General Cardiovascular Disease Fellowship
The General Cardiovascular Disease Fellowship Program at Thomas Jefferson University provides broad exposure to acute and chronic cardiovascular disease. Emphasis is placed on the accurate ambulatory and inpatient bedside clinical diagnosis and appropriate utilization and interpretation of diagnostic studies and therapeutic procedures, with the integration of all data into the highest level of clinical care for the individual patient. Throughout the academic year, fellows also participate in a wide range of clinical and basic science research endeavors independently with attending mentorship and/or through the Jefferson Coordinating Center for Clinical Research.
This three year accredited training program begins with a clinical core of 24 months divided into:
12 months of non-laboratory clinical practice activities (cardiovascular consultation, inpatient cardiovascular care, cardiac medical and surgical intensive care, advanced heart failure and transplantation and preventive cardiology / cardiac rehabilitation)
Four months in the cardiac catheterization laboratory
Six months in the noninvasive imaging laboratories (echocardiography [minimum four months] and nuclear cardiology [minimum two months]) and
Two months in clinical electrophysiology consultation.
The last 12 months of fellowship are generally devoted to the fellow’s area of interest. Senior fellows may elect to obtain more experience on advanced rotations through the cardiac catheterization laboratory, electrophysiology laboratory, noninvasive imaging laboratories, advanced heart failure and transplant service, and/or mentored clinical and basic science research.
A continuing ambulatory cardiovascular care experience occurs throughout the three-year training program consisting of one half day per week of patients directly assigned to the fellow, under the guidance of a different assigned attending each year.
The Cardiovascular Disease Fellowship Program at Thomas Jefferson University emphasizes the six competencies recognized by the Accreditation Council for Graduate Medical Education (ACGME) expected of a new cardiovascular practitioner, and required for successful completion of the program:
Practice-based learning and improvement
Interpersonal and communication skills
Advanced Heart Failure & Transplant Fellowship
The Advanced Heart Failure and Transplant Fellowship Program at Thomas Jefferson University is a one-year program that requires fellows to obtain competencies in the 6 areas as defined by the Accreditation Council for Graduate Medical Education (ACGME) to the level expected of a new advanced heart failure and transplant practitioner.
To qualify, applicants will have completed a minimum of three years of residency training in Internal Medicine and an additional three years of fellowship training in Cardiovascular Disease accredited by the ACGME. Our Advanced Heart Failure and Transplant Program was certified by the ACGME in 2012.
The fellow is responsible for patients admitted to the Advanced Heart Failure and Transplant inpatient service, as well as for patients referred for outpatient and inpatient consultation and follow-up. Daily inpatient rounds are conducted with an attending Advanced Heart Failure and Transplant specialist. The service is involved in evaluating and managing patients with advanced heart failure, some of whom will be evaluated for cardiac mechanical assist devices and cardiac transplantation to be performed here at Thomas Jefferson University Hospital.
The fellow is integrally involved in the evaluation of these patients and participates in all management decisions. In addition, fellows are required to observe and/or assist in cardiopulmonary exercise studies, mechanical assist device placement, orthotopic heart transplantation and post-heart transplant right heart biopsies. The fellow is expected to gain a current working knowledge of heart transplantation medicine, including the care of acute and chronic heart failure, use of mechanical assist devices, donor selection, recipient selection, pre- and post-heart transplant hemodynamic management, post-heart transplant immunosuppression, histologic interpretation and grading of biopsies and long-term outpatient follow-up. The fellow is also required to participate in clinical or basic science research under the guidance of an Advanced Heart Failure and Transplant mentor.
Clinical Cardiac Electrophysiology Fellowship
The Clinical Cardiac Electrophysiology (CCEP) Fellowship Program at Thomas Jefferson University Hospital is a two-year accredited program that requires fellows to obtain competencies in the six areas as defined by the Accredited Council for Graduate Medical Education (ACGME) to the level expected of a new CCEP practitioner. It is recognized that the CCEP fellow is a mature individual who will be in his or her seventh year of post-graduate training, having already completed a minimum of three years of residency training in Internal Medicine and an additional three years of fellowship training in Cardiovascular Disease accredited by the ACGME. During the time leading up to the CCEP fellowship, the CCEP fellow will have already learned and mastered many of the important skills (such as consultative skills, professionalism, interpersonal and communication skills, compassionate caregiving, etc.). These skills will be preserved, reinforced and re-assessed throughout the CCEP fellowship via close observation and interpersonal contact.
