Cardiology

1st Year
Ju Young Bae, MD
Nneka Nwokeocha, MD

2nd Year
Gini Priyadharshini Jeyashanmugaraja, MD 
Mary Quien, MD

3rd Year
Leonidas Miras, MD 

Key Faculty

Craig A. McPherson, MD, FACC – Program Director, Director Cardiac EP Service

• Medical School: Tufts 
• Internal Medicine: Tufts-New England Medical Center
• Fellowship: Yale 

Stuart Zarich, MD, FACC – Chief, Cardiology Section

• Medical School: Upstate University of New York
• Internal Medicine: Deaconess (Boston, MA)
• Fellowship: Deaconess

Gilead Lancaster, MD, FACC – Associate Program Director, Director Noninvasive Cardiology

• Medical School: Sackler
• Internal Medicine: St. Lukes (New York)
• Fellowship: St. Lukes (New York)

Robert Fishman, MD, FACC – Director, Interventional Cardiology Fellowship

• Medical School: Boston University 
• Internal Medicine: Beth Israel (Boston, MA)
• Fellowship: Beth Israel (Boston, MA)

Candidates for fellowship must have completed a Residency in Internal Medicine that is accredited by the Accreditation Council for Graduate Medical education (ACGME) and be Board eligible / Board certified in Internal Medicine. Candidate selection criteria include academic achievements (including USMLE scores), letters of recommendation (3) and demonstrable interest in the field of cardiology. Research experience is desirable. Additionally applicants must demonstrate a consistent record of academic achievement and future academic potential, a commitment to the process of career development in academic medicine, personal integrity and a commitment to humanistic values expected of compassionate physicians.

1. Clinical and research components: During their 3 years of training, Cardiology fellows amass knowledge of the basic science, anatomy, physiology, pharmacology and clinical principles required to direct the cardiac care of patients with diverse cardiovascular disease. Concurrent with their clinical experience, fellows learn basic principles of clinical cardiovascular research and are required to participate in clinical research projects. Components of this clinical experience (“clinical rotations”) occur on a rotating basis and include the elements listed below.

   • Clinical Cardiology Service – approximately 8 months over 3 years. During this experience fellows participate in care of patients in the CCU, in the post-operative ICU and the Cardiology Consultation Service. Perioperative management of cardiac surgical patients is included in the Clinical Cardiology Service.
     
     

   • Cardiac Catheterization Laboratory – approximately 4 to 6 months over 3 years. This experience includes training in cardiac catheterization, coronary intervention (including management of acute myocardial infarction), intra-arterial support (intra-aortic balloon and other cardiac output support devices), temporary pacer insertion, right heart hemodynamic assessment, temporary transvenous pacing and pericardiocentesis. The ACGME requirement is 4 months; most trainees receive training beyond this, particularly those who wish to pursue a career in Interventional Cardiology. During the course of their training, all fellows perform at least 100 cardiac catheterization studies (as per ACGME requirements).
     
     

   • Cardiac Electrophysiology Service – 2 months over 3 years (ACGME requirement). This experience includes exposure to invasive electrophysiology testing and intra-cardiac ablation procedures, tilt-table testing, interpretation of ambulatory ECG monitors and recording devices, evaluation of patients with known or suspected arrhythmias and interrogation and programming of pacemakers and internal defibrillators.
     
     

   • Noninvasive Cardiology – approximately 6 to 9 months over 3 years

     This experience includes several distinct components many of which occur concurrently:

