Overview of Clinical Service Rotations
- In the Ambulatory Clinical Center, the trainee meets for an average of one sessions every week in the clinic of his/her mentor. The trainee interviews and examines patients, arrives at a diagnosis, and proposes appropriate studies and therapeutic programs. The case is then reviewed with the senior clinician, who checks the salient features of the history and physical exam and the suggested treatment. The mentor then reviews the general knowledge of the issues involved and suggests appropriate reading and management. This rotation continues throughout the entire duration of the training program.
- The Zoll Cardiology Firm (Intermediate Care Unit) provides experience in the diagnosis and management of cardiac hospital patients. The cardiac fellow admits and follows all service patients of the attending cardiologist during a one-month period. He/she supervises and advises the interns and general medicine residents. The fellow makes rounds with the attending cardiologist and is present during clinical conferences when he/she may present relevant literature reviews. During this rotation, the fellow obtains experience in the management of cardiac patients who have been discharged from the CCU as well as newly admitted patients with cardiac problems that do not require CCU care.
- The Cardiology Consult Service. In this experience, requests for cardiac consultation come from all divisions of the hospital. The consultations are evaluated by the fellow who later presents them to the attending physician; he or she then reviews patient history and physical exam results and joins in a consultative opinion. Cases are then followed by the fellow and attending until specialized cardiac opinion is no longer necessary.
- The Cardiac Intensive Care Unit. During this rotation, the cardiology fellow is responsible for supervising the medical resident team under the direction of the cardiology attending. Critically ill patients who require circulatory assist devices, invasive monitoring, and temporary pacemakers are cared for in this unit. Consultative services are provided for the Cardiothoracic Intensive Care Unit, Surgical Intensive Care Unit, and Medical Intensive Care Unit.
- Emergency Ward. The fellows on the clinical cardiology rotation provide consultation to the EW staff for problems in general cardiology and for evaluation of patients with diseases such as acute myocardial infarction, cardiac tamponade and ventricular tachycardia.
- The Primary Care Clinical Cardiology experience is enhanced by a rotation at the MetroWest Medical Center. Cardiologists who hold appointments at Beth Israel Deaconess Medical Center as well as at MetroWest Medical Center staff the Cardiovascular Division. The emphasis in this program is on direct patient management and extends and enhances the clinical experience available in the Boston area.
On each of the clinical rotations, the fellow supervises medical students and residents who are taking electives or assigned rotations and reviews with them not only relevant clinical observations, but also provides appropriate reviews of the literature with reading lists. Fellows spend approximately six months of their first year and two months of their second year on these services.