Curriculum
The three-year ACGME-accredited Cardiovascular Disease Fellowship provides rigorous academic and clinical experience in various areas of general cardiovascular disease in full compliance with the American College of Cardiology. General fellows will build their clinical cardiology diagnostic and treatment skills predominantly through the first two years, while polishing their clinical expertise and/or engaging in skills refinement directed toward a particular subspecialty or research in their third year.
At the completion of their training, all fellows will be expected to:
- Demonstrate mastery of the cardiovascular anatomy, physiology, pathophysiology and treatment and their integration into other medical and surgical specialties.
- Demonstrate proficiency as a clinical cardiology consultant on all levels of primary, secondary, and tertiary care, from the ambulatory clinic to the cardiac intensive care unit.
- Demonstrate proficiency in performing and interpreting all aspects of basic cardiac diagnostics, including electrocardiography, echocardiography, cardiac stress testing, nuclear cardiology, cardiac CT and MRI, vascular sonography, diagnostic ambulatory and invasive electrophysiology, and invasive cardiac and vascular catheterization.
- Demonstrate familiarity with techniques, post-operative care and basic manipulation of various aspects of cardiac treatment devices including invasive hemodynamic monitoring, bedside pericardiocentesis, emergent and elective direct current external cardioversion, temporary transvenous pacing, permanent pacemaker and defibrillator placement and interrogation, cardiac ablation, percutaneous coronary intervention, septal closure, valvuloplasty, transcatheter interventions, atrial appendage exclusion, circulatory support devices (intra-aortic balloon pump, Impella, ECMO, VADs) and open heart surgery.
- Develop skills in didactic and clinical medical teaching.
- Develop skills in evidence-based medicine integration, literature search and critical interpretation, and familiarity with the major and landmark cardiovascular clinical trials.
- Meaningfully participate in clinical research, professionally present lecture topics and complete at least one original research manuscript preparation and grant exploration.
Rotations
Cardiac Intensive Care Unit (CCU)
One cardiac fellow works with internal medicine residents to supervise the management of the patients in the CCU and in the adjacent post recovery unit. Patients following ST-elevation myocardial infarction, high-risk non-ST-elevation myocardial infarction and unstable angina, cardiogenic shock or other hemodynamic instabilities with complicated cardiac disease, severe heart failure, and life-threatening arrhythmias are admitted to this unit. In addition to perfecting their physical examination skills, and critical treatment planning, fellows become proficient in the insertion, interpretation, and management of Swan-Ganz catheters, complex central venous access, pericardial drainage, temporary transvenous pacemakers, arterial line placement, intra-aortic balloon, left ventricular support devices, noninvasive hemodynamic monitoring and ventilator management. Fellows will also lead the multidisciplinary team of medical residents, nursing, and students in directing patients' care and overall management of patients from admission to discharge. Twice daily multidisciplinary rounds are conducted with the attending on service.
Cardiac Telemetry Unit
One cardiac fellow, working in collaboration with the CCU fellow manages the 33-bed telemetry unit. During this rotation fellows begin to understand the pathophysiology, diagnosis and treatment of the basic cardiac conditions such as evaluation for acute coronary syndromes, treatment for unstable angina and non-ST elevation myocardial infarction, chronic and acute decompensated heart failure, tachyarrhythmias and bradyarrhythmias, and triaging patients with various hemodynamic instabilities or needs for in-hospital cardiac testing. They also head the team of medical residents and students in leading guideline directed care and overall management of patients from admission to discharge. Daily teaching rounds are conducted with the telemetry attending physicians on service.
Consultation Service
Our cardiology consult service provides a strong clinical experience in which fellows step into the role of the hospital's primary cardiology consultant. You’ll lead a team of internal medicine residents and medical students, working closely alongside dedicated attendings across a broad range of subspecialties.
You’ll manage a diverse array of inpatient consultations, building strong foundations in clinical reasoning, communication, and the core principles of consultative cardiology. Our program ensures comprehensive exposure to cardiovascular pathology, with strengths in pre- and perioperative care, cardio-obstetrics, and the management of cardiovascular conditions in critically ill medical and surgical patients.
It’s a high-volume, high-impact rotation that sharpens your ability to synthesize complex cases quickly, teach on the fly, and collaborate across specialties.
