Interventional Cardiology Fellowship

Every rotation has its own competency based curriculum, approved by the Program Director. Individual curricula document the skills in each of the six competencies that are expected to be acquired at each level of training. A Core Curriculum forms the backbone of the educational experience at all levels of the training program, with focus on 3 general disciplines in cardiology, each of which are taught via a competency-based curriculum:

1. Interventional coronary, structural, and peripheral procedures
2. Continuity clinic
3. Clinical Research

Fellow involvement in one or more research projects is a requirement for accreditation of the training program and for the fellow’s board eligibility. Published manuscripts are strongly suggested but not mandatory due to the short duration of the training. The program will provide instructions in the critical assessment of new therapies published in medical literature during research conference and journal clubs. A list of fellows’ publications in peer reviewed journals and presentations at scientific meetings by the fellows will be maintained. The type of project a fellow selects will depend on his/her interest and expertise. The ideal project would be one that is designed and implemented primarily by the fellow.

While considering a project, the fellow should identify an attending mentor who has expertise and interest in that particular area. The mentor will provide feedback regarding the feasibility, administrative support needed, and scientific strengths and weaknesses of the project. The fellows should select projects that are relatively straight forward and can be completed during their short training period. The fellow may also participate in a research project that is already on-going. They may also participate in multicenter cooperative studies. After the study is completed, the fellow will be advised and supervised by the mentor in the preparation of the manuscript or the abstract for publication. Monthly research conferences are held during the Thursday conference. Interventional fellows must attend this conference monthly and will occasionally present. Scholarly activities such as writing review articles and reports of interesting or unusual cases are strongly encouraged.

The objective of on-call activities is to provide fellows with acute cases which allow them to develop skills to perform interventions in patients with acute myocardial infarction and cardiogenic shock. At-home call (pager call) is defined as call taken from outside the medical center, and the duty hours are kept precisely in accordance with the ACGME requirements.

a. Fellows taking at-home call are provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.

b. When fellows are called into the hospital from home, the hours fellows spend in-house are counted toward the 80-hour limit.

c. The program director and the faculty monitor the demands of at-home call in the program and, when necessary, make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. Feedback from the fellows is a crucial part of the monitoring process. This feedback is recorded by quarterly monitoring of work hour logs.

d. The on-call and vacation schedules are developed and distributed well in advance.

There are three principal hospital sites for the training program, each with high educational impact:

1. Jackson Memorial Hospital (JMH), a 1300-bed teaching hospital, is the primary teaching institution of the program. Fellows spend four months at JMH. Faculty coverage is provided by University of Miami Miller School of Medicine and Jackson Memorial Hospital academic faculty. The clinical experience is a particular strength in JMH, and includes tertiary care private as well as indigent patients with acute and chronic cardiac disease, advanced heart failure, cardiac surgery, cardiac transplantation, and continuity clinic. Fellows perform approximately two thirds of their total number of coronary procedures at JMH, as well as performing a number of peripheral vascular interventions, structural interventions, septal ablation for hypertrophic myopathy and septal closure of congenital heart defects. The institutional support for the training program is excellent. Thus, given the extent and breadth of cardiology exposure, JMH has high educational impact.
2. The Miami Veterans’ Administration Medical Center (VAMC), a 563-bed general hospital, is a critical part of the training program. Fellows spend four months at the Miami VAMC. The faculty coverage is provided entirely by University of Miami Miller School of Medicine academic faculty. The clinical experience is the strength of the Miami VAMC, and includes a mix of local VAMC patients and tertiary care VA patients as well. In regards to clinical services at the Miami VAMC, fellows supplement their coronary interventional procedures at the VAMC. The patient population includes patients with fairly advanced vascular disease, high risk subsets and complex interventions are performed at the VAMC. Many peripheral vascular disease interventions are done at the VAMC. Thus, the Miami VAMC plays an important role in the training program and has high educational impact.
3. The University of Miami Hospital (UMH), formerly Cedars Medical Center (465-beds) adds a sophisticated and cutting-edge interventional experience within a University-based hospital. The case mix at UMH includes an especially broad range of procedures, allowing fellows exposure to structural cardiac interventions such as percutaneous aortic valve implantation and catheter-based injection of stem cells into infarcted myocardium, in addition to a very active acute MI program, advanced coronary disease intervention and a peripheral arterial disease program. Fellows spend four months at University of Miami Hospital.

Our training program offers the following interventional techniques:

1. Balloon Angioplasty (PTCA)
2. Percutaneous Coronary Intervention (PCI)
3. Primary PCI for acute myocardial infarction
4. Intravascular Imaging (IVUS and OCT)
5. Coronary Physiology (iFR, FFR, CFR)
6. Atherectomy techniques (rotational, orbital, and laser)
7. Mechanical Circulatory Support (IABP, Impella, Tandem Heart, ECMO)
8. Balloon aortic and mitral valvuloplasty
9. Endomyocardial biopsy
10. Transcatheter closure of PFO and ASDs
11. Peripheral interventions
12. Distal protection devices
13. Assist in Transcatheter Aortic Valve Replacement (TAVR procedures under the structural heart program. Thrombectomy devices

Fellows will be exposed to patients with a wide range of cardiovascular disorders and complications requiring cardiac or peripheral interventions. Patients seen by the fellow will include a full range of adults and selected adolescent patients, from a comprehensive mix of ethnic and racial origins. At JMH, the gender mix will be balanced; at the VAMC, the majority of patients will be male. At UMH a larger percentage of valvular heart disease cases will be encountered.

Cardiac diseases encountered and managed typically include but are not limited to the following: Coronary artery disease, advanced heart failure and shock, valvular heart disease, peripheral vascular disease and hypertrophic cardiomyopathy for septal ablation, as well as congenital heart disease in the adult.