Fellowships

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Cardiovascular, Interventional Cardiology and Vascular Fellowship Program Instructions

The following items are needed to complete your application:

  1. Complete application along with a photo for identification purposes.
  2. Three letters of recommendation (one letter sent from your Program Director).
  3. Curriculum Vitae and Personal Statement.

Candidates who have submitted their completed applications and letters of recommendation are often scheduled for interviews. Letters of recommendation can be address to:

Cardiovascular Fellowship
Denise Zingrone, DO, FACC, FACOI
Director, Cardiovascular Fellowship Program

Any questions may be directed to the program administrator or Fellowship Program Director at 609-893-1200 ext. 5066 or fellowship@deborah.org.

PDF Cardiovascular Fellowship Application (19KB)

Cardiology Fellowship Program

Deborah Heart and Lung Center is a tertiary care referral center specializing in the management of cardiovascular and pulmonary disease. Located in Browns Mills in southern NJ, this 89 bed hospital is midway between Philadelphia and the Jersey shore. The Center offers, with the exception of cardiac transplant, the full spectrum of diagnostic and therapeutic services to patients with cardiac and vascular disease. We annually perform diagnostic, interventional cardiac and peripheral vascular procedures, nuclear cardiac diagnostic tests, echocardiographic procedures and electrophysiology device implantations. Patient access to Deborah by way of referral from regional community hospitals and a large out-patient clinic service has resulted in a patient population with diverse and complex cardiovascular disease.

Three Year Fellowship Program

The fellowship for general training in Cardiovascular Diseases is offered to graduates of AOA approved Internal Medicine residency programs. The cardiology fellowship program is sponsored through the Philadelphia College of Osteopathic Medicine OPTI network (PCOM Med-Net) and is an AOA approved fellowship program. Two fellowship tracks are available and the trainees choice is made toward the end of their first year of training: 1) The Invasive Track includes focused lab based training in diagnostic cardiac catheterization and echocardiography, 2) The Non-invasive Track includes focused lab based training in echocardiography and nuclear cardiology (including didactic training to qualify for a license from the Nuclear Regulatory Commission). All fellows, regardless of their chosen career track, receive training in all facets of clinical cardiology.

In addition to the three year program, Deborah offers advanced training programs in Interventional Cardiology and Electrophysiology for fellows who have completed an AOA approved three year fellowship. There is a one year Echocardiography-Nuclear training program for qualified fellows who wish to pursue advanced echo training that would meet ACC guidelines for Echo Laboratory Directors and provide training in Nuclear Cardiology to qualify for a license from the Nuclear Regulatory Commission.

One month elective rotations in the MICU or on a clinical cardiology in-patient service are offered to internal medicine residents at their request. This is not only a worthwhile learning experience, but affords prospective applicants a chance to experience the cardiology training program at Deborah. This is not, however, a requirement for application or admission to the fellowship program. Housing is available on the hospital campus. Fellowship applications may be obtained by contacting our program administrator (see below). Completed applications and interviews are processed and final decisions made one year prior to your expected July 1st start date. Thus, interested applicants should begin their application process during their second year of residency.

Any questions may be directed to the program administrator or Fellowship Program Director at 609-893-1200 ext 5066 or fellowship@deborah.org.

Interventional/Endovascular Fellowship Program

Deborah sponsors a one year Cardiology Subspecialty Training Program in Interventional Cardiology for graduates of AOA approved general cardiology fellowships who are board eligible or board certified in general cardiology.

Interventional Cardiology Fellowship
Vincent Varghese, DO, FACC, FSCAI
Director, Interventional Fellowship Program

Any questions may be directed to the program administrator or Fellowship Program Director at 609-893-1200 ext. 5066 or fellowship@deborah.org.

PDF Interventional Fellowship Application (81KB)

Guidelines for One Year Program Osteopathic Fellowship

Osteopathic 4th year Interventional Cardiology trainees who have graduated from an AOA accredited medical school and have competed an AOA approved internal medicine residency program and who have also completed a three year general cardiology fellowship program. They are to be board eligible or board certified in general cardiology.

