Fellowship Policies and Procedures
The Cardiovascular Medicine training program is conducted at two hospitals: Stanford Hospital and Clinics and the VA Palo Alto Health Care System. Both hospitals have a full complement of Stanford Medicine housestaff.
New fellows receive an orientation notebook which contains the policies of the fellowship and the requirements of ABIM and ACGME. In addition, the Division of Cardiovascular Medicine maintains a web site with all this information so that fellows and faculty are able to gain access easily and rapidly to clarify issues regarding these policies.
During orientation the fellows receive the curriculum for each rotation. In addition, the curriculum and the goals of each rotation is reviewed by an attending at the start of each rotation.
Medicine housestaff have primary responsibility for the care of inpatients. Cardiovascular Medicine serves as a consultant to these services. The Medicine residents write all orders.
Cardiovascular Medicine fellows write orders on outpatients who are seen in the various clinical laboratories. Certain specialized patients (for example, patients undergoing a coronary intervention) may be admitted directly to the Cardiovascular Medicine service, in which case the fellow may write orders.
Policies Regarding Performance of Various Procedures
Throughout the year, fellows on call may be called upon to provide vascular access, to place pulmonary artery catheters, to place temporary pacemakers, and to perform transthoracic echocardiograms. A system is in place to track the competency of each fellow as they learn those skills. Once the fellow has received the requisite training, and is listed as being competent in performing those studies, he/she may perform these procedures without an attending directly present. However, the results of these studies are discussed with an attending physician, and are formally reviewed with the attending.
Advanced procedures such as diagnostic cardiac catheterization, coronary angiography, transesophageal echocardiography, right ventricular biopsy and elective cardioversion are only performed under the supervision of the attending physician.