The first two years of the cardiovascular fellowship offer intensive clinical experiences spanning general cardiology and subspecialty fields in both inpatient and outpatient settings. The first year curriculum will immerse fellows in general cardiology, echocardiography, cardiac catheterization, cardiovascular imaging, heart failure, consultative cardiology, and electrophysiology. The second year curriculum will build upon these skills and incorporate experiences in cardiac transplantation/mechanical circulatory support, vascular medicine, adult congenital heart disease and as the team leader in the cardiac step down unit and coronary care unit. Additionally, fellows have the opportunity to explore many of the unique clinical subspecialty programs during 6-8 weeks of elective time, in order to tailor their clinical training to their goals. Clinical fellows rotate primarily at the Massachusetts General Hospital with a weekly half day continuity clinic on site, and also rotate at Brigham and Women’s Hospital as well as the West Roxbury VA Hospital.
|Rotation*||Site||First Year||Second Year|
|Cardiac step-down unit||MGH||3-5 weeks||3-4 weeks|
|Echocardiography||MGH||4 weeks||3-4 weeks|
|Cardiac catheterization||MGH||4 weeks||4 weeks|
|Cardiac catheterization||BWH||3-4 weeks|
|Coronary care unit||BWH||3-4 weeks|
|Coronary care unit||MGH||4-5 weeks|
|Electrophysiology||MGH||4 weeks||2 weeks|
|Heart Failure/Transplant||MGH||2 weeks||4 weeks|
|Nuclear cardiology||MGH||3-4 weeks||3-4 weeks|
|Preventive Cardiology & Genetics||MGH||3-4 weeks|
|Cardiovascular Imaging||MGH||4 weeks|
|Nightfloat||MGH||2-4 weeks||2-4 weeks|
|Adult congenital heart disease||MGH||4 weeks|
|Vascular medicine||MGH||2 weeks|
|Vascular medicine||BWH||2 weeks|
|Elective||MGH||3 weeks||4-5 weeks|
|Cardiothoracic surgery / ICU||MGH||2 weeks|
|Vacation||MGH||4 weeks||4 weeks|
* Please note these are estimates, we are continuously working to optimize our schedule to maximize clinical experiences.
Rotation Director: Dr. Judy Hung
First year fellows develop proficiency in the performance of diagnostic ultrasound, understanding of basic principles and competence in study interpretation. A particular strength is the direct instruction fellows receive from senior sonographers in the performance of the echocardiographic examination during their first rotation.
For second-year fellows, emphasis is placed on interpretive skills and advanced procedures, such as stress echo studies and transesophageal echocardiography. Fellows developing interest in the research aspects of diagnostic cardiac ultrasound are encouraged to pursue projects under supervision of the laboratory staff. Level II training in transthoracic and transesophageal echocardiography imaging can be completed during elective time and/or during the later years of fellowship.
Rotation Coordinator: Dr. Danita Sanborn
One of the strengths of clinical training at MGH is the remarkable variety and complexity of patients seen during this rotation. Fellows serve as the primary cardiologists on new hospital-wide cardiology consultations and admissions to the cardiac step-down unit. Although senior staff provide careful oversight and teaching, the fellow is the main provider and decision maker for patient care. The patients seen while on service are followed as outpatients and form the bulk of each fellow’s practice in the Paul Dudley White associates clinic.
Rotation Director: Dr. Douglas Drachman
Fellows are lead operators on diagnostic procedures in the Knight Cardiac Catheterization Laboratory, a state-of-the-art suite of six rooms with high-resolution digital fluoroscopy units. A wide variety of diagnostic and interventional procedures are performed, with approximately 6,000 cases done per year, approximately 1,400 of which are coronary interventions. Since MGH serves as the primary hospital for the local neighborhood as well as a tertiary referral center for high-risk patients from state, nation and worldwide health centers, cases are varied and challenging. Fellows gain a strong foundation in appropriateness and indications for catheterization, protocols for venous and arterial access, the hemodynamic assessment of cardiac, valvular and coronary function, angiography of coronary and bypass vessels, and post-procedural management. Furthermore, the laboratory is academically-based and has approximately 20 active research protocols. This provides ample opportunity for fellows to pursue their research interests.