Fellow Evaluation

Formal evaluation with feedback to the fellows is an important part of the training process. Each quarter will require an evaluation of the fellow by the interventional attending laboratory staff. This evaluation will be conducted by the Interventional Cardiology Program Director. The fellows may review their evaluations and questions can be directed to the Program Director.

Service Evaluation

Fellows evaluations of the training program are important for maintaining and improving the quality of the teaching program. Each quarter, the fellow will complete an evaluation form. The forms will be forwarded to the Program Director for review. All responses are kept confidential and used to provide general feedback to individual Catheterization Laboratory attendings, nursing and auxiliary staff.

Record Keeping

A database will be maintained by the training program. This will include the number of diagnostic and interventional catheterization laboratory procedures performed by each fellow. The database will be quite specific as to the procedures performed with each individual catheterization laboratory diagnostic and/or interventional device.

Conferences

Interventional Skills review weekly on Tues. at 12:00pm; Adult Congenital Conference monthly on Tues. at 7:30am; Cath Conference weekly on Wed. at 7:30am; Endovascular Conference weekly on Thurs. at 7:30am; Monthly M&M/PI case reviews for all adverse events. An assigned attending physician will present these conferences. Individual cases may be presented by the training fellow. Teaching objectives of the invasive cardiology conferences as noted will be primarily case review type conferences. The individual cases may be presented by the attending physician and/or fellow in training. Case selection, invasive-interventional equipment choices and interventional techniques will be discussed in detail. Complications and/or possible complications will be reviewed. Pre and post procedure care will be discussed. Alternative therapies will be reviewed. Individual attending preferences will be discussed and when appropriate clinical data supporting decision making will be reviewed.

At the assigned attending’s discretion, this case review conference may alternatively be in the form of didactic lecture directed towards emerging and/or controversial issues in the field of invasive-interventional cardiology.

Clinic

Applicant will participate in Interventional Endovascular clinic ½ day/week on Thurs. and Fri. (rotational coverage by 4 Interventional Fellows.

Program Knowledge and Skill Set Requirements

The duration of the training program in interventional cardiology shall be 12 months. Of this period a full 11 months should be spent in the interventional cardiology laboratory. One month will be provided for vacation or “elective” time to be used by the trainee at their discretion. The formal interventional cardiology training program will:

