCATS Level III training during the general fellowship with the echo lab director. This will include (but is not limited to):
      • More intensive exposure to and experience with all areas of echocardiography including:
        • Echo Lab Administration
        • Quality Improvement
        • Advanced Echo Modalities/Techniques
        • Echo Focused Teaching
      • Minimum number of TTE examinations performed/interpreted: 300/750
      • Although not formally outlined in COCATS, a substantially higher number of stress echoes and TEEs is also anticipated for those fellows who desire to attain Level III training.
    • This decision should be made before the beginning of the third year of training to ensure proper preparation of the schedule and training experience.

Specific curricular milestones for Echocardiography, as they relate to the Core Competencies promulgated by the ACGME, are adopted from the COCATS 4 Task Force 5 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend and participate in the echocardiography conference series throughout the year.
    • When assigned, prepare a topic or case review for presentation during Echocardiography conference.
  • Track participation in performing and interpreting studies.
    • Separate tracking of TTEs, stress echoes, and TEEs is required.
    • Studies performed or interpreted during conferences and while not on the echocardiography rotation should also be tracked.
  • Be present in the echo lab area throughout the working day to maximize education and learning from direct experience, faculty supervision, and focused teaching.  This includes:
    • Be available to answer the phones and field questions from sonographers, staff, and referring providers.
    • Assist with the evaluation and management of critical findings, patient complaints, and test complications.
    • Prepare comprehensive preliminary reads on transthoracic, exercise stress, and dobutamine stress echocardiographic studies.
  • Provide preliminary interpretation of the resting and stress ECGs for all stress echoes.
    • Supervise stress echocardiogram exams when required.
      • All fellows are expected to directly supervise at least 10 stress echoes.
    • When necessary, contact ordering physicians directly with significantly abnormal or unexpected findings (such as abnormal stress test, cardiac tamponade, or new diagnosis severe aortic stenosis).
    • Learn the appropriate technique for ultrasound contrast preparation and administration including agitated saline and microbubble contrast.
      • Assist with preparation and administration of ultrasound contrast when nursing is not available.
  • One fellow in the lab must be assigned to transesophageal echocardiography studies on a daily basis. This responsibility should not be assigned to first-year fellows during their first two months in the lab. The following responsibilities pertain to TEE:
    • There should be one upper-year fellow assigned and available to cover TEE each day.
      • When more than one qualified fellow is available on the rotation, the fellows are responsible for arranging daily coverage assignments.
    • Carry the TEE pager (3335) or have this forwarded to your pager.
      • If forwarded, this forward should be removed at the end of the day.
    • Review each request for a TEE to determine appropriateness.
    • Review patient history, physical, and prior studies.
    • Understand and evaluate any potential contraindications for a TEE procedure.
    • Discuss each case with the supervising faculty before arranging or performing the study.
    • When appropriate arrange for TEE with anesthesia.
    • Be aware of the risk and benefits of sedation and of the TEE and provide informed consent to the patient or surrogate.
    • Administer moderate conscious sedation and perform the TEE under the direct guidance and supervision of the TEE attending.
    • Communicate results of the study to the patient and/or family.
    • Contact the referring provider with results when appropriate.
    • When there are no TEEs to perform, or all TEE responsibility for the day is completed, the TEE fellow should continue all other general responsibilities for the echo lab as outlined.
  • Senior fellows are encouraged to participate in the orientation, supervision, and guidance of new first-year fellows in the echo lab.
  • Fellows on call will also be expected to triage, perform, interpret, and communicate results from STAT TTE and TEE studies requested during nights and weekends while sonographer coverage is not available.
    • An on call echo faculty will always be available for TEEs and as back-up for TTEs.
    • Please refer to addendum for additional information.
  • Fellows who desire Level III Training should discuss additional expectations with the Echo Lab Director.

Electrophysiology

The clinical cardiac electrophysiology rotation provides direct exposure to the fundamentals of diagnosis and management of cardiac arrhythmias and conduction disorders. This includes understanding the mechanisms and management of arrhythmias required to provide comprehensive patient care.  The trainee will participate in electrophysiology focused consultation and management in the inpatient and outpatient settings; observe and participate in EP studies, testing, and procedures; and work with appropriate staff on the interrogation and programming of implanted cardiac devices. The electrophysiology rotation is a key component of the fellows’ exposure to ECG interpretation.

