Core Curriculum

When on the inpatient Heart Failure and Transplant Cardiology service, the cardiology fellow will hold primary responsibility for care of all patients on the service as well as those patients on whom the service is consulted by cardiac surgery and other services in the hospital. While at times there will be a resident or nurse practitioner on the service as well, allowing the fellow to work in a supervisory manner, at other times patients will be cared for primarily by the fellow under the supervision of the attending physician. The fellow will participate in daily rounds Monday through Friday and one weekend day.

A. Initial Patient Evaluation (for both primary service patient and consult patients)

  1. Careful history-taking and physical examination skills are essential to care of the heart failure patient. Emphasis is placed on learning how to take an accurate heart failure history and how to perform a bedside
    physical examination for determination of volume status and perfusion.
  2. Generation of written or dictated history and physical and impression with treatment plan.
  3. Interaction with the attending Heart Failure/Transplant Cardiologist for refinement of history and physical and discussion of evaluation and treatment plan.
  4. Review of diagnostic studies patient has had (echocardiogram, coronary angiography, stress tests) with the attending Heart Failure/Transplant Cardiologist.
  5. Interaction/discussion of patient with appropriate consultants.

B. Subsequent Patient Follow Up (daily rounds)

  1. Daily rounds (including bedside discussion, patient examination) with Heart Failure/Transplant Cardiologist, nurse practitioner, social worker.
  2. Ordering of pertinent tests and therapies.
  3. Interactions with consultants and other members of the healthcare team as care evolves.
  4. Interaction with all members of the multidisciplinary team to address barriers to compliance and optimize all aspects of care.
  5. Participation in discussion with the patient and family and discharge
    planning.

C. Procedural Skills

  1. The fellow will learn how to assess volume status and perfusion at the bedside in cardiac patients using refined physical diagnosis skills.
  2. The fellow will be responsible for all invasive procedures performed on inpatients on the heart failure and transplant cardiology service, including obtaining informed consent.
  3. There will be opportunity to perform multiple right heart catheterizations, primarily via the right internal jugular approach but occasionally via the left internal jugular or subclavian approach. Fellows will receive instruction in sterile technique and venous access.
  4. Interpretation of hemodynamics obtained from invasive monitoring and understanding of management of the heart failure patient based on invasive hemodynamics.
  5. There will be opportunity for fellow to become experienced in endomyocardial biopsy technique.
  6. Familiarity with implantable cardiac devices used in the management of heart failure patients, including implanted cardiac defibrillators, resynchronization pacemakers, and ventricular assist devices. Emphasis
    will be placed on appropriate patient selection for these therapies.
  7. Familiarity with cardiopulmonary exercise testing, including indications, performance and interpretation of tests.