Rotations

Description

Cardiac Care Unit

Fellows in our 16-bed CCU take primary responsibility for patients with acute MI, shock, heart failure, cardiac arrest and arrhythmias. They are responsible for running rounds and making decisions under the guidance of experienced faculty members. Fellows learn to manage intra-aortic balloon pumps, temporary pacemakers, pulmonary arterial catheters and peripheral ventricular assist devices (Impella CP, Impella RP). 

Cardiac Catheterization Laboratory

On the cardiac catheterization rotation, fellows perform catheterizations in a supervised setting. They become proficient in obtaining informed consent, gaining radial and femoral access, and performing right and left heart catheterization. Radiation safety is emphasized.

Vascular Medicine

This rotation immerses fellows in the care of patients with vascular disease. Fellows attend outpatient clinics, assist in the operating room and catheterization lab, and learn to perform and interpret noninvasive vascular testing. There is also exposure to cardiac surgery during this rotation.

Echocardiography/ Heart Station

Fellows on the echocardiography/ heart station rotation become proficient in performing and interpreting transthoracic echocardiograms, stress echocardiograms (both treadmill and pharmacologic), treadmill stress tests and electrocardiograms.

Transesophageal Echocardiography

Fellows on the busy TEE rotation learn to understand the indications and contraindications for the procedure, manage moderate sedation, and perform and interpret TEEs in multiple settings (echo lab, OR, ICU, EP lab).

Electrophysiology

During the EP rotation, fellows perform consultations, interrogate and program devices, and interpret Holter and event monitors. Those who are interested in doing so may implant ICDs and PPMs and observe ablations.

Nuclear Cardiology

Fellows on the nuclear rotation become proficient in the performance and interpretation of nuclear stress testing, including exercise and pharmacologic tests. They become familiar with radiation safety and the QA procedures that are necessary for running a nuclear laboratory.

Consultation

During the consult rotation, fellows take charge of the busy service and supervise medical residents and students. The goal of the rotation is to become an excellent consultant, supervisor and communicator.

Inpatient

Fellows evaluate and manage admitted patients on the inpatient rotation.  They formulate their own assessments and plans, supervise the house staff, and communicate with patients, families and referring physicians, all under the guidance of the attending.

Heart Failure

On the heart failure rotation, fellows supervise house staff in the care of patients admitted to the service, perform consultations, and spend time in the heart failure clinic, including the VAD clinic. Two to four weeks of the rotation are spent at Tufts Medical Center in Boston gaining experience with the evaluation and management of patients who are awaiting or have undergone heart transplantation. 

Night Float

First and second year fellows spend four weeks (in two-week blocks) on the night float rotation. They are responsible for seeing emergent consultations, formulating tentative plans for admitted patients, performing urgent echocardiograms, and supervising residents in the care of critically ill patients in the CCU. While the rotation offers fellows a high degree of independence, they are encouraged to call their attendings for back up at any time.

Multimodality Imaging 

Fellows spend two months on the multimodality imaging rotation, during which they are exposed to cardiac CT and MRI. Their experience includes image acquisition and processing as well as interpretation of studies.

Ambulatory

Activities on the ambulatory rotation include lipid clinic, nutritional counseling with dieticians, cardiac rehab, heart monitor interpretation, and time with subspecialists in their clinics.

Continuity clinic

Each fellow has a supervised continuity clinic for one half-day per week at the Ambulatory Care Center. Some fellows opt to split their clinic time between UMass and the Worcester Veterans Administration Outpatient facility. Fellows gain experience in caring for a wide range of adult patients with cardiac disease and learn to communicate effectively with referring physicians. All fellows take turns participating in the monthly Adult Congenital Heart Disease clinic and the bimonthly Pulmonary Hypertension clinic. Additionally, fellows now have the opportunity to participate in a clinic for pregnant patients with heart disease.

Elective time

Fellows have approximately 6 months of elective time in their third year. Most fellows choose to use their elective time on their area of primary clinical interest, whether it be EP, cath lab, advanced echo, critical care, heart failure, CT/MR, or a combination of those areas. Some fellows have participated in outside electives including adult congenital heart disease, cardio-oncology and global health. The program director is happy to help fellows design electives that further their career goals. 

Research

Fellows may spend some or all of their elective time on research. In the past few years, most of our fellows have chosen to start their research projects during their first year and engage in research throughout their fellowship, allowing them to spend their valuable elective time on areas of clinical interest. Fellows who are planning careers in academic medicine may be permitted to stay for up to two extra years of funded research, provided they meet NIH eligibility requirements.