Clinical Experience

All fellows will have a minimum of two months of direct electrophysiology experience. Additional elective time for interested fellows is available.

Further exposure and overlap experience to electrophysiology content comprises, but is not limited to, ECG review and interpretation, arrhythmia diagnosis and management, and pacemaker/AICD exposure is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • Heart Failure Service
  • Consults
  • CCU
  • Outpatient Continuity Clinics (HMC and VA)
  • Nuclear Cardiology
  • Echocardiography

Training Goals and Objectives

The electrophysiology rotation and associated training is designed to provide the trainee, within the standard three-year program, two potential levels of COCATS training.

  • COCATS Level I: (two months experience minimum)
    • All fellows are expected to achieve COCATS Level I training within the standard three-year training program.
      • Minimum number of procedure involvement:
        • Electrocardioversions: 20
        • Temporary pacemakers: 5
  • COCATS Level II:  (six months experience minimum)
    • Interested fellows must discuss the opportunity to achieve COCATS Level II training during general fellowship with a member of the EP faculty. This will include (but is not limited to):
      • Requisite number of EP rotations.
      • Minimum number of device interrogations/programming: 100 (25 remote)
      • Arranging additional EP focused outpatient clinic exposure
    • It is anticipated this level of training will be pursued by fellows who desire to move on to Level III subspecialty training in electrophysiology or who intend a career in an area with limited access to EP specialists.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease. Penn State Health offers subspecialty training in electrophysiology which can be applied for following general cardiology fellowship.

Specific curricular milestones for electrophysiology as they relate to the Core Competencies promulgated by the ACGME are adopted from the ACC COCATS 4 Task Force 11 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule a fellow may achieve these milestones ahead or behind the suggested timeframe in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend and participate in the electrophysiology conference series throughout the year.
    • When assigned, prepare a topic or case review for presentation during electrophysiology conference.
  • Track participation in at least the following procedures:
    • Temporary Pacemaker Placement
    • Electrocardioversion (ECV)
      • Temporary Pacemakers and ECVs performed while not on EP rotation should also be tracked.
  • Daily availability to see new EP consults and write an appropriate consult note, present pertinent data to the assigned EP faculty, communicate recommendations and provide longitudinal follow-up to the referring team as appropriate.
  • In addition to daily assistance with EP consults the fellow is expected to participate in AT LEAST one of the following activities on a daily basis:
    • Observe and participate in electrocardioversions, electrophysiology studies, ablations, and device implantations in the EP lab.
      • The minimum numbers for participation in temporary pacemakers and ECVs are outlined, but observing all the procedures at least once is encouraged.
      • Check with EP lab staff about procedure availability on a daily basis
    • Review and provide preliminary interpretation for exercise ECG testing.
      • Performed on most days.
      • Contact person: Rich Bradford (or any exercise physiologist)
    • Review and provide preliminary interpretation for ambulatory ECG monitoring (Holter monitors)
      • Performed in Lumedex
    • Observe and participate in device interrogations and programming in the outpatient device clinic and on the inpatient units.
      • Shadowing an EP technologist during the rotation is strongly encouraged. With appropriate training, fellows should perform their own interrogations
      • Outpatient appointments occur every Monday, Wednesday, and Friday in the Device Clinic; Tuesday and Thursdays are telephonic interrogation and potentially not as useful for the fellows’ experience.
    • Observe and participate in tilt table testing
      • This occurs every other Monday morning in the Non-Invasive Lab (Stress Lab 1)
      • Contact person: Barbara Bentz, CRNP (pager 2853)
    • Attend outpatient EP clinic with an EP faculty member for one half day per week.
      • This will occur on Fridays at Nyes Road clinic with Drs. Samii and Hussain
      • The fellowship coordinator will confirm these dates with you two weeks before the start of your rotation so new patient visits can be specifically assigned for you to see with EP faculty supervision.

The availability of several of the activities outlined above for the EP rotation fluctuates on a weekly basis. In general, it is anticipated the fellow will spend, on a daily basis, the equivalent of a half day seeing and following up on consults as needed and the equivalent of a half-day participating in one of the other recommended or required activities. Reasonable adjustments will be suggested by faculty when appropriate, but are ultimately the responsibility of the fellow to maximize educational opportunities.

