Cardiology – Interventional Cardiology Fellowship

Overview

This highly specialized one-year AGCME approved program provides state-of-the-art training in interventional cardiology. The goals of the program are for trainees to become competent in performing a variety of coronary artery interventional procedures including but not limited to balloon angioplasty and stenting, atherectomy, intracoronary physiology and imaging, and mechanical circulatory support. Trainees will also work towards obtaining competency in non-coronary cardiac and peripheral interventions. Heavy emphasis is placed on both pre- and post-operative evaluation and management. Engagement in scholarly activity is expected during the program and promoted though faculty mentorship. Graduates of our program are poised to successfully compete for advanced fellowships, and clinical and academic positions and have demonstrated a track record of success and leadership in the field.

Omar N. Hyder, MD
Director, Vascular Imaging, Lifespan Cardiovascular Institute
Director, Interventional Cardiology Fellowship Program

Faculty

J. Dawn Abbott, MD
Director, Interventional Cardiology, Director, Cardiac Catheterization Laboratories, Rhode Island and The Miriam Hospitals

Douglas M. Burtt, MD
Medical Director Inpatient Services, Lifespan Cardiovascular Institute

Paul Gordon, MD
Program Director Structural Heart Disease Fellowship
Interventional Cardiologist

Shafiq T. Mamdani, MD
Interventional Cardiologist

Marwan Saad, MD
Interventional and Structural Cardiology

Barry L. Sharaf, MD
Interventional Cardiologist

Mitchel Sklar, MD
Interventional Cardiologist

Peter A. Soukas, MD
Director, Peripheral Vascular Interventional Laboratory, The Miriam Hospital

Program Description

The Interventional Cardiology Fellowship Program at Brown is based at Rhode Island Hospital (RIH) and The Miriam Hospital (TMH). The program is one year in duration and trains four fellows annually. Fellows’ time is split evenly between RIH and TMH. The rotation schedule is designed to optimize integration among the fellows and faculty at the two sites. The rotations at each site will include experience performing interventions in the Catheterization Laboratory and a half-day weekly outpatient experience in the subspecialty clinics of interventional, structural and endovascular cardiology. One half-day weekly is also protected from clinical responsibility to pursue scholarly activity. Fellows take call from home on average every other night split between primary and secondary call covering the two institutions (RIH/TMH). Including the daytime schedule and call, fellows will work no more than 80 hours in a given week.

• Training Sites

  The Emergency Room of Rhode Island Hospital is one of the busiest emergency rooms in the Northeast with over 150,000 patient visits/year and over 500 patients admitted with confirmed myocardial infarction. We are a center of referral for patients with shock or who have failed lytic therapy at other medical centers. Rhode Island has a cardiac catheterization lab within the emergency room, a 10 bed CCU and a 24 bed intermediate coronary unit. It is home to busy cardiac surgical and structural heart programs. The Miriam Hospital is a 247 bed facility with a busy cardiac cath lab and a large cardiac rehab program. Both RIH and TMH have 24/7 primary PCI programs for ST elevation myocardial infarction. The volume of patients coupled with multiple protocols for acute myocardial infarction provides Interventional fellows with a unique experience of emergency cardiac catheterization and intervention in unstable patients with coronary disease. Each fellow participates in the cognitive and procedural aspects of managing such patients including the use of percutaneous mechanical circulatory support, emergency cardiac care and primary and rescue percutaneous coronary intervention.

• Conferences

  Interventional fellows attend and participate in several conferences. Weekly conferences include the interventional didactic curriculum conference, the peripheral clinical conference, the cardiac catheterization and intervention clinical conference, as well as the Division of Cardiology Grand Rounds. Interventional fellows present cases at the clinical conferences and are asked to discuss patient selection, procedural strategy and patient management. Interventional fellows will be expected to review topics and make formal presentations at the didactic conference and the Division grands rounds. Fellows have a quality improvement (QI) curriculum and carry out a QI project over the course of the year. The fellows are also responsible for preparing the monthly Cath Lab Morbidity and Mortality Conference, and an Interventional Journal Club which is held quarterly. Fellows are assigned a faculty mentor for presentations and journal clubs.

