GME PROGRAMS

Program Accreditation

 The Cardiovascular Diseases Fellowship Program at NMCSD is accredited by the Accreditation Council for Graduate Medical Education (ACGME).  All requirements for the fellowship program are detailed in the “ACGME Program Requirements for Graduate Medical Education in Cardiovascular Disease” last updated in July 2012.  This document is available on the NMCSD Cardiology SharePoint site. 

Fellow Appointments

Prior to appointment in the fellowship, fellows must have completed an ACGME-accredited, 3-year Internal Medicine residency.

Clinical Rotations

ROTATION

BLOCKS1

COMMENTS

Inpatient

10

3-4 blocks per year

Echocardiography

6

2 blocks per year

1 block at UCSD and during 3rd year

Cardiac Catheterization

4

1 block at Sharp during 3rd year

Electrophysiology

2

1 each during 1st and 2nd years

Nuclear Cardiology

2

1 each during 1st and 2nd years

Cardiovascular CT and MRI

2

1 each during 1st and 2nd years

Consult – Exercise Testing

1

During 1st year only

Advanced Heart Failure

1

Done at Sharp during 2nd year

Congenital Heart Disease

1

Done during 3rd year

Research

3

1 block per year

Quality Improvement

3

1 block per year

Electives2

4

During 2nd and 3rd years only


1Each block is four weeks long.  There are 13 blocks during each academic year.
2Electives include:
Cardiac Catheterization at NMCSD or Sharp Memorial
Cardiovascular Imaging at NMCSD, Scripps Clinic, or UCSD
Echocardiography at NMCSD or Kaiser
Electrophysiology at Scripps Clinic or UCSD
Heart Failure at Scripps Clinic, Sharp Memorial, or UCSD
Nuclear Cardiology at NMCSD
Preventive Cardiology at Scripps Clinic
Research or Quality Improvement (no more than 1 additional block per year)