Heart Failure

The heart failure service rotation provides the opportunity to diagnose, evaluate and treat patients who encompass a broad range of heart failure disorders. This rotation will allow the trainee to acquire the appropriate foundational tools to care for this unique population including knowledge pertaining to medical management, procedural techniques and advanced heart failure therapies including mechanical circulatory support. The rotation will also provide exposure to transplant medicine and management of patients both pre- and post-transplant. The heart failure rotations are also a component of the fellows’ exposure to ECG interpretation with routine review of inpatient ECGs.

Clinical Experience

All fellows will have a minimum of two months of direct heart failure experience. Additional elective time for interested fellows is available.

Further exposure to Heart Failure content comprises, but is not limited to, acute inpatient care of heart failure patients, long-term management and follow-up of heart failure patients, imaging review and clinical correlation is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • CCU
  • Consults
  • Outpatient Continuity Clinics (HMC and VA)
  • Echocardiography

Training Goals and Objectives

The heart failure service rotation is designed to provide the trainee, within the standard three-year program, two potential levels of COCATS training:

  • COCATS Level  I: (two months experience minimum)
    • All fellows are expected to achieve COCATS Level I training within the first two years of fellowship.
  • COCATS Level II:  (four months experience minimum)
    • Interested fellows must discuss the opportunity to achieve COCATS Level II training during the general fellowship with a member of the CHF faculty. This will include (but is not limited to):
      • The requisite minimum number of CHF service rotations.
      • Arranging CHF focused outpatient clinic exposure during the 3rd year of fellowship.
      • Dedicated experience in right heart catheterization and biopsies with CHF faculty.
      • CHF Focused Teaching.
    • It is anticipated this level of training will be pursued by fellows who desire to move on to Level III subspecialty training in heart failure or who intend a career in an area with limited access to CHF specialists.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during the general fellowship in cardiovascular disease.  At the present time, Penn State Health does not offer subspecialty training in heart failure.

Specific curricular milestones for heart failure as they relate to the Core Competencies promulgated by the ACGME are adopted from the ACC COCATS 4 Task Force 12 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Daily triage, evaluation, continuing care and disposition of patients admitted to the general cardiology heart failure service including:
    • Evaluation and triage of new patients from the emergency department and consultative service.
    • Review and confirm patient assessments performed by medicine resident and fellow coverage from night and weekend admissions.
    • On admitted patients a history and physical is performed to supplement the admitting resident’s comprehensive history and physical as needed.
  • Develop an evidenced-based, individualized diagnostic and management plan for testing and treatment based on the current ACC/AHA, HFSA or ISHLT guidelines as it pertains to each patient.
  • Present the history, physical examination, testing and/or treatment plans to the attending physician.
    • When the presentation is provided by residents or medical students, provide supplementary information as necessary.
  • Communicate the provisional diagnosis, recommendations, test results and plan of care with the patient and/or family in addition to potential complications associated with recommended testing or treatment.
  • Provide education to the patient and/or family about their disease process.
  • Serve as a team leader and role model for the heart failure service team.
    • Attend, supervise or perform any necessary bedside procedures based on the skill level of associated house staff team members.
    • Review patient care plans and directly supervise residents and medical students.
    • Provide education to the residents, medical students and other heart failure team members.
  • Serve as a liaison between the heart failure team and other services that may be providing non-cardiac treatment for heart failure patients.
  • Assist in the management of patients who are undergoing evaluation for or who have had cardiac transplantation in conjunction with designated transplant coordinators.
  • Attend weekly Transplant/VAD meeting.

Cardiac MR Imaging

The cardiac MRI portion of the Vascular/Imaging rotation exposes the fellow to the basics of cardiac MRI protocols, acquisition, measurement, and interpretation. Fellows will gain an understanding of clinical indications of cardiac MRI with attention to published appropriate use criteria. Evaluation of cardiac structure, function, and tissue characterization will be reviewed.  An overview of cardiac MRI physics and general MRI safety will be included in the training.

Clinical Experience

All fellows will have one month cardiac magnetic resonance imaging experience. This will be obtained during the combined Vascular/Imaging rotation and in aggregate exposure on other rotations. Additional elective time for interested fellows is available.

Further exposure to cardiac magnetic resonance imaging content comprises, but is not limited to, ordering, reviewing, and applying results from cardiac MRI studies is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • CHF Service
  • Consults
  • CCU
  • Outpatient Continuity Clinics (HMC and VA)
  • ACHD

Training Goals and Objectives

The cardiac MRI portion of the Vascular/Imaging rotation and associated training are designed to provide the fellow, within the standard three-year program, one potential level of COCATS training:

  • COCATS Level I: (one month experience minimum)
    • All fellows are expected to achieve COCATS Level I training within the first two years of fellowship.

