General Cardiovascular Medicine Fellowship

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Robert Harrington, MD
Arthur L. Bloomfield Professor of Medicine

Chairman of the Department of Medicine


Joshua Knowles, MD, PhD
Assistant Professor, Cardiovascular Medicine

Program Director,
Cardiovascular Medicine Fellowship Program

Co-Director,
Stanford Translational Investigator Pathway


Christiane Haeffele, MD
Clinical Assistant Professor, Cardiovascular Medicine

Clinical Assistant Professor, Pediatrics Cardiology

Associate Program Director,
Cardiovascular Medicine Fellowship Program


Program Structure

Each fellow will complete at least 2 years of clinical training. Clinical rotations at Stanford Health Care and the Palo Alto VA are of 1 month duration.

Typically fellows complete:

  • 5 months of cardiac catheterization
  • 4 months of echocardiography
  • 2 months of advanced imaging
  • 4 months of cardiac consultation
  • 2 months of critical care cardiology (CCU)
  • 2 months of nuclear cardiology
  • 2 months of electrophysiology
  • 1 month of elective rotation
  • 1 year of dedicated research

 

The Stanford training program provides a clinically rich educational environment. Fellows have protected time to attend both weekly dedicated didactic teaching from our faculty and our weekly Cardiovascular Medicine Grand Rounds often featuring expert clinicians and researchers from across the world. We also offer weekly clinical conferences on electrophysiology, cardiac transplantation, vascular medicine, pediatric cardiology. A major forum of interaction is provided by joint clinical conferences with cardiovascular surgery for both coronary cases and cardiomyopathy.

Clinical Training and Education

With a foundational three-year training duration, our program offers both a structured training environment and opportunities for individualization of training based on fellows’ clinical and research interests.

All of our fellows complete a minimum of 24 months of intensive clinical rotations designed to exceed ACGME requirements for Cardiovascular Medicine . Clinical rotations typically occur consecutively during the first two years of the program, with opportunities for a broad number of established elective rotations (including advanced imaging, heart transplant and mechanical circulatory support, preventive cardiology, pulmonary hypertension, adult congenital heart disease, interventional cardiology, electrophysiology). Additionally, we offer trainees the opportunity to design elective rotations, with the support of a faculty mentor, tailored to their clinical interests.

Through integration of our research curriculum and mentorship during clinical training, our fellows are well prepared and funded to ‘hit the ground running’ during their research year(s). Our approach to research training includes 1) mentor identification prior to day 1 of fellowship, 2) research plan presentation, developed in collaboration with their mentor, to the Cardiovascular Division at Grand Rounds prior to application for funding, and 3) a structured curriculum focused on approaches to grant application and writing that begins during your 1st year of fellowship. Research activities may be mentored by faculty from the Cardiovascular Medicine Division and/or any of the collaborating Divisions and Departments at Stanford. Our fellows’ track record of research productivity, across the full spectrum of research disciplines (e.g., basic, translational, trials, outcomes, health services, health economics, digital-health, etc.) is evidenced by representation at international conferences, publication in high impact journals, and funding through both fellowship and early career awards.

In addition to a ‘traditional’ training schedule (2 years of clinical followed by 1 year of research), we offer opportunities for additional years of research training both as part of ACGME accredited “short tracking” experiences (with upfront commitment to additional research training) and as a flexible training model to achieve evolving career goals. A sizeable proportion of our fellows invest in these additional research years as they pursue career development grants (e.g., NIH K awards), Master’s-level degrees in research methodology, and transition to academic independence.

Clinical Rotations at Stanford

Stanford Health Care is a quaternary care center and is consistently ranked as one of the leading hospitals in the US. In 2018, a new 824,000-square-foot facility will open and will feature amenities and services focused on the health and well-being of patients, as well as the most advanced diagnostic, therapeutic and surgical technologies. It will house an additional 368 beds, bringing the total to 600 on site, and will greatly expand the footprint for Cardiovascular Medicine including additional capacity in the cath/angio and echo labs. The building will be connected to the current hospital by a bridge and tunnel.

