Continued responsibility for principal care, co-management with primary care physicians and consultation outpatient cardiovascular patient management is achieved in the outpatient continuity clinic.
Each fellow has one-half day per week of clinic for the 36 months of training. An ambulatory continuity clinic is essential for the duration of training, and is not interrupted during any of the rotations throughout the three years of training. There is exposure to a wide age range of patients, from adolescence through old age, including an appropriate distribution of both genders, with a spectrum of cardiovascular diagnoses. This includes post-operative patients, patients with congenital heart disease and patients for evaluation and management related to pregnancy.
Each fellow is, on average, responsible for 4-8 patients during each half-day session. The outpatient clinical experience is provided in four different settings on a rotating basis:
Additional ambulatory experience in specialty clinics or hospital-based settings may include participation in same-day diagnostic or therapeutic procedures.
On any given night, two fellows are on call. One fellow is in-house at the Hospital Center. His/her on call duties begin with sign out rounds in the Coronary Care Unit (CCU) promptly at 5 p.m., and end at 8 a.m. the following morning, with sign off to the fellow doing the monthly CCU rotation.
The fellow provides support to the residents on call in the CCU, and performs consultative emergency services throughout the hospital, including the Emergency Department. The fellow is involved in the triage of patients to decide the most appropriate treatment, including the performance of invasive procedures and escalation in the level of care. All admissions to the CCU are funneled through the on call fellow, with the use of a dedicated phone line and pager.
Often, the patient’s evaluation requires a transthoracic echocardiogram, so fellows must be familiar with the performance and interpretation of cardiac ultrasound studies. If a transesophageal echocardiogram is required, then the fellow involves the Echo Lab attending physician on call, who will come to The Hospital Center to perform the study.
The following attending cardiologists are on call at home, to support the in-house fellow with immediate consultation by phone and by coming into the hospital, if needed:
A separate fellow is on call at home to cover the consultative service needs at MedStar Georgetown University Hospital and the Washington DC Veterans Affairs Medical Center. The fellow carries a dedicated pager that can be activated by either institution.
The fellow is responsible for providing immediate consultation to in-house residents and other physicians by phone, and is available to come into the hospital if needed. The need for consultation may include the performance of a transthoracic echocardiogram.
The fellow is involved in the triage of patients to decide the best treatment strategy and escalation of care, if necessary, including activating the transfer to a tertiary referral center – as in the case of patients presenting to Georgetown with acute ST segment elevation coronary syndrome that require transfer to the Hospital Center for primary percutaneous coronary intervention.
Fellow duty hours are strictly enforced according to the ACGME program requirements. Duty hours are limited to a maximum of 80 hours per week averaged over a four-week period, and inclusive of all in-house activities and all moonlighting.
The fellow on call at the Hospital Center may stay in the hospital for an additional four hours beyond the 24-hour tour of duty, but only for the purpose of continuity of care or education. Time spent in the hospital by fellows on at-home call counts toward the 80-hour maximum weekly hour limit.
Moonlighting is allowed as long as it does not interfere with the ability of the fellow to achieve the goals and objectives of the educational program. All moonlighting must be approved annually and in writing by the Program Director.