  1. Diagnosis of cardiovascular disease states amenable to catheter based interventions. Catheter based interventional procedures should be discussed in the context of therapeutic options for the patient including medical therapy or surgery.
  2. Indications for urgent catheterization in the management of patients with acute coronary syndromes. Issues regarding the choice of therapy including catheter based intervention, medical or surgical therapy should be established.
  3. Indications for and the proper technical placement of intra-aortic balloon counter pulsation devices and other ventricular support devices including Impella®.
  4. Indications for and the proper technique for placement of emergency temporary pacemakers.
  5. Preparation and performance of interventional cardiology procedures including, but not limited to:
    • Balloon angioplasty
    • Cutting balloon angioplasty
    • Laser atherectomy
    • Rotational atherectomy
    • Intracoronary bare metal and drug eluting stent deployment
    • Thrombectomy (mechanical+aspiration)
    • Intravascular ultrasound
    • Fractional flow reserve
    • Guidewire advancement
    • Guide catheter placement
    • Femoral, brachial and radial access
    • Selection and use of vascular access devices
    • Selection and use of vascular closure devices
    • Aortic and mitral balloon valvuloplasty
    • Trans-septal catheterization
    • Coil embolization
    • Alcohol septal ablation
    • Pericardiocentesis
  6. Preparation and performance of peripheral endovascular interventional procedures, including but not limited to:
    • Femoral, brachial, radial and pedal access
    • Selection and use of vascular access devices
    • Selection and use of vascular closure devices
    • Angiography of all peripheral vascular beds, including carotid angiography
    • Guide catheter or sheath advancement
    • Guide wire techniques and choices for patent vessels and total occlusions (including “sub-intimal wiring”)
    • Total occlusion devices
    • Re-entry devices
    • Atherectomy, including laser, rotational atherectomy, orbital atherectomy, directional atherectomy (Silverhawk®), mechanical atherectomy with aspiration (Pathways®)
    • Balloon angioplasty
    • Cutting balloon angioplasty
    • Stents, balloon expandable and self expanding
    • Covered stents and other bail out devices
    • Coil embolization
    • Interprelation of non invasive peripheral vascular studies
    • Drug eluting balloons and other local drug delivery devices
    • Intravascular ultrasound
    • Prolonged lytic therapy
    • IVC filters
    • Venous stenting
    • DVT management with catheter directed thrombolysis
  7. Research
    • Active participation in and recruitment for all ongoing peripheral vascular and coronary research protocols
    • Generation of at least 2 case reports with extensive literature review
    • Protected research time for self generated projects
  8. Knowledge of the biological effects and indications for the use of pharmacologic agents common to the practice of interventional cardiology. These agents should include, thrombolytics, antiplatelet agents, anti-thrombin agents, anticoagulants, vaso-active drugs and anti-arrhythmics, sedatives and analgesics. Additionally, indications for the use of various radio contrast agents should be established.
  9. Recognition and Management of all potential coronary and peripheral interventional complications, including but not limited to:
    • Coronary and peripheral vascular dissection
    • Acute vessel closure
    • Slow and no reflow phenomenon
    • Distal embolization
    • Side branch loss
    • Vascular access site complications
    • Infection: recognition, treatment and follow up
    • Acute blood loss and retroperitoneal bleeding
    • Cardiac tamponade
    • Compartment syndrome
    • Acute MI/unstable angina
    • Significant cardiac arrhythmias
    • Acute stroke
    • Acute hypotension and hypertension
    • Over sedation/airway management
    • Covered stents for perforation
    • Snaring of foreign bodies
  10. Knowledge of vascular biology including the processes involved in plaque formation, vascular injury and vaso reactivity. A thorough understanding of the process of restenosis and the therapeutic options available for the treatment of this phenomenon. Knowledge of the coagulation cascade and the effect of pharmacologic agents as noted above.
  11. Sufficient patient volume to provide the cardiovascular fellow training with a total case volume of 400 interventional procedures. The cardiovascular trainee should serve as the primary operator. The primary operator shall perform under supervision the majority of the technical aspects of the procedure. The primary operator shall be actively involved in decision making regarding equipment selection, problem solving, post procedural assessment and complication management. There will be no volume requirements in regards to diagnostic cardiac catheterization. However, it is strongly encouraged that the trainee perform the minimum number of diagnostic procedures to maintain clinical competency in this field.
  12. Understanding of radiation safety and overview of x-ray equipment function.
  13. Adequate communication skills to enable the trainee to convey the risks, benefits and general technique of interventional procedure to the patient and family. The trainee should be able to obtain informed consent in this context.
  14. Participate in 100% of interventional cases (divided evenly among all fellows) and as many diagnostic cases as possible. Act as primary operator in at least 50% of interventional cases in which fellow participates.
  15. Optional training will be available in carotid stenting with both distal and proximal protection devices. To receive certificate, applicant must attend didactic sessions for each device, and must participate in 20 cases, half as primary operator.
  16. Optional training will be available for management of structural heart disease, including, ASD, VSD and PFO closure, perivalvular leak closure, left atrial appendage occlusion devices and percutaneous valve replacement.
  17. Optional training will be available for management of venous insufficiency, including radio frequency or laser venous ablation. Applicant must participate in a minimum of 20 cases and be primary operator in half.
  18. Optional training for abdominal thoracic endograph repair will also be available. Applicant must collaborate with vascular surgery and participate in a minimum of 10 cases.

