Interventional Cardiology Fellowship

Program Overview

The Interventional Cardiology Fellowship at Penn State Health Milton S. Hershey Medical Center is a one-year, ACGME-accredited program that admits one fellow per year.

Program Details

The Interventional Cardiology Fellowship provides fellows with state-of-the-art training. 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 cardiovascular disease fellowship, as well as a three-year ACGME-accredited internal medicine residency. It is expected that the candidate be board-certified in internal medicine and be board-eligible for cardiovascular disease medicine by the start of the training program.

The program is designed to meet all of the requirements for board eligibility in Interventional Cardiology and provides level 3 COCATS training.

The Interventional Cardiology fellow will be provided with an opportunity to acquire knowledge of the indications, contraindications, risks, limitations and complications associated with catheter-based interventions, and will perform a minimum of 250 coronary interventions during training. The program will provide instruction and opportunities to acquire knowledge in the use of IVUS, Excimer laser, cutting-balloon, PTCRA, intracoronary stents, distal protection devices, pressure and Doppler flow wires. In addition, the fellow will participate in ongoing clinical trials studying the effects of pharmacological therapies and new interventional devices.

Penn State Heart and Vascular Institute has five attending interventionalists. The fellow will work in tandem with an attending interventionalist in the cath lab and clinic.

Our Team

Curriculum

During the year, the fellow will be trained to be practitioners in the discipline of interventional cardiology. The fellow will also gain exposure to peripheral vascular angiography and intervention as well as intervention for structural heart disease. Fellows will receive their training at Penn State Health Milton S. Hershey Medical Center, a 600-bed tertiary care hospital providing the full range of cardiovascular services.

There are five cardiac catheterization laboratories. Two are used primarily for electrophysiology studies, but are fully equipped to perform all cardiac procedures. One lab is equipped for the performance of peripheral vascular procedures. About 600 cardiac intervention procedures are performed annually.

The facilities are located on the first floor, adjacent to the Emergency Department. There is a 15-bed procedure unit located next to the catheterization laboratories; the unit has staffing and equipment to permit overnight care of low-risk patients. Two nurse practitioners work with the interventional cardiology faculty and fellow to facilitate care. The non-invasive cardiology suite and the vascular laboratory are adjacent to the catheterization laboratories. The suites for interventional radiology are one floor below; the Heart and Vascular Intensive Care Unit and Operating Rooms are one floor above. In addition, there is an active cardiac surgery program at Hershey Medical Center.

Program Structure

The 12-month training program is divided into 12 one-month rotations as follows:

  • Cardiac catheterization laboratory – 8 months
  • Peripheral Intervention – 2 months
  • Research – 1 month
  • Vacation – 1 month

Each fellow will also participate in an ambulatory care experience one half-day per week for the entire year. The focus of this experience will be the rapid evaluation of patients with chest pain and positive stress tests as well as post-procedure follow-up.

Cardiac Catheterization Rotation

During the cardiac catheterization rotation, the fellow will be responsible for the preprocedure evaluation of patients undergoing cardiac catheterization and PCI. The fellow will also perform PCI with the a faculty member. The fellow will also be expected to see patients post-procedure to assess for any immediate complications of the procedure. The focus of the fellow will be interventional procedures; however, the fellow may be required to participate in diagnostic procedures if it does not conflict with an interventional procedure.

Peripheral Intervention

During the rotation in Peripheral Intervention, the fellow will participate in procedures performed at Hershey Medical Center under direction of the Vascular Surgery service or the Interventional Radiology service. In addition, there will be opportunities for additional procedural volume at affiliated institutions. The fellow will participate in both diagnostic and interventional procedures.

Research

All fellows will be expected to participate in some form of research, and time will be allotted for this. The fellow will be expected to select a topic near the beginning of his/her training, so that the research work will be concurrent with clinical training. One month of protected time will be available for preparation of a manuscript, presentation at meetings, or other efforts.

Ambulatory Care

The fellow will see outpatients one half-day per week in the Cardiology clinic, supervised by one of the interventional cardiology faculty members. The purposes of this clinic are to allow for rapid evaluation of patients with chest pain and to provide follow-up care for patients who have had procedures.

Call

As a significant number of interventional procedures are performed emergently, night and weekend call are essential to interventional cardiology training. The fellow will take call one in every three to four nights and one in every three to four weekends. All call is taken from home. Should an emergency require a significant amount of time, the fellow will be permitted to depart before noon on the following day.

Clinical Training

Fellows will have been trained (level 2) in diagnostic right and left heart catheterization during their general cardiovascular disease fellowship. The fellow will begin assisting with interventional procedures at the beginning of the Interventional Cardiology Fellowship. The fellow will be expected to evaluate patients scheduled for a planned PCI. Many patients will have been evaluated and had a diagnostic procedure performed by the general Cardiology fellow. If ad hoc intervention follows, the Interventional Cardiology fellow will then enter the case. The fellow will discuss the clinical indications for the procedure with the attending faculty member before participating.

