Curriculum

Goals of individual rotations

Choose a rotation from the list below to learn about the goals of that specific rotation:

• Inpatient Advanced Heart Failure and Transplant Service
• Outpatient Advanced Heart Failure and Transplant Clinic
• Lung Transplant Service
• Renal Transplant Service
• Pulmonary Hypertension Service
• Electrophysiology Service
• Research

Inpatient advanced HF/Tx service

Patient care

1. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Fellows must demonstrate competence in the diagnosis, care, and treatment of patients of each gender, from adolescence to old age, from diverse ethnic groups, during health and all stages of illness.
3. Fellows must demonstrate competence in prevention, education, evaluation, and management of inpatients with:
   • Cardiac transplant (at least five are seen during initial transplant hospitalization and peri-operative management)
   • Mechanical assist devices (at least two are being managed during peri-operative hospitalization).
   • Chronic heart failure with dilated or non-dilated left ventricle.
   • New onset heart failure and acute decompensation of chronic heart failure.
   • Acute cellular and antibody mediated rejection.
   • Complications of cardiac transplantation including allograft vasculopathy, cytomegalovirus and other opportunistic infections, post-transplant hypertension, and post-transplant renal insufficiency.
   • Heart failure secondary to cancer chemotherapy, congenital heart disease, hypertrophic cardiomyopathies, inherited cardiomyopathies) infiltrative/inflammatory cardiomyopathies.
   • Heart failure and arrhythmias, including patients being evaluated for implantable cardioverter-defibrillators and/or resynchronization therapy (at least 50 patients)
   • Heart failure with other transplanted organs
   • Heart failure during pregnancy or in patients recently post-partum.
   • Hypertension
   • Heart failure in the setting of cardiac and non-cardiac surgery.
   • pulmonary hypertension.
4. Fellows must demonstrate competence in heart failure evaluation to include:
   • Applying and interpreting approaches to evaluating symptom severity, functional capacity, and health-related quality of life in patients with heart failure.
   • Recognizing clinical features in all forms and etiologies of heart failure.
   • Recognizing the indications for, and interpreting the results of all diagnostic tests and modalities relevant to evaluating and managing patients with/suspected heart failure, particularly cardiopulmonary exercise testing.
5. Fellows must demonstrate competence in heart failure management to include:
   • Device interrogation and interpretation in patients with implanted cardioverter-defibrillators or implanted cardioverter-defibrillator-cardiac resynchronization therapy devices.
   • Recognizing the indications for, prescribing, and monitoring all classes of drugs relevant to patient care.
   • Recognizing the indications for and prescribing immunomodulating drugs, and managing their adverse effects, therapeutic levels, and interactions with other drugs.

Medical knowledge

1. Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socio-behavioral sciences, as well as the application of this knowledge to patient care, including the impact of psychosocial factors on the manifestations, expression, and management of heart failure.
2. Fellows must demonstrate knowledge of the scientific method of problem solving and evidence-based decision making.
3. Fellows must demonstrate knowledge of indications, contraindications, limitations, complications, techniques, and interpretation of results of those diagnostic and therapeutic procedures integral to the discipline, including the appropriate indications for and use of screening tests/procedures. These include but are not limited to:
   • Interpretation of endomyocardial biopsy results with regard to implications for therapy
   • The role and interpretation of hemodynamic monitoring.
4. Fellows must demonstrate knowledge of basic mechanisms of heart failure, to include
   • Pathophysiology of heart failure including neurohormonal activation, cardiomyocyte biology, extracellular matrix biology, and ventricular remodeling.
   • Differential diagnosis of heart failure that includes specific etiologies and exacerbating factors for patients presenting with new onset heart failure and with acute exacerbation of chronic heart failure
   • Genetics in heart failure, including common mutations leading to hypertrophic and dilated cardiomyopathies, and pharmacogenomics

Practice-based learning and improvement

1. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.
2. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.
3. Apply new contributions to the management and care of their patients.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Communicate effectively in a compassionate and informative manner.
3. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.
4. Provide education including instructional material to patients to promote optimal medical care and to foster healthy lifestyles.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
2. Utilize evidence-based, cost-conscious strategies to ensure quality comprehensive cardiac care.
3. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.