Echocardiography
New York-Presbyterian Brooklyn Methodist Hospital has a very busy state-of-the-art echocardiography laboratory that performs more than 25,000 transthoracic echocardiograms and over 550 transesophageal echocardiograms annually. Training includes hands-on acquisition and interpretation of transthoracic and transesophageal images with digital storage and retrieval technology. Every fellow will learn the basic aspects of cardiac ultrasound, including physical principles, knobology, instrumentation, cardiovascular anatomy, cardiovascular physiology, and cardiovascular pathophysiology. Fellows will also become adept at performance and interpretation of transesophageal echocardiograms and understand the basics of conscious sedation administration. On average, our fellows personally perform 75 to 100 transesophageal echocardiograms during their second- and third-year echocardiography rotations. Given the expertise of our noninvasive faculty members and the high volume of the procedures, all our fellows graduate with level II training in echocardiography as outlined in the 2003 ACC/AHA Clinical Competence Statement on Echocardiography. The majority of our fellows become board certified by the National Board of Echocardiography prior to their graduation from the program.
Nuclear Cardiology and Cardiac Stress Testing
The Nuclear Cardiology Laboratory performs over 2,600 nuclear cardiac procedures annually and is equipped with two dedicated treadmill exercise suites.
Procedures performed include:
- Treadmill exercise stress testing
- Myocardial perfusion imaging (planar and SPECT) with ECG-gated SPECT
- Radionuclide ventriculography (MUGA)
- Pharmacologic stress testing using vasodilators (dipyridamole and adenosine) and inotropic stress with dobutamine
- Stress echocardiography for evaluation of ischemia, valvular heart disease, hypertrophic cardiomyopathy, diastolic dysfunction, and pulmonary hypertension.
- Cardiac PET/CT protocols include sarcoidosis assessment, myocardial viability and perfusion.
The goals of the nuclear cardiology rotation are to achieve proficiency in the interpretation of stress tests, nuclear-angiographic correlation, appropriate selection of imaging modalities, and understanding of quality control issues in the laboratory. Most fellows successfully obtain Certification Board of Nuclear Cardiology (CBNC) certification upon graduation from the fellowship.
Cardiac Magnetic Resonance Imaging (CMR)
Third-year fellows have the opportunity to rotate in the Cardiac Magnetic Resonance (CMR) Center, gaining hands-on exposure to a busy clinical CMR program. All fellows receive Level I training in CMR, which provides the foundational knowledge required for the practice of adult cardiology and for appropriate referral of patients for CMR evaluation.
The CMR program offers a full spectrum of cardiac MRI studies, including:
- Viability assessment
- Evaluation of hypertrophic cardiomyopathy (HCM)
- Cardiomyopathy workup
- Parametric mapping
- And other advanced tissue characterization techniques
In addition to clinical imaging experience, fellows are encouraged to participate in ongoing clinical research projects in cardiovascular imaging. An active patient imaging database supports fellow-led research, which has frequently resulted in national presentations and peer-reviewed publications.
Cardiac Computerized Tomography (Cardiac CT)
Third-year fellows complete at least one dedicated month of cardiac CT rotation. This experience includes hands-on image manipulation, interpretation of cardiac CT studies, and daily clinical readout sessions with faculty.
Fellows benefit from a large teaching file of existing studies combined with a high-volume daily imaging schedule. By the end of the rotation, fellows will gain:
- A solid understanding of cardiac CT technology and protocols
- Proficiency in 3D reconstruction and advanced post-processing techniques
- Experience with emerging technologies such as FFR-CT and comprehensive plaque analysis
- Skills in comprehensive structural/procedural planning
Monthly multimodality imaging lectures complement the rotation by reviewing complex cases. Fellows achieve Level I training in cardiac CT. Level II training is available for fellows who arrange additional dedicated time in the cardiac CT center.
Cardiac Catheterization/Interventional Service
New York-Presbyterian Brooklyn Methodist Hospital has a very active cardiac catheterization laboratory with three fully equipped suites. Two have state-of-the-art digital X-ray systems installed in the last three years, and a third will be refitted in the coming year. Over 2500 diagnostic angiograms, 900 interventional procedures, and over 100 emergent and urgent PCI for STEMI and NSTEMI are performed annually. A full range of diagnostic procedures, including right- and left-heart catheterizations, intravascular imaging, wire- and angiography-based iFR and FFR, microvascular function testing with CFR, and provocative testing for coronary vasospasm, provides general fellows with a comprehensive introduction to invasive diagnostic procedures. The cath lab performs the full spectrum of interventional and structural procedures, ranging from simple coronary stent procedures to complex high-risk procedures requiring mechanical circulatory support with Impella or ECMO. Complex lesions are addressed with a wide range of devices, including rotational atherectomy, intravascular lithotripsy, and laser. Chronic total obstructions and left main stenting are addressed with state-of-the-art techniques. The general fellows are given supervised access to these procedures. A wide range of structural interventions are performed in the cath lab, including TAVR, mTEER, transeptal repair of bioprosthetic mitral valves, tricuspid interventions, and PFO and ASD closures. Fellows become proficient in pre- and post-catheterization management, arterial cannulation, performance of right heart and left heart catheterizations with coronary angiograms, interpretation of intravascular imaging, and evaluation of hemodynamic data. Clinical fellows have an opportunity to participate in research activities in the laboratory. An extensive patient database is available for clinical research. NewYork-Presbyterian Brooklyn Methodist Hospital also offers two ACGME-accredited fourth-year positions dedicated to training in interventional cardiology.
