Interventional Cardiology

Application Overview

All applications must be submitted through ERAS, and the program participates in the National Residency Matching Program (NRMP). Applications will not be received outside of ERAS, and positions will not be filled outside the match.

Application deadline is July 31, 2024.

Eligibility

Qualified candidates will be:

• U.S. citizens, permanent residents or J-1 visa holders (no additional visa types are sponsored)

• Board-eligible or board-certified in internal medicine

• Pennsylvania medical training license eligible

Required Supporting Documents

The following documents should be uploaded to ERAS for review:

• ERAS application, inclusive of current photograph

• Personal statement

• Curriculum vitae

• USMLE or COMLEX transcript

• ECFMG certificate (if applicable)

• Letters of recommendation – minimum 3-4 letters, including one from current program director

Interview Process

Thank you for your interest in our program. Interviews are expected to take place virtually for 2024; however, this is subject to change, and we encourage you to check back often.

Interview dates for 2024 will be:

• Oct. 3

• Oct. 9

• Oct. 17

• Oct. 23

All interviews are by invitation only and will be scheduled through Thalamus.

Leadership

Amanda Cai, MD Faculty Leader

Dorothy Jung, MD Fellow Leader

Overview

Women in Cardiology:

• Strives to foster a supportive environment for women in Cardiology and its subspecialties at Penn State Hershey Medical Center

• Offers unique opportunities to address and support career-focused education for women within our field

• Provide resources for leadership, mentoring and families

• Minimum of bi-annual events for participation

• Attending and fellow-level support system

The Interventional Cardiology fellowship training program extends for a period of one year. This one-year program complies with all Accreditation Council for Graduate Medical Education (ACGME) requirements, in addition to following the guidelines and recommendations of the American College of Cardiology's (ACC) COCATS. All applicants entering Interventional Cardiology must have completed an ACGME-accredited Cardiovascular Disease fellowship or its equivalent.

A subspecialty educational program in Interventional Cardiology must function as an integral component of an accredited subspecialty fellowship in Cardiovascular Disease. Therefore, the guidelines that follow are complementary to those in general cardiology.

Program Objectives

The Interventional Cardiology fellowship training is designed to provide the fellow with COCATS Level III training. Specific curricular milestones for training in Coronary Angiography and Intervention and Peripheral Vascular Angiography and Intervention, as they relate to the Core Competencies promulgated by the ACGME, are adopted as outlined in the COCATS 4 Task Force 10 document. They are included in this curriculum with the appropriate associated Evaluation Methods for fellows. Additionally, specific curricular milestones for Ambulatory and Longitudinal Care, as well as Research, are also included.

Procedural Training

In order to ensure the appropriate training of the Interventional Cardiology fellow the training program will ensure that a minimum of 400 interventional procedures are performed per year and that the Interventional fellow has the opportunity to acquire skill in the performance of a minimum of 250 coronary interventions.

The program provides instruction and opportunities to acquire knowledge in the following:

• Pathophysiology of atherosclerosis and response to vascular injury

• Pathophysiology of restenosis

• Role and limitations of therapy for restenosis

• Advanced invasive cardiac imaging (ICE, OCT, NIRS, IVUS, FFR)

• Detailed coronary, valvular, and structural anatomy

• Radiation physics, biology, and safety related to the use of X-ray imaging equipment

• Critical analysis of published interventional cardiology data in laboratory and clinical research

• Role of randomized clinical trials and registry experiences in clinical decision-making

• Cardiovascular pharmacology

• Valvular and structural heart diseases

• Adult congenital heart disease

• Devices

  • Ultrasound for vascular access and intracoronary imaging

  • DES and bare metal stents

  • Bioresorbable vascular scaffolds

  • Rotablator, orbital atherectomy

  • Thrombectomy devices

  • Distal and proximal protection devices

  • iFR and FFR

  • Impella and support devices

  • Left atrial appendage occlusion

  • MitraClip

  • TAVR

  • PVL repair

The Interventional Cardiology fellow will spend approximately 10 months in the Cardiac Catheterization Laboratory at Penn State Health Milton S. Hershey Medical Center and has two electives that may be spent elsewhere in order to enhance their experience in technology not available at Penn State Health Milton S. Hershey Medical Center. For each elective month the Interventional Cardiology fellow will be evaluated by attending staff with whom they have had significant contact with at each of the teaching institutions.

Ambulatory Clinic

The Interventional Cardiology fellow is required to spend one half-day a week in the outpatient clinic for the follow-up of patients treated with drugs, interventions, devices, or surgery. In this setting, they are also expected to be involved in the pre-procedural workup of interventional cases. This outpatient exposure is expected to focus and build on the experience already gained during general cardiology training.

