Training & Curriculum

• To understand the effectiveness and limitations of cardiovascular interventional procedures in order to appropriately select patients and procedure types
• To achieve the appropriate cognitive knowledge and technical skills needed to perform interventional cardiac procedures at the level of quality attainable through the present state-of-art equipment
• To foster an attitude of lifelong learning and critical thinking skills
• To understand and commit to quality assessment and improvement in procedure performance

Interventional cardiology fellows spend 12 months rotating on the interventional cardiology service at Cedars-Sinai. Time is distributed among well-defined experiences in a number of clinical settings (listed below), which are designed to assure that all the educational objectives are met:

• Catheterization laboratory
• Inpatient and outpatient consultations
• Intensive care units
• Longitudinal outpatient clinic
• Non-invasive testing
• Educational conferences
• Research experience

The interventional cardiology fellow's responsibilities are designed to support ACGME competencies in patient care, medical knowledge, communication, professionalism, and systems-based practice.

• Teaching: Fellows progressively take on teaching roles, such as supervising cardiology fellows, based on their level of experience.
• Patient Care: Fellows are responsible for outpatient consultations, interventional procedures, and post-procedure care.
• Rotating Duties: Fellows participate in procedural cases, supervise cardiology fellows on inpatient rotations, and assist with patient rounding, discharge, and follow-up.
• Team approach to Clinical Care: While faculty oversee patient care, fellows contribute as active team members, participating in case discussions and catheterization lab meetings.
• Consultations: Fellows perform initial patient evaluations, present cases to attending physicians, and collaborate on treatment plans in various settings, including the ER, ICU, and outpatient clinic.
• Follow-up and Continuity of Care: Fellows participate in ongoing care through follow-up clinics and manage inpatient consultations and outpatient device patient care.
• Practice and Systems-Based Management: Fellows write orders after discussing treatment plans with attending physicians and ensure quality patient care through clear communication with patients and families. They advocate for cost-effective, high-quality care in collaboration with the team.

Training includes clinical activity as a primary physician or patient consultant to establish indications for coronary interventional procedures. The fellow’s clinical activity is supervised by a qualified interventional cardiology specialist and provides balanced experience in a variety of clinical settings, including the following:

• Catheterization lab
• Emergency department
• Coronary care and observation units
• Operating room
• Echocardiographic laboratory
• Imaging department
• Ambulatory clinic

Fellows should engage in clinical activities that provide opportunities to acquire knowledge in the evaluation of the following:

• Chronic and acute ischemic heart disease
• Valvular heart disease

Fellows should also have clinical experience in the prevention and management of bleeding complications secondary to thrombolytic agents and antithrombotic and antiplatelet drugs.
Fellows should develop clinical experience involving the following:

• Consultation
• Evaluation and management of patients in the intensive care unit and emergency department
• Pre- and post-procedure management of patients
• Outpatient evaluation and follow-up of patients for pre- and post-cardiac intervention procedures

The program focuses on developing the procedural and technical skills required for diagnostic and therapeutic cardiovascular interventions. Fellows must master key skills, including understanding indications, contraindications, complications, and result interpretation. Proficiency must be demonstrated as the primary operator in the following procedures:

• Right and left heart catheterization including coronary arteriography, ventriculography, and hemodynamic measurements
• Intravascular ultrasound
• Doppler flow, intracoronary pressure measurement and monitoring, and coronary flow deserve
• Minimum of 250 coronary interventions, including complex coronary interventional procedures and devices
• Femoral and brachial/radial cannulation of normal and abnormally located coronary ostia
• Intracardiac and transesophageal echocardiographic diagnosis and guidance of structural heart disease interventions
• Minimum of 50 structural heart disease interventions, including but not limited to: vavulplasty, valve replacement, valve repair, closure of cardiac defects and transseptal catheterization

In addition, the fellows have the opportunity to perform at least 10 valvuloplasty procedures and 10 adult congenital interventional procedures. They should acquire skills in the management of mechanical complications or percutaneous interventions.

• The IC Journal Club meets on the second Tuesday of each month, combining cardiovascular and interventional cardiology fellows to review and discuss recent peer-reviewed journal articles. Fellows take turns presenting, fostering an environment of scholarly inquiry. Attendance is mandatory.