 
Cardiac Catheterization
The goals of this rotation are for fellows to 1) develop effective technical skills in the performance of diagnostic and therapeutic catheter-based procedures, 2) learn the indications, risks, and benefits of catheter-based procedures, and 3) understand the role of catheter-based procedures in the management of patients with cardiovascular disease. The initial months will focus on safe vascular access, flushing of catheters, use of the manifold, simple catheter manipulation, and hemodynamic interpretation. Successive months will focus on selective engagement of coronary arteries and bypass grafts, moving the table and setting up appropriate views, and participating in percutaneous coronary interventions. In order to graduate, each fellow must meet the ACGME requirements (and COCATS Level I training) by completing at least 4 months of cardiac catheterization (“cath”) rotations and performing at least 100 cardiac cath cases (including at least 50 coronary angiograms and at least 25 right heart caths). In order to perform diagnostic cardiac caths independently, fellows must achieve COCATS Level II training by completing at least 6 months of cath rotations and performing at least 300 cardiac cath cases. The specific objectives for this and all other rotations are based on the ACGME core competencies, the ACGME Internal Medicine subspecialty milestones, and the ACC COCATS 4 recommendations according to fellow year (1-3) and COCATS level (1-2).
Cardiovascular Imaging
According to the ACGME program requirements, all fellows need experience in advanced cardiovascular imaging methods, namely cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR). In order to achieve COCATS Level I training, each fellow must complete at least 2 months (8 weeks) and interpret at least 50 CCTs and 25 CMRs. Fellows who wish to achieve Level II training must complete at least 4 months (16 weeks) and interpret at least 250 CCTs and 150 CMRs.
Clinic and Consults
The overall purpose of Continuity Clinic and the Outpatient Consult rotation is for fellows to develop and demonstrate the knowledge and skills necessary to diagnose, treat, manage, and prevent cardiovascular disease (CVD) in an outpatient setting. The continuity clinic provides experience in the outpatient management of stable ischemic heart disease (SIHD), heart failure (HF), valvular heart disease, myocardial disease, pericardial disease, atrial fibrillation (AF) and other dysrhythmias, peripheral vascular disease, hypertension (HTN), and dyslipidemia (DLP). It also provides opportunities for the fellows to maintain some of their ambulatory general internal medicine knowledge and skills. The Outpatient Consult rotation provides greater experience in the preoperative evaluation of patients undergoing noncardiac surgery as well as outpatients referred for evaluation of chest discomfort, dyspnea, palpitations, syncope, or abnormal test results.
Congenital Heart Disease
This purpose of this one-month rotation is to provide fellows with an introduction to the field of congenital heart disease (CHD) and to familiarize them with the diagnosis and management of adult congenital heart disease (ACHD). The major emphasis is on acquiring the medical knowledge and patient care skills needed for the diagnosis and management of common congenital lesions expected to be encountered in adults. This rotation typically occurs during the second year of fellowship. Additional opportunities to evaluate and manage patients with ACHD will occur throughout the three-year fellowship during clinic consultations, echocardiographic evaluations, and cardiac catheterizations.
ECG – Exercise Testing
Cardiology fellows must have at least 1 month of experience in noninvasive cardiac evaluations to include electrocardiogram (ECG) interpretation, ambulatory ECG monitoring (both Holter and event), and stress testing (both exercise and pharmacologic). This can be done concurrently with other rotations. To achieve COCATS Level 1 training, each fellow must interpret 3000-3500 ECGs, interpret 100-200 ambulatory monitors, and perform 300 stress tests.
Echocardiography
The purpose of this rotation is to provide fellows with an understanding of the fundamental aspects of cardiac ultrasound including physical principles, instrumentation, cardiovascular anatomy, cardiovascular physiology, and cardiovascular pathophysiology. Over six months of Echo rotations, each fellow will become familiar with the technical performance, interpretation, strengths, and limitations of 2-dimensional, 3-dimensional, and Doppler echocardiography. One month during the third year of fellowship will be spent at either UCSD or Kaiser, which will expose the fellows to a different population of patients and allow them to work with and learn from highly-experienced echocardiographers.
Electrophysiology
The purpose of this rotation is to provide fellows with an introduction to the field of cardiac electrophysiology (EP) and to familiarize them with the diagnosis and management of arrhythmias. The fellows will gain a greater understanding of the indications for and performance of diagnostic EP studies and intracardiac ablations. They also will learn how to interrogate arrhythmia devices (CIEDs) including pacemakers, implantable cardioverter-defibrillators (ICDs), and loop recorders. In order to graduate, each fellow must complete 2 months of EP rotations and achieve COCATS Level 1 training by performing at least 20 cardioversions, inserting at least 5 transvenous pacemakers, interpreting at least 3000 ECGs, and interpreting at least 200 ambulatory monitors.
Inpatient
The overall purpose of this rotation is to provide fellows with the opportunity to manage patients admitted to the inpatient Cardiology service with various acute, decompensated, or unstable cardiovascular diseases including, but not limited to, ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), acute or decompensated heart failure (HF), acute myocarditis, acute pericarditis, atrial fibrillation with rapid ventricular response, infective endocarditis, and syncope. During their three years of training, the fellows will be given progressive responsibility for the care of patients and for the education of interns and residents on the inpatient Cardiology service, thereby developing the knowledge and skills expected of a junior staff cardiologist.
Nuclear Cardiology
According to the ACGME program requirements, all fellows must complete at least 2 months (8 weeks) of Nuclear Cardiology and interpret at least 100 radionuclide studies, including single photon emission computed tomography (SPECT) myocardial perfusion studies and ventriculograms. The ACC COCATS 4 recommendations for Level I training are the same. Fellows who wish to achieve Level II training must complete at least 4 months (16 weeks) and interpret at least 300 studies.
Bryan Spalding, MD
CDR, MC, USN
Department Dead, Cardiovascular Disease Department
 
Dylan E. Wessman, MD
CDR, MC, USN
Program Director, Cardiovascular Disease Fellowship
 
