Cardiology Residency Program Structure

Supervisor

Dr. J. Velianou
Email: velianj@mcmcaster.ca

The Coronary Care Unit of the Hamilton General Hospital is a busy 10-bed in-patient unit, with high turnover. The trainee will be exposed to a large variety of both common and uncommon acute cardiac problems and will develop proficiency in their evaluation and management. These will include acute myocardial infarction, unstable angina pectoris, congestive heart failure and pulmonary edema, aortic dissection, pulmonary embolism, hypertension, acute valvular problems, cardiac arrest and other arrhythmia emergencies. The trainee will be exposed to medical, invasive and surgical approaches to the management of these acute problems, and will be expected to develop a high degree of proficiency in understanding indications, alternatives and complications of each potential therapy. The cardiology resident will be directly responsible for overseeing junior colleagues, including medical students, interns and internal medicine residents. Development of supervisory skills is an important component of this rotation.

Supervisor

Dr. N. Valettas
Email:valettn@mcmaster.ca

The Clinical Cardiology rotation is a ward-based rotation centered on the Cardiology Inpatient Unit located on 4 West. The focus of the rotation is on the management of cardiac in-patients but will also include the provision of consultation services to the ER and other clinical services. Exposure will be obtained in all areas of clinical cardiology, including acute coronary syndromes, valvular heart disease, congestive heart failure, and the common arrhythmias. The cardiology resident will be expected to supervise junior colleagues rotating on the CTU, including internal medicine residents, clinical clerks, and elective medical students.

This will be primarily an out-patient-based rotation and will consist of attending the following clinics with their individual focus.

Person-based-Clinics: The trainee will attend on a regular basis, out-patient office-based clinics, under the supervision of a specific faculty member. Five half-day clinics (each with their own supervisor) will be attended each week. This will allow the trainee exposure to a wide variety of patient problems commonly encountered in the outpatient setting, as well as allowing follow-up of inpatients. This rotation is designed to teach residents appropriate follow-up of cardiac patients and also expose trainees to a variety of practice styles. We include not only General Cardiology Clinics but also encourage participation in specialized clinics such as Lipids, Hypertrophic Cardiomyopathy, Heart Function, Vascular and Adult Congenital clinics. A longitudinal clinic also occurs at MUMC, which provides continuity of follow-up for these Consultant based clinics.

Supervisors

Dr. S. Anand
Email:  anand@hhsc.ca

Dr. Patrick Magloire
Email:  pmagloire@cardio.on.ca

The trainee will participate in the Cardiac Care Clinic under the direction of Dr. R. McKelvie. The goal of this rotation is to understand the objectives and structure of a multidisciplinary cardiac rehabilitation programme. This will include exercise prescription, and the role of Nutritional counseling, Smoking Cessation, Metabolic assessment of risk and Psychologic assessments of at risk cardiac patients. This rotation will also help provide the trainee with skills in patient advocacy and give the opportunity to develop teaching skills.

Supervisors

Dr. A. Montgomery
Email: montali@hhsc.ca

Dr. O. Salehian
Email: salehian@hhsc.ca

This rotation takes advantage of the specialties specific to McMaster University Medical Centre. The trainee attends 2 half-day Pediatric Cardiology clinics as well as providing consultation on inpatient referrals to Pediatric Cardiology. They will also attend Dr. Gordon’s clinic seeing Adult Congenital Cardiac patients as well as pregnant patients referred for cardiac assessment. The trainees also attend the Heart Function Clinic where the region’s most complex heart failure patients are seen. This also provides the trainee the opportunity to learn issues relating to Cardiac Transplantation including patient referral and follow-up. This rotation also provides excellent one-on-one teaching with exercise physiologists as well as direct teaching and feedback on the interpretation of Cardiorespiratory exercise tests, Holter monitors and EKGs. This graduated ability to report these studies allows the residents to develop graded responsibility and proficiency in a supportive academic environment.

Supervisor

Dr. M. Rokoss
Email: rokossm@mcmaster.ca

The trainee will be responsible for the evaluation of patients admitted to the heart investigation unit for elective cardiac catheterization, assisting with the procedures, and supervising post-procedural care. The trainee will be exposed to a wide variety of procedures, including left and right heart catheterizations, valvular heart disease and cardiomyopathies. The trainee will learn the indications, interpretations and complications of coronary angiography. As trainees advance in their skills, they will be introduced to interventional procedures, including balloon angioplasty and directional coronary atherectomy, intracoronary stent deployment, emergency coronary angiography for acute coronary syndromes, and balloon valvuloplasty and intra-aortic balloon pumps. Hamilton General Hospital is also now actively accepting Primary PCI in acute myocardial infarction.

