Core Curriculum

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 series, which features expert clinicians and researchers from across the world. We also offer weekly clinical conferences on electrophysiology, cardiac transplantation, vascular medicine, and 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.

Each fellow will complete at least 24 months of intensive clinical rotations designed to exceed ACGME requirements for cardiovascular medicine. Clinical rotations at Stanford Health Care and the Veterans Affairs Palo Alto Health Care System are 2-4 weeks in duration.

Typically, fellows complete:

4-5 months of Cardiac Catheterization
4 months of Echocardiography
4 months of Consultation
2 months of Critical Care Cardiology (CICU)
2 months of Nuclear Cardiology
2 months of Cardiac Electrophysiology
3 months of Multi-Modality Imaging (including transesophageal echo, CT, MRI)
1 month of Elective
2-4 weeks of Specialized VAD/Transplant
2-4 weeks of Adult Congenital Heart Disease
1 year of dedicated research following two intensive clinical years

Clinical rotations typically occur consecutively during the first two years of the program, with opportunities for a broad number of established elective rotations (including multimodality imaging, heart transplant and mechanical circulatory support, preventive cardiology, pulmonary hypertension, adult congenital heart disease, interventional cardiology, and electrophysiology). Additionally, we offer trainees the opportunity to design elective rotations, with the support of a faculty mentor, tailored to their clinical interests. Each fellow gets 1 month of vacation per year.

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 2019, we opened a new 824,000-square-foot facility (referred to as 500P), featuring amenities and services focused on the health and well-being of patients, as well as the most advanced diagnostic, therapeutic and surgical technologies. The opening of 500P brought online an additional 368 beds, bringing the total to 600 on site, and has greatly expanded the footprint for Cardiovascular Medicine including additional capacity in the cath/angio and echo labs. The building is connected to the current hospital (called 300P) 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 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 structural interventions are primarily performed by interventional cardiology fellows.

Cardiac Intensive Care Unit (CICU)

The Stanford CICU cares for patients 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 house staff, as well as working with the CICU attendings who are highly experienced, engaged in patient care, and consistently rated among the best teachers in the Division.

Echocardiography

Fellows rotating through the echocardiography laboratory receive hands-on training in both the acquisition and interpretation of echo images. Fellows become comfortable with the latest two-dimensional, Doppler and three-dimensional techniques in both transthoracic and transesophageal echocardiography and receive daily one-on-one instruction with faculty. In an average month, approximately 1800 transthoracic echocardiograms, 80 transesophageal echocardiograms 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. This rotation provides significant exposure to the growing field of cardio-oncology as many of the consultations are requested for patients admitted to Stanford’s oncology services with cardiac complications of cancer or its treatment.

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, in addition to an active outpatient and consultative program. General cardiology fellows on this rotation lead the EP inpatient consult service, evaluating and treating rhythm disorders, and assist in device interrogations. Advanced skills in device implantation, arrhythmia mapping, and electrosurgery are generally performed by dedicated EP fellows, with ample opportunity for general fellow involvement as desired.

Advanced Cardiac Imaging Rotation

Multimodality Imaging Rotation

VAD/Transplant Rotation

This rotation allows fellows to have direct exposure to advanced heart failure management, including ventricular assist devices, extracorporeal membrane oxygenation (ECMO) management, and post-heart transplant management. The rotation is a combination of outpatient clinic time and inpatient consult services, and includes weekly transplant and cardiomyopathy conferences.

Adult Congenital Heart Disease

The adult congenital heart program outpatient and inpatient rotation at Lucile Packard Children’s Hospital (LPCH) and Stanford Hospital & Clinics (SHC) offers a broad experience in the care of adults with congenital heart disease. This experience will cover the medical and surgical management (pre and post-operatively) of patients with congenital heart disease. Congenital heart disease lesions include but are not limited to atrial septal defect, ventricular septal defect, atrioventricular septal defect, anomalous pulmonary venous return, aortic and mitral valve disorders, left ventricular outflow tract obstruction, patent ductus arteriosus, aortic coarctation, truncus arteriosus, Ebstein anomaly, tricuspid and pulmonary valve disorders, tetralogy of Fallot, pulmonary atresia with intact ventricular septum, transposition of the great arteries, single ventricle, cyanotic congenital heart disease, Fontan, Eisenmenger syndrome, and coronary anomalies. Additionally, the fellow will gain experience in the care of adult cardiovascular, medical and obstetrical issues in congenital heart disease.

Continuity Clinics

All fellows are assigned one cardiology clinic per week throughout their 3 years of training. Fellows 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.

Conference Schedule

Clinical and research conferences are an integral part of the fellowship educational experience. All core fellows (both clinical and research) are required to attend the following conferences:

Day	Time	Conference	Requirement
Monday	7:30am-8:30am	Interventional Conference	Biweekly
Varies	Varies	Cardiovascular Imaging Conference	Weekly (optional)
Tuesday	7:30am-9:00am	Core Fellows Curriculum	Weekly
Thursday	8:00am-9:00am	Cardiology Grand Rounds	Weekly
Thursday	12:00pm-1:00pm	Cardiomyopathy Conference	Weekly
Tuesday	6:30pm-8:30pm	Journal Club	Monthly