Deborah sponsors a one year Cardiology Subspecialty Training Program in Interventional Cardiology for graduates of AOA approved general cardiology fellowships who are board eligible or board certified in general cardiology.
Guidelines for One Year Program Osteopathic Fellowship
Osteopathic 4th year Interventional Cardiology trainees who have graduated from an AOA accredited medical school and have competed an AOA approved internal medicine residency program and who have also completed a three year general cardiology fellowship program. They are to be board eligible or board certified in general cardiology.
Formal evaluation with feedback to the fellows is an important part of the training process. Each quarter will require an evaluation of the fellow by the interventional attending laboratory staff. This evaluation will be conducted by the Interventional Cardiology Program Director. The fellows may review their evaluations and questions can be directed to the Program Director.
Fellows evaluations of the training program are important for maintaining and improving the quality of the teaching program. Each quarter, the fellow will complete an evaluation form. The forms will be forwarded to the Program Director for review. All responses are kept confidential and used to provide general feedback to individual Catheterization Laboratory attendings, nursing and auxiliary staff.
A database will be maintained by the training program. This will include the number of diagnostic and interventional catheterization laboratory procedures performed by each fellow. The database will be quite specific as to the procedures performed with each individual catheterization laboratory diagnostic and/or interventional device.
Interventional Skills review weekly on Tues. at 12:00pm; Adult Congenital Conference monthly on Tues. at 7:30am; Cath Conference weekly on Wed. at 7:30am; Endovascular Conference weekly on Thurs. at 7:30am; Monthly M&M/PI case reviews for all adverse events. An assigned attending physician will present these conferences. Individual cases may be presented by the training fellow. Teaching objectives of the invasive cardiology conferences as noted will be primarily case review type conferences. The individual cases may be presented by the attending physician and/or fellow in training. Case selection, invasive- interventional equipment choices and interventional techniques will be discussed in detail. Complications and/or possible complications will be reviewed. Pre and post procedure care will be discussed. Alternative therapies will be reviewed. Individual attending preferences will be discussed and when appropriate clinical data supporting decision making will be reviewed.
At the assigned attending’s discretion, this case review conference may alternatively be in the form of didactic lecture directed towards emerging and/or controversial issues in the field of invasive- interventional cardiology.
Applicant will participate in Interventional Endovascular clinic ½ day/week on Thurs. and Fri. (rotational coverage by 4 Interventional Fellows.
Program Knowledge and
Skill Set Requirements
The duration of the training program in interventional cardiology shall be 12 months. Of this period a full 11 months should be spent in the interventional cardiology laboratory. One month will be provided for vacation or “elective” time to be used by the trainee at their discretion. The formal interventional cardiology training program will:
1) Diagnosis of cardiovascular disease states amenable to catheter based interventions. Catheter based interventional procedures should be discussed in the context of therapeutic options for the patient including medical therapy or surgery.
2) Indications for urgent catheterization in the management of patients with acute coronary syndromes. Issues regarding the choice of therapy including catheter based intervention, medical or surgical therapy should be established.
3) Indications for and the proper technical placement of intra-aortic balloon counter pulsation devices and other ventricular support devices including Impella®.
4) Indications for and the proper technique for placement of emergency temporary pacemakers.
