Interventional Cardiology Fellowship Program 
Program Overview
The Western Pennsylvania Hospital (WPH) Interventional Cardiology Fellowship is a one-year training program which functions as an integral component of the subspecialty residency in cardiology and the categorical residency program in internal medicine. During the year of interventional training, fellows are expected to learn the indications, risks and techniques used in interventional cardiology practice and to develop the judgment and experience necessary to select patients and function as independent operators during interventional procedures.
Basic background information on the training requirements for interventional cardiology provides a useful basis for understanding the content and conduct of the WPH fellowship program. For example, the ACGME specifies that interventional cardiology fellows must participate in a minimum of 250 coronary interventions (i.e., a single coronary intervention is defined as all coronary interventions performed during one hospitalization) during the one year program, with the ACC recommending a maximum participation level at 600 procedures per year. We estimate the number of coronary interventions performed by each fellow during their matriculation in the WPH training program at 400 per year. Furthermore, our structure concurs with the ACC's stated requisite participation to permit a trainee to gain appropriate experience, which includes the following:
- Preprocedural evaluation to assess appropriateness and plan procedure strategy
- The trainee's personal performance of the case's critical manipulations under the direct supervision of a program faculty member. The faculty member who takes overall responsibility for the case must be immediately available to supervise the trainee's actions and to take over performance of the case any time it is in the patient's best interest.
- The trainee's active involvement in postprocedural management both in the catheterization laboratory at the conclusion of the case and on the inpatient unit afterward. This includes assessment for possible adverse outcomes, and the management of vascular access sites and anticoagulation issues.
The WPH Interventional Cardiology Program truly combines the best of academics and private practice. Fellows have the opportunity to work with a variety of invasive cardiologists in the setting of a very active interventional program which performs approximately 1,000 cases per year. The case material is outstanding and varied as the institution serves as the primary hospital for the local neighborhood as well as a referral center which draws patients from a wide area of Western Pennsylvania and contiguous areas of Ohio and West Virginia. Additionally, the WPH Division of Cardiovascular Disease has a strong academic base with over 20 active research protocols, numerous areas in which fellows can purse their research interests, and a well-developed conference schedule.
Curriculum Overview
Core Training Activities
1. Primary Teaching Institution - Fellows spend 8 months assigned to the catheterization lab and 3 months in the peripheral interventional laboratory. Additionally, there is an elective month. Prior to a procedure, the resident sees and examines the patient, explains the procedure to be performed and obtains informed consent. Whenever possible, the resident reviews the case with the faculty attending before the patient is taken into the laboratory. The attending is scrubbed during every interventional procedure. As the fellow develops his/her skills, he/she progressively performs more of the procedures. Advancement of responsibility is at the discretion of the faculty attending until the fellow is capable of performing cases as primary operator. At this point, the attending may assist or stand aside to observe, giving verbal instructions and feedback as necessary. The resident reviews pressure tracings, ultrasound recordings and films with the attending, dictates the procedure notes and follows the patient post procedure. The patient is seen again the next morning or before discharge when the fellow writes a progress note detailing the apparent results of the procedure and records any interim complications.
2. Continuity Clinic - Fellows are assigned to continuity clinic one-half day per week over the course of the one-year training program. The majority of patients seen in follow-up will have undergone interventional procedures in which the resident participated during previous rotations in the catheterization laboratory. The resident follows their course and, under the supervision of the preceptor, orders medications and diagnostic testing as clinically indicated. Patients referred to the preceptor for consideration of revascularization will be scheduled as new patients for the fellow. These new patients provide the fellow with consultative experience in the outpatient setting. Resident and preceptor discuss the indications, if any, for percutaneous revascularization and the anatomical or clinical characteristics which would favor by-pass surgery as an alternative.
3. Teaching Experience - Due to the diverse teaching activities conducted at WPH, fellows have the opportunity to participate in training medical students as well as residents from various GME training programs (e.g., internal medicine and family practice residents). Primarily, the interventional fellow is the designated leader of the cardiology residents who are rotating through the catheterization laboratory. He/she, along with the cath lab support staff, is responsible for orienting first-year subspecialty cardiology residents to angiographic anatomy, to the equipment and supplies used during invasive procedures, and to the correct interpretation of pressure tracings. He/she serves as a resource person for these individuals throughout the year. Additionally, fellows are active presenters in the Division of Cardiovascular Disease conference schedule.
4. Research - There is a research requirement for all Interventional Cardiology Fellows, which includes the full scope of project involvement (e.g., enrollment of patients, data analysis and presentation or publication of results). The program director and many of the faculty members have ongoing research projects in which fellows may participate. The program director and faculty researchers can provide fellows with guidance in this area.
Conferences
Fellows' Presentations
The Interventional Cardiology Fellow prepares and presents the two (2) Interventional Cardiology Conferences each month that he/she rotates in the cath lab and one to two conferences per month when assigned to the peripheral vascular laboratory. Twice monthly, the fellow presents multiple cases along with noninvasive studies and any procedure complications which have occurred in the preceding week. Once monthly, the fellow, selects a topic, often based upon suggestions of the faculty or cases of particular interest, and presents the case summary, noninvasive studies, cath films, etc., followed by a focused didactic discussion of the topic and corresponding literature review. Every fourth Journal Club deals with a topic in interventional cardiology and is prepared by the interventional fellow.
Attendance
Fellows are expected to participate in the following conferences.
- Interventional Cardiology Conference (weekly on Fridays, 7:30 am)
*Includes Basic Science Conference (once per month) and M&M (last Friday of each month)
- Fellows' Lecture Series (weekly on Tuesdays and Thursdays, 7:30 am)
- Fellows' Meeting and Research Review (Wednesdays, 8:00-10:00 am, twice per month)
- Journal Club (once per month, on Thursdays, 7:30 am)
- Noon Lecture Series (weekdays at 12:00 Noon)
- Interventional Cardiology & Cardiovascular Surgery Conference (twice per month - see schedule)
Basic Rotations/Blocks Distribution
A basic overview of the rotations/blocks for the one-year fellowship program is provided below.
Fellowship Program Basic Rotations/Block Distribution
| Rotation/Activity |
| Cath Lab |
8 months |
| Peripheral Intervention Laboratory |
3 months |
| Elective |
1 month |
| Continuity Practice |
1/2 day per week |
Fellows are allotted a maximum of 3 weeks of vacation per year and 1 week conference time.
For an application, click here.
Checklist for completed application:
- Completed application including photograph
- Dean's Letter
- Medical School Transcript
- USMLE scores
- Letter of recommendation from the Internal Medicine Residency Program Director
- Letter of recommendation from the Cardiology Fellowship Program Director
- One letter of recommendation from a Cardiologist
- ECFMG certificate (International Graduates Only)
- Copy of Visa (International Graduates Only)
- Internal Medicine Residency Completion Certificate (upon entering program)
- Cardiology Fellowship Completion Certificate (upon entering program)
Please forward completed application to:
Venkatraman Srinivasan, MD, FRCPC, FACP, FACC
Chief, Division of Cardiovascular Diseases
Program Director, Interventional Cardiology Fellowship Program
Department of Medicine
Suite 2800 North Tower
Pittsburgh, PA 15224
Attention: Rose Santonastaso, Residency Coordinator
(412) 578-6902 Phone
(412) 578-6804 Fax
rsantona@wpahs.org
