Curriculum

Your clinical training will consist of the first two years spent in core rotations. During the core rotations you will obtain the basic knowledge and technical skills needed to proceed to more advanced training in a subspecialty area. The first year consists of rotations through the various subspecialty laboratories. During the second year, the information learned in the laboratories will be applied to patient care (both inpatient and outpatient). The core rotation areas are described below. A typical rotation schedule follows the core rotation descriptions.

First Year

Cardiac Catheterization Laboratory
While you are in the Cardiac Catheterization Laboratory at Saint Marys Hospital, you will:

• Perform at least 250 catheterization procedures as primary operator
• Develop formal presentations and lead discussions at weekly conferences
• Evaluate patients prior to catheterization procedures and select appropriate intervention techniques
• Gain experience in cardiovascular hemodynamics with assessment of congenital, myocardial, valvular and coronary artery diseases
• Gain experience in coronary angiography and right-heart catheterization
• Interpret hemodynamic data
• Participate in a research project

The staff at the Cardiac Catheterization Laboratory perform more than 6,000 procedures each year. Clinical practice and research are at the forefront of interventional cardiology, including techniques such as atherectomy, laser angioplasty, stent placement and valvuloplasty.

Echocardiography Laboratory
During this rotation you will perform echocardiographic examinations on at least 250 patients and attend several weekly conferences to review basic and advanced echocardiography-related topics.

Mayo's Echocardiography Laboratory performs 25,000 examinations annually, including approximately 1,700 transesophageal echocardiograms and 2,000 exercise and pharmacologic stress echocardiograms.

Electrophysiology Service
During the seven-week electrophysiology rotation, you will:

• Assist the medical staff with managing patients' rhythm disturbances
• Complete electrophysiology consultations on hospitalized patients
• Interpret data collected during studies
• Learn techniques of right-heart catheterization and catheter manipulation as they apply to electrophysiology
• Learn the indications for electrophysiological studies
• Practice various approaches for managing a wide variety of rhythm disturbances
• Be encouraged to participate in a clinical research project

Electrophysiology service physicians perform invasive electrophysiological studies and catheter ablation procedures in two fully dedicated laboratories at Saint Marys Hospital. They also participate in endocardial and epicardial mapping during surgical procedures, and assist with the placement of implantable cardioverter defibrillators. More than 1,300 diagnostic and therapeutic electrophysiology procedures are performed annually.

Nuclear Cardiology Laboratory
During this eight to nine week rotation, you will:

• Develop a basic understanding of the techniques used to determine ejection fraction
• Learn how to assess regional wall motion and estimate ventricular volume
• Learn how to safely conduct exercise tests and interpret exercise electrocardiograms
• Interpret radionuclide angiography, thallium scintigraphy and sestamibi studies
• Participate in regular reading sessions with a nuclear cardiologist
• Present one or more conferences that focus on unusual clinical cases

Mayo's Clinical Nuclear Cardiology Laboratory performs approximately 4,000 studies each year.

Pacemaker Service
During the eight to nine week Pacemaker Service rotation, you will:

• Evaluate all hospitalized patients who may need pacemaker implantation
• Oversee the postoperative care of these patients
• Participate in implantation procedures for pacemakers and implantable cardioverter defibrillators
• Learn the indications for pacing, the principles of pacemaker function and the method for analyzing that function
• Participate in the long-term follow-up of pacemaker patients in the Pacemaker Clinic

Cardiologists perform pacemaker and defibrillator implantation in a fully dedicated operating suite located next to the Electrophysiology Laboratories at Saint Marys Hospital. Specially trained nurses and technicians participate in all of these procedures — over 600 each year. The Pacemaker Clinic handles follow-up consultations for 200 to 250 transtelephonic electrocardiogram transmissions each week.

Second Year

Coronary Care Unit
While you are on the Coronary Care Unit rotation, you will treat critically ill patients and:

• Gain experience running the intensive care unit
• Insert all hemodynamic lines and temporary pacemakers
• Supervise the medical residents and students taking rotations on the unit

The Coronary Care Unit averages 1,500 admissions per year. These patients have acute ischemic syndromes, arrhythmias, refractory heart failure, pacemaker difficulties and a wide variety of other complex cardiac problems.

Cardiology Hospital Service
This important rotation allows the fellow to have primary responsibility for the evaluation and treatment of patients hospitalized with cardiology problems. Through overview by cardiology staff, expeditious cost-effective medicine is emphasized.

