Description of Fellowship Program
Creighton University's Cardiovascular Fellowship Training
Program recruits four fellows per academic year for a three year
period which results in a total of twelve fellows. In the first
two years the cardiovascular trainee rotation consists of
the following areas:
1) Inpatient Management: The cardiovascular trainee is responsible for the evaluation, management and care of the cardiology patients in the intensive coronary care, intensive post-surgical care, and the diagnostic medical care units. The medical residents assigned to the cardiovascular trainee's team are also involved in the care of these patients and are under the direct supervision of the cardiovascular trainee. The Staff Cardiologist has the ultimate responsibility for these patients. The fellow is responsible for all intial consultations from other medical and surgical services. She/he is required to supervise and teach the first, second, and third year medical residents as well as the medical students who are assigned to the cardiology service.
Creighton University Medical Center (CUMC): There are currently two cardiology services at CUMC. Each service is staffed by two full time attending cardiologists, one cardiovascular fellow, two medical residents, and anywhere from two to four medical students. The daily census for each service varies between 10 - 20 patients daily. The type of patient problems include a variety of cardiovascular pathology, both acute and chronic, and those requiring acute intervention as well as chronic medical management. The age range is an adult 18 & over. Each service is responsible for the patient's care from the time s/he enters the hospital until discharge. Those responsibilities include evaluation, following the patient through diagnostic procedures and interventions and throughout the remainder of his/her hospital stay. Arrangements are made for patient follow up at the time of discharge. The total number of patients is 3500-4000 per year.
Bergan Mercy Medical Center: A second or third year fellow rotates monthly at Bergan Mercy Medical Center. Each monthly rotation is staffed by an attending physician and one fellow. The daily census at the hospital is approximately five to eight patients. The responsibilities are similar to those for CUMC. In addition, the fellow is an active participant in the performance and interpretation of cardiac caths, stress tests and stress echos.
2) Outpatient Management: The outpatient facilities that may be utilized by the cardiology fellows include:
a) The Cardiac Center, th Ambulatory Cardiology Center, located at 3006 Webster (directly across from CUMC) which is staffed by cardiology faculty.
b) There are 16 outreach sites in outlying Nebraska and Iowa which are visited approximately 46 times per month where both outpatients and inpatients are seen. The average patient volume for the entire outreach program is approximately 750 per month.
c) The Cardiovascular trainee will also rotate through the various cardiac sections at least once but no more than three times during their first two years in the program. Those cardiac sections include: Electrocardiography, Cardiac Catheterization and Invasive Cardiology, Echocardiography, Stress Testing, Nuclear Medicine, Electrophysiology and Pacing, Peripheral Vascular Disease, Preventive Medicine and Cardiovascular Research. The trainee will achieve a Level II training qualification in these sections.
The 3rd year training program will comprise the following areas:
1) Invasive Studies: The trainees who have a special interest and competence in invasive studies will have the option of spending additional time in the Cardiac Catheterization Laboratory. It will be expected that they will develop a degree of expertise that will allow them to perform cardiac catheterizations on acutely ill patients such as those with cardiogenic shock, acute myocardial infarction, or unstable angina. In addition, they will gather experience in hemodynamic and angiographic evaluation and be able to supervise and direct a hemodynamic laboratory. These candidates in general would be expected to pursue an academic career. All 3rd year fellows also will be given additional responsibilities in teaching junior fellows, medical residents, and 2nd and 4th year medical students on the cardiology service.
2) NonInvasive Studies: The noninvasive option in the third year of training will consist of advanced training in echocardiography, doppler echocardiography, and color doppler studies. At the completion of the advanced noninvasive training the trainee should be able to maintain and supervise a noninvasive laboratory and in general will pursue an academic career. The noninvasive cardiology fellows are also required to complete a research project and either complete or publish a manuscript.
3) Nuclear Medicine: The trainees will have the opportunity to achieve a Level II qualification in Nuclear Medicine during their third year of fellowship. They will participate in all nuclear cardiology imaging for an additional 2 to 4 month training period. The fellow will have experience in correlating catheterization/angiographic data with radionuclide data in a minimum of 30 patients. The trainee will be responsible to present clinical data and scintigraphic results in an appropriate teaching forum. They will have extensive hands-on experience with 50 patients; 25 patients consisting of myocardial (perfusion) imaging and 25 patients for radionuclide angiography. The supervised experience will include pretest patient evaluation, radiopharmaceutical preparation, performance of the study, administration of the dosage, calibration and set up of the gamma camera, setup of the imaging computer and processing the data for display acquisition. The trainee must have experience in computer methods for analysis of nuclear medicine studies.