Rotation Director: Dr. Ahmed Tawakol
Nuclear cardiology at MGH is a joint effort between the cardiology and radiology departments and provides various types of cardiac stress tests that help to identify and diagnose heart disease. The laboratory has six SPECT cameras and two PET cameras and performs over 7,500 imaging procedures per year. Fellows learn the integral role of cardiac stress testing in the practice of clinical cardiology, as well as its limitations, by performing and interpreting studies. The second year rotation focuses on multimodality imaging techniques. From a research perspective, the laboratory is involved in several multi- and single-center trials, including, for example, the evaluation of new myocardial tracers, the usage of PET for quantitative coronary physiology and nuclear studies of peripheral vascular disease and plaque inflammation.
Rotation Director: Dr. David Dudzinski
The cardiac ICU is a 16-bed unit serving critically-ill patients requiring acute care for advanced heart failure (including those awaiting transplant), periprocedural management of high-risk coronary disease, malignant arrhythmias and cardiac arrest and mechanical ventricular support. Fellows are involved in management of complex cases and play a primary leadership role on the team.
Rotation Directors: Drs. David Sosnovik and Dr. Nina Meyerhson
Fellows spend a month rotating through the cardiac CT and cardiac MRI facilities at Mass General. Fellows also spend a full day of cardiac imaging with Dr. Marcelo DiCarli at Brigham and Women’s Hospital. The second is a half day in the vascular laboratory at Brigham and Women’s Hospital with Dr. Marie Gerhard-Herman.
Rotation Director: Dr. Pradeep Natarajan
Preventive cardiology and cardiac rehabilitation was an innovation at Mass General in 2002. The primary goal of the Preventive Cardiology rotation is to provide the knowledge and skills necessary to successfully initiate and maintain long-term preventive therapies, characterize the inherited basis of cardiovascular disease, and recognize cardiovascular genetic conditions in general clinical cardiology practiceFellows participate in intake sessions, exercise sessions, nutrition visits and team meetings.
Rotation Director: Dr. Erin Coglianese
The management of patients with advanced heart failure at Mass General is a multidisciplinary effort with input from physicians and non-physicians alike. Fellows are integrated into a team consisting of members of the heart failure and cardiac surgery services by caring for patients with advanced disease and participating in meetings discussing transplant status. Fellows should gain a solid grasp of management of chronic severe heart failure and pulmonary hypertension, assessment of candidates for transplantation and left ventricular mechanical circulatory support.
Rotation Director: Dr. Doreen DeFaria Yeh
Fellows become familiar with the anatomy and physiology and current therapies of patients with congenital heart disease or pulmonary hypertension. The multidisciplinary group at Mass General is dedicated to the advancement of care for adolescents and adults born with heart disease. Fellows participate in the weekly Multidisciplinary ACHD Meeting, rotate in pediatric cardiology, genetics aortopathy clinic, as well as Pulmonary Hypertension Clinic in our Pulmonary Unit. Additionally there are several weekly conferences including ACHD Echo Review as well as ACHD Radiology Review and montly review of pregnant patients with cardiovascular disease.
Rotation Director: Dr. Ido Weinberg
Second-year fellows spend one month becoming familiar with the evaluation and management of patients with peripheral vascular disease, including cerebrovascular disease, peripheral arterial disease, renal artery stenosis, complications of venous thromboembolism, and others, 2 weeks at MGH and 2 weeks at BWH.