Outpatient Consultations
There is a large, outpatient subspecialty practice in cardiovascular diseases. During this rotation you will see 15 to 20 new outpatients per week, with a diversity of diagnoses, including coronary artery disease, valvular heart disease, pericardial disease, cardiomyopathy and vascular disease. You will be responsible for the full work up and follow-up of these patients.

Inpatient Consultations
During these rotations you will see up to eight new cardiac patients per day on the consulting services of Saint Marys Hospital, and make follow-up visits on previous patients as needed. A cardiovascular consultant will be assigned to discuss each case with you and help you develop a plan for diagnosis and patient management.

Vascular Medicine Hospital Service While assigned to this service, you will:

• Care for patients with vascular diseases
• Conduct bedside diagnoses of the peripheral vascular system
• Learn noninvasive techniques for evaluating peripheral venous and arterial circulation
• Learn to interpret arteriograms and venograms

Peripheral vascular disease is an integral part of cardiovascular medicine. Mayo has established a dedicated vascular center that brings together the disciplines of clinical medicine, vascular radiology and vascular surgery. The vascular practice performs approximately 1,400 surgical procedures, 4,500 peripheral arteriograms and venograms and 5,500 noninvasive procedures each year.

Cardiovascular Health Clinic and Cardiovascular Surgery
The Cardiovascular Health Clinic, located at Saint Marys Hospital, provides graded exercise testing, inpatient and outpatient cardiac rehabilitation services, and preventive clinical cardiology services. While you are at the clinic, you will:

• Advise patients about lipid control
• Develop appropriate exercise programs and advise patients about them
• Learn how to care for patients and organize their rehabilitation following cardiac surgery or myocardial infarction

During the cardiovascular surgery assignment, you will:

• Spend time in the operating room observing cardiac bypass and other procedures
• Attend rounds with consulting surgeons
• Learn about drugs used for recovering cardiovascular surgery patients
• Participate in the postoperative care and management of patients in the intensive care unit

Electrocardiography Laboratory
During this rotation you will:

• Learn to read a wide variety of complex tracings dealing with disorders of cardiac rhythm, acute myocardial infarction or ischemia, and congenital heart disease
• Review 24-hour ambulatory monitoring recordings and interpret signal-averaged electrocardiograms
• Participate in a clinical research project

You may assist with Electrocardiography Laboratory emergencies, such as when a patient has markedly abnormal rhythms or evidence of myocardial ischemia or injury during an electrocardiogram.

Continuity Clinic
During all four years of your fellowship, you will spend one-half day every week in the Continuity Clinic, providing follow-up care to your patients.

Adult Congenital Heart Disease Service and Heart Failure Clinic
Mayo operates one of the few adult congenital heart disease clinics in the United States. Referrals from all over the world come to this clinic for subspecialty consultation and possible surgery. The Heart Failure Clinic is a busy practice, managing all aspects of advanced cardiac dysfunction. Active research protocols in this area include investigational drugs, unique permanent pacing protocols and experimental surgical procedures. These are optional rotations.

Typical Core Rotation Schedule
The following is a typical two-year core rotation schedule.

First Year Rotations	Length
Cardiac Catheterization Laboratory	16 weeks
Echocardiography Laboratory	13 weeks
Electrophysiology Service	7 weeks
Nuclear Cardiology Laboratory	9 weeks
Pacemaker Service	7 weeks
Second Year Rotations	Length
Coronary Care Unit	12 weeks
Inpatient Consultations	12 weeks
Cardiology Hospital Service	12 weeks
Cardiovascular Health Clinic and Cardiovascular Surgery	4 weeks
Advanced Echocardiology, Cardiac Catheterization or Pacemaker Laboratory	8 weeks
Electrocardiography Laboratory	4 weeks

Didactic Training

Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one instruction are integral parts of Mayo's Cardiovascular Diseases Fellowship Program. You will have ample opportunity to attend and participate in these activities. For example:

Weekly

• Adult Catheterization Laboratory Conference
• Cardiovascular Grand Rounds
• Catheterization Laboratory Hemodynamic Conference
• Clinical Examination Rounds
• Echocardiography Laboratory Conference
• Electrophysiology Conference
• Electrophysiology Journal Club
• Hypertension Conference
• Nuclear Cardiology Conference
• Pacemaker Conference
• Pediatric Catheterization Conference
• Vascular Conferences

Monthly

• Cardiovascular Society Dinner Meeting (visiting lectures)
• Echocardiography Journal Club
• Heart Failure Journal Club
• Nuclear Journal Club
• Trainee Journal Club

A core curriculum conference sequence for cardiovascular fellows is held each Monday evening throughout the academic year. This series covers all major areas of cardiovascular medicine. The initial half-hour of each meeting is devoted to the teaching of electrocardiography. In addition, six to eight visiting faculty dinner meetings and lectureships are held annually.