Outpatient advanced HF/Tx clinic

Patient care

1. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Fellows must demonstrate competence in the practice of health promotion, disease prevention, diagnosis, care, and treatment of patients of each gender, from adolescence to old age, from diverse ethnic groups, during health and all stages of illness.
3. Fellows must demonstrate competence in prevention, education, evaluation, and management of outpatients with:
   • Cardiac transplant (at least 30 patients)
   • Mechanical assist devices (at least 10 patients).
   • Chronic heart failure with dilated or non-dilated left ventricle.
   • New onset heart failure and acute decompensation of chronic heart failure.
   • Acute cellular and antibody mediated rejection.
   • Complications of cardiac transplantation including allograft vasculopathy, cytomegalovirus and other opportunistic infections, post-transplant hypertension, and post-transplant renal insufficiency.
   • Heart failure secondary to cancer chemotherapy, congenital heart disease, hypertrophic cardiomyopathies, inherited cardiomyopathies) infiltrative/inflammatory cardiomyopathies.
   • Heart failure and arrhythmias, including patients being evaluated for implantable cardioverter-defibrillators and/or resynchronization therapy (at least 50 patients)
   • Heart failure with other transplanted organs
   • Heart failure during pregnancy or in patients recently post-partum.
   • Hypertension
   • Heart failure in the setting of cardiac and non-cardiac surgery.
   • Pulmonary hypertension.
4. Fellows must demonstrate competence in heart failure evaluation to include:
   • Applying and interpreting approaches to evaluating symptom severity, functional capacity, and health-related quality of life in patients with heart failure.
   • Recognizing clinical features in all forms and etiologies of heart failure.
   • Recognizing the indications for, and interpreting the results of all diagnostic tests and modalities relevant to evaluating and managing patients with/suspected heart failure, particularly cardiopulmonary exercise testing.
5. Fellows must demonstrate competence in heart failure management to include:
   • Assigning methods of surveillance for transplant rejection and immune status.
   • Device interrogation and interpretation in patients with implanted cardioverter-defibrillators or implanted cardioverter-defibrillator-cardiac resynchronization therapy devices .
   • Recognizing the indications for and prescribing nonpharmacologic, non-device treatment modalities including diet and exercise.
   • Recognizing the indications for, prescribing, and monitoring all classes of drugs relevant to patient care.
   • Recognizing the indications for and prescribing immunomodulating drugs, and managing their adverse effects, therapeutic levels, and interactions with other drugs.

Medical knowledge

1. Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socio-behavioral sciences, as well as the application of this knowledge to patient care, including the impact of psychosocial factors on the manifestations, expression, and management of heart failure.
2. Fellows must demonstrate knowledge of the scientific method of problem solving and evidence-based decision making.
3. Fellows must demonstrate knowledge of indications, contraindications, limitations, complications, techniques, and interpretation of results of those diagnostic and therapeutic procedures integral to the discipline, including the appropriate indications for and use of screening tests/procedures. Including but not limited to:
   • Interpretation of endomyocardial biopsy results with regard to implications for therapy
   • The role and interpretation of hemodynamic monitoring.
4. Fellows must demonstrate knowledge of basic mechanisms of heart failure, to include
   • Pathophysiology of heart failure including neurohormonal activation, cardiomyocyte biology, extracellular matrix biology, and ventricular remodeling.
   • Differential diagnosis of heart failure that includes specific etiologies and exacerbating factors for patients presenting with new onset heart failure and with acute exacerbation of chronic heart failure
   • Genetics in heart failure, including common mutations leading to hypertrophic and dilated cardiomyopathies, and pharmacogenomics

Practice-based learning and improvement

1. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.
2. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.
3. Apply new contributions to the management and care of their patients.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Communicate effectively in a compassionate and informative manner.
3. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.
4. Provide education including instructional material to patients to promote optimal medical care and to foster healthy lifestyles.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
2. Utilize evidence-based, cost-conscious strategies to ensure quality comprehensive cardiac care.
3. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.

Lung transplant service

Patient care

1. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Fellows must demonstrate competence in the practice of health promotion, disease prevention, diagnosis, care, and treatment of patients of each gender, from adolescence to old age, from diverse ethnic groups, during health and all stages of illness.
3. Fellows must demonstrate competence in prevention, education, evaluation, and management of inpatients and outpatients with:
   • Heart failure with Lung transplant
   • Pulmonary hypertension
   • Acute cellular and antibody mediated rejection.
   • Complications of transplantation including cytomegalovirus and other opportunistic infections, post-transplant hypertension, and post-transplant renal insufficiency.
   • Heart failure coexisting with other transplanted organs
4. Fellows must demonstrate competence in organ transplant management to include:
   • Assigning methods of surveillance for transplant rejection and immune status.
   • Recognizing the indications for and prescribing nonpharmacologic, non-device treatment modalities including diet and exercise.
   • Recognizing the indications for, prescribing, and monitoring all classes of drugs relevant to patient care.
   • Recognizing the indications for and learning appropriate prescribing of immunomodulating drugs, managing their adverse effects, therapeutic levels, and interactions with other drugs.

Medical knowledge

1. Fellows must demonstrate knowledge of indications, contraindications, limitations, complications of lung transplantation.
2. Fellows must demonstrate knowledge of basic mechanisms of rejection.

Practice-based learning and improvement

1. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Communicate effectively in a compassionate and informative manner.
3. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.
4. Provide education including instructional material to patients to promote optimal medical care and to foster healthy lifestyles.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
2. Utilize evidence-based, cost-conscious strategies to ensure quality comprehensive cardiac care.
3. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.

Renal transplant service

Patient care

1. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Fellows must demonstrate competence in prevention, education, evaluation, and management of inpatients and outpatients with:
   • Acute cellular and antibody mediated rejection.
   • Complications of transplantation including cytomegalovirus and other opportunistic infections, post-transplant hypertension, and post-transplant renal insufficiency.
   • Heart failure with transplanted kidney
   • Coexisting Heart and Renal transplants
3. Fellows must demonstrate competence in organ transplant management to include:
   • Assigning methods of surveillance for transplant rejection and immune status.
   • Recognizing the indications for and prescribing nonpharmacologic, non-device treatment modalities including diet and exercise.
   • Recognizing the indications for, prescribing, and monitoring all classes of drugs relevant to patient care.
   • Recognizing the indications for and learning appropriate prescribing of immunomodulating drugs, managing their adverse effects, therapeutic levels, and interactions with other drugs.

