Clinical Training (Combined Fellowship Program)

The clinical curriculum at UT Southwestern takes place at three distinctive clinical settings, providing a rich mixture of patients with diverse cardiovascular problems. Parkland Memorial Hospital is a state-of-the-art safety-net hospital with one of the busiest emergency departments in the country. William P. Clements Jr. University Hospital is a 750-bed quaternary care referral hospital with a vibrant advanced heart failure/transplant program and patients with complex valvular, coronary, and congenital heart diseases. Dallas Veterans Affairs Medical Center is the second-largest VA hospital system in the country (853 beds) with a busy cath lab and a large electrophysiology referral center.

The core curriculum includes rotations on the cardiology consultation service, cardiac care unit, noninvasive echo laboratory, nuclear cardiology, cardiac CT and MRI, cardiac catheterization laboratory, cardiac electrophysiology, and advanced heart failure/cardiac transplantation. In addition, each fellow is assigned a continuity clinic which meets one half-day per week throughout the three-year training period.

Completion of the core curriculum satisfies certification requirements of the American Board of Internal Medicine (ABIM), as well as those of the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Privileges in Cardiology. After completing the 2-year core curriculum, each fellow pursues an individualized plan for clinical and research training that meets their unique career goals.

• Acute Cardiac Care

  Acute Cardiac Care

  The cardiology inpatient service at Parkland Memorial Hospitalthe major county hospital for Dallas County—occupies a 47-bed combined medical and cardiac unit with a 36-bed step-down unit. All patient rooms in the hospital have telemetry capabilities. Four teams of house staff and students, supervised by two cardiology fellows and two attending cardiologists, serve about 1,500 patients with diverse cardiovascular illnesses annually.

  At Clements University Hospital, fellows rotate through a Cardiology ICU Service, where patients with acute coronary syndromes and other cardiovascular emergencies are managed in a multidisciplinary team setting. As part of the ICU team, fellows will round on post-cardiac surgery patients and those requiring mechanical support devices, and will also spend time in the OR with cardiovascular surgeons.

  At the Dallas VA, the cardiopulmonary ICU serves approximately 1,300 patients annually. The pulmonary critical care and cardiology teams round together with a team of residents and interns. The unit is equipped with state-of-the art data-managing and -monitoring systems.

• Noninvasive Imaging

  Noninvasive Imaging

  Our fellows train at hospitals with high-volume, high-complexity, non-invasive imaging laboratories. Complex valvular disease, mechanical cardiac support, oncologic and transplant-related complications are the new norm in our diagnostic laboratories.

  The hospitals offer a wide variety of non-invasive diagnostic testing, including exercise stress testing, transthoracic and transesophageal echocardiography (TTE and TEE), nuclear perfusion imaging, cardiac MRI, and cardiovascular CT.

  The echocardiographic laboratory performs 18,000 studies annually in the UTSW hospitals and 15,700 at Parkland Hospital. All fellows who graduate from the three-year general cardiology fellowship obtain ample TTE and TEE volumes to achieve COCATS level II certification and sit for the NBE Special Competence in Adult Echocardiography board examination. Furthermore, we offer the opportunity for a non-invasive imaging fellowship to complete COCATS level III certification.

  The Dallas VA Medical Center and Clements University Hospital have state-of-the-art TEE probes and structural procedures [MitraCip, Tricuspid Clip, TMVR, WATCHMAN, Atrial Septal Defect closure, etc.] for fellows to learn the basics in 3-dimensional imaging, speckle-tracking strain processing, and other advanced techniques. The echocardiography labs work in tandem with division-wide quality-improvement endeavors, advances in echocardiography-based education, epidemiologic research, and our growing cardio-oncology protocols.

  The nuclear and echocardiographic stress testing labs offer the opportunity for fellows to achieve COCATS level II certification, including MUGA and viability modalities with a variety of different radionuclides. Most of our fellows sit for the CBNC Certification Examination for Nuclear Medicine. In conjunction with the UTSW radiology department, the cardiac CT And cardiac MRI faculty offers fellows a comprehensive perspective on various cardiomyopathies, coronary anatomy, and anatomic planning prior to high complexity cardiac procedures.