Clinical Cardiac Electrophysiology Service
The cardiac electrophysiology services include four dedicated faculty members and a large number of health care professionals. Two positions for a two-year ACGME accredited Clinical Cardiology Electrophysiology (CCEP) Fellowship are available; additionally, the program offers the opportunity for Cardiology Fellows to meet all requirements for combined CVD and CCEP board eligibility in a 5-year span, through the CVD-CCEP Aire Training Program Pathway Pilot (2+2). There are two dedicated electrophysiology laboratories with state-of-the-art equipment, consisting of a biplane x-ray suite, intracardiac echocardiography, multiple 3D mapping systems, as well as laser energy sources. A full range of electrophysiology procedures are performed, including complex ablations, left atrial appendage occlusion, transvenous, subcutaneous and EV implanted devices. More than 1200 procedures are performed yearly. A busy arrhythmia and device clinic, in which clinical cardiology fellows can participate, is held daily. Opportunities for clinical research are available.
Cardiothoracic Surgery and Vascular Surgery
Third-year fellows will spend a total of one month in vascular and cardiothoracic surgery learning about pathophysiology of arterial atherosclerosis, surgical management of severe coronary and peripheral arterial disease that are not amendable to percutaneous therapy and they will have an opportunity to take part in the management of patients in the preparation for surgical procedures and post-operatively, and also to scrub in along with surgeons for elective and emergent cases in the operating room.
Advanced Heart Failure and Transplant
Fellows will learn about all aspects of managing advanced heart failure, pulmonary hypertension, complex congenital heart disease, and heart transplantation. They will participate in the perioperative preparation of patients, understand the physiology of denervation, be responsible for postoperative management including selection of immunosuppressive therapy and learn post-transplant complications, including infectious and malignant disease. On leaving the clinical rotation, the fellow will be familiar with advanced medical and surgical intervention for late stage heart failure, have developed clinical judgment to independently recognize, manage and treat complications and be proficient in interpretation of diagnostic studies pertinent to advanced heart failure and transplantation.
Research
Our cardiology department offers a vibrant and collaborative research environment with broad opportunities for fellows to engage in impactful clinical investigation. The division is actively involved in more than 16 sponsored clinical trials spanning interventional cardiology, heart failure, electrophysiology, and advanced cardiovascular imaging. Fellows are encouraged to participate meaningfully in study design and enrollment, abstract presentations at major national and international cardiovascular meetings, and manuscript development, with strong mentorship and institutional support aimed at fostering academic growth and preparing trainees for successful careers in clinical research and academic cardiology.
Continuity Clinic
The outpatient clinic is an important part of cardiovascular training, and all fellows spend a half-day per week paired with a faculty member in outpatient clinic. In the clinic, fellows develop knowledge and understanding of primary and secondary prevention of ischemic and structural heart disease, appropriate follow-up of patients with disorders such as advanced heart failure, basic arrhythmia, peripheral vascular disease, malignant hypertension, etc. Fellows will also gain skills in the business and management of ambulatory cardiac clinics and take on greater responsibilities in on-call care and diagnostic planning as their experience grows. Continuity clinic exposure can be tailored to fellow's clinical interest.
Night and Weekend Calls
The fellow on call is required to stay in the hospital through the entirety of the shift as their presence is required for rapid evaluation of highly acute patients. Night-calls are between 7 pm to 7 am Sunday-Friday, with Saturday night being the day/night off for the week. A large cardiology fellows call room suite is conveniently located across the street from the main Hospital and is equipped with basic amenities. During the call, the fellow is responsible for STEMI evaluation and cath lab activation/triage, service/faculty consultations and supervising the CCU-telemetry units. The fellow will also partake in emergency room triage of patients to the cardiac units.
Although the on-call fellows are supported by a variety of attendings including STEMI, CCU, HF/Shock, General and EP.
The details of frequency and totality of 24hr calls and Nights are further explained in the section "Schedule."