Cath/Angio Laboratory: Fellows evaluate patients for which cardiac catheterization may be indicated and are the primary operators on a variety of different diagnostic procedures. In an average month, the Stanford cath lab performs 400 coronary diagnostic and interventional procedures, 50 myocardial biopsies, and a variety of other specialized procedures, including structural interventions (TAVR, mitral valve clip, valvuloplasty), microvascular studies, intracoronary ultrasound recordings, coronary and peripheral stent placements and a variety of investigational protocols. Percutaneous coronary intervention and trans-aortic valve replacement are performed by interventional cardiology fellows.

Coronary Care Unit: The Stanford CCU cares for patients often referred from throughout Northern California with complex and critical cardiac conditions, frequently requiring escalation to advanced therapies and mechanical support. The fellow is responsible for overseeing patient care in the unit and supervising housestaff, as well as working with the CCU attendings who are highly experienced, engaged in patient care, and consistently rated among the best teachers in the division.

Echocardiography: Fellows rotating on echo will receive hands-on training in both the acquisition and interpretation of echo images. Fellows will become comfortable with the latest two-dimensional, Doppler and three-dimensional techniques in both transthoracic and transesophageal echocardiogram and receive daily one-on-one instruction with faculty. In an average month, approximately 1800 transthoracic echocardiograms, 80 transesophageal echoes and 350 stress echocardiograms are performed.

Inpatient Consultation: The inpatient cardiology consult fellow interfaces with non-cardiology services throughout the hospital in caring for patients with a wide variety of cardiovascular disorders. In addition to providing first-line consultative care on approximately 100 patients/month, the fellow is also responsible for reviewing computer-generated ECG reports.

Cardiac Arrhythmia and Electrophysiology Consult Service: The Stanford electrophysiology service provides state of the art care for complex arrhythmias. This service performs an average of 150 procedures per month and is responsible for an inpatient service that averages 6 to 10 patients at any time, in addition to an active outpatient and consultative program. Fellows rotating through the EP inpatient consult service will evaluate and treat rhythm disorders and assist in device interrogations and implantations. Advanced skills in device implantations, arrhythmia mapping, and electrosurgery are generally performed by dedicated EP fellows.

Advanced Cardiac Imaging Rotation: Senior cardiology fellows will dedicate 4 weeks to enhance exposure to the acquisition and interpretation of CMR, CCT, and Echo studies, including interventional TEE.

Palo Alto Veterans Administration

The Palo Alto VA, located 4 miles from Stanford Health Care, is one of the newest and most modern VAs in the US. It serves as the referral center for a large catchment area across California and Nevada and is equipped with state-of-the-art facilities for Cardiovascular Medicine.

Fellows will have an integrated experience in outpatient and inpatient cardiology evaluations with participation in exercise tests, echocardiography, and catheterization. In an average month, 200 patients visit the outpatient clinic, 120 patients receive consultative care on an inpatient basis, 120 patients undergo echocardiography and 45 patients undergo cardiac catheterization procedures.

Inpatient Fellow, Veterans Administration Medical Center: Senior fellows have the opportunity to take on the role of advanced fellow in a variety of cardiac subspecialties including interventional, advanced heart failure, and imaging. Fellows will serve as primary operator on percutaneous coronary interventions, assist with TAVR and device implantations, round on patients on the heart failure and cardiac transplant service, and receive further training in CCT and CMR.

Consult Fellow, Veterans Administration Medical Center: The fellow assumes considerable responsibility in overseeing the cardiology consultation team comprising housestaff and medical students in caring for virtually all cardiology patients throughout the hospital. Fellows will gain experience with the management of acute coronary syndrome, heart failure, arrhythmias, and critical care cardiology.

Noninvasive Stress Testing and Nuclear Medicine: The nuclear medicine department at the Veterans Affairs Medical Center performs an average of 7-10 myocardial perfusion studies per day, including exercise and pharmacologic perfusion studies as well as viability studies (thallium, PET scans). During this rotation, the fellow supervises exercise treadmill testing and gains proficiency in the supervision and interpretation of nuclear myocardial perfusion studies.

Continuity Clinics

All fellows are assigned one cardiology clinic per week throughout their 3 years of training, where they examine and discuss patients referred to Stanford Cardiovascular Medicine. Continuity of care is emphasized. In addition to general cardiology, the Stanford Program offers subspecialty clinic experience in: electrophysiology, interventional cardiology, end-stage heart failure, post-cardiac transplantation or ventricular assist device, inherited cardiovascular disease, preventive cardiology, adult congenital heart disease and vascular medicine.

Research Opportunities

The research interests of the members of the Division of Cardiovascular Medicine the Stanford Cardiovascular Institute and affiliated faculty in other Divisions and Departments are broad, and include clinical, translational and basic studies. Particular strengths include:

  • Genetics and genomics
  • Vascular biology
  • Clinical trials
  • Outcomes Research
  • Stem cells
  • Cardiomyopathy
  • Women's Heart Health
  • Big Data
  • Mobile health
  • Bioinformatics, including electronic health records
  • Transplant
  • Drug discovery
  • Cardio oncology
  • Health disparities
  • Advanced Imaging
  • Coronary physiology
  • Device development and innovation

 

Fellows are encouraged to tap into the vast educational resources tailored to research offered both with the Division and beyond. The Cardiovascular Institute sponsors weekly cardiovascular research seminars from renowned scientists from around the world. Tutorial lectures are provided each year to provide fellows with basic concepts in biostatistics and clinical epidemiology as well as cellular and molecular biology. The fellows are afforded opportunities to present seminars on clinical or basic research topics as well as to participate in monthly journal clubs held in the homes of faculty members. In addition to these opportunities, fellows can participate in intensive clinical and research courses offered within the Stanford University community, including those through SCCR and SPECTRUM.  

Research funding, including stipend support, is available from multiple sources including several NIH training grants. Individual applications for NIH National Research Service Awards, AHA Fellowships and other corporate and foundation sponsored programs are encouraged. The Division supports dedicated courses on grant writing and employs dedicated personnel to assist fellows and faculty in grant submission. These efforts have resulted in our fellows having an extraordinarily successful track-record of obtaining mentored training grants.

Summary

The Cardiovascular Medicine Fellowship Program at Stanford is a rigorous but collegial and supportive experience, designed for those individuals with an interest in developing an academic career. Intensive, individually tailored training in invasive and noninvasive clinical cardiologic techniques as well as in basic and clinical cardiovascular research prepares each fellow to pursue his/her career at the forefront of cardiology.

How to Apply

We participate in the match exclusively through ERAS. We receive approximately 450-500 applicants for each fellowship cycle starting around July 15th. We typically extend interview invitations to 40-50 highly qualified applicants by the beginning of August. Four interview dates are offered between early September to mid-October. We also encourage talented physician scientists (typically with PhDs) to apply to the Stanford Translational Investigation Pathway (TIP)] the time of their Internal Medicine Residency Application. If accepted to the TIP program, candidates are guaranteed to match into Cardiovascular Medicine Fellowship assuming successful completion of 2 (for those interested in "short-tracking") or 3 years of Internal Medicine Residency.

Applicants must be eligible to obtain a California medical license for consideration as a fellowship candidate.

Stanford University is an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.

Contact Information

Program Director: Joshua W. Knowles, MD, PhD (knowlej@stanford.edu)

Associate Program Director: Christiane Haeffele, MD (haeffele@stanford.edu)

For further information, contact our fellowship coordinator Laura Dodera at (650) 725-4177.

Our fax number is (650) 725-1599.

E-mail inquiries should be sent to CVMedFellowship@stanford.edu.

Postal Address:
Falk Cardiovascular Research Center
Stanford University Medical Center
870 Quarry Road
Stanford, CA 94305-5406