  Furthermore, Clements University Hospital and Children’s Medical Center work together to offer a full spectrum of imaging modalities for our adult congenital heart disease patients, to which the fellows have open access.

• Cardiac Catheterization and Interventional Cardiology

  Cardiac Catheterization and Interventional Cardiology

  The Cardiac Catheterization Service at Parkland currently performs 1,400 procedures annually, of which 500 are interventional procedures. The spectrum of interventional procedures includes a robust program in acute coronary syndromes, complex PCI for multiple vessel coronary disease, endovascular interventions for peripheral arterial disease, mechanical support for shock, and structural heart interventions such as adult congenital repairs, left atrial appendage occlusion, and valvuloplasty. Fellows serve as the primary operators on all cases, with direct faculty supervision.

  Two hours a week are devoted to formal didactics, covering invasive and interventional cardiology. The catheterization labs at Clements University Hospital (CUH) perform close to 2,000 interventions annually, including approximately 450 coronary interventions, 150-200 structural heart interventions (TAVR, MitraClip, TMVR, left atrial appendage occlusion, paravalvular leaks, adult congenital etc.). CUH has a busy transplant program, giving fellows valuable experience with short-term mechanical circulatory support devices in a multidisciplinary setting. The VA Hospital treats 1,700 cases annually, encompassing more than 100 peripheral arterial cases, over 500 interventional procedures, and approximately 100 structural interventions. The VA also has a robust clinical research program.

• Cardiac Electrophysiology

  Cardiac Electrophysiology

  The Clinical Electrophysiology Service cares for patients with cardiac arrhythmias at Clements University Hospital, Parkland Memorial Hospital, and the VA Medical Center, where full-time faculty members actively participate in all aspects of clinical electrophysiology. These diverse patient populations provide an unparalleled diversity of patient experiences. Our fellows receive training in all types of procedures, including ablation of supraventricular tachycardias, ventricular tachycardias, other complex arrhythmias, atrial fibrillation, and implantation of cardiac pacemakers and defibrillators.

  Combined, these facilities see nearly 2,000 cases each year, guaranteeing plenty of case volume for our fellows. In addition, a comprehensive didactic curriculum enhances a rich learning environment. The General Cardiology fellows spend two months of their core curriculum on the electrophysiology service, and closely interact with EP fellows and faculty.

• Consultative Cardiology

  Consultative Cardiology

  Active consult services at Parkland Hospital and Clements University Hospital involve trainees in the care of patients with an extraordinary diversity of cardiovascular diseases. Clements is home to one of the nation’s largest pulmonary hypertension programs, along with active transplant programs for liver, lung, kidney and bone marrow. Fellows have the opportunity to combine forces with other specialties to provide care to highly complex patients. Special experiences also are available in postoperative management of patients undergoing cardiac surgery, cardiac rehabilitation, and pediatric cardiology treatment.

• Congestive Heart Failure and Cardiac Transplantation

  Congestive Heart Failure and Cardiac Transplantation

  Fellows spend at least one month on the heart failure/transplant/device therapy service at Clements University Hospital, receiving training in the diagnosis and management of patients with advanced heart failure, and perioperative and long-term management of patients receiving left ventricular assist devices or transplants. The service is staffed by heart failure/transplantation faculty members, a senior and junior cardiology fellow, plus a team of medical residents and interns.

• Preventive Cardiology

  Preventive Cardiology

  The Program in Preventive Cardiology offers exposure to diverse conditions and programs such as complex dyslipidemias, metabolic syndrome, premature and familial coronary artery disease, exercise and nutritional counseling, cardiac rehabilitation, and atherosclerotic imaging. Additional exposures to preventive care are available through the Hypertension Program, the Center for Human Nutrition, and the Eugene McDermott Center for Human Growth and Development at UT Southwestern.