Rotation Director: Dr. Conor Barrett
The MGH Cardiac Arrhythmia Service was founded in 1978 and was one of the first clinical subspecialty services in United States. The cardiac electrophysiology laboratory comprises a state-of-the-art facility constructed in 2000 and is currently undergoing an expansion and renovation to keep with the newest technologies, needs and volume. Second-year fellows on this rotation gain competence in the interpretation of commonly performed electrophysiology studies, manage inpatients with arrhythmias or dyssynchrony, learn indications for pacemaker and ICD implementation and become experienced in programming and interrogation of devices.
Rotation Director: Dr. Kenneth Shelton
Fellows rotating on the cardiac surgical intensive care unit gain further experience in the postoperative care of cardiac surgical patients. Patients on the surgical service often undergo complex procedures with significant comorbidities, so fellows learn the ramifications of the technical and anatomic problems tackled during the operation. Fellows participate in daily morning rounds with cardiac anesthesiologists, heart failure speacialists and cardiac intensivists. They attend surgical cases in the operating room, to gain an appreciation of the complexity of cardiac bypass pump physiology and intraoperative management.
Rotation Director: Dr. Doreen DeFaria Yeh
Fellows have dedicated time to rotate through three subspecialty programs of their choosing including: Women’s Heart Health Program, Thoracic Aortic Program, The Cardiac Performance Program (Sports Cardiology), CardioOncology, as well as the Heart Valve Program.
Rotation Director: Dr. Doreen DeFaria Yeh
In addition to dedicated subspecialty program selective blocks, two to three additional weeks each clinical year are set aside for elective, spent either at MGH or BWH. These have proven to be popular and educationally valuable experiences for fellows in past years. The third year and beyond function as unrestricted elective time to pursue research, academic endeavors and/or complete level II imaging training.
One of the most valuable aspects of the cardiology program is the opportunity to be the primary outpatient cardiologist for patients across the three years of training. Many of the first encounters a fellow has with these patients will be during their initial inpatient stay, after which they are enrolled in the fellow’s clinic. It is an opportunity to learn the fine points of the longitudinal management of a range of cardiac problems in ambulatory patients. Added to this is the challenge of evaluating new patients referred to the clinic by other providers.
Clinical Opportunities and Electives
Our program core conferences deliver a structured didactic curriculum to supplement clinical experiences in a variety of learning formats, including traditional lectures, hands-on workshops or bootcamps, fellow case presentations, and chalk talks. These conferences include:
After two clinical years of fellowship, most cardiology fellows work with a specific scientific mentor learning the tools of investigation across a broad range of research areas. However, our mentorship program starts at the very beginning of fellowship, when each of our first year fellows is paired with a peer mentor (second year fellow) as well as a faculty career mentor. Both mentors together with the Program Leadership serve as invaluable resources, as fellows hone their academic pursuits and interests.
Our areas of research and expertise are broad and include: cardiac physiology and disease, vascular biology and metabolism, genetics, chemical biology and therapeutics, development and regeneration, computational biology, cardiovascular epidemiology, molecular biology, outcomes research, and clinical trials. Our cardiology fellows have been mentored by on-site faculty as well as offsite faculty at allied institutions across Boston. Faculty are often affiliated with the MGH Cardiology Division, Cardiovascular Research Center, or the Center for Genomic Medicine at MGH. Successful mentorship has also come from faculty mentors at BWH, Harvard Medical School, Harvard School of Public Health, MIT, the Broad Institute, the Framingham Heart Study, the Baim Institute for Clinical Research, and others.
Once a specific investigative area has been identified, our fellows work closely with their primary scientific mentor. In addition, many other resources exist to provide opportunities for the development of non-clinical skills. We have an institutional training grant providing support for up to two years of additional training with a large number of cardiovascular investigators affiliated with the Cardiovascular Research Center. Through the CVRC, fellows have opportunities to present their research at recurrent seminars, and to participate in a core curriculum focused on scientific and investigative skill development.
In addition, many fellows interested in clinical research choose to pursue structured training in research methodology, bioinformatics and biostatistics at the Harvard School of Public Health. Recent fellows have participated in the following structured coursework: