Technical and Other Skills

Technical and Procedural Skill Requirements

The program provides sufficient experience for the fellows to acquire skill and proficiency in the performance and interpretation of:

  1. History and physical examination. This is supervised by faculty members while on the clinical services. The fellows have the opportunity to correlate their physical findings with results of cardiac diagnostic procedures.
  2. Basic and advanced cardiac life support. Fellows entering their training have documented certification in ACLS. Their ability to supervise complex resuscitative procedures and treat complex acute life threatening arrhythmias takes place in the CCU rotation. 
  3. Elective cardioversion. Both in-patient and out-patient cardioversions of atrial arrhythmias are performed by the fellows and supervised by the faculty members. 
  4. Bedside right heart catheterization pacemakers (transvenous and transcutaneous). In the CCU, cardiology fellows will perform bedside right heart catheterization under the supervision of faculty members for the first several months. The insertion and management of temporary pacemakers is performed routinely in the electrophysiology and catheterization laboratories, as well as in emergencies in the CCU.
  5. Right and left heart catheterization including coronary arteriography. Fellows perform and participate in at least 100 diagnostic catheterizations in the Yale and VA cath labs. 
  6. Exercise stress testing. Fellows perform a minimum of 50 tests. 
  7. Echocardiography. Fellows perform at least 75 studies, including transthoracic and transesophageal, and interpret 150 studies.
  8. Pericardiocentesis. Performed during the cardiac catheterization rotations at YNHH and the VA. 
  9. Programming and follow-up surveillance of permanent pacemakers. Performed on an out-patient basis during the electrophysiology rotation.
  10. Nuclear cardiology studies. Fellows will learn the basic aspects of image acquisition and interpretation in at least 100 cases.

Procedural Logs

Fellows are expected to keep complete and accurate logs of their procedures during their core training. They are expected to log their procedures into the E*Value system. 

The following procedures should be included in procedure logs at minimum. Fellows seeking advanced training in subspecialty areas (e.g. echocardiography) should consult the ACC website (guidelines for training) as well as professional societies (e.g. American Society of Echocardiography, American Society of Nuclear Cardiology, etc) for specific requirements, and add to this list as appropriate to meet professional goals. 

  1. Catheterization (min. 100)
  2. Echo (min. 75)
  3. Pericardiocentesis
  4. Temporary pacers
  5. ACLS training documentation

Additional Procedural Opportunities

The program provides opportunities for fellows to acquire experience with the performance and interpretation of: 

  1. Intracardiac electrophysiologic studies. As part of the electrophysiology rotation, fellows assist in performing and interpreting at least 15 such studies in two years. 
  2. Intra-aortic balloon counterpulsation. As part of the catheterization laboratory rotation and in the CCU. 
  3. Percutaneous transluminal coronary angioplasty and other interventional procedures. Fellows assist in these procedures on a limited basis during their core training for exposure to the technique. All fellows are versed in the indications for, management of and complications of patients with regard to interventional procedures.

Additional Interpretive Opportunities

The program provides sufficient experience for fellows to acquire skill in the interpretation of: 

  1. Chest x-rays. On an individual basis with the attending radiologist as well as didactic training. 
  2. Electrocardiograms. As part of the weekly conference schedule, ECGs are reviewed. All clinical services require ECG review. ECGs are read at the VA by the fellow with the attending cardiologist. A minimum of 3500 ECGs must be interpreted over the course of the two year core fellowship. 
  3. Ambulatory ECG recording. Supervised at the VACT and the YNHH EP lab, a minimum of 150 recordings will be interpreted by each fellow. 
  4. Radionuclide studies of myocardial function and perfusion. Intensive rotation with didactic and practical interpretation during the Nuclear Cardiology rotations. 
  5. Cardiovascular literature. A monthly Journal Club is held to review a recent manuscript, and formal training in clinical epidemiology is provided during the core didactic sessions each month. Attendance is mandatory and is recorded at each session.