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

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

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