Goals and Mission
The goal of our program is to provide the highest quality training in Cardiovascular Medicine. Our program strives to uphold the Hopkins tradition of clinical excellence, teaching and research. We have a strong history of preparing leaders in the field of academic cardiology, providing them with the tools to become skilled clinicians as well as providing outstanding experience in the field of cardiovascular research.
Fellows receive training and supervised experience in the evaluation and management of a wide variety of patients with acute and chronic cardiovascular conditions. They will become proficient in all aspects of cardiovascular disease including chronic coronary heart disease, congestive heart failure, arrhythmias, acute myocardial infarction and other acute ischemic syndromes, lipid disorders, hypertension, cardiomyopathy, valvular heart disease, pulmonary heart disease, peripheral vascular disease, infections and inflammatory heart disease, and adult congenital heart disease.
Fellows will develop and demonstrate competence in basic and clinical knowledge, procedural skills, clinical judgment, professionalism and interpersonal skills required as a specialist in cardiovascular diseases. At the completion of the training program, Fellows will have acquired the competency to pass the appropriate specialty boards required to practice as a specialist in the field.
This three-year program complies with all ACGME requirements, in addition to following the guidelines and recommendations of the American College of Cardiology (COCATS).
All fellows are offered an optional fully funded fourth year of mentored research or advanced clinical training. This year is offered immediately following the standard three-year ACGME-accredited program. This optional year allows fellows time to further develop their skills in clinical or basic investigation or to take advantage of the subspecialty tracks of interventional cardiology, electrophysiology, heart failure, and non-invasive imaging during this year.
At the end of the training period, Fellows will be equipped with the knowledge, skills and abilities to meet the requirements for certification in cardiovascular diseases, as determined by the Accreditation Council for Graduate Medical Education. These include experience and training in ambulatory medicine, inpatient experience, and special clinical experiences and research. The Fellowship program offers considerable flexibility, and may be tailored to fit the individual needs.
Introductory Lecture Series
During the first year of the program, in addition to clinical rotations, the introductory lecture series provides instruction in the basic and clinical sciences as they relate to cardiovascular disease. These subjects consist of:
- Antiarrhythmic therapy
- CABG/On and Off Pump
- Cardiac MRI
- Cardiac Rehab
- Compensated CHF
- Congenital Heart Disease
- Conscious Sedation
- Decompensated CHF
- Echo Conference
- Intro to Echo/Doppler
- Management of Acute CVA
- Multi vessel PCI vs CABNuclear Cardiology
- Pacers, Pumps, and Politics
- Palliative Care
- Peripheral Vascular Disease
- Pre-op evaluation
- Physician impairment
- Pulmonary HTN
- Radiation Safety
- Renal Artery Stenosis
- Risk stratifying post-MI
- Stress Testing
- Unstable Angina
- Valvular Heart Disease
- Ventricular Tachycardia
Fellows are provided instruction and experience in patient care and management, diagnosis, prevention and treatment of cardiovascular disease and related sciences through the following required curriculum:
- Key to the Learning Objectives
- Coronary Care Unit (The Johns Hopkins Hospital/Johns Hopkins Bayview)(3 months)
- Heart Failure and Heart Transplantation (General/Advanced) (2 months)
- Diagnostic Cardiac Catheterization (General/Advanced) [concurrent exposure to vascular medicine] (4 months)
- General Cardiology Consultations (3 months)
- Electrophysiology (2 months)
- Preventive Cardiology (1 month)
- Non-Invasive Cardiology, including echocardiography, TTE and TEE's, Doppler, stress testing and Holter monitoring. (4 months)
- Nuclear cardiology (2 months)
- Continuity Clinic (The Johns Hopkins Hospital/Johns Hopkins Bayview) (1/2 day weekly for 36 months)
- Instruction also is provided in Cardiac Rehabilitation, Palliative Care, Ethics, and PET.
- Elective experiences are available in the following areas: Pediatric Cardiology; Vascular Medicine/Intervention; Advanced Non-invasive imaging, including Echocardiography, MRI, and CT; and, Cardiothoracic Surgery. These experiences are recommended and are available to interested Fellows.
Consult the program director for advanced training in the areas of cardiomyopathy, interventional cardiology, and electrophysiology.
First Two Years
During the first two years fellows are exposed to acute and chronic cardiovascular diseases, emphasizing accurate ambulatory and bedside clinical diagnosis, appropriate use of diagnostic studies and integration of all data into a well-communicated consultation, with sensitivity to the individual patient.
The order of clinical rotations is based primarily upon availability and the interests of the fellow. During this time, under the direct supervision of the attending on each rotation, Fellows will begin to acquire and develop skill in the diagnosis and treatment of cardiovascular disease, demonstrate their ability to gather, synthesize and organize information relating to their patients, as well as demonstrate their understanding of the pathophysiology of cardiovascular disease.