Additional discussion will include a general approach to the treatment of the specific lesion, choice of anticoagulation therapy for the procedure, and selection of equipment. During the course of the year, the fellow will be expected to predict technical challenges and potential complications of the planned procedure. During the first months of the fellowship, the fellow will obtain vascular access and engage the coronary artery with the guiding catheter. The fellow will perform angiography with the goal of displaying the lesion in a projections suitable for the performance of PCI. During the PCI, the fellow will then advance the guidewire across the lesion.

Over the course of the year, the fellow will learn to guide balloons, stents, and other devices into position while protecting the position of the guidewire. At the end of the procedure, the fellow will discuss access site management with the attending and will perform device closure of the access site if applicable.

By the end of the year, the fellow will be expected to have gained expertise in the following areas:

  • PCI equipment selection
    • Guiding catheter
    • Coronary guidewires
    • Adjunctive devices (IVUS, FFR, etc.)
    • Balloon selection
    • Stent selection
  • Engagement of the coronary artery with the guiding catheter
  • Angiographic imaging for PCI
  • Guidewire manipulation
  • Balloon angioplasty
  • Coronary stenting
  • Thrombectomy (suction catheters, rheolytic thrombectomy)
  • Rotational atherectomy
  • Distal protection (distal occlusion and filters)
  • Chronic total occlusions
  • Vascular closure device selection and use

The fellow will perform about 400 PCI procedures during the course of the year with a minimum of 250 procedures performed as the primary operator.

Research

The Interventional Cardiology fellow will choose a research project at the beginning of the year. As the program is one year, this will likely be part of a program that is conducted by a faculty member. Research work will be conducted in parallel with clinical training. One month of dedicated time is available to complete a project, prepare a manuscript, etc. A fellow with an established research interest will be encouraged to continue in this area if feasible. The cardiac catheterization laboratory at Hershey Medical Center collects data on every patient undergoing a procedure. Some of this data is submitted to the ACC-NCDR. The Interventional Cardiology fellow may choose to test a hypothesis through retrieval of data from one of these data sets.

Faculty will be available for assistance, both within the Heart and Vascular Institute and elsewhere in the institution (i.e. Health Evaluation Sciences). Interventional faculty members are investigators in many multi-center clinical trials. The Interventional Cardiology fellow will be expected to be a co-investigator for at least one of these studies. As a co-investigator, the fellow will screen, obtain consent, and ensure that the protocol is followed. This experience will give the fellow exposure to clinical trials.

Systems Based Quality Improvement (QI)

As noted previously, the catheterization laboratory at Hershey Medical Center has quarterly meetings to review complications and assess other measures of quality.

Each fellow will participate with a faculty member in a quality improvement initiative within the cardiac catheterization laboratory.

At the present time, several important (QI) initiatives are in progress. These include analysis and reduction of door-to-balloon time for STEMI, drug-eluting stent utilization, prevention of vascular access site complications, and prevention of contrast-induced nephropathy.

The fellow will meet with the assigned faculty member and review all cases that fall within the purview of their initiative and initiate system and policy modifications that will improve patient care.

Core Curriculum and Self-Learning

The Interventional Cardiology Fellowship at Hershey Medical Center will use the curriculum of the Interventional Fellows Institute (IFI), a program sponsored by the Society for Cardiac Angiography and Interventions (SCAI). This valuable online resource contains approximately 60 one-hour slide presentations (divided into ten modules) narrated by the foremost thought leaders in interventional cardiology. These presentations cover basic topics in interventional cardiology.

The website allows the program director to select which presentations he/she wishes the fellows to review and permits the program director to track which presentations the fellow has completed. A timeline for completion of modules will be given to the fellow at the start of the academic year. Each module also contains a quiz which can be used to assess the medical knowledge of the fellow.

To Apply

All applications are accepted through the Electronic Residency Application Service (ERAS). The application deadline is Jan. 31.

Eligibility

Qualified candidates will be:

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

Required Supporting Documents

The following documents should be uploaded to ERAS for review:

  • ERAS application, including 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

All interviews are by invitation only and are conducted in February. Candidates selected to interview will be contacted by the program coordinator.

Faculty

Current Fellows

Contact Us

Mailing Address

Penn State Heart and Vascular Institute
Interventional Cardiology Fellowship Program
500 University Dr.
PO Box 850, MC H047
Hershey, PA 17033

General Contact Information

Phone: 717 531-6746

Email: asmith5@pennstatehealth.psu.edu