COCATS Level II training requires a minimum of three months of dedicated training in cardiac MRI. At the current time, Level II training is not available during the standard fellowship. Fellows who wish to achieve Level II in cardiac MRI should discuss this with fellowship leadership to see if arrangements external to Penn State can be made.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease. Penn State Health does not offer subspecialty training in cardiac MRI.

Specific curricular milestones for magnetic resonance imaging, as they relate to the Core Competencies promulgated by the ACGME, are adopted as outlined in the COCATS 4 Task Force 8 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend and participate in the monthly Multimodality Imaging conferences throughout the year.
  • Review planned cardiac MRI cases for clinical background and medical history prior to the cardiac MRI study.
    • Evaluate the appropriateness of the study and anticipated clinical data.
    • Review prior CMR studies and/or other imaging modalities.
    • Discuss planned protocol with the responsible faculty.
  • Attend the Tuesday morning cardiac MRI acquisitions.
    • Scheduled adult cardiac MRI cases are on Tuesdays from 8:30 a.m. to 2:30 p.m.
  • Observe and/or participate in the measurement and interpretation of the cardiac MRI studies under the guidance of the interpreting faculty member.
  • Refer to and follow the Vascular/Imaging Rotation Schedule.

Nuclear Cardiology

The nuclear cardiology rotation provides direct exposure to the fundamentals of nuclear imaging as they pertain to cardiovascular disease. This includes the ordering, administration, and interpretation of nuclear cardiology studies in patients with suspected or known cardiovascular disease. These rotations also include a high level overview of radiation biology and safety training.  Fellows who desire to sit for the CBNC Board Exam and/or obtain Level II status will need to complete an external course to satisfy the requirements of the NRC. The nuclear cardiology rotations are also a component of the fellows’ exposure to ECG interpretation and stress testing (pharmacologic and exercise modalities) with routine review of rest and stress ECGs.

Clinical Experience

All fellows must have a minimum of two months of direct nuclear cardiology experience. The average experience is three to four months. Additional elective time for interested fellows is available.

Further exposure to nuclear cardiology content comprises, but is not limited to, ordering, reviewing, and applying results from nuclear cardiology studies is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • CHF Service
  • Consults
  • Outpatient Continuity Clinics (HMC and VA)

Training Goals and Objectives

The nuclear cardiology rotation and associated training is designed to provide the trainee, within the standard three year program, two potential levels of COCATS training.

  • COCATS Level I: (two months experience minimum)
  • All fellows are expected to achieve COCATS Level I training within the first two years of fellowship.
    • Minimum number of nuclear cardiology studies: 100
  • COCATS Level II: (four months experience minimum)
  • All fellows have the opportunity to achieve COCATS Level II training during the fellowship program.
    • Minimum number of nuclear cardiology studies: 300
  • Required to perform and interpret nuclear cardiology studies independently in practice.
  • Many or all can achieve this in time to take the CBNC Board Exam in their third year of fellowship.
    • An external radiation safety training course is required to fulfill the NRC requirement for Classroom and Laboratory Training and sit for the CBNC Board Exam.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease. At the present time, Penn State Health does not offer subspecialty training in nuclear cardiology.

Specific curricular milestones for nuclear cardiology as they relate to the Core Competencies promulgated by the ACGME are adopted from the ACC COCATS 4 Task Force 6 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend the Nuclear Cardiology and Nuclear/Cath Correlate Conferences throughout the year.
    • When assigned, prepare cases for the Nuclear/Cath Correlate Conferences with appropriate correlations to coronary angiography and other imaging modalities.
    • When assigned, prepare one topic review for Nuclear Cardiology Conference during second and third year of fellowship.
  • Track participation in performing and interpreting cases.
    • Studies performed or interpreted during conferences and while not on the nuclear cardiology rotation should also be tracked.
  • Daily supervision of nuclear stress testing (at the Medical Center) including:
    • Documentation of the reason for the stress test.
    • Obtain an appropriate history and physical (H&P) to ensure the test can safely and appropriately be performed.
    • Oversee the performance of the stress test with the clinical nurse in nuclear radiology.
    • Review and provide preliminary interpretation of the resting and stress ECGs (at the Medical Center).
    • Attend the daily afternoon reading session held jointly with Nuclear Radiology.
    • Review and provide preliminary interpretation of the nuclear imaging results (at the Medical Center and those performed at satellite locations).
  • Communicate with the patient as necessary during the time surrounding their testing.
  • Communicate abnormal test results to requesting/ordering physicians.
  • Participate in the following activities under the guidance of a nuclear cardiology technician and/or health physicist:
    • Radiopharmaceutical Handling and Dose Preparation.
      • Performed at 6 a.m. on all weekdays.
      • Must notify nuclear technologist at least 24 to 48 hours in advance.
    • Image Acquisition and Processing.
      • Performed throughout the morning on all weekdays.
      • May ask nuclear technologist to participate on a daily basis.
  • Dedicated Health Physics Experience.
    • Performed one-on-one with the Health Physics Department.
    • Can be done in a single day or broken up over two to four days.
    • Can be done at any time, but is recommended in the second or third year before taking boards.
    • Must be set up in advance.

