A Day in the Life of a Fellow

Below we have included some pictures of the daily life of General Cardiology Fellows during core rotations. We hope you find it useful.

Cardiology consultation service

Fellows on the consult rotation gain the skills to be excellent consultants while providing compassionate care to patients. Fellows run an inpatient cardiology consult team that provides recommendations to the 65-bed cardiac telemetry ward as well as the hospital’s non-cardiology services. Fellows benefit from the guidance and autonomy provided to them by our world-class full-time Senior Staff Cardiologists.

Above: Sign out. The consult day begins with Fellows obtaining sign out from the night float Fellow.
Above: The consult team is composed of Fellows, Residents, Medical Students, Nurse Practitioners, and one Senior Staff Cardiologist.
Above: Every day Fellows attend a well planned general cardiology noon conference in our state of the art conference room. Noon conferences are designed to cover topics you will need for your future practice, general cardiology boards, and subspecialty boards.
Above: Fellows and Senior Staff both give noon conferences. If a Fellow is off-campus they can “web conference” in. Also, lectures can be recorded in case Fellows miss them.

Cardiac Intensive Care Unit

The Henry Ford Hospital Cardiovascular Intensive Care Unit (CICU) is a 26-bed combined cardiology and surgical ICU. Between 90-150 patients per month are admitted to the CICU from the Henry Ford Hospital Emergency Department, Cardiac Catheterization Lab,Cardiac Electrophysiology Lab, other inpatient units, outside referring hospitals and urgent care centers. During the CICU rotation, Fellows are responsible for the diagnosis and management of patients with cardiovascular and critical care diseases including life-threatening acute coronary syndromes, cardiac arrhythmias, congestive heart failure, hypertensive emergencies, and acute aortic syndromes.

Above: The day in the CICU starts with pre-rounds. The Cardiology Fellow discusses patients with Residents in preparation for rounds.
Above: CICU rounds. The CICU team is composed of a Fellow, Residents, Medical Students, Pharmacists, Nurses, and one Senior Staff Cardiologist. Fellows have the benefit of direct supervision and teaching by a Henry Ford Senior Staff Cardiologist.

Heart Failure service

On this rotation, the fellow runs the inpatient Heart Failure ICU and consultative services. The clinical experience offered by Henry Ford’s Heart Failure service is unmatched in competitive fellowship programs. One of the primary educational activities is daily bedside teaching rounds with the Advanced Heart Failure Cardiologist. During these rounds, the Fellow takes an active role in patient management and oversees a team of Residents rotating on the service. The Fellow has comprehensive exposure to advanced invasive hemodynamic monitoring, pre-transplant evaluation, post-transplant immunosuppressive management, myocardial biopsy interpretation, and management of implanted ventricular assist devices and other forms of artificial hearts.

Above: A Fellow rounding with a Senior Staff Heart Failure Cardiologist.
Above: The Heart Failure team conducting bedside rounds in the CICU.

Echocardiography

The goal of the rotation in echocardiography is to train Cardiology Fellows in the performance and interpretation of numerous imaging modalities including but not limited to transthoracic echocardiography, exercise and pharmacological echocardiography, exercise treadmill testing, electrocardiography and holter monitor interpretation and transesophageal echocardiography.

Fellows are under the direct supervision of Henry Ford cardiovascular imaging faculty and receive guidance, feedback and evaluation by the echo lab supervisors/directors. All cardiology fellows are given the ability to obtain COCATS level 2 independent proficiency in echo.

Above: Cardiology Fellows pre-reading echo studies. Senior Staff and Fellows review studies together, and Fellows receive one on one comprehensive teaching.
Above: A cardiology fellow prepares to scan a patient. Fellows have the advantage of being paired with dedicated teaching sonographers to teach them the fundamentals of scanning.

Nuclear cardiology

The nuclear cardiology rotation focuses on teaching the principles of nuclear medicine, cardiac physiology and pharmacology, as well as stress testing. Fellows learn the skills of the adequate performance and interpretation of nuclear cardiology studies including the full spectrum of exercise and pharmacologic myocardial perfusion imaging (SPECT) with all the latest protocols, including CT attenuation correction, gated SPECT blood pool studies, and cardiac stress and viability PET.

Above: A Cardiology Fellow pre-reading nuclear studies. Mornings are spent supervising and processing studies, and in the afternoons the Fellows read the studies with board certified Nuclear Cardiologists.

Cardiac Catheterization

The Cardiac Catheterization Lab provides the opportunity for Fellows to obtain both cognitive and technical knowledge of invasive cardiology. Fellows gain an understanding of the indications, contraindications, and potential complications of procedures commonly performed in the cardiac catheterization laboratory. Fellows are trained by cardiologists who pride themselves on performing interventions that are evidence-based and appropriate. In addition to technical training in coronary angiography, Fellows are all taught the fundamentals of hemodynamics and angiogram interpretation. At Henry Ford we believe that all Fellows should be able to achieve independent proficiency in performing cardiac catheterization, and thus all Fellows are offered COCATS level 2 training with the option to do more or less depending on the individual’s interests.

Above: A Fellow looks up a patient prior to the procedure. All patients in the cath lab are assigned to a Fellow. General Fellows perform all the diagnostic cardiac caths in addition to having the opportunity to scrub in to interventions.
Above: After cases are complete, Fellows generate the angiogram and hemodynamics reports. Here a Senior Fellow is teaching the Junior Fellow.
Above: A Fellow scrubbed in to a case in the cath lab.

Electrophysiology

During the EP rotation, Fellows learn about the fundamentals of electrophysiology. Fellows learn the indications for EP studies, ablations, pacemakers, biventricular devices and ICD’s, as well as the risks and benefits of these procedures. The fundamentals of cardiac pacing and a basic understanding of both normal and abnormal pacemaker function are taught. Fellows gain an understanding of the appropriate use and contraindications of antiarrhythmic agents, including the potential for drug interaction and proarrhythmia. Particular focus is given to interpretation of complex arrhythmias using surface electrocardiography. There is exposure to both noninvasive (including tilt table testing) and invasive cardiac electrophysiology testing.

Above: A Fellow with the EP nursing staff. In addition to seeing EP consults, Fellows scrub in to EP procedures and perform tilt table testing and DC cardioversions. Fellows also spend time learning how to interrogate implanted devices.

Research

Research and scholarly activity are integral parts of the Cardiology Fellowship Curriculum. All Fellows receive protected research time. Every Cardiology fellow is expected to initiate or participate in an original research project during their fellowship that produces a manuscript representing original research for submission to a peer-reviewed journal. Fellows have world-renowned research mentors to guide them through their activities. All Fellows also have access to institutional grants as well as paid biostatistics support for their projects.

Above: Fellows presenting their research with their Senior Staff Cardiologist during the annual Graduate Medical Education Research Forum.
Above: Another Fellow presenting his research. Fellows are involved in most projects in the Division, and routinely present at regional and national meetings.

Ambulatory experience

Fellows spend one half day per week in continuity clinic at Main Campus or one of the core satellites (Sterling Heights, Fairlane, or West Bloomfield). Patients assigned to Fellows follow them for the full 3 years of their fellowship. Fellows are staffed by one of our full-time Senior Staff Cardiologists.

Once a month fellows will convene with their preceptor during a protected didactic time (first 30 minutes of their clinic time) to discuss a list of case-based questions pertaining to a specific ambulatory curriculum topic.

Above: A Fellow about to see her patient during afternoon continuity clinic.
Above: A Fellow presenting to her Senior Staff after seeing her patient.
Information for Applicants
Interested in applying to one of our programs?