Keshav Nayak, MD
CAPT, MC, USN
Interventional Cardiology
 
William Bennett, MD
CDR, MC, USN
Interventional Cardiology
 
Justin Cox, MD
CDR, MC, USN
Interventional Cardiology
 
Gregory Francisco, MD
CDR, MC, USN
Electrophysiology
 
Choi, Anthony, MD
LCDR, MC, USN
Electrophysiology
 
Steven Romero, MD
CDR, MC, USN
 
Bryan Spalding, MD
CDR, MC, USN
Department Dead, Cardiovascular Disease Department
 
Dylan E. Wessman, MD
CDR, MC, USN
Program Director, Cardiovascular Disease Fellowship
 
Keshav Nayak, MD
CAPT, MC, USN
Interventional Cardiology
 
William Bennett, MD
CDR, MC, USN
Interventional Cardiology
 
Justin Cox, MD
CDR, MC, USN
Interventional Cardiology
 
Gregory Francisco, MD
CDR, MC, USN
Electrophysiology
 
Choi, Anthony, MD
LCDR, MC, USN
Electrophysiology
 
Steven Romero, MD
CDR, MC, USN
Echocardiography
 
David Krause, MD
CDR, MC, USN
Heart Failure
 
Richard Stoebner, MD
CDR, MC, USN
Cardiac Imaging
 
Anthony Keller, MD
CDR, MC, USN
General Cardiology
 
Travis Harrell, MD
LCDR, MC, USN
Cardiology Fellowship Program
 
Olamide Oladipo, MD
LCDR, MC, USN
Cardiology Fellowship Program
 
Adam Overbey, MD
LT, MC, USN
Cardiology Fellowship Program
 
Marc Kajut, MD
LT, MC, USN
Cardiology Fellowship Program

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Wessman D, Kim T, Parrish  J. “Acute Respiratory Distress following Liposuction.” Mil Med 2007; 172: 666-668.

Nayak K, White A, Cavendish J, Barker C, Kandzari D. “Anaphylactoid Reactions to Radiocontrast Agents: Prevention and Treatment in the Cardiac Catherization Laboratory.” J Invasive Cardio 2009; 21: 548-551.

Choi A, Nayak K, Jaski B. “Approach to Left Ventricular Assist Devices and Follow-up in Advanced Congestive Heart Failure.” Textbook Chapter 2014; 474-483.

Oakley L, Love K, Ramirez A, Boswell G, Nayak K. “Cardiac Gated Computed Tomography Used to Confirm Iatrogenic Aortic Valve Leaflet Perforation after Mitral Valve Replacement.” Case Reports in Cardio 2013; 528439.

Byrne B, Falzon C, Johenk P, Romero S. “Congenital pericardial cyst in a naval special warfare candidate; Clearance for diving after resection.” UHM 2011; 38: 143-148.

Medina S, Wessman D, Krause D, Stepenosky J, Boswell G, Crum-Cianflone N. “Coronary Aging in HIV-Infected Patients.” CID 2010; 51:990-992.

Oakley L, Prahl J, Massoud D, Price G, Gilbert B, Alexander S. “Diagnosis of Right Ventricular Cardiac Sarcoidosis With Cardiac Magnetic Resonance in a Patient Presenting With Ventricular Tachycardia.” Mil Med 2013;178, 2e265.

Tschanz M, Elexis M, Travis H, Spalding B. “Efficacy of Low-Dose Chlorthalidone versus Hydrochlorothiazide Remains Ambiguous.” JACC 2016; 68, 426-33.

Wessman D, Blanchard D, Kahn A. “Elongated Eustachian Valve Dividing the Right Atrium.” Wiley Periodical, Inc. 2011; 10.1111.

Crum-Cianflone N, Krause D, Wessman D, Medina S, Stepenosky J, Brandt C, Boswell G. “Fatty liver disease is associated with underlying cardiovascular disease in HIV-infected persons.” HIV Med 2011; 10.0.111.

Crum-Cianflone N, Stepenosky J, Medina S, Wessman D, Krause D, Boswell G. “Clinically Significant Findings Among Human Immunodeficiency Virus-Infected Men during Computed Tomography for Determination of Coronary Artery Calcium.” AJC 2011; 107:633-637.

