Description of Rotations:
Cardiac Consult Service
The cornerstone of the clinical training at Rutgers Robert Wood Johnson University Hospital is the cardiac consult service, which exposes fellows to a diverse and complex patient population. Fellows serve as the primary decision maker for complex valve disease, heart failure, acute coronary syndromes, arrhythmias and other cardiac conditions, with oversight by attending faculty. There is continuity of many inpatients to the outpatient setting where fellows can continue to participate in their care by directly seeing them in their own fellow’s clinic. The consult service also provides cardiology fellows with opportunities for teaching both medical residents and medical students on bedside rounds. The consult service serves as a robust learning experience that is core to the clinical training of our fellows.
Non-Invasive Cardiovascular Program
Our program provides the full spectrum of diagnostic cardiac ultrasound services including 2-dimensional and Doppler transthoracic echocardiography with and without contrast, 3-dimensional transthoracic echo and strain; stress echocardiography, including bicycle and treadmill exercise, as well dobutamine adjunctive pharmacotherapy; Trans-esophageal echocardiography including 3D imaging
During their first year, training is designed to assist the cardiovascular fellow in developing skills in the performance of diagnostic ultrasound, as well as, mastering basic principles and achieving competence in study interpretation. Senior sonographers supervise the fellow offering direct instruction in performance of the echocardiographic examination. In addition to performing and interpreting their own studies, fellows also attend daily reading sessions. During the second-year fellows, emphasis is placed on interpretive skills and advanced procedures, such as stress echo studies and trans-esophageal echocardiography. All fellows graduate with level 2 training and most take echocardiography boards before they graduate. Fellows who exhibit a particular interest in non-invasive imaging are encouraged to pursue research projects under supervision of the laboratory staff.
Exercise Physiology Laboratory – Nuclear Cardiology
Nuclear cardiology at the Robert Wood Johnsons University Heart Center provides various types of cardiac stress tests that help to identify and diagnose heart disease. The educational initiative is jointly run between the cardiology and radiology services. The laboratory is fully equipped to perform SPECT, PET and Cardiac MRI. Fellows learn the integral role of cardiac stress testing in the practice of clinical cardiology, as well as its limitations, by performing and interpreting studies. The full spectrum of diagnostic services, with and without adjunctive radionuclide imaging, is provided, including: exercise stress testing using treadmill or bicycle, stress testing using atrial pacing, pharmacological stress testing using adenosine, dobutamine or dipyridamole, and metabolic stress testing.
Cardiac Catheterization Laboratory
Each fellow is expected to spend at least 4 months in the cardiac catheterization laboratory. Fellows are lead operators on diagnostic procedures in the Cardiac Catheterization Laboratory, a state-of-the-art suite of five rooms with high-resolution digital fluoroscopy units. A wide variety of diagnostic and interventional procedures are performed. By virtue of being a tertiary referral center, as well as, serving the local New Brunswick community and its environs, Robert Wood Johnson University Hospital exposes the trainee to a varied and complex case load. Fellows gain experience in the appropriateness of interventions, contraindications and potential complications of cardiac catheterization and interventions for assessment of coronary, valvular, myocardial, and adult congenital heart disease. The fellows learn the appropriateness of coronary bypass surgery versus percutaneous revascularization and post-procedural care. Fellows are taught to integrate results obtained from noninvasive imaging modalities and are exposed to an interdisciplinary approach in the formulating the care of each particular patient. Fellows present cases in which they were actively involved in weekly cardiac catheterization conferences and attend monthly multidisciplinary quality improvement conferences. Research opportunities are available and encouraged. For fellows interested in pursuing a career in interventional cardiology an ACGME accredited Advanced Interventional Cardiology Fellowship is available.
Coronary Care Unit
Patients requiring acute care for advanced heart failure (including those awaiting transplant), peri-procedural management of high-risk coronary disease and malignant arrhythmias, patients post cardiac arrest and those in need of extracorporeal ventricular support are admitted to a state of the art 14-bed unit, reserved for the management of these critically-ill patients. During this rotation, fellows are exposed to extremely complex patients and not only learn to manage these patients but take on a leadership role, mentoring residents and medical students during the rotation.