Case Studies
During your fellowship you will prepare case study presentations for CV Grand Rounds, present the pertinent information of an interesting case, conduct an in-depth discussion of that case, and create a current bibliography.

Teaching Opportunities
You will have the opportunity to teach Mayo Medical School students, residents and visiting students from other medical schools through bedside instruction and formal didactic lectures.

Call Frequency
Your call schedule will vary by individual rotation. Mayo Clinic College of Medicine follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME).

Moonlighting
Moonlighting is permitted for licensed fellows. Moonlighting activities may be scheduled during those times when you are assigned to consultative or outpatient rotations.

Moonlighting should not interfere with the required learning and must not violate the ACGME's work hour rules or visa regulations. Moonlighting should not compromise your education, but rather enhance it.

Evaluation
To ensure that you acquire adequate knowledge and develop your technical skills, your performance will be monitored carefully during the course of your cardiovascular fellowship program. You will be evaluated formally by your supervising faculty member after each clinical rotation. In addition, you will regularly evaluate the faculty to ensure that your educational needs are being met.

Research Training
After two years of core rotations, you will finish your fellowship with one year each of research and electives. These years are tailored to individual interests and goals. Although you will participate in research activities throughout your entire fellowship, this additional year of research allows you to gain significant experience in a particular basic science or clinical subspecialty area.

Subspecialty research positions are available in the following basic sciences:

• Cardiovascular Imaging
• Cardiovascular Molecular Biology
• Electrophysiology
• Endothelial function
• Genetics/Epidemiology
• Restenosis

Your clinical subspecialty research options include:

• Adult Congenital Heart Disease Clinic
• Cardiac Catheterization Laboratory
• Cardiac Imaging
• Echocardiography Laboratory
• Electrophysiology Laboratory
• Heart Failure Clinic and Transplant Service
• Hemodynamics
• Nuclear Medicine Laboratory

Mayo cardiovascular fellows have consistently succeeded in publishing the results of their research; approximately 60 papers and abstracts are published by fellows each year. Mayo fellows also have received many national awards, including the American College of Cardiology Young Investigators Award, American College of Cardiology/Merck Scholarship, American College of Cardiology/Bristol Laboratories Travel Award and the North American Society of Pacing and Electrophysiology Young Investigators Award.

Electives
Your elective options in Mayo's Cardiovascular Diseases Subspecialty Fellowship Program are outstanding. Your elective options include:

• Six to 12 months focusing on invasive cardiology — including complex hemodynamics, procedures such as transseptal catheterization and endomyocardial biopsy and clinical invasive investigation
• More training in the Cardiovascular Health Clinic
• Six to 12 months in echocardiography, including intensive exposure to transesophageal and stress echocardiography
• Six to 12 months in advanced training in nuclear cardiology, which can fulfill the requirements for licensure by the Nuclear Regulatory Commission (This training will include in-depth exposure to physics, radiation safety, radiopharmaceuticals and instrumentation, as well as more experience in reading and interpreting radionuclide angiograms and thallium/sestamibi scintigrams.)
• Six months gaining intensive implantation experience in the pacemaker laboratory
• More clinical experience in peripheral vascular diseases and training in noninvasive testing, imaging techniques and catheter therapies
• Training in adult congenital heart disease

Two years of advanced training and research meeting board eligibility requirements are available in:

• Electrophysiology
• Interventional cardiac catheterization

Board Review
To prepare for the American Board of Internal Medicine Certifying Examinations, 70 one-hour review sessions are presented by staff from January through May. All PGY-3 residents receive a complimentary copy of the board review textbook published by Mayo. Videotapes and lecture notes of the presentation also are available at Mayo's libraries.

Cardiovascular Board Review
Provided free to Mayo Cardiovascular fellows, the Mayo Cardiovascular Review Course for Cardiology Boards and Recertification will provide the internist and cardiologist with an overview of all aspects of cardiovascular medicine. In-depth didactic lectures on state-of-the-art subjects in cardiovascular medicine will be given by well-know experts in each field. Although this course is designed specifically to prepare the cardiovascular specialist for the Cardiovascular Boards, it will also provide the internist or practicing cardiologist with an update on the latest knowledge and advances in cardiovascular medicine. This course will also serve as a review for those who will be taking the cardiovascular recertification boards.

Each participant will be givena comprehensive syllabi, specifically written for those taking the Cardiovascular Boards.

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