Vascular Surgery Fellowship Program

Contact

Karen Goebel
Training Coordinator
Residency & Fellowship Program
Deborah Heart and Lung Center
Phone 609-893-1200 ext 4771
goebelk@deborah.org

PDF Vascular Surgery Fellowship Application (19KB)

Vascular Surgery Fellowship Program

Deborah Heart and Lung Center extends a warm welcome to you at the beginning of this new academic year in our General Vascular Fellowship program! We are proud of the fact that we are able to provide the best in medical care while maintaining the warm and friendly atmosphere of a small hospital environment. You will find our institution to be a comfortable learning environment while also being academically challenging.

Vascular Surgery Fellowship Program Goals and Objectives

Vascular surgery fellows at Deborah are expected to achieve the six core competences to the level expected of a new practitioner. The vascular surgery fellow will have progressive responsibility for patient management that will demonstrate competence in technical skills and clinical decision-making. Competency-based objectives are expected to be a cumulative experience throughout the fellowship.

The first year of the General Vascular Surgery Fellowship Program focuses on the anatomy, pathophysiology, differential diagnosis and diagnostic studies, and management of common vascular problems. The fellow is expected to fluently discuss open and endovascular surgical approaches and perform surgical dissections tailored to the individual patient. The fellow should competently perform various vascular accesses and basic diagnostic and interventional procedures.

The second year of the General Vascular Surgery Fellowship Program focuses on clinical research skills, comprehensive experience in noninvasive vascular diagnostic laboratory, and preoperative and postoperative assessment in the outpatient setting. The Vascular fellow will continue to gain experience in surgical decision-making and is expected to perform complex surgical revascularization through a combination of open and endovascular techniques.

The General Vascular Surgery Fellowship Program at Deborah Heart and Lung Center builds upon the core education of general surgery to provide the knowledge, skills, and abilities to develop proficiency and mature surgical judgment in the diagnosis and management of diseases of the arterial, venous, and lymphatic circulatory systems, exclusive of the vessels of the heart and intra-cranial vessels. Fellows are trained in both open and endovascular approaches to vascular disease.

Vascular Surgery Fellowship Program Faculty

Kane L. Chang, MD
Director, Vascular and Endovascular Surgery
Department of General Surgery
Division of Vascular Surgery

The General Vascular Surgery Fellowship Program must provide a meaningful education that prepares residents upon graduation to meet certification requirements of the AOA through the American Board of Osteopathic Surgeons and to demonstrate these competencies:

  • Cognitive skills.
  • Integrate the sciences applicable to general vascular surgery with clinical experiences in a progressive manner.
  • Develop critical thinking skills which result in making decisions for patient management.
  • Understand the relevance of research to the practice of general vascular surgery.
  • Read, interpret, and participate in clinical research.
  • Psychomotor and technical skills.
  • Demonstrate osteopathic diagnoses and manipulative therapy in the care of patients.
  • Demonstrate proficiency with the necessary technical skills required for the practice of general vascular surgery.
  • Demonstrate the ability to provide progressive patient management. responsibilities based upon knowledge of the basic and clinical sciences.o Communication skills.
  • Demonstrate the ability to collaborate with colleagues and allied healthcare professionals.
  • Educate patients and their families concerning healthcare needs.
  • Demonstrate the ability to teach medical students, interns, other residents, and allied healthcare staff within the context of fellowship education.
  • Practice management.
  • Demonstrate leadership and management skills.
  • Provide cost-effective care to patients.
  • Professional attitudes and abilities.
  • Demonstrate a broad understanding of the role of general surgery as it relates to other medical disciplines.
  • Appreciate the value of lifelong learning in medical education and as related to a professional career in the field.
  • Demonstrate the ability to provide sound ethical and legal judgments.
  • Participate in continuing education to promote personal and professional growth.
  • Participate in community and professional organizations.
  • Apply the principles of evidence-based medicine to their professional practice.

Each fellow must document by program completion a minimum of 200 major vascular surgery procedures performed as surgeon or first assistant and under supervision.