Lin A, Oakley L, Krause D, Francisco G. “Left atrial thrombus in a patient with left atrial appendage ligation.” Tex Heart Inst2013; 10.1136.

Lin A, Francisco G. “Loss of Capture due to Hyperkalemia: Is That the Whole Story?” PACE 2012; 35, 1273.

Lin A, Shutt B, Robert D, William B. “Multivessel spontaneous coronary artery dissection treated with staged percutaneous coronary intervention in a non-postpartum female.” BMJ Case Reports 2012; 10.1136.

Lin A, Phan H,  Barthel R, Maisel A, Crum-Cianflone N, Maves R, Nayak K. “Myopericarditis and Pericarditis in the Deployed Military Member: A Retrospective Series.” Mil Med 2013; 178, 1-18.

Overbey A, Austin A, Seidensticker D, Lin A. “Overdrive pacing a patient with incessant torsades de pointes.” BMJ Case Report 2013; 10.1136.

Hopkins S, Cox J, Nayak K. “Percutaneous Mechanical Circulatory Support in Cardiogenic Shock.” Textbook Chapter 2014; 54, 1-7.

Lin A, Oakley L, Phan H, Shutt B, Birgersdotter-Green U, Francisco G. “Prevalence of stroke and the need for thromboprophylaxis in young patients with atrial fibrillation: a cohort study.” J Cardiovasc Med 2014; 00, 1-4.

Wentworth B, Stein M, Redwine L, Xue Y, Taub P, Clopton P, Nayak K, Maisel A. “Post-Traumatic Stress Disorder A Fast Track to Premature Cardiovascular Disease.” Cardiology in Review 2013; 21:16-22.

Brent L, Lin A. “Radiologic Evaluation of Right Ventricular Outflow Tract Myxomas.” Tex Heart Inst J 2013; 40, 68-70.

Fentanes E, Wessman D, Villines T, Steel K. “Serving to Heal and Honored to Serve An Insight Into Military Cardiovascular Fellowship.” JACC 2016; 68 2118-2121.

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DHA Address

7700 Arlington Boulevard
Suite 5101
Falls Church, VA 22042-5101

Logo for NMCSD Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134

CONTACT

GME Department Head:
Mike Simons, 619-532-7936, Michael.d.simons2.civ@mail.mil
Assistant Department Head:
Rose Sifuentes, 619-532-5998, rose.a.sifuentes.civ@mail.mil
Financial:
Angelique Stewart, angelique.m.stewart.civ@mail.mil

LOCATION
Graduate Medical Education
Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134

HOURS
7:00 am – 3:00 pm

1. For Verification of Training, please send request to corresponding Residency Program Manager. Contact information can be found by visiting the respective program page under the SPONSORED PROGRAMS drop down link on the left side of the screen.

2. Navy Medicine & Readiness Training Command San Diego does not participate in the Electronic Residency Application Service (ERAS). In order to apply you must be an Active Duty member of the United States Armed Forces and utilize the Medical Operational Data System (MODS) application in accordance with  BUMED NOTICE 1524. 
 

Contact

Phone

Main
Damon Dertina, M.D., Director, MOCA Simulation Program
(619) 453-6922 

Location

34800 Bob Wilson Drive
Bldg. 1, Ground Floor
San Diego, CA 92134

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GME PROGRAMS

Cardiology GME Residency

Welcome

Program Information - Cardiovascular Disease

Contact

Resident Program Manager:
Virginia Wareing
virginia.l.wareing.civ@health.mil
619-532-9248

LOCATION
Graduate Medical Education
Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134

HOURS
7:00 am – 3:00 pm

1. For Verification of Training, please send request to corresponding Residency Program Manager. Contact information can be found by visiting the respective program page under the SPONSORED PROGRAMS drop down link on the left side of the screen.

2. Navy Medicine & Readiness Training Command San Diego does not participate in the Electronic Residency Application Service (ERAS). In order to apply you must be an Active Duty member of the United States Armed Forces and utilize the Medical Operational Data System (MODS) application in accordance with  BUMED NOTICE 1524. 
  
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