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The educational methods for all fellows are didactic and clinical. A written curriculum is distributed at the beginning of each rotation and the goals and objectives are reviewed with each fellow. The curriculum is revised annually with special attention to the fellow's recommendations and comments. The rotations are in one to two month blocks through Consultative Service, Continuity Clinic, Coronary Care Unit, Electrophysiology, Nuclear Cardiology, Echocardiography, Catheterization Laboratory, Vascular Medicine, Congenital Heart Disease, Congestive Heart Failure, Huntington Hospital and CT/MR. In addition, the residents rotate through the noninvasive peripheral vascular laboratory and out-patient vascular medicine clinic.

Catheterization Laboratory - The rotation includes both didactic and procedural based learning. A daily morning conference consists of cine review and lectures by interventional attendings at both campuses. The cardiology fellow participates in the pre-procedure evaluation, intra- and post-procedure care of patients undergoing invasive procedures. The fellow interprets the hemodynamic data and angiogram independently, actively participates in the decision-making process and performance of diagnostic and interventional coronary and peripheral procedures and works closely with the nurse practitioners in post-procedural management. The fellow develops a gradually expanding role as primary operator and teacher/supervisor to the junior fellows. The high volume laboratories and wide variety of operators at both campuses with state of the art digital flat panel technology provides an unique opportunity.

Congestive Heart Failure - During this rotation, residents are responsible for managing heart failure patients and triaging patients for transplant surgery. Under the supervision of an attending cardiologist specializing in congestive heart failure, the residents learn to determine who should be a candidate for transplant surgery and how to manage a patient who will be sent for a transplant. Residents have the opportunity to participate in basic science research on the pathophysiology of congestive heart failure and the treatment of the disease.

Consultative Service - Under the supervision of an attending physician, the cardiology fellow responds to consultative requests for pre-operative evaluation, post-operative care in the ambulatory surgery unit, intensive care units including the cardiothoracic unit, in-patients, patients in the rehabilitation unit and emergency room consultations. The cardiology fellow is responsible for the evaluation and management of all patients and participates in the supervision of residents and medical students. There are formal teaching sessions on a daily basis.

Continuity Clinic - There are two continuity clinics, one at North Shore University Hospital and a separate clinic at Long Island Jewish Medical Center. The cardiology fellows participate in one clinic for the duration of their three year fellowship. They attend the clinic on a weekly basis, where they develop a panel of patients for whom they provide care throughout their fellowship.

Coronary Care Unit - The cardiology fellow in the CCU, under the supervision of the attending, is responsible for the care of the patients in the units. Formal rounds occur in the CCU Monday through Friday with the attending cardiologist, internal medicine residents and nursing staff. The cardiology fellow is responsible for the evaluation and management of all patients admitted to the CCU, the review of the internal medicine residents' history and physicals, as well as teaching. They also have the opportunity to perform procedures such as temporary pacemakers, right heart catheterization and the management of intra-aortic balloon pumps.

CT/MR - Cardiology fellows rotate through CT/MR with an attending radiologist or cardiologist who is an expert in coronary imaging. T he fellows learn the indications, procedural management, the processing of images and interpretation of both MR and CT imaging of the heart with a 64-slice scanner. The fellows will complete level II training during their fellowship.

Echocardiography - Hands-on experience in the performance and interpretation of transthoracic, transesophageal and stress echocardiograms are provided to all cardiology fellows in this rotation, along with exposure to an active intraoperative transesophageal echo program. Junior fellows are trained in the basic scanning techniques so they become proficient in performing transthoracic echocardiograms by the end of their monthly rotation. Senior fellows advance to performing transesophageal and stress echocardiograms. They also have the opportunity to learn 3D ECHO and intra-cardiac echo. Fellows and echo attendings meet each afternoon to read, discuss and interpret echocardiograms. In addition, there are monthly echo conferences where interesting case studies are presented.

Electrophysiology - The electrophysiology team consists of cardiology fellows, attending physicians and nurse practitioners. The team formally meets every morning to review the patients on the service and management plans. The junior fellow is responsible for evaluation and follow-up of all patients for arrhythmia and syncope consultation and pre-procedure evaluation. The senior fellow develops a progressively active procedural responsibility and independence. All fellows participate in the interrogation of pacemakers and implantable cardioverter defibrillators under the supervision of nurse practitioners and/or attending electrophysiologists. The fellow will become proficient in interpreting rhythms, the interrogation of devices, performing cardioversions, tilt table tests and participating in complex ventricular ablations, atrial fibrillation ablations and biventricular device implantation.

Nuclear Cardiology - During this rotation, cardiology fellows are responsible for pre-procedural evaluation, performance and post-procedural management of all in-patients and out-patients. The fellows perform a variety of tests including treadmill exercise, pharmacologic myocardial perfusion and equilibrium gated blood pool (or MUGA) nuclear studies. They are exposed to a variety of myocardial tracers (e.g.Tl-201, Tc99m sestamibi, Tc99m-tetrofosmin, Tc99m pertechnetate) and different pharmacologic agents (e.g. adenosine, dobutamine). State-of-the art imaging techniques are used to increase test accuracy, including dual-isotope protocols, attenuation and scatter corrected imaging, motion-corrected imaging and quantitative gated single photon emission computed tomography (SPECT) analysis. An attending nuclear cardiologist interprets all studies during daily teaching sessions. A training course in nuclear physics is provided to all fellows throughout the three-year period.

Vascular Medicine - Cardiology fellows rotate through the noninvasive vascular lab. They observe the performance of aortic, carotid and peripheral vascular noninvasive studies including exercise ankle brachial indices. The fellow participates in the reading session with an attending physician.
Congenital Heart Disease – Senior fellows rotate through the adult congenital heart disease clinic at both North Shore and LIJ. There are dedicated echo, MR and cath sessions for weekly adult congenital heart disease patients.

Research - Each fellow is paired with a research mentor depending on their interests. They have dedicated research time to complete their projects. Study design, progress and results are presented to the research committee for guidance.

Conferences - Daily morning teaching conferences take place from 7:30-8:30AM. Topics include: interesting cases presented by residents and discussed with faculty members, didactic lectures given by the faculty attendings from the NSUH andLIJ campuses, as well as guest faculty from other disciplines, journal club, research topics, QM, and device management. There is a monthly combined cardiology and cardiothoracic surgery conference, a morbidity and mortality conference and cardiology grand rounds. Board reviews are held biweekly.

Huntington Hospital - The rotation at Huntington Hospital provides exposure to clinical cardiology in a community setting. The fellows present at a weekly Journal Club and attend a monthly cardiac catheterization conference. They learn the business of medicine by spending two days in different practice models, ie. solo practice, multispecialty practice and different cardiology only practices.

Nassau University Medical Center (NUMC) - Senior fellows have the opportunity to rotate through NUMC, a county hospital. They rotate in the CCU with a team including house staff an nurses. They have the opportunity to work with the site director to perform and interpret ECHOs. They attend CHF clinic and return for their continuity clinic.


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