5) Preparation and performance of interventional cardiology procedures including, but not limited to:
a) balloon angioplasty
b) cutting balloon angioplasty
c) laser atherectomy
d) rotational atherectomy
e) intracoronary bare metal and drug eluting stent deployment
f) thrombectomy (mechanical+aspiration)
g) intravascular ultrasound
h) fractional flow reserve
i) guidewire advancement
j) guide catheter placement
k) femoral, brachial and radial access
l) selection and use of vascular access devices
m) selection and use of vascular closure devices
n) aortic and mitral balloon valvuloplasty
o) trans-septal catheterization
p) coil embolization
q) alcohol septal ablation
6) Preparation and performance of peripheral endovascular interventional procedures, including but not limited to:
a) femoral, brachial, radial and pedal access
b) selection and use of vascular access devices
c) selection and use of vascular closure devices
d) angiography of all peripheral vascular beds, including carotid angiography
e) guide catheter or sheath advancement
f) guide wire techniques and choices for patent vessels and total occlusions (including “sub-intimal wiring”)
g) total occlusion devices
h) re-entry devices
i) atherectomy, including laser, rotational atherectomy, orbital atherectomy, directional atherectomy (Silverhawk®), mechanical atherectomy with aspiration (Pathways®)
j) balloon angioplasty
k) cutting balloon angioplasty
l) stents, balloon expandable and self expanding
m) covered stents and other bail out devices
n) coil embolization
o) interprelation of non invasive peripheral vascular studies
p) drug eluting balloons and other local drug delivery devices
q) intravascular ultrasound
r) prolonged lytic therapy
s) IVC filters
t) venous stenting
u) DVT management with catheter directed thrombolysis
a) active participation in and recruitment for all ongoing peripheral vascular and coronary research protocols
b) generation of at least 2 case reports with extensive literature review
c) protected research time for self generated projects
8) Knowledge of the biological effects and indications for the use of pharmacologic agents common to the practice of interventional cardiology. These agents should include, thrombolytics, antiplatelet agents, anti-thrombin agents, anticoagulants, vaso-active drugs and anti-arrhythmics, sedatives and analgesics. Additionally, indications for the use of various radio contrast agents should be established.
9) Recognition and Management of all potential coronary and peripheral interventional complications, including but not limited to:
a) coronary and peripheral vascular dissection
b) acute vessel closure
c) slow and no reflow phenomenon
d) distal embolization
e) side branch loss
f) vascular access site complications
g) infection: recognition, treatment and follow up
h) acute blood loss and retroperitoneal bleeding
i) cardiac tamponade
j) compartment syndrome
k) acute MI/unstable angina
l) significant cardiac arrhythmias
m) acute stroke
n) acute hypotension and hypertension
o) over sedation/airway management
p) covered stents for perforation
q) snaring of foreign bodies
10) Knowledge of vascular biology including the processes involved in plaque formation, vascular injury and vaso reactivity. A thorough understanding of the process of restenosis and the therapeutic options available for the treatment of this phenomenon. Knowledge of the coagulation cascade and the effect of pharmacologic agents as noted above.
11) Sufficient patient volume to provide the cardiovascular fellow training with a total case volume of 400 interventional procedures. The cardiovascular trainee should serve as the primary operator. The primary operator shall perform under supervision the majority of the technical aspects of the procedure. The primary operator shall be actively involved in decision making regarding equipment selection, problem solving, post procedural assessment and complication management. There will be no volume requirements in regards to diagnostic cardiac catheterization. However, it is strongly encouraged that the trainee perform the minimum number of diagnostic procedures to maintain clinical competency in this field.
12) Understanding of radiation safety and overview of x-ray equipment function.
13) Adequate communication skills to enable the trainee to convey the risks, benefits and general technique of interventional procedure to the patient and family. The trainee should be able to obtain informed consent in this context.
14) Participate in 100% of interventional cases (divided evenly among all fellows) and as many diagnostic cases as possible. Act as primary operator in at least 50% of interventional cases in which fellow participates.
15) Optional training will be available in carotid stenting with both distal and proximal protection devices. To receive certificate, applicant must attend didactic sessions for each device, and must participate in 20 cases, half as primary operator.
16) Optional training will be available for management of structural heart disease, including, ASD, VSD and PFO closure, perivalvular leak closure, left atrial appendage occlusion devices and percutaneous valve replacement.
17) Optional training will be available for management of venous insufficiency, including radio frequency or laser venous ablation. Applicant must participate in a minimum of 20 cases and be primary operator in half.
18) Optional training for abdominal thoracic endograph repair will also be available. Applicant must collaborate with vascular surgery and participate in a minimum of 10 cases.