Beginning in the first year, and continuing throughout the training program, fellows will develop their ability to lead, teach and learn from other members of the healthcare team, as well as their honing their consultative skills in the performance and interpretation of diagnostic tests and procedures. Training will include instruction in the prevention, therapeutics and management of cardiovascular diseases as well as the social, humanistic, moral and ethical aspects of cardiovascular disease. Fellows will demonstrate empathy for patients and their families by attention to pain control, patient comfort, family counseling, informed consent, as well as the ethical and legal principles involved with care and end of life decisions.
Fellows will complete their clinical requirements of the program in the second year. They are expected to continue to refine their clinical skills and assume additional responsibilities in the management of patients with cardiovascular disease, obtain additional training and experience in the performance and applications of diagnostic and therapeutic procedures while under the direct supervision of the faculty member.
In their first year, fellows receive guidance in the selection of a research project. Near the conclusion of this first year, Fellows are asked to select a research mentor, decide on a research project, and prepare a formal research protocol. Early in the second year, the fellows are asked give a ten-minute oral presentation of their proposed project to the clinical faculty, with fellows invited as well. Feedback by the faculty is given to ensure a productive research experience.
At the beginning of the third year, fellows will begin their mentored research projects. Active participation in research will provide the trainee with experience in critical thinking, and in evaluating the cardiology literature. This experience is essential in providing a solid foundation in clinical cardiovascular medicine. A fourth year, immediately following the ACGME-accredited three-year program which ends with this third (research) year, is offered and funded, and fellows are encouraged to elect this fourth year, to ensure a productive research experience, and to provide sufficient time for the development of research presentations at national scientific meetings and of publications for submission to peer-reviewed journals.
Fellows will perform their research with a member of the cardiology faculty. Under very limited circumstances a fellow may train in a laboratory outside the division, but with a mentor within cardiology. Each request for training outside the division must be approved by the fellowship director and the division director.
A Ph.D. or M.Sc. in Clinical Investigation is offered as a joint program between the Johns Hopkins School of Medicine and Public Health, incorporating didactic coursework and mentored research.
During the optional fourth year following the accredited three-year program, fellows may elect to pursue advanced subspecialty training in one of several areas which include:
- Echocardiography and advanced imaging
- Heart failure/transplantation
The following fellow lectures and/or seminars have priority over other clinical or research activities.
- Fellowship orientation lecture series
- Fellows’ clinical seminar series
- Fellows’ research conference
- Cardiology divisional grand rounds
Numerous other divisional conferences are held on a continuing basis which include:
- Electrocardiogram conference
- Echo conference
- Clinical correlative conference
- Interventional cardiology
- Preventive cardiology
- Heart failure/transplantation
In addition, journal club, cardiomyopathy conference (with faculty from Cardiac surgery) and advanced imaging conferences are held at least monthly. These are to be attended by the fellows.
All teaching activities are carried out by the faculty of The Johns Hopkins University School of Medicine. Faculty members are expected to demonstrate the highest standards of patient care, scholarship and clinical knowledge in their capacity as educators and role models for the trainees. The faculty to fellow ratio is approximately 2:1.
Since the division of cardiology is within the department of medicine, fellows are able to maintain their skills in the aspects of general internal medicine and those that relate to cardiology. They will interact closely with the medicine residents, interns and students as they rotate through the cardiology services. Fellows will also maintain close working relationships with faculty and fellows in other divisions of medicine and in other departments in their role as consultative physicians. They will also work closely with technicians, physician assistants, nurses and other staff in the division.
Fellows must also participate in a weekly outpatient clinic for the accredited three years of their training. This important aspect of the training will allow fellows to apply what they are learning in their clinical rotations to the actual practice of medicine, under the guidance and supervision of their clinical mentor. Fellows may have their outpatient clinic with a clinical mentor at the Johns Hopkins Outpatient Center or at Bayview Medical Center. Approximately 140 patients are seen each month in the fellows' clinics. Fellows in the optional year are given the opportunity to continue their continuity clinic and most elect to do so.
Learning activities take place at the East Baltimore Campus (including the Johns Hopkins Hospital), and the Johns Hopkins Bayview Medical Center. The Johns Hospital has 1,040 acute beds, of which approximately 46 beds are assigned to patients requiring cardiac-related care on Halsted 5 and in the Coronary Care/Step-down Unit (24 beds). Approximately 75 patients per month are seen on the Division's Clinical Consult Service. The Bayview Medical Center is a 692-bed facility, which includes a 12-bed Coronary Intensive Care Unit (CICU) and 16-bed Progressive Care Unit (PCU).
The two main campuses function as a unified division to provide the highest standard of care to a wide variety of patients. The patient population seen at Hopkins provides a broad range of cardiovascular disorders. In addition to patients from the surrounding area, Hopkins attracts patients from a worldwide catchment area. Patients are seen on a referral basis from the Johns Hopkins Emergency Department, other services within the hospital, and from physicians in the Mid-Atlantic community and beyond. In the course of their training, fellows will see virtually every known form of adult cardiovascular disorder.