Clinical Research

During the Interventional Cardiology training year the fellow is expected to be involved in clinical research in order to foster their experience and to understand the role of randomized clinical trials and registry experiences in clinical decision making. Quality and safety improvement projects along with a focused review on practices relating to interventional cardiology will also be considered as research efforts during this one-year fellowship.

The fellow will become familiar with:

• All aspects of pharmacologic interventions as they relate to the interventional patient. These include platelet inhibitors, all anticoagulants and thrombolytic drugs, as well as beta blockers, calcium channel blockers and nitrates as they relate to the catheterization laboratory. As well, the trainee will become familiar with emerging data as they relate to free radical scavengers, leukocyte inhibitors and other aspects of the inflammatory process.

• All aspects of the performance and management of complications of routine coronary and peripheral angioplasty. This includes both elective and complex and multivessel interventions, as well as other mechanical interventions for acute myocardial infarction. This will include the management of restenosis, the management of chronic total occlusions, reperfusion angioplasty and supported/protected angioplasty.

• New device technologies. This includes receiving full exposure and training to rotational atherectomy, clot extraction technology, future innovative devices and all aspects of intravascular imaging.

• Indications for and technique of percutaneous intracardiac defect closure (ASD, PFO) and the technical aspects of TEE or intracardiac echo guidance of these procedures.

• Performance of aortic and mitral balloon valvuloplasty as well as pulmonary valvuloplasty.

• TAVR procedures, including participating actively in pre- and post- procedure care of the TAVR patients.

The principal teaching method by the faculty follows the recommendations and guidelines set forth by the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and the American Heart Association and covers the following:

• Anatomy: Cardiac, vascular and coronary artery anatomy, including anatomic variants and congenital abnormalities.

• Physiology: Basic circulatory physiology, coronary vascular physiology, myocardial blood flow regulation, myocardial physiology and metabolism.

• Vascular biology and pathology: Normal vascular structure and function, response to injury, mechanisms of atherosclerosis and mechanisms of restenosis.

• Hemostasis: Intrinsic and extrinsic coagulation cascade and platelet physiology.

• Pathophysiology: Myocardial ischemia and infarction, myocardial reperfusion, circulatory shock, anaphylaxis and cardiac arrhythmias.

• Pharmacology: Anticoagulants, antiplatelet drugs, thrombolytic drugs, X-ray contrast agents, myocardial inotropes, vasopressors, vasodilators, antiarrhythmic drugs and drugs affecting lipid metabolism.

• Radiology imaging and radiation safety: Principles of X-ray imaging, quantitative coronary arteriography, operation of cinefluorographic X-ray equipment, operation of digital video imaging systems, radiation biology and radiation protection.

• Intracoronary imaging and coronary physiology: Principles of intravascular ultrasound imaging and Doppler coronary flow velocity and coronary pressure measurements.

• Interventional device design and performance: Device materials and characteristics.

• Clinical management strategies: Performance and limitations of interventional devices, spectrum of coronary ischemic syndromes, results of interventional cardiology clinical trials, management of acute hemodynamic alterations and mechanical and pharmacological circulatory support.

• Attend the Cardiac Catheterization conferences throughout the year.

  • When assigned, prepare a topic or case review for presentation during Cardiac Cath conference.

• Attend the Interventional Cardiology Journal Club once per month.

  • Read and prepare article for discussion with faculty member(s).

• Attend and participate in the Interventional Cardiology morbidity and mortality conference.

• Attend HVI Multidisciplinary Conferences and HVI Grand Rounds.

• Track participation in performing cardiac catheterization procedures in New Innovations.

• Participate in the weekly Structural Heart Disease (SHD) multidisciplinary meetings.

• See patients in consultation for interventional procedures.

• Provide direct care to patients who undergo interventional procedures, under the direction of the interventional attending. This includes:

  • Pre-procedural evaluation

  • Procedural note

  • Writing orders

  • Performing procedure under direct supervision of Interventional Cardiology attending

  • Post-operative care

• Communicate plan of care to other subspecialty fellows, internal medicine residents, or other trainees at Penn State Health Milton S. Hershey Medical Center. This frequently involves didactic education as to the underlying pathophysiologic and medical rationale for the care and treatment plan.

• Participate in ongoing Cardiac Catheterization Laboratory continuous quality improvements projects such as door-to-balloon time, outcomes and complication rates for intervention.