The field of clinical electrophysiology is a procedure-based subspecialty. Accordingly, the main emphasis of the CCEP fellowship training is to attain procedural proficiency in all aspects of invasive electrophysiology, become skilled at consultative electrophysiology and provide individualized ambulatory follow-up and troubleshooting for patients with implanted devices.
The CCEP Fellow is selected from internal and nation-wide applicants. In the fall of each year, all qualified applicants are offered in-person interviews. During the interview process, each applicant has an opportunity to meet with each CCEP Core Faculty member, tour the EP laboratory, meet with the current CCEP fellows and support staff and have lunch with the program director. By early winter, the CCEP Core Faculty convenes and selects the best applicant; the program director then directly calls the selected applicant and offers the position. Written commitment is then obtained.
Methodology of CCEP Fellow Selection
At the end of the CCEP fellowship program, the fellows should be able to:
Provide expert consultation in all aspects of rhythm management and clinical electrophysiology, pacing and defibrillation, assessing the syncopal patient and managing genetically transmitted diseases such as hypertrophic cardiomyopathy, long QT syndrome and other “channelopathies”
Show knowledge of, indications for and procedural skills and expertise in all electrophysiologic procedures. Such procedures include diagnostic electrophysiology studies (with analysis of complex intra-cardiac electrograms), mapping and ablation for all types of supraventricular tachycardia (including atrioventricular nodal reentry in all its forms, reentry due to an accessory pathway, atrial flutter and atrial fibrillation), mapping and ablation (endocardial and epicardial) for ventricular tachycardia, atrioventricular node modification for rate control in atrial arrhythmias, defibrillator and pacemaker implantation (including cardiac resynchronization devices with left ventricular lead placement), lead extraction including laser extraction, electric cardioversion and tilt table testing
Show expertise in electroanatomic mapping using both CARTO and Velocity mapping systems
Provide individualized outpatient follow-up, management and trouble-shooting of implanted defibrillators and pacemakers
Review, critique and analyze published scientific literature and incorporate the findings of clinical trials into routine clinical practice
Propose, plan and carry out clinical research that will confirm or refute a proposed hypothesis or investigate a clinical issue
Communicate effectively with referring physicians and other medical personnel
Above all, provide ethical, professional and compassionate care to patients and their families
Interventional Cardiovascular Fellowship
The Interventional Cardiology Fellowship Program at Thomas Jefferson University is a one-year accredited program that requires fellows to obtain competencies in the six areas as defined by the Accreditation Council for Graduate Medical Education (ACGME) to the level expected of a new interventional cardiology practitioner. There is an optional non-accredited second year for selected fellows with a focus on advanced structural heart and peripheral vascular disease.
The goal of the interventional fellowship is to prepare the fellow to be a skilled, independent operator in the performance of diagnostic and therapeutic cardiac catheterization procedures. To qualify, all applicants entering interventional cardiology must have first completed a minimum of three years of residency training in Internal Medicine and an additional three years of fellowship training in Cardiovascular Disease accredited by the ACGME. The fellows are required to engage in clinical or basic science research endeavors during the fellowship.
The fellow is expected to perform over 250 coronary interventional procedures (functioning as the primary operator) during the 12-month fellowship. In all clinical experiences, fellows must:
Participate in pre-procedural planning, including the indications for the procedure and the selection of the appropriate technical strategy and equipment
Perform the critical technical manipulations of the procedure
Demonstrate substantial involvement in post-procedural care
Be supervised by teaching faculty responsible for the procedure
The fellow is also exposed to peripheral arterial disease and intervention, as well as structural and valvular heart disease and intervention.