Educational conferences provide a unique but key perspective that complements clinical experience. There are two “lunch conferences,” which take place each Tuesday and Wednesday, a “didactic” lecture on Thursday morning, and an invasive conference on Friday mornings. Additionally, fellows are encouraged to attend a variety of institutional conferences outside the Department of Cardiology. The following describes the educational objectives of the individual cardiology conferences.
The emphasis of this lecture series is on core curriculum, current state of the art, and controversies surrounding a given topic. The scope of this conference spans a wide spectrum of topics, including basic science lectures on lipid metabolism, vascular endothelium biology, mechanics of left ventricular systolic and diastolic function, cardiac pathology and pharmacology, coronary and valvular heart disease, as well as a variety of clinical topics. Presentations are given by Lahey faculty and invited guest lecturers with recognized expertise from outside the institution.
Articles from the medical literature are carefully selected from peer-reviewed journals and presented by the fellow. A critical appraisal of design, strengths, use and limitations of biostatistics, article conclusions, clinical relevance, and impact on medical decision-making is presented and discussed by the presenting fellow in conjunction with other fellows and faculty members. Two fellows are assigned the responsibility of conducting Journal Club each month.
Presentation of interesting and instructive echocardiographic studies takes place. Emphasis is on recognition of pertinent findings, differentiation from artifact, differential diagnosis, derived hemodynamic data, and impact of findings on clinical decision making.
While flexible in format, this is typically a case-oriented conference with an underlying theme. The cardiology or interventional cardiology fellow is responsible for gathering and presenting relevant clinical information and noninvasive data (such as CXR, stress testing, nuclear, and Echo). This is followed by presentation of hemodynamic and angiographic findings. The emphasis of discussion is on indication of procedure, integration of noninvasive and invasive data, and impact on decision-making. The specific intervention, as well as the outcome, is then discussed, with appropriate reference to the literature.
This is a didactic teaching conference with emphasis on basic hemodynamic and technical as well as angiographic principles. This conference is generally organized by Dr. Piemonte.
Presentation of interesting ECGs. Tracings are typically shown as “unknown.” The findings are described and interpreted by a fellow. This is followed by further analysis and commentary by faculty members. This conference is generally organized by Dr. Alexander.
Presentation of interesting arrhythmias, mechanism, diagnosis and management. Presentation and discussion of intracardiac recordings by the electrophysiology fellow and the clinical fellow on the rotation with input from an electrophysiology attending.
Discussion of selected morbidity and mortality cases with emphasis on risk management and “lessons learned” from a given experience. Cases are compiled by Dr. Mirbach, presented by the fellow or attending involved in the case, or review of outcome data from department or individual laboratory database.
This monthly conference has a flexible format. It may serve as a forum for various staff members to list and discuss ongoing or potential research projects for consideration. Original as well as multicenter trials that involve Lahey participation may be discussed. Fellows may use this conference to present data prior to official presentation at a national meeting.
This monthly conference is dedicated to a formal, in-depth, one-hour discussion of a selected cardiology topic. Topics for presentation may include a didactic topic, background and data of a fellow’s research project, or a state-of-the-art topic of controversy.
This is a multidisciplinary conference that highlights patients with complex peripheral vascular disease. Input is solicited from vascular medicine, radiology, vascular surgery, and interventional cardiology. The conference takes place on Tuesday morning, and is optional but strongly encouraged, particularly during invasive rotation.
It is important for fellows to maintain their skills in internal medicine during subspecialty training. We strongly encouraged attendance at the weekly Medical Grand Rounds on Fridays at 8 am in Alumni Auditorium.
Ambulatory Care Experience
Longitudinal care in the outpatient setting provides for appreciation of the natural history of an array of cardiovascular problems. It allows the fellow to become familiar with early manifestations and the evolution of cardiovascular diseases, the psychosocial impact of disease, and the effects and side effects of treatment. Longitudinal care also allows the fellow to meaningfully participate in preventive aspects of cardiovascular diseases, such as behavior modification. More important, it also allows for the establishment of a sustained, trusting relationship between patient and fellow.
We have an active outpatient facility at Lahey Hospital. The source of appointments varies and includes patients referred by primary care physicians from within or outside the institution, or from the section of surgery for preoperative consultation. It also includes patients who are self-referred for cardiac evaluation and patients who are seeking a second opinion with regard to a cardiac condition.
Each fellow is assigned to one half-day per week. Fellows are, on average, responsible for one to three new patients and one to three return visits during each-half day session. Patients who require continued care are followed by the same fellow throughout his or her three-year training period. Patients who may no longer require cardiology follow-up are referred back to their primary care physician.
The fellow is responsible for the evaluation and management of outpatients under the supervision of a faculty member who works with the fellow on a one-to-one basis. The fellow is also responsible for record keeping and correspondence with referring physician as needed on patients under the fellow’s care.
Research and scholarly activities are essential components of a fellow’s training experience. Fellows are expected to gain first-hand familiarity with research project conception, review of the literature, IRB procedure and responsible use of informed consent, and data collection and analysis. They also develop competence in critical appraisal of new therapies in the medical literature.
All fellows should participate in scholarly activities such as comprehensive case reports and review of literature, and/or research projects including single and multicenter clinical trials. Fellows are expected to complete at least one project for submission to a regional or national meeting and/or publication. Fellows are also encouraged to submit their projects to the Lahey Postgraduate Recognition Day contest. Deadline for receipt of materials is generally in early May. If selected, presentation is in June.
In working closely under the preceptorship of a faculty member, the fellow participates in data collection, interpretation, and the writing of the abstract/publication. By doing so, the fellow learns the design, limitations and interpretation of studies and is better able to provide a critical appraisal of new studies as they appear in the medical literature.
There are a number of clinical research protocols ongoing at Lahey Hospital & Medical Center at any given time. Fellows are encouraged to become actively engaged in some of these protocols, including multicenter clinical trials for which Lahey is a participating site. This provides an opportunity for fellows to gain familiarity with the state of the art in a given field; to understand the clinical question at hand, which the trial is attempting to answer; and to become versed in current literature leading to this question. They become thoroughly familiar with the inclusion/exclusion criteria and overall design of the trial, and learn the responsible use of informed consent.
First-year fellows are allotted two weeks during the latter part of the first year for research; second-year fellows are allotted one month. Third-year fellows are assigned a minimum of two full months of research / elective (which may be utilized exclusively for research, or combined with an elective, depending on the individual fellows’ interest and past academic productivity). If needed, the third-year fellow can arrange for up to a total of four months of dedicated research time through the program director.