Rotations

Clinical Training

The UVA Clinical Fellowship in Cardiovascular Disease strives to provide fellows with the training needed to provide high-quality care across the spectrum of cardiovascular disease pathology. All rotations occur at a single busy academic hospital location in Charlottesville, Virginia. A large, diverse patient population is referred to UVA from far-reaching areas of Virginia, West Virginia, and beyond, ensuring that fellows are exposed to some of the most interesting and complex cases in the country. A weekly continuity clinic with dedicated nursing support allows fellows to longitudinally manage common and uncommon cardiovascular conditions while focusing on learning and patient care. On the inpatient side, a night-float system is used on weekday nights to provide overnight coverage for critical cardiology issues and services.

Fellows participate in the following clinical rotations on one to two-week blocks during their training:

Acute Cardiology Service (ACS)

Fellows work in a multi-disciplinary team consisting of an attending cardiologist, Housestaff, students, social workers, and pharmacists caring for patients on a dedicated hospital floor presenting with a wide range of cardiology issues, including myocardial infarction, heart failure, valve disease, and arrhythmias.

Coronary Care Unit (CCU)

Fellows are part of a team of attending cardiologists, Housestaff, and students managing patients with complex cardiovascular diseases, including acute myocardial infarction, intractable arrhythmias, cardiogenic shock with advanced mechanical support (Impella, IABP, LVAD), complex valve disease, and pulmonary hypertension. Fellows supervise or perform procedures such as right heart catheterizations, arterial lines, and temporary pacemaker placement. Fellows carry the STEMI alert pager and serve as the first point of contact to help in decision-making for all inpatient and transfer STEMI patients.

Cardiology Consult Service

Fellows direct a team composed of an attending cardiologist, Housestaff from multiple specialties, and students to help guide other services in the management of inpatient cardiology problems.

Electrophysiology Service

Fellows work closely with an attending electrophysiologist in providing consultation for common arrhythmia-related issues. In addition to learning the advanced principles of device interrogation, they also gain exposure and experience with procedures such as pacemaker/ICD placement and complex ablation.

Advanced Heart Failure Inpatient Service

Fellows are part of a comprehensive team composed of an advanced heart failure cardiologist, advanced providers, Housestaff, pharmacist, and students that manages and consults on patients with a wide range of advanced heart failure pathology. Fellows learn to manage ventricular assist devices and their complications, as well as understand pre- and post-transplant decision-making given UVA’s role as a heart transplant center.

Cardiac Catheterization Laboratory

Fellows work closely with attending interventional cardiologists to gain robust experience in coronary angiography (and its interpretation), right heart catheterization, invasive hemodynamic assessment, LV-grams, mechanical circulatory support, and pericardiocentesis, in addition to exposure to peripheral angiography and structural heart disease cases. With one fellow paired with one attending for each case, the fellows are able to gain gradual independence with the goal of performing these procedures independently well before graduation.

Transthoracic and Transesophageal Echocardiography

Fellows begin their training by being paired with a teaching sonographer to begin to learn the basics of transthoracic image acquisition and are slowly transitioned to a primary interpreter/reader role after satisfying image acquisition skills. Dedicated twice-daily reading sessions with echocardiography attendings serve to build upon this knowledge. Fellows perform transesophageal echocardiograms in a variety of settings, including outpatient and inpatient cases as well as the cardiac surgery operating suite, taking advantage of the diverse valvular pathology that is seen at UVA due to its robust referral network for advanced valve disease and participation in numerous cutting-edge percutaneous valve trials. Most of our fellows elect to sit for the echocardiography boards.

Nuclear Cardiology and Stress Testing

Fellows work with the stress lab staff and a nuclear cardiologist to supervise stress testing, acquire and process images, and interpret studies. The stress lab provides exposure to a wide range of modalities including echocardiography, SPECT, PET, and technetium pyrophosphate.

Additional elective time is provided that can be used among other things for:

Research
Vascular medicine (UVA has a dedicated vascular medicine program and fellowship)
Congenital heart disease (including sports cardiology for university teams)
Specialty outpatient clinics (HCM, vascular, pulmonary hypertension, advanced valve, etc.)
CT/MRI/Advanced Cardiac Imaging modalities
Additional training experiences tailored to each individual fellow’s career interests