Six patient-based clinical rotations and four clinical laboratory rotations comprise our highly academic clinical training ground. The fellow will encounter a remarkable range of diagnoses imparted by the breadth and diversity of the patient population of our three adjacent hospital centers.
The Bellevue Coronary Care Unit is a signature rotation for the Training Program in Cardiovascular Disease. Fellows assume responsibility for supervising medical house staff in the care of patients with the vast spectrum of acute cardiovascular diseases particular to this large municipal hospital. This is accomplished under the close supervision of the Director of the CCU and the attending cardiology faculty. The patient population is amongst the most diverse imaginable and the tradition of altruism that permeates this Bellevue learning experience is nowhere more palpable.
The fellow will encounter patients with all manner of cardiac arrhythmias, chest pain and acute coronary syndromes, acute and advanced chronic heart failure, syncope, valvular heart disease, pericarditis, myocarditis, endocarditis and cardiomyopathy. Coordination of care amongst multiple consultants is a must given the array of medical disorders with which these complex patients present. Whether the fellow is suppressing malignant arrhythmias, supporting the deranged hemodynamics of cardiogenic shock, diagnosing a ruptured myocardium or implementing a hypothermia protocol for a cardiac arrest victim, the Bellevue CCU is consistently an exciting challenge.
Educational methods in the CCU include combined teaching and work rounds with the presentation of all admissions to two faculty members, followed by incisive discussion and bedside confirmation of history and physical findings. A basic curriculum is presented and an extensive reading list is supplied. The responsibility is remarkable and the supervision superb.
The Bellevue Hospital Consultation Service allows the fellow in cardiovascular disease to evaluate and assume consultative responsibility for approximately five newly referred patients each day. The fellow will come face-to-face with the entire spectrum of cardiovascular illness at all stages of disease progression. Thus the repeated monthly experiences at this venue prove to be a key part of the fellow’s training and play a central role in the maturation one’s differential diagnostic and patient management skills. The fellow will benefit from the simultaneous service of two fellows, one junior and one senior, as well as the responsibility for teaching of rotating medical house staff and students of medicine. The faculty supervisors are exceedingly experienced and provide daily instructional rounds for 2-4 hours. The Director of the Consultation Service is Dr. William Slater, a premier teacher whose efforts have been recognized repeatedly with “great teacher” awards from the Division of Cardiology, the Department of Medicine and the greater university community of New York University.
The Tisch Hospital Cardiac Care Service affords the fellow in cardiovascular disease the opportunity to manage a large volume of patients admitted by the cardiology faculty for a wide variety of cardiovascular problems. The fellow will personally evaluate each patient and guide their evaluation and management by a team of dedicated second year internal medicine residents. The fellow conducts combined work and teaching rounds daily under the direct supervision of two cardiology faculty members, specifically paired for a synergistic educational endeavor. The fellow’s responsibilities prominently include the teaching of the resident house staff through rounds, the review of clinical laboratory test results and the presentation of prepared didactic sessions. Interaction with a large number of individual attending physicians broadens the experience. The importance of systems-based practice skills in cardiovascular medicine is stressed as the fellow undertakes interdisciplinary rounds and ensures the documentation of all core measures required for optimal care of patients with acute coronary syndromes, heart failure and preventive cardiology. The entire cardiology community benefits from this experience, as the fellow becomes a primary player in the implementation of evidence-based cardiovascular care.
This advanced clinical rotation imparts to the more senior fellow responsibility for the care of critically ill patients in the VA Hospital CCU and medical ICU, as well as the responsibility for providing cardiology consultation to the VA medical center as a whole. This campus of the veterans administration hospital system is a central referral site for almost all the interventional cardiology presenting across a large swath of the greater New York area including Long Island, the Hudson Valley, northern New Jersey and eastern Pennsylvania. The critical care of our ever growing and aging population of veterans is implemented by the fellow in cardiovascular disease under the direct supervision of a remarkably experienced faculty, both in terms of their patient care record and their clinical research portfolio. This intense learning experience is widely viewed by our trainees as an important step in consolidating the fellow’s knowledge base and translating that into effective, high quality care.
The fellow in cardiovascular disease will rotate for a month’s time on the Heart Failure Service under the direct supervision of our heart failure faculty. This advanced clinical experience encompasses consultation responsibilities at both Bellevue and Tisch Hospitals for patients with a broad array of heart failure etiologies, presentations and degrees of decompensation. The educational process concentrates on historical and physical findings in addition to a strong emphasis on evidence based therapies and diagnostics. A very strong instructional effort focuses on myocardial and circulatory pathophysiology, and complex hemodynamics in particular. A variety of implantable therapeutic and diagnostic devices are available to our heart failure specialists and their patients; familiarity with these state-of-the-art approaches is an important objective of this rotation. Coordination of care with our electrophysiologists, interventional cardiologists, imaging specialists and cardiothoracic surgeons is at the core of this rotation’s responsibilities.
The first cardiology clinic in the U.S., the John Wyckoff Cardiology
Clinic at Bellevue Hospital originally met for two hours every Thursday
night to accommodate working patients who had previously suffered from
myocardial infarction. It has grown to encompass several afternoons
weekly and to care for patients suffering from the entire gamut of
cardiovascular disease. In addition, satellite clinics for patients with
chronic heart failure and for patients with pacemakers and
defibrillators are a part of our outpatient training. The fellow will
assume the care for a panel of patients that will become “their own,”
and follow these patients for the duration of fellowship training. This
continuity clinic affords the trainee an excellent experience in the
longitudinal care of cardiac patients, one that imparts an understanding
of the natural history of disease and the effects of its treatment.
Moreover, the fellow can expect to build the relationships and trusting
interactions that reward the practice of cardiovascular medicine
throughout one’s career.