Facilities are available for fellows to gain experience in electrocardiography, exercise and pharmacologic stress testing, as well as Doppler/echocardiography, ambulatory ECG monitoring and noninvasive peripheral vascular studies. There are also appropriate facilities for cardiac catheterization, angiography, and other invasive procedures.
The cardiology division at both Johns Hopkins Hospital and the Bayview campus have their own 64 detector CT scanners as well as facilities for MR imaging. PET viability imaging facilities are also available at the Johns Hopkins Campus.
Appropriate facilities are also available for laboratory testing, nuclear cardiology, myocardial perfusion imaging, managing patients with arrthymias, including all areas of electrophysiological testing. The division also maintains modern intensive cardiac care facilities at both the Hopkins and Bayview campuses.
In addition to the research facilities and laboratories at the East Baltimore Campus, the Bayview campus has extensive research facilities. It also houses the offices and laboratories of The National Institute on Aging, with which Hopkins has an affiliation and has actively collaborated for 30 years. A 563,000-square-foot Biomedical Research Center (BRC), which will house both the National Institute on Aging (NIA) and the National Institute on Drug Abuse (NIDA) is nearing completion.
Frequent evaluation and constructive feedback are essential for fellows to learn and grow during their training. It is therefore imperative that rotation directors discuss goals and learning objective at the start of each rotation. They must also provide feedback and discuss performance with each Fellow, particularly at the end of the rotation.
Fellow and faculty evaluations are officially documented each month using the web-based evaluation system E*Value. The emphasis of the E*Value program is mutual evaluation. Fellows are evaluated monthly by the faculty members and nursing staff with whom they have worked, using the ACGME competency categories, as well as rotation-specific learning objectives set forth by each rotation director. A “360 degree” evaluation scheme provides for fellow evaluations of specific rotations, the program as a whole and individual faculty. This is done through the online evaluation program E-Value.
Fellows may review their evaluations and faculty feedback in the system at any time using their password to gain access to the secure program at either their personal computer or at a hospital workstation. To ensure anonymity, faculty members will receive an anonymous aggregated report once a critical mass of comments has been accumulated.
Evaluation of performance is based on the following standard ACGME Competencies as well as the learning objectives for each rotation, as set forth by the Rotation Director (see individual rotation descriptions): Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism and Systems-Based Practice.
The faculty as a whole meets annually to discuss the program and each trainee's performance. The program director also completes a final evaluation for fellows who are leaving the program each year. The program director also monitors a procedure report to make sure that each fellow has participated in the appropriate number of required procedures.
Fellow meetings are held at least quarterly with the program director to air any issues or grievances that may need to be addressed, although fellows may speak freely to the program director (or to the chief fellow) at anytime if they have a concern about any aspect of their training. At the end of each year, fellows are asked to evaluate the program as a whole and are encouraged to offer suggestions for improvement.
Fellows are not required to generate any portion of their salary. Fellows in the clinical training program are guaranteed salary support for the three ACGME-accredited years plus the optional fourth research year. The NIH Training Grant in Cardiovascular Diseases funds several Fellows during the research component of the program. Johns Hopkins has the highest proportion of trainees entering academic cardiology programs of any training program in the United States (approximately 80%), and we are committed to maintaining this track record. The future careers of those supported by the training grant are carefully monitored. The Donald W. Reynolds Cardiovascular Clinical Research Center provides funding for four Fellows.
During the second year, Fellows are also expected to submit applications for independent research funding. A grant writing workshop is provided and faculty mentors are available to provide additional advice and assistance in the process. This valuable educational exercise provides Fellows with experience and knowledge in the preparation of grant applications, which is an important aspect of their future academic careers. It should be emphasized that regardless of whether the application is funded, fellows are never required to generate any portion of their salaries.
Fellows' salary levels are in line with NIH / PGY requirements and are adjusted on an annual basis.
Fellows are funded to attend one major national conference per year following established University guidelines for reimbursed travel. Travel grants are also made available by several pharmaceutical companies, which may allow additional travel if a Fellow is presenting a paper at more than one professional meeting.
Also provided is a common room, dedicated exclusively to Fellows' activities. This room includes individual workspaces, a locker for each fellow and several computers and printers. Fellows may join the Cooley Athletic Center for a nominal monthly membership fee. On-site parking in the Hospital garage is provided free of charge.
All Fellows are provided with individual health insurance, dental insurance, a term-life insurance policy, and disability coverage. Fellows may also elect to contribute to a pre-tax voluntary retirement fund (403-b). On-site day care facilities are available to Fellows with children. Fellows are also eligible for paid maternity, paternity, and parental leave.
Johns Hopkins also recognizes that the intensity of a training program can be a time of high stress to fellows and their families. Assistance in dealing with the many issues related to work or personal life can be obtained through mySupport, a free and confidential referral service.
There is a strong sense of collegiality and family within the Division. Fellows are an integral part of our divisional activities. The activities of the Fellows are structured mainly by their educational needs, and not by the service needs of the Division.
Currently our program participates in the ERAS application program, and accepts eight Fellows through the National Resident Matching Program. We remain committed to the highest quality of training for the Fellows in our program.