     • Echocardiography: Fellows learn how to perform and interpret M-mode, 2-dimensional, 3-dimensional, exercise and transesophageal echocardiography and Doppler studies. Each fellow, over the course of 3 years of training, interprets over 150 and performs over 150 echocardiograms (as per ACGME guidelines), thereby guaranteeing a sufficient experience base for full echocardiography proficiency. All fellows become eligible to sit for echocardiography boards and most have successfully become board certified in this discipline during their training.
     • Nuclear Cardiology and advanced cardiovascular imaging: All fellows receive annual training and certification in radiation safety. Nuclear Cardiology provides experience in performing and interpreting nuclear studies of myocardial performance and perfusion at rest and during exercise, cardiac CT and magnetic resonance imaging (MRI) and positron emission tomography (PET) studies. In addition to ongoing such training at Bridgeport Hospital, all fellows spend 2 to 3 months over 3 years at Yale New Haven Hospital, where many nuclear cardiac procedures were developed and advanced.
     • Electrocardiography: Fellows read electrocardiograms throughout their training. Focused supervision of ECG interpretation occurs at a weekly one to two hour didactic ECG reading conference with the Director of Cardiac Electrophysiology. Exercise electrocardiography includes supervision of exercise treadmill testing, exercise echocardiographic and exercise nuclear myocardial perfusion imaging studies. During the course of their training, as required by the ACGME, all fellows interpret at least 3500 ECG tracings and perform at least 50 exercise studies.
       
       

   • Cardiology Clinics

     • Continuity Clinic: Longitudinal continuous care and consultative experience are gained in an on-site ambulatory adult Cardiology Clinic, which all fellows attend one-half day weekly for 3 consecutive years (as per ACGME requirements).
     • Subspecialty Clinics: During elective rotations at Yale New Haven Hospital fellows participate in non-continuity, subspecialty clinics that include Cardiomyopathy Clinic, Adult-Congenital Heart Disease Clinic, Heart failure-transplant Clinic, Cardiac Genetic Disorders Clinic and Cardio-Oncology Clinic
     • Cardiac rehabilitation – Level 1 experience is gained during the Clinical Cardiology Service rotations. Levels 2 and 3 experience is obtained at the Cardiac Rehabilitation Center of Fairfield County. Fellows learn proper writing of exercise prescription and monitoring of patient progress in the cardiac rehabilitation process while working in a multi-disciplinary team that includes nutritionists, nurses and exercise physiologists.
       
       
   • Research:
     

     A vital component of a well-rounded training experience is the opportunity to participate in ongoing research. At Bridgeport Hospital clinical research is emphasized. Every fellow is required to participate meaningfully in at least one clinical research project during the required three-year curriculum. Ample attending staff supervision is available to provide assistance in formulating and carrying out projects. This work is generally performed as part of elective or non-invasive rotation blocks. All past fellows have presented research at regional and/or national meetings. Many of these have led to publication. In addition, the Cardiology Section is actively involved in industry and NIH-sponsored multicenter trials and fellows participate in these activities.
     
     

2. Trainee’s supervisory and patient care responsibilities
   Cardiology fellows supervise medical residents, medical students and physician associate students in the care of patients on the Clinical Cardiology Service. They are responsible for writing progress and consultation notes on patients on the Clinical Cardiology Service and in the Cardiology Clinic. They coordinate the overall care of their patients in the Cardiology Clinic. They write procedure reports on patients at whose procedures they assist, and pre and post-procedure orders on such patients. They prepare reports on patients whose studies they perform and/or interpret in the non-invasive cardiovascular laboratories. The fellow is the first physician to evaluate patients on the Cardiology Consultation Service and those who present to the Emergency Department with cardiovascular symptoms or conditions. All fellows take night call (from home) approximately every 6th night and every 5th or 6th weekend (call is shared with the Fellow in Interventional Cardiology).
   
   
3. Clinical procedural requirements
   Procedural requirements are established by the ACGME and are enumerated above. Fellows track their procedure volumes in logs that are periodically reviewed with the Program Director to insure that all fellows will meet required procedure volumes.
   
   

4. Didactic Conferences
   The following conferences are included in the curriculum:

   1. Cardiac catheterization conference – weekly
   2. Noninvasive Cardiology conference – weekly
   3. ECG Conference - weekly
   4. Core curriculum conference – 2 to 3 times per month
   5. Journal Club – monthly
   6. Research Conference – quarterly
   7. Morbidity and mortality Conference – quarterly
   8. Yale Cardiovascular Grand Rounds – weekly (this is viewed via videoconference)