Supervisor

Dr. A. Montgomery
Email:  montali@hhsc.ca

The trainee will be involved in performing a large number of diagnostic treadmill exercise tests on out-patients and in-patients with suspected coronary artery disease. The trainee will be exposed to the performance and interpretation of exercise and pharmacologic thallium and sestamibi perfusion imaging. Other procedures performed include radionuclide angiography and viabiltiy assessments with both perfusion and PET imaging. The trainee will be expected to learn indications, interpretation and clinical application of these tests.

Supervisor

Dr. G. Nair
Email:  nairg@mcmaster.ca/girish.nair@phri.ca

The trainee will be responsible for performing consultations on patients referred to the arrhythmia service. He/she will be exposed to a wide variety of rhythm disturbances including bradycardias, supraventricular dysrhythmias and ventricular dysrhythmias. This includes both inpatients and outpatients. Trainees will participate in the performance and interpretation of diagnostic invasive electrophysiologic studies, as well as therapeutic (ablative) procedures. Participation in non-invasive EP testing particularly in the autonomic lab is also fundamental to this rotation. The trainee will participate in permanent pacemaker and defibrillator implantation and follow-up. This rotation will also be used to read and review a large number of diagnostic 12 lead electrocardiograms, holters and to develop proficiency and expertise in this area.

Supervisor

Dr. V. Chu
Email: chu@hhsc.ca

This rotation allows the Cardiology trainee to work directly with the CV surgeons to help understand the evaluation of patients’ eligibility for revascularization and other forms of cardiac surgery. They will learn the management of patients intra-operatively and peri-operatively including the use of intra-aortic balloon pumps and principles of intra-operative perfusion and pharmacology related to inotropic support.

Supervisor

Dr. E. Lonn
Email: lonnem@fhs.mcmaster.ca

The cardiac trainee will be involved in the performance and interpretation of two dimensional and doppler echocardiographic examinations, out-patients, in-patients and emergency cases. The trainee will develop a high degree of proficiency in these skills. Advanced trainees will learn transesophageal echocardiography. There will also be opportunity to perform and learn echocardiography of congenital heart disease.

Supervisor

Dr. P. J. Devereaux
E mail: philipj@mcmaster.ca

McMaster University is a leader in cardiovascular research, and research is considered an integral component of the development and training of adult cardiologists. A number of major projects are always ongoing and the resident has the opportunity to work on these from the “inside”. An ongoing commitment throughout the three years to research is expected, and dedicated blocks of time, with no other scheduled responsibilities, are scheduled in each year. Opportunities exist to develop and answer questions in both the basic sciences (with the Henderson Research Centre in Vascular Biology and Thrombosis) and the clinical/and population arena (with the Population Health Research Institute). It is expected that the trainee will identify a mentor in an area of his/her interest, will early in the course of their training develop a protocol, submit for internal and possibly external review, and execute the planned investigation. It is the goal of the program to have each trainee present at least one oral presentation at a national/international meeting, and first-author one peer reviewed paper, and one review article in their area of interest.

Supervisor

Depends on Rotation

Two - four months of elective time are available. Trainees who wish to pursue further advanced clinical training in a diagnostic clinical laboratory will use this time to develop their skills. They then will be prepared to enter a fourth year of advanced training at the institution of their choice. Trainees who wish to pursue a career in clinical or basic research can utilize this time for that purpose as well.

An academic half-day occurs each Thursday. This includes a comprehensive, interactive, core curriculum which annually covers the topics outlined by the Royal College on Cardiology. These presentations are a collaboration between trainees and Cardiology teaching staff. An electronic library of these presentations is accumulated for future reference. Prior to the Core Curriculum, the half-day begins with Echo rounds. Once monthly radiology rounds and weekly physical exam sessions/hemodynamic sessions follow the core curriculum. Other weekly rounds include cardiac catheterization/cardiac surgery rounds, EKG rounds, Regional Cardiology rounds and Research rounds. Once monthly Journal review clubs are held.