Clinical Rotations

During the first 24 months of training, fellows spend time on all the key cardiology services, both clinical (e.g., Cardiac Care Unit [CCU], consult service, heart failure) and lab-based (e.g., echocardiography, cardiac catheterization). In addition to providing thorough exposure with broad cardiology experiences, these years are designed to meet the requirements of the Accreditation Council for Graduate Medical Education (ACGME) and Core Cardiology Training Symposium (COCATS) for Level 1 training. Following completion of the first two years, fellows on the clinical pathway are encouraged to “think outside the traditional training box” for their customized third year of training. The goal for this year is to incorporate adjacent domains to best advance their career goals.

First-Year Rotations

Cardiology Consults

First-year fellows spend two 3-week blocks on the general cardiology consultation service. This service covers general consultative service throughout the hospital on topics with incorporating chest pain evaluation, pre-operative cardiovascular risk assessment, evaluation of imaging findings, and management of atherosclerotic disease, arrhythmias, and cardiomyopathies.

Cardiac Catheterization Lab

First-year fellows spend two 3-week blocks in the catheterization lab. They work closely with attending cardiologists and senior fellows in learning to perform and interpret right heart catheterizations, left heart catheterizations and, and endomyocardial biopsies.

Cardiac Care Unit

First-year fellows spend two 3-week blocks in the Cardiac Care Unit (CCU). They work closely with the CCU attending and resident teams to manage critically ill patients. They also are responsible for triaging and stabilizing cardiovascular emergencies throughout the hospital. Washington University in St. Louis is a STEMI-accredited center and a tertiary referral center for hospitals in the area. The CCU is supervised by both clinical cardiologists and cardiac intensivists. Fellows gain experience managing inotropes and cardiogenic shock, mechanical circulatory support devices, unstable arrhythmias and more.

Electrophysiology (EP)

First-year fellows spend two 3-week blocks on the Electrophysiology service. They work closely with the Electrophysiology fellows and attendings to see consults and participate in procedures within the EP lab.

Heart Failure

First-year fellows spend two 3-weeks on the “pre” Advanced Heart Failure service where they serve as the senior fellow and work closely with our advanced heart failure specialists. They gain experience caring for patients with end-stage heart failure undergoing evaluation for advanced therapies such as home inotropes, left ventricular assistive devices (LVAD), or heart transplant.

Graphics/Nuclear Cardiology

First-year fellows spend 4 weeks learning ECG interpretation s and nuclear medicine study interpretation. We partner with our colleagues from Mallinckrodt Institute of Radiology. There are additional learning opportunities from combined Cardiology/Radiology conferences and third-year electives.

Echocardiography

First-year fellows spend 6 weeks in the Cardiac Diagnostic Lab learning how to perform and interpret transthoracic echocardiograms.

Cardiac CT/MRI

First-year fellows spend 2 weeks learning how to read cardiac CT and MRI studies. We partner with the Mallinckrodt Institute of Radiology’s cardiac imagers as well as imagers from our own division. There are additional learning opportunities from combined Cardiology/Radiology conferences and third-year electives.

Night Float

First-year fellows spend a total of 6 weeks on night float during the year, covering CCU, STEMI pages, stat TTE, and urgent consults. Night float spans from Sunday night to Friday morning over a single week. After first year, there are no further in-house call responsibilities.

Veteran’s Administration Hospital

First-year fellows spend two 3-week blocks at the John Cochrane VA in St. Louis. Three weeks are spent on the consult service, and three weeks are spent in the Cardiac Stress Lab where there is a large focus on reading exercise and pharmacologic ECG studies.

Continuity Clinic

Fellows are paired with an attending and spend 1 half-day per week in their continuity clinic. This provides a longitudinal outpatient clinic experience. Fellows have the choice to remain in the same clinic for all 3 years or to switch to different clinics as their clinical interests develop.

Second-Year Rotations

Cardiology Consults

Similar to first year, second-year fellows spend two 3-week blocks on the general cardiology consultation service.

Congenital

Second-year fellows spend two three-week blocks seeing inpatient congenital consults and attending outpatient congenital clinics. They participate in multi-disciplinary management conferences learning and discussing complex congenital lesions.

Cardiac Catheterization Lab

Second-year fellows spend four 3-weeks blocks in the cardiac catheterization lab. They work closely teaching first-year fellows and learning from Interventional Cardiology fellows and attendings to perform right and left heart catheterizations and percutaneous coronary interventions.

Cardio-Oncology

Second-year fellows spend three-weeks seeing inpatient cardio-oncology consults and spending time in outpatient cardio-oncology clinics. The Cardio-Oncology Center of Excellence works closely with the world-renowned Siteman Cancer Center.

Electrophysiology

Second-year fellows spend 3-weeks on the Electrophysiology service. Similar to the first year on the EP service, second year fellows work closely with the Electrophysiology fellows and attendings to see consults and participate in procedures within the EP lab.

Transesophageal echocardiography

Second-year fellows spend two 3-week blocks in the Echo lab performing and interpreting transesophageal echocardiograms.

Advanced Heart Failure

Second-year fellows spend 3 weeks on the Heart Failure “post” service, taking care of patients who have received LVADs and heart transplants. Working closely with the Advanced Heart Failure and Transplant fellows and attendings, they learn how to manage LVADs and heart transplants and the complications that can arise. There are bi-weekly multidisciplinary meetings to discuss patients, particularly for those who are being evaluated for advanced therapies such as home inotropes, left ventricular assistive devices (LVAD), or heart transplant. Fellows also participate in outpatient “post” clinic evaluating patients who have undergone heart transplantations.

Continuity Clinic

Third-Year Rotations

The third year of fellowship training is designed for individual customization. In the past, fellows have spent time garnering expertise in Sports Cardiology and Maternal Cardiology. Additional elective opportunities include CCU, Pulmonary Hypertension, and Structural Heart Disease. Fellows can also spent time in either the EP lab or catheterization lab in preparation for their next advanced fellowship. Some fellows will obtain Level 2 Nuclear training, others take advantage of opportunities within the Division and with colleagues at Mallinckrodt Institute of Radiology interpreting CT/MRI studies.

Continuity Clinic