Curriculum

The curriculum spans several aspects of interventional cardiology from basic science to psychomotor skills of procedural practice. Specific areas of concentration are:

• Basic science

  • Vascular biology including the process of plaque formation, vascular injury, vasoreactivity, vascular healing and restenosis
  • Hematology including the clotting cascade, platelet function, thrombolysis and methods for altering clot formation
  • Coronary anatomy and physiology including location and distribution of vascular segments, lesion features and their significance to intervention, alterations in coronary flow due to obstruction, assessment of flow dynamics, function of the collateral circulation and the effects of arterial spasm or microembolization

• Pharmacology including

  • Biologic effects and appropriate use of vasoactive agents, antiplatelet drugs, thrombolytics, anticoagulants and antiarrhythmics
  • Biologic effects and appropriate use of angiographic contrast agents

• Patients selection and procedural indications and contraindications

  • Indications for angioplasty and related catheter-based interventions in ischemic heart disease including factors that differentiate patients who require interventional procedures rather than coronary bypass surgery or medical therapy
  • Indications for catheterization on intervention for patient having acute myocardial infarction
  • Indications for mitral, aortic and pulmonary balloon valvuloplasty in the management of valvular heart disease including factors that differentiate patients needing valvuloplasty from those who need surgical valve repair or replacement
  • Indications for catheter-based intervention for patients with congenital heart disease
  • Indications for interventional approaches to patients with acute coronary syndromes who are hemodynamically compromised including the use of pharmacologic agents, balloon counterpulsation, emergency pacing and stent placement

• Procedural techniques

  • Planning and conduct of interventional procedures including knowledge of options, limitations, outcomes and complications
  • Selection and use of guiding catheters, guidewires, balloon catheters, ultrasound catheters, stents and atherectomy devices
  • Knowledge of intravascular catheter techniques and their risks
  • Use of antithrombotic agents during interventional procedures
  • Management of hemorrhagic complications
  • Management of hemodynamic complications

• Imaging

  • Identification of anatomic features and visualization of lesion morphologies by angiography and intravascular ultrasonography
  • Radiation physics, radiation risks and injury and radiation safety including methods t control radiation exposure for patients, physicians and staff

• Research

  • Designing and investigation to test a research hypothesis in interventional cardiology
  • Creation of a database for data entry and analysis
  • Interpretation of scientific data
  • Understanding and application of statistical techniques

• Other areas

  • Ethical issues and risks associated with diagnostic and therapeutic techniques
  • Obtaining proper informed consent for clinical and research purposes

Research

• Clinical and Animal Investigation

  A required component of the curriculum is for fellows to identify a research theme and to complete at least one research project from beginning to end. There are faculty members at the Rhode Island Hospital and Miriam Hospital campuses that can serve as mentors for these efforts. Resources to support research include a fully equipped and staffed animal lab experienced in the porcine model, an angiographic core laboratory with a large database derived from multiple clinical trials, information technology support to assist in the creation of computer databases, support for statistical analyses, equipment in the adult cath lab for measuring coronary flow and fractional flow reserve, quantitative coronary angiography and digital subtraction angiography. The objective of the research experience is to promote lifelong involvement in scientific research and to begin preparing fellows to become capable independent investigators should they choose a career in academic medicine. A monthly Interventional research conference is held at RIH with the program director and faculty research mentors. Interventional fellows also attend a monthly Division of Cardiology Research Conference.

• Participation in Multicenter clinical trials and Exposure to New Therapies in Interventional Cardiology

  The Interventional Cardiology programs at Rhode Island Hospital and The Miriam Hospital have a long history of participation in clinical trials of new interventional therapies. Both sites have a cardiac research office staffed with research nurses and support personnel. Many trials enroll at both sites. Fellows are exposed to the issues of study design, trial conduct, data collection, analysis, presentation and manuscript preparation. In addition, fellows may have the opportunity to participate in the evaluation of new devices prior to clinical release. These have included directional atherectomy, perfusion balloon catheters, local delivery devices, rotational atherectomy devices, brachytherapy devices, endomyocardial laser devices and second and third generation stents. These activities expose fellows to new therapies and instruct them in techniques for objective evaluation.

• Protected Time for Education

  The Interventional Program curriculum is structured to permit fellows adequate time to read, complete research assignments and perform other scholarly activities. The Hospitals support Physicians Assistants for the Cath Labs. Physicians Assistants can work-up patients, assist in procedures and perform post-procedural care thus allowing fellows protected time free of clinical obligations.

Application Information

We participate in the ERAS application process. For information on application timeline, please go to: https://students-residents.aamc.org/training-residency-fellowship/article/eras-fellowship-timeline/

If you have any questions please contact:

Jane Freer
Interventional Cardiology Program Coordinator
Rhode Island Hospital / Brown University
593 Eddy Street
Providence, RI 02903
Tel: 401-444-8689
Fax: 401-444-4652