Research

The research rotation provides the ability for cardiology fellows to directly participate in cardiovascular research and scholarly activity (CRSA). This includes exposure to conducting research, increasing knowledge of the scientific method and enhancing the ability to critically evaluate published scientific data. These exposures will allow emerging cardiologists to adapt their knowledge and practice as new scientific investigations occur.

Clinical Experience

All fellows will have a minimum of three months of dedicated research time. Additional elective time for interested fellows is available.

It is anticipated that fellows will engage in cardiovascular research and scholarly activities during the dedicated rotations as well as longitudinally, concurrent with other rotations, throughout the three-year fellowship. Discussion and application of current medical research and literature as it pertains to clinical cardiology will also be an active part of all cardiac rotations.

Training Goals and Objectives

The research rotation, along with longitudinal effort occurring concomitantly with other training, is designed to provide the trainee, within the standard three-year program, training that meets or exceeds COCATS Level I expectations.

  • COCATS Level I:
    • Trainees should establish a relationship with a research mentor and devote six to 12 months to one or more scholarly activities or cardiac research projects.
    • Trainees are encouraged to develop a quality improvement project to enhance system based practices that will help him or her throughout their professional careers. This could be part of the research project mentioned above; however, for it to count as research project it must include a specific research question (i.e. did a particular QI measure lead to a change in behavior or outcomes?).
  • Advanced training:
    • Trainees preparing for careers in research need an extensive foundation in scientific investigation.
    • These skills can be achieved in combined degree programs including MD/PhD, MD/MPH and MD/MS.
    • Trainees seeking a career in investigative cardiology without an advance degree are encouraged to obtain necessary scientific analytical course work and clinical research experience to promote a productive research career.

Specific curricular milestones for cardiovascular research and scholarly activity, as they relate to the Core Competencies promulgated by the ACGME, are adopted from the COCATS 4 Task Force 15 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Responsibilities

  • Trainee should find a faculty member to assist with the development of clinical questions and to oversee the scientific method as it pertains to cardiovascular research or scholarly activity.
    • After developing clinical questions, research project should be followed until completion.
    • Project results should be written up and submitted for presentation at a cardiovascular conference or publication in a peer reviewed journal.
    • The minimum research requirement is one project, however it is strongly encouraged to spend additional time on other cardiovascular research or scholarly activity.
  • Trainee is encouraged to work on a quality improvement project to enhance patient care and improve systems-based practice.
  • Become more knowledgeable about the scientific method including hypothesis generation, reading background literature, developing methods to test hypothesis and examining data to determine if it confirms or denies the hypothesis.
  • Develop competency in critically interpreting cardiovascular research literature.
  • Develop an understanding of the issues concerning scientific integrity and ethical conduct.

Vascular

The vascular portion of the Vascular/Imaging rotation exposes the fellow to evaluation and management of peripheral vascular disease.  The vascular portion of the rotation experience is designed to emphasize exposure to vascular ultrasound imaging and outpatient management of peripheral vascular disease.   Additional multimodality imaging of the peripheral vasculature as well as inpatient care of non-coronary cardiovascular disease is anticipated in aggregate throughout other rotations.

Clinical Experience

All fellows will have two months of vascular experience. This will be obtained during the combined Vascular/Imaging rotation and in aggregate exposure on other rotations. Additional elective time for interested fellows is available.