Medical knowledge

1. Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socio-behavioral sciences, as well as the application of this knowledge to patient care.
2. Fellows must demonstrate knowledge of indications, contraindications, limitations, complications of lung transplantation.
3. Fellows must demonstrate knowledge of basic mechanisms of rejection.

Practice-based learning and improvement

1. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Communicate effectively in a compassionate and informative manner.
3. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
2. Utilize evidence-based, cost-conscious strategies to ensure quality comprehensive cardiac care.
3. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.

Pulmonary hypertension service

Patient care

1. Fellows must demonstrate competence in prevention, education, evaluation, and management of inpatients with:
   • WHO type I Pulmonary hypertension.
   • Pulmonary hypertension due to (or in the setting of) Left heart failure
2. Fellows must demonstrate competence in heart failure evaluation to include:
   • Applying and interpreting approaches to evaluating symptom severity, functional capacity, and health-related quality of life in patients with heart failure.
   • Recognizing clinical features in various forms and etiologies of pulmonary hypertension.
   • Recognizing the indications for, and interpreting the results of all diagnostic tests and modalities relevant to evaluating and managing patients with/suspected pulmonary hypertension including 6 minute walk test.
3. Fellows must demonstrate competence in pulmonary hypertension management to include:
   • Recognizing the indications for classes of relevant drugs.
   • Recognizing the potential complications and proper monitoring of pulmonary hypertension medications.

Medical knowledge

1. Fellows must demonstrate knowledge of indications, contraindications, limitations, complications, techniques, and interpretation of results of those diagnostic and therapeutic procedures integral to the discipline, including the appropriate indications for and use of screening tests/procedures. Including but not limited to:
   • The role and interpretation of hemodynamic monitoring/right heart catheterization.
2. Fellows must demonstrate knowledge of basic mechanisms of pulmonary hypertension, to include neurohormonal activation, vasoactive pathways altered in pulm hypertension, and vascular remodeling.

Practice-based learning and improvement

1. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.
2. Apply new contributions to the management and care of their patients.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Communicate effectively in a compassionate and informative manner.
3. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.
4. Provide education including instructional material to patients to promote optimal medical care and to foster healthy lifestyles.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
2. Utilize evidence-based, cost-conscious strategies to ensure quality comprehensive cardiac care.
3. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.

Electrophysiology service

Patient care

1. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Fellows must demonstrate competence in, education, evaluation, and management of the following inpatients and outpatients:
   • Patients with heart failure and arrhythmias
   • Patients being evaluated for implantable cardioverter-defibrillators and/or resynchronization therapy.
   • Those with existing implanted cardioverter-defibrillators and/or resynchronization devices.
3. Fellows must demonstrate competence in heart failure management to include:
   • Device interrogation and interpretation in patients with implanted cardioverter-defibrillators or implanted cardioverter-defibrillator-cardiac resynchronization therapy devices.
   • Recognizing the indications for and prescribing nonpharmacologic, non-device treatment modalities including diet and exercise.
   • Recognizing the indications for, prescribing, and monitoring antiarrhythmic drugs.

Medical knowledge

1. Fellows must demonstrate knowledge of indications, contraindications, limitations, complications of electrophysiological devices.
2. Fellows must demonstrate knowledge of basic mechanisms of arrhythmias in the setting of heart failure.

Practice-based learning and improvement

1. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.
2. Apply new contributions to the management and care of their patients.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Communicate effectively in a compassionate and informative manner.
3. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.
4. Provide education including instructional material to patients to promote optimal medical care and to foster healthy lifestyles.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
2. Utilize evidence-based, cost-conscious strategies to ensure quality comprehensive cardiac care.
3. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.

Research

Medical knowledge

1. Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and socio-behavioral sciences.
2. Fellows must demonstrate knowledge of the scientific method of problem solving and evidence-based decision making.
3. Fellow must be able to assess existing knowledge base for areas lacking sufficient evidence to then direct investigation/innovation.

Practice-based learning and improvement

1. Systematically analyze practice using quality improvement methods, and implement
2. Locate, appraise, and assimilate evidence from scientific studies related to health problems.
3. Apply new contributions to the management and care of their patients.

Communication and interpersonal skills

1. Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
2. Work in a collegial manner with all members of the health care team treating each person with dignity and respect.

Professionalism

1. Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
2. Fellows must demonstrate the following:
   • High standards of ethical behavior, including maintaining appropriate professional boundaries and relationships with other physicians, and other health care team members
   • Ability to avoid conflicts of interest
   • A commitment to lifelong learning
   • An attitude of caring that is derived from humanistic and professional values.

Systems based practice

1. Adherence to institutional policies regarding patient care, patient safety, and patient confidentiality.