Each fellow has a supervised ambulatory clinic one half-day per week. Some second and third year fellows opt to split their clinics between UMass and the Worcester Veterans Administration Outpatient facility. The goals of the clinic are:

• To gain experience in caring for a wide range of adult patients with cardiac disease in the outpatient setting.
• To learn to communicate well with referring physicians.
• To use clinical experiences to stimulate expansion of medical knowledge and clinical skills.

The cardiac catheterization rotation allows for the performance of catheterizations in a highly supervised setting. The goals of the rotation are:

• To learn to appropriately select patients for cardiac catheterization.
• To understand the risks of cardiac catheterization and to obtain informed consent.
• To gain experience in the performance of right and left heart catheterization.
• To safely attain arterial access.
• To gain a practical knowledge of radiation safety.

This one month rotation prepares the fellow to serve as a consultant to cardiac surgeons and to care for patients before and after surgery. Fellows round with the surgery team, observe surgical procedures and help manage post-operative complications. A better understanding of cardiac surgery enhances the cardiologist’s ability to appropriately select patients for surgical therapy.

Fellows rotate in the CCU for two or three months during their fellowship. The primary educational objective of the CCU experience is the acquisition of the knowledge and experience needed for management of critically ill patients with a variety of cardiac and non-cardiac disease processes. Fellows learn to manage intra-aortic balloon pumps, temporary pacemakers and pulmonary arterial catheters. Peripheral ventricular assist devices are sometimes utilized.

Fellows spend several months on the echocardiography/heart station rotation. The goal of this rotation is to gain a full understanding of the role of noninvasive diagnostic testing in contemporary clinical cardiology. The fellows learn all the applications of the following noninvasive modalities during the course of this rotation:

• Transthoracic echocardiography (performance and interpretation)
• Transesophageal echocardiography
• Stress echocardiography (treadmill and pharmacologic)
• Treadmill stress testing
• Interpretation of electrocardiograms
• Interpretation of holter monitors and 30-day event monitors

There is ample opportunity for fellows to obtain "hands-on" experience in performing echocardiograms. This experience provides valuable training for fellows and enhances appreciation of how technical aspects of the ultrasound examination impact the ultimate quality of the data. Fellows also gain extensive experience with quantitative aspects of echocardiography during their rotations and gain familiarity with measurements of left ventricular mass, volume, fractional shortening, and wall stress. Fellows are encouraged to perform quantitative analysis of studies using the off-line analysis systems both for clinical and research studies.
Fellows also have responsibility for EKG interpretation and for performance and interpretation of exercise treadmill tests while on the heart station rotation.

Fellows spend two months on the EP rotation. The goal of the EP experience is to develop the ability to diagnose and manage arrhythmias. The fellow is expected to become familiar with the HRS/AHA/ACC guidelines for pacemaker and ICD implantation, as well as drug therapies for arrhythmias. Fellows perform consultations, implant and program devices, and assist with EP studies.

The major goal of the nuclear cardiology rotation is to become proficient in the performance and interpretation of nuclear stress testing. This training should give fellows the skill and knowledge to perform exercise and pharmacologic stress testing, including dipyridamole, adenosine and dobutamine stress, and to interpret myocardial perfusion and radionuclide ventriculography images.

Fellows spend two or three months on the consultation service over the course of three years. Each fellow takes charge of the busy inpatient consultation service and supervises medical residents and students. The goal of the rotation is to become an excellent consultant, supervisor and communicator.

Fellows rotate on the inpatient “ward” cardiology service, evaluating newly admitted patients. Fellows formulate their own assessments and plans and communicate with housestaff, patients, families and referring physicians, under the guidance of the “ward” attending.

Each first year fellow spends one month at Health Alliance, a community hospital in Leominster, about 20 miles north of Worcester. Fellows work closely with a small private cardiology group, performing inpatient and outpatient consultations and interpreting echocardiograms and nuclear perfusion scans. The goal of the rotation is to gain experience in a community hospital setting.

Each fellow spends at least one month on the heart failure service. Fellows follow patients admitted to the service, perform consultations, and spend time in the heart failure clinic. Two weeks of the rotation are spent at New England Medical Center in Boston, gaining experience with advanced heart failure, ventricular assist devices and heart transplantation.

Fellows spend one month gaining experience with cardiac MRI and cardiac CT. Fellows interpret studies with experienced faculty members.