Clinical Training (Combined Fellowship Program)

Two years are devoted to a core curriculum in clinical cardiology with rotations through the clinical units at Parkland Memorial Hospital (940 beds), University Hospital–St.Paul (300 beds), and the Dallas Veterans Affairs Medical Center (720 beds). These hospitals are staffed entirely by full-time faculty members of the Division of Cardiology. These three distinctive clinical settings provide fellows a rich mixture of patients with diverse cardiovascular problems.

The core curriculum includes rotations on the cardiology consultation service, coronary care unit, noninvasive laboratory, cardiac rehabilitation service, nuclear cardiology, cardiac MRI, cardiac catheterization laboratory, cardiac electrophysiology, and congestive heart failure/cardiac transplantation. In addition, each fellow is assigned a continuity clinic that meets one morning or afternoon per week throughout the three-year training period.

Completion of the core curriculum satisfies certification requirements of the American Board of Internal Medicine (ABIM), as well as those of the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Privileges in Cardiology. After completion of the two-year core curriculum, subsequent experiences in clinical cardiology are determined by the career goals of each individual fellow.

Clinical Training Highlights

Acute Coronary Care

The coronary care unit (CCU) service at Parkland occupies a 12-bed intensive care unit and an adjacent 24-bed telemetry monitoring unit. Approximately 1,500 patients annually are served by four teams of house staff and students, supervised by two cardiology fellows and two attending cardiologists. A fluoroscopic procedure suite located within the CCU is used for approximately 400 invasive procedures annually. Patients with acute coronary syndromes or other cardiovascular emergencies are also managed in a combined medical-surgical ICU at University Hospital–St. Paul. At the VA Medical Center, the CCU occupies 16 beds and serves approximately 1,300 patients annually. The unit is equipped with state-of-the art data managing and monitoring systems. A procedure room located within the CCU is used for more than 600 invasive procedures annually, including heart catheterizations, temporary and permanent pacemaker insertions, and pericardiocentesis.

Noninvasive Imaging

Both Parkland and the VA Medical Center maintain high-volume, noninvasive laboratories that offer a wide range of diagnostic tests, including resting and ambulatory ECG, exercise testing, transthoracic and transesophageal echocardiography, Doppler color flow mapping, and nuclear perfusion imaging. Both Parkland and University Hospital–St. Paul are also large volume centers for cardiac MRI imaging and have growing programs in cardiovascular CT. Fellows on the noninvasive rotations are assisted by skilled technicians and supervised by faculty members with a goal of attaining proficiency in the performance, interpretation, and clinical application of these procedures.

Cardiac Catheterization and Interventional Cardiology

The Cardiac Catheterization Service at Parkland currently performs 1,250 procedures annually, of which 250 to 300 are interventional procedures. About 65 percent of patients present with coronary artery disease, while the remainder have primary myocardial, valvular, or congenital heart disease. Fellows serve as the primary operators on all cases, with faculty supervision. At least one to two hours daily are devoted to a didactic session in which cases are discussed in depth by faculty and fellows. Fellows also rotate through the catheterization labs at University Hospital–St.Paul, which performs 1,500 cases annually (250 interventional procedures) and the VA Medical Center, which performs 1,400 cases annually, including more than 50 peripheral arterial cases and more than 400 interventional procedures.

Cardiac Electrophysiology

The Clinical Electrophysiology Service cares for patients with cardiac rhythm disturbances at Parkland, University Hospital–St.Paul, and the VA Medical Center, where full-time faculty actively participate in all aspects of clinical electrophysiology, including ablation of supraventricular and ventricular tachycardias and implantation of cardiac pacemakers and defibrillators. Approximately 900 to 1,000 cases each year are performed in these institutions. Cardiology fellows spend two months of their core curriculum on the electrophysiology service. Fellows with plans to specialize in clinical cardiac electrophysiology spend two full years training in clinical and research electrophysiology.

Consultative Cardiology

Active consult services at each of the three teaching hospitals permit trainees to be involved in the care of patients with an extraordinary diversity of cardiovascular diseases. Fellows supervise the activities of house staff in conjunction with senior cardiology faculty. Special experiences also are available in postoperative management of patients undergoing cardiac surgery, cardiac rehabilitation, and pediatric cardiology.

Congestive Heart Failure and Cardiac Transplantation

Special training in the diagnosis and management of patients with ventricular dysfunction is available in the context of a specialized heart failure service. Mark Drazner, MD, oversees the congestive heart failure service/transplantation programs at Parkland and University Hospital–St. Paul. Fellows have the opportunity to participate in the care of patients with advanced congestive heart failure, perioperative, and long-term management of patients receiving transplants, and an active clinical and basic research program.

Preventive Cardiology

The Program in Preventive Cardiology offers exposure to diverse areas in the field of preventive cardiology, such as complex dyslipidemias, metabolic syndrome, premature and familial coronary artery disease, exercise and nutritional counseling, cardiac rehabilitation, and atherosclerotic imaging. Additional exposure to preventive care is available through the Section of Hypertension within the Division of Cardiology and the Center for Human Nutrition.