Further exposure to vascular content comprises, but is not limited to, the presentation, evaluation, and management of peripheral vascular disease as well as the ordering, reviewing, and applying results from multimodality imaging of the central and peripheral vasculature is anticipated for all fellows on the following rotations:

  • Inpatient Acute Service
  • CHF Service
  • Consults
  • CCU
  • Outpatient Continuity Clinics (HMC and VA)
  • ACHD

Training Goals and Objectives

The vascular portion of the Vascular/Imaging rotation and associated training are designed to provide the fellow, within the standard three-year program, two potential levels of COCATS training:

  • COCATS Level I: (two months experience minimum)
    • All fellows are expected to achieve COCATS Level I training within the first two years of fellowship.
  • COCATS Level II: (training duration not defined)
    • Interested fellows must discuss the opportunity to achieve COCATS Level II training during general fellowship. This will include:
      • Additional scheduled time (as elective rotation or concomitant with other rotations) in the vascular imaging lab.
      • To sit for the Physician’s Vascular Interpretation Examination requires interpretation of a minimum of 500 total vascular studies across the vascular testing areas.

COCATS Level III training requires experience beyond a three-year fellowship and by definition cannot be obtained during general fellowship in cardiovascular disease.

Specific curricular milestones for vascular imaging, as they relate to the Core Competencies promulgated by the ACGME, are adopted as outlined in the COCATS 4 Task Force 9 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Based on our curriculum and rotation schedule, a fellow may achieve these milestones ahead or behind the suggested time frame in the COCATS 4 document. All Level I milestones represent minimum expectations during general fellowship.

Fellow Expectations and Responsibilities

  • Attend Vascular Laboratory reading sessions with on Tuesday afternoons and Thursday mornings.
    • Participate in the review and interpretation of peripheral vascular studies.
  • Attend weekly Vascular lectures during your rotation on Thursday mornings at 8 a.m.
    • Schedule to be confirmed at the start of the rotation.
  • Attend outpatient clinic to shadow and participate in the evaluation and treatment of patients with peripheral vasculature disease.
  • Track reading of peripheral vascular studies for documentation.
    • New Innovations is the preferred method of tracking.
  • Refer to and follow the Vascular/Imaging Rotation Schedule.
  • Notify the respective faculty of your expected attendance or if you are unable to attend the scheduled sessions as a courtesy for their involvement in your education.

Conferences

The Penn State Cardiovascular Disease Fellowship curriculum is structured to meet the requirements of COCATS 4, according to the American College of Cardiology.

Conferences are an important part of the fellowship training program. Integration of conferences and clinical rotations provides essential education in areas of cardiovascular pathophysiology. A series of case-based and didactic lectures have been assembled to meet the educational goals of the program.

Conferences include:

To Apply

All applications must be submitted through ERAS, and we participate in the National Residency Matching Program (NRMP). Applications will not be received outside of ERAS, and positions will not be filled outside the match.

Application deadline is Aug. 15; however, our application review process begins July 15, so we encourage you to apply early.

Eligibility

Qualified candidates will be:

  • U.S. citizens, permanent residents or J-1 visa holders (no additional visa types are sponsored)
  • Board-eligible or board-certified in internal medicine
  • Pennsylvania medical training license eligible

Required Supporting Documents

The following documents should be uploaded to ERAS for review:

  • ERAS application, inclusive of current photograph
  • Personal statement
  • Curriculum vitae
  • USMLE or COMLEX transcript
  • ECFMG certificate (if applicable)
  • Three letters of recommendation, including one from current program director

Interview Process

Interview dates for 2017 are:

  • Aug. 22, 2017
  • Sept. 1, 2017
  • Sept. 7, 2017
  • Sept. 12, 2017
  • Sept. 22, 2017
  • Sept. 26, 2017

All interviews are by invitation only. Candidates selected to interview will be contacted by the program coordinator and/or Thalamus. Thalamus is the scheduling service that our program uses to streamline interview scheduling; all interviews must be scheduled and managed through Thalamus. If you encounter problems with Thalamus, please contact the program coordinator.

Faculty

Current Fellows

Past Fellows

Contact Us

Mailing Address

Penn State Heart and Vascular Institute
Cardiovascular Disease Fellowship Program
500 University Drive
PO Box 850, MC H047
Hershey, PA 17033

General Contact Information

Phone: 717-531-6746

Email: asmith5@pennstatehealth.psu.edu

Penn State College of Medicine is an equal-opportunity employer and accepts all qualified applications regardless of their gender, ethnic origin or religious background.