Continued responsibility for principal care, co-management with
primary care physicians and consultation outpatient
cardiovascular patient management is achieved in the outpatient
Outpatient Continuity Clinic
Each fellow has one-half day per week of clinic for the 36 months
of training. An ambulatory continuity clinic is essential for the
duration of training, and is not interrupted during any of the
rotations throughout the three years of training. There is
exposure to a wide age range of patients, from adolescence
through old age, including an appropriate distribution of both
genders, with a spectrum of cardiovascular diagnoses. This
includes post-operative patients, patients with congenital heart
disease and patients for evaluation and management related to
Each fellow is, on average, responsible for 4-8 patients during
each half-day session. The outpatient clinical experience is
provided in four different settings on a rotating basis:
- MedStar Washington Hospital Center Cardiology Outpatient
- Washington DC Veterans Affairs Medical Center Cardiology
- MedStar Washington Heart Failure Service Clinic
- MedStar Washington Cardiac Arrhythmia Device Clinic
Additional ambulatory experience in specialty clinics or
hospital-based settings may include participation in same-day
diagnostic or therapeutic procedures.
On any given night, two fellows are on call. One fellow is
in-house at MedStar Washington. His/her on call duties begin
with sign out rounds in the Coronary Care Unit (CCU) promptly at
5 p.m., and end at 8 a.m. the following morning, with sign off to
the fellow doing the monthly CCU rotation.
The fellow provides support to the residents on call in the CCU,
and performs consultative emergency services throughout the
hospital, including the Emergency Department. The fellow is
involved in the triage of patients to decide the most appropriate
treatment, including the performance of invasive procedures and
escalation in the level of care. All admissions to the CCU are
funneled through the on call fellow, with the use of a dedicated
phone line and pager.
Often, the patient's evaluation requires a transthoracic
echocardiogram, so fellows must be familiar with the performance
and interpretation of cardiac ultrasound studies. If a
transesophageal echocardiogram is required, then the fellow
involves the Echo Lab attending physician on call, who will come
to MedStar Washington to perform the study.
The following attending cardiologists are on call at home, to
support the in-house fellow with immediate consultation by phone
and by coming into the hospital, if needed:
- CCU Attending
- Heart Failure Service Attending
- Echo Lab Attending
- Consult Service Attending
- Interventional cardiologist
A separate fellow is on call at home to cover the consultative
service needs at MedStar Georgetown University Hospital and the
Washington DC Veterans Affairs Medical Center. The fellow carries
a dedicated pager that can be activated by either institution.
The fellow is responsible for providing immediate consultation to
in-house residents and other physicians by phone, and is
available to come into the hospital if needed. The need for
consultation may include the performance of a transthoracic
The fellow is involved in the triage of patients to decide the
best treatment strategy and escalation of care, if necessary,
including activating the transfer to a tertiary referral center -
as in the case of patients presenting to MedStar Georgetown with acute ST
segment elevation coronary syndrome that require transfer to MedStar Washington for primary percutaneous coronary intervention.
Duty Hours and Moonlighting
Fellow duty hours are strictly enforced according to the
ACGME program requirements.
Duty hours are limited to a maximum of 80 hours per week averaged
over a four-week period, and inclusive of all in-house activities
and all moonlighting.
The fellow on call at MedStar Washington may stay in the
hospital for an additional four hours beyond the 24-hour tour of
duty, but only for the purpose of continuity of care or
education. Time spent in the hospital by fellows on at-home call
counts toward the 80-hour maximum weekly hour limit.
Moonlighting is allowed as long as it does not interfere with the
ability of the fellow to achieve the goals and objectives of the
educational program. All moonlighting must be approved annually
and in writing by the Program Director.