Heart Failure and Transplantation
The management of patients with advanced heart failure at Robert Wood Johnson is a team effort. The fellows are an integral component of the service working closely with physicians and non-physicians alike. This multidisciplinary team consists of members from the heart failure, electrophysiology and cardiac surgery services; caring for patients with advanced disease. The fellows participate in transplant meetings and gain a solid grasp in the management of chronic severe heart failure, pulmonary hypertension, assessment of candidates for transplantation and left ventricular mechanical circulatory support.
Electrophysiology
The Arrhythmia Diagnosis and Treatment program provides the full spectrum of diagnostic and therapeutic cardiovascular services. Diagnostic cardiac electrophysiologic studies are performed, as well as therapeutic cardiac electrophysiologic procedures, including radiofrequency transcatheter ablation, insertion of temporary and permanent pacemakers, and implantation of automatic defibrillators. The cardiac electrophysiology laboratory comprises a state-of-the-art facility accommodating the newest technologies, needs and volume. It’s equipped with new X-ray imaging, mapping systems and a Stereotaxis catheter navigation system. Second-year fellows on the electrophysiology rotation gain competence in the interpretation of commonly performed electrophysiology studies, manage inpatients with arrhythmias or dyssynchrony, learn indications for pacemaker and ICD implementation and become experienced in programming and interrogation of devices. Research is available and encouraged. We are in the process of offering an ACGME accredited Clinical Cardiac Electrophysiology Fellowship for fellows interested in continuing in a career as an electrophysiologist.
Cardiac Surgical Intensive Care
Fellows rotating on the Cardiology Consult service follow patients in the surgical intensive care unit gaining experience in the postoperative care of cardiac surgical patients. Patients on the surgical service often undergo complex procedures with significant comorbidities, so fellows learn the ramifications of the technical and anatomic problems tackled during the operation. Fellows are encouraged to attend surgical cases in the operating room, to gain an appreciation of the complexity of cardiac bypass pump physiology, cardiac transplantation, insertion of left ventricular assist devices and the intricacies of intraoperative management. During their elective time fellows are encouraged to spend time in the surgical ICU.
Structural Heart Disease
Robert Wood Johnson University hospital has a robust Structural Heart Disease Program which sponsors a 1-year, non-ACGME-accredited fellowship opportunity. Our cardiovascular fellows have the opportunity to rotate through this service during their elective months. The program provides a unique exposure in the interventional and medical therapy of structural heart disease with a special focus on transcatheter valve therapeutics. Fellows will participate in the full spectrum of transcatheter structural heart procedures, including aortic and mitral valve therapies, atrial and ventricular septal occlusion, and left atrial appendage intervention. Pre-procedural evaluation, complication management, and post-operative care will be emphasized. During their elective fellows spend approximately one day per week in the Valve Clinic and rotate on the Inpatient Valve Service. An emphasis will be placed on the longitudinal care of patients from evaluation through hospital admission, treatment, post-operative care, and discharge. Fellows are encouraged to participate in faculty-directed clinical research projects and have the opportunity to participate in the enrollment and follow-up of patients in clinical trials.
Elective
Four months of the third year may be spent as Elective at Robert Wood Johnson University Hospital or any prearranged outside institution. These electives are coordinated through the Division Chief and the Program Director. These have proven to be popular and educationally valuable experiences for fellows in past years.
Research Opportunities
The fellows are required to complete a research project prior to completion of their fellowship. The fellows are given research elective beginning their second year. The fellows are encouraged to identify a research mentor in the first few months of their fellowship. The Cardiovascular Research Program performs the full spectrum of basic, translational and clinical research on inpatients and outpatients with cardiovascular diseases and hypertension. Cardiovascular clinical trials, clinical pharmacology studies and outcomes research are three major areas of research activity. The Division is currently involved in 18 active Clinical Trials.
Navigate through our Cardiology Fellowship pages to learn more: