Aims, Objectives & Expectations

EP Lab
Procedure Room & Implant Lab
Clinical
Education
Research
Conferences
Vacation

EP Lab

Electrophysiology (EP) Fellows will be qualified Cardiologists performing 12-24 months of fellowship training in clinical electrophysiology. EP Fellows will be responsible for staffing the EP lab on a rotating basis. This typically involves one fellow operating the stimulator and interpreting electrograms, and a second fellow as a catheter operator. During the course of a year, each fellow can expect to participate in approximately 250 EP studies, split evenly between the catheter and electrograms. This will include the expectation that over 2 years, the fellow will develop proficiency in use of the CARTO and NAV-X mapping systems, and be capable of independent performance of ablation including atrial fibrillation ablation. The fellow will report studies within 48 hours of the study. The first half of fellowship training will entail SVT ablation to learn fundamentals of electrophysiology and catheter manipulation. The second half will involve complex ablation such as pulmonary vein ablation.

Procedure Room & Implant Room

Fellows are expected to develop proficiency in implantation of pacemakers and defibrillators. This includes implantation of single and dual chamber pacemakers, biventricular leads, ICD implantation, loop recorder implantation as well as programming and troubleshooting of all arrhythmia devices. This should include subcutaneous insertion, and limited exposure to sub-muscular implantation as well. Fellows will also have exposure to lead extraction. During the course of a year, fellows can expect to be the primary implanter in 150 pacemakers, 35 biventricular systems and 75 implantable defibrillators and 5-10 lead extractions.

Clinical

Fellows are expected to attend clinic punctually on a regular basis. This is typically 1-2 days every two weeks. Every clinic at London Cardiac Institute must have fellow coverage.

They will also be expected to rotate through supervision of patients on the ward, and performance of consultations throughout the hospital. Duties pertaining to in-patients will be assisted by the expanded role nurse, with the fellow primarily responsible. The ward fellow is responsible for the management of all in-patients, and daily rounds with the attending physician.

Fellows will be expected to carry the pager on a 1 in 3-5 week basis, equally shared. The call is intended as a back-up consultative call within the hospital, and primary response call for in-patients on the arrhythmia service. Call will involve nighttime and weekend work, but this should not be excessive. First call overnight coverage of the inpatients can be provided by house staff if there is evening sign out to the covering resident. The frequency of call is likely to be variable, based on the number of fellows, absences etc. The consultant on call for the service will be available to discuss management issues with the fellow and field outside referrals.

Education

Fellows will be expected to present interesting cases, recent papers or review topics at Wednesday and Friday morning rounds on a rotating basis. These rounds are intended to be spontaneous, lighthearted and educational.

Fellows will be expected to participate in teaching sessions of medical students and house staff on a regular basis. This includes small group tutorials and resident rounds. This is an occasional responsibility.

Fellows will be expected to make one formal slide presentation to the medicine residents which simulates a community CME lecture. This will provide a forum for constructive feedback of speaking style/ability.

Each fellow can expect an informal review with the program director every 6-12 months, with an opportunity for bidirectional feedback. This will be reflected in brief written form in the fellow's file.

Research

Although the ultimate career goal of fellows is highly variable, all fellows will be expected to participate in research.

During the course of a year, each fellow should identify at least one project. Ideally this would be a prospective project that would include a full research cycle of data collection, abstract preparation and completion of a manuscript.

Fellows should also avail themselves of the opportunity to i) do a retrospective study, ii) write a review article with one of the consultants, or iii) write a book chapter with one of the consultants.

Fellows are expected to present their research progress at rounds on a quarterly basis, and annually at Cardiology Resident Research Day.

Conferences

Fellows are expected to attend conferences on a rotating basis. During meetings, at least one fellow will remain in London to cover clinical duties. Priority for attendance at meetings will be given to fellows presenting abstracts. Fellows should notify the Program Director if they plan to attend a meeting. Funding to cover expenses will be sought from the Department of Medicine, from educational funding within the Division, and from industry. Scientific meeting will be considered to include the CCS, AHA, ACC, HRS, ESC and Cardiostim. Other meetings attended will be considered on a case-by-case basis, but may require use of holiday time.

Vacation

Fellows are entitled to 4 weeks vacation for each academic year. Fellows must notify the Program Director within ample time when they plan to use their vacation time. A senior fellow will be designated to make the schedule for the fellows, who should also be notified of vacation time. This is generally an amiable process involving division of duties.