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), William P. Clements Jr. University Hospital (460 beds), and the Dallas Veterans Affairs Medical Center (720 beds). These three distinctive clinical settings provide a rich mixture of patients with diverse cardiovascular problems
This 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 which 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, an individualized plan is created for each individual fellow for subsequent experiences in clinical and research training depending upon their unique career goals..
Clinical Training Highlights
Acute Coronary Care
The coronary care unit (CCU) service at Parkland, the major county hospital for Dallas County, occupies a 35-bed intensive care unit shared with the MICU service and an adjacent 18-bed sub acute cardiac care floor. All patient rooms in the hospital have telemetry capabilities. Approximately 1500 patients annually with diverse cardiovascular illnesses are served by four teams of housestaff and students, supervised by two cardiology fellows and two attending cardiologists. Patients with acute coronary syndromes or other cardiovascular emergencies are also managed in a combined medical-surgical cardiovascular ICU at Clements University Hospital. At the Dallas VA, 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.
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 Memorial Hospital and Clements University Hospital 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 1,500 procedures annually, of which approximately 500 are interventional procedures. Approximately 65 percent of patients present with coronary artery disease, while the remainder have primary myocardial, valvular, peripheral arterial 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 the Clements University Hospital which performs 1,700 cases annually, including almost 400 coronary interventions. They will also gain experience with structural interventions including TAVR, MitraClip, and adult congenital cases as experience with short term mechanical circulatory support. The VA Hospital which performs 1500 cases annually, including more than 150 peripheral arterial cases and over 600 interventional procedures, with a robust clinical research program and particular expertise in complex coronary interventions including one of the largest chronic total occlusion (CTO) programs in the country.
The Clinical Electrophysiology Service cares for patients with cardiac rhythm disturbances at Parkland, Clements University Hospital, and the VA Medical Center where full-time faculty actively participate in all aspects of clinical electrophysiology, including ablation of supraventricular tachycardias, ventricular tachycardias and atrial fibrillation and implantation of cardiac pacemakers and defibrillators. Approximately 900-1000 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 years training in an ACGME-accredited advanced fellowship in electrophysiology.
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 housestaff 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 advanced heart failure is available in the context of a specialized heart failure service. In addition to participating in the CHF clinic at Parkland Memorial Hospital, fellows will spend at least one month on the heart failure/transplant/device therapy service at Clements University Hospital which is staffed by heart failure/transplantation faculty member, a senior and junior cardiology fellow, as well as a team of medical residents. Fellows have the opportunity to participate in the care of patients with advanced heart failure, perioperative, and long-term management of patients receiving left ventricular assist devices or transplants, and an active clinical and basic research program
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 exposures to preventive care are available through Hypertension, the Center for Human Nutrition, and the Eugene McDermott Center for Human Growth and Development at UT Southwestern.