SCHOOL OF MEDICINE • DEPARTMENT OF MEDICINE

Introduction/Overview

The consultation services of University Hospitals Case Medical Center and Louis Stokes VAMC are a team consisting of one fellow and an attending physician. There may be both medical residents and medical students on an elective rotation. The overall goal of the rotation is to enable cardiology fellows to achieve the knowledge, skills, and attitudes of competent cardiologists providing consultative care to a diverse patient population. Learning occurs by the bedside, formal attending rounds daily, review of appropriate diagnostic testing, and through participation in divisional conferences. The consult service meets 6 days/week; the fellow on-call and the CICU attending cover the service on Sundays.

Fellows are responsible for seeing all new general cardiology consults, writing the initial consult and subsequent follow-up notes, reviewing all pertinent diagnostic studies, and preparing a formal case presentation with the attending physician, who will formulate a treatment plan to be implemented by the primary team. Evidenced-based treatment algorithms will be emphasized. Fellows will be expected to communicate all aspects of treatment recommendations to the primary team, to the patient, family and to other members of the healthcare team, as appropriate.

 

Principle Teaching Methods

Direct Supervision of Patient Care
The attending physician provides supervision to all members of the cardiology consult team, which includes a cardiology fellow, medical resident(s), and medical student(s).The fellow provides additional supervision to the rotating residents and students.

Case-Based Learning
Attending physicians are expected to teach during team rounds in addition to discussing routine patient management; teaching time averages ~ 5-10 hours/week. The fellow is expected to take a leadership and teaching role on rounds commensurate with is/her experience and knowledge.

Divisional and Departmental Conferences
Fellows are expected to attend all divisional and departmental conferences while rotating through consult service.

 

Clinical Content

Patient Characteristics
UHCMC serves a primary care suburban and urban local population in Cleveland, Ohio and is also a tertiary care referral center for Northeast Ohio and the University Hospital Health System. The Louis Stokes VAMC is also tertiary care hospital, provding care to veterans throughout Ohio. The Cleveland VAMC is the ONLY VA hospital in Ohio to offer cardiac surgery. Patients present with the full spectrum of acute and chronic cardiologic problems.

Patients admitted to UHCMC come from a broad mixture of ethnic and socioeconomic backgrounds. Patient ages range from young adults to the elderly. There is an equal mix of male and female patients. Patients admitted to VAMC are veterans, typically with complex medical problems and with high acuity of care. All patients seen during the rotation are inpatients receiving care for acute medical problems. The mix of patients includes consultative care for patients admitted to the medical intensive care unit, surgical intensive care unit, post-operative recovery room, emergency room, and patients on the general medical and surgical units.

 

Principle Educational Material Used

Fellows have a dedicated office with all access computers and a growing cardiology -specific library. All general medicine wards have computers with access to literature searching, online journals, Up-to-Date, and textbooks. Fellows have 24-hour access to the core library located in the hospital. A medical librarian from the Core Library provides assistance in literature searches pertaining to issues discussed there. Therapeutic recommendations should be guided by the medical literature with emphasis given to Society-written (e.g. ACC/AHA) clinical guidelines and consensus statements.

 

Methods used in Evaluation and Performance

A competency-based evaluation matrix for written evaluations is to be completed at the end of the rotation by the Fellow using the www.myevaluations.com system. Evaluations are sent electronically to the fellows upon completion and are available for review by the fellows. In addition to a written evaluation, the attending gives verbal feedback. Fellows complete an anonymous written rotation evaluation as well as anonymous attending evaluation. Feedback is also solicited via written feedback from other team members, medical personnel and patients. Duty hour compliance is monitored by the program director and Chief Fellow.

 

Graded Responsibilities

While the general responsibilities for all years of fellowship are the same, the expectations and independence increase with each successive year of training. Specific personal goals and expectations for further development are assessed before the rotation begins. These will be related to the fellow’s learning portfolio, and should take into account the fellows prior performance, degree of competence, comfort and experience. First year fellows are expected to discuss in detail consultations with the attending while patients are actively followed. Second year fellows are expected to have a comfortable handle on management, and to discuss patients with an eye to subtleties of management and future plans. Senior fellows are expected to have facile handling of complex cases, as well as a sophisticated and maturing clinical judgment. Thus, the expectation is that the leadership and teaching roles will progress during training.