The Training Program in Cardiovascular Disease
The primary mission of the Stony Brook University Fellowship Program in Cardiovascular Medicine is to develop the next generation of leaders in academic medicine. It is assumed that all graduates of our training program will be expert clinicians. In addition we expect our graduates to be master teachers and/or successful clinical or basic investigators. In order to meet the rigors of cardiology in the 21st Century, we have developed two major training pathways. The Clinician tract will involve an intense 3-year training experience that is designed to develop expert clinicians. It is anticipated that many of these individuals will pursue a fourth year in interventional cardiology or electrophysiology (recognized subspecialties of the ABIM). The Investigator tract is designed for individuals interested in a career in academic cardiology. These individuals will complete 24 months of in-depth clinical training. An additional 2 to 3 years will be devoted exclusively to research. The research experience is designed to give the trainee the necessary tools in the techniques of investigator-initiated clinical and/or basic research.
Clinical training involves rotations in the CCU, Nuclear Cardiology, Echocardiography, Magnetic Resonance Imaging, the Cardiology Consultation Service, the Arrhythmia Service, the Cardiac Catheterization/Interventional Service and outpatient activities in the General Cardiology Clinic. Elective rotations include pediatric cardiology, heart failure and cardiac MR/CT.
Subspecialty fellowships are offered in cardiac catheterization/intervention and cardiovascular magnetic resonance imaging (through St. Frances Hospital).
Clinical conferences include:
- Non-invasive Conference covering all aspects of echocardiographic, nuclear, magnetic resonance and CT imaging as well as an Integrated Imaging Conference and an Intra-Operative TEE Conference
- Cardiac CT/MR Conference
- Electrocardiographic/EP Conference
- Cardiology Grand Rounds
- Fellows Journal Club
- Cardiology Research Conference
- Cardiac Catheterization Conference
- Interventional Cardiology Conference
- Vascular Medicine Conference
A new program in Cardiovascular Bioengineering has been established as a collaborative effort between the Division of Cardiovascular Medicine and Department of Biomedical Engineering. Successful completion of this 4-year program will result in a master’s degree in Biomedical Engineering and clinical cardiology training leading to board-eligibility.
Nearly 1,000 patients per year are admitted to the 10-bed Cardiac Intensive Care Unit (CICU) facilities at Stony Brook University Hospital, including those with acute myocardial infarction, complications of myocardial infarction, unstable ischemic syndromes, severe heart failure, cardiogenic shock and life-threatening arrhythmias. The CICU provides a unique environment for treating patients with acute ischemic heart disease; it is supported by extensive facilities for electrocardiographic and hemodynamic monitoring, a centralized telemetry system, and direct access to the adjacent catheterization laboratories. Patients admitted to the unit may be enrolled in multicenter trials of treatments for acute myocardial infarction and unstable ischemic syndromes, and in trials seeking optimal management strategies for patients with severe heart failure. Post-CICU care is supported by an adjacent 25-bed telemetry unit.
Clinical trainees in the CICU act as consultants to residents and attending physicians, and are responsible, in consultation with the full-time attending staff, for the care of all patients. In addition, under the supervision of attending physicians, they perform all invasive procedures, are involved in a large number of clinical research protocols, and participate in the daily work and attending rounds.
The formation of a Cardiovascular Imaging section within the Division of Cardiovascular Medicine recognizes the increasing number of imaging modalities, their complexity and their often complementary ability to detect cardiovascular pathology. The stated goal of Cardiovascular Imaging at Stony Brook is to match the appropriate imaging modality or modalities to an individual patient rather than the traditional approach of bouncing a patient from one disconnected imaging laboratory to the next in the hopes of making a diagnosis. In collaboration with our colleagues in the Department of Radiology we are establishing an Imaging Consultation Service where the most complex patients can be referred for a single evaluation in which multiple imagers contribute to the creation of tailored imaging approach.
The Echocardiography Laboratory at Stony Brook University Medical Center performs a full range of procedures, including transthoracic echocardiograms, transesophageal echocardiograms, treadmill stress tests and dobutamine stress tests. With a total of 10 state-of-the-art ultrasound systems, and a new treadmill and stress testing system, our laboratory performs approximately 10,000 procedures annually. The laboratory is fully digital and all studies are securely stored on a dedicated server to facilitate retrieval and interpretation of data for clinical and teaching purposes.
All cardiology fellows learn how to scan patients from our registered sonographers. The fellows are expected to preliminary read their own studies, and are encouraged to read as many studies as possible. Feed back and teaching is provided daily by our cardiologists who specialized in echocardiography.
The fellows rotating in the lab will get to learn the most innovative technologies available in echocardiography today, such as 3D echocardiography, tissue Doppler, strain and strain rate imaging, and will participate in the most cutting edge procedures, such as cardiac resynchronization therapy, pacemaker optimization and intracardiac echocardiography. As part of their training, the fellows will perform echocardiograms in the operating room, catheterization laboratory and electrophysiology laboratory and will guide innovative surgical and percutaneous procedures, such as investigational mitral valve repair, closure of intracardiac defects, and ablation of various arrhythmias.
Upon completion of cardiology fellowship, interested fellows should be able to achieve level II training in echocardiography and be prepared to pass the echo boards.
The laboratory is committed to performing research and is currently involved in various research studies, including evaluation of new technologies not yet available for clinical use. Fellows are encouraged to initiate research projects as well as participate in the on going ones.
The Nuclear Cardiology Service is a collaboration between the Cardiovascular Division and the Division of Nuclear Medicine of the Department of Radiology. The service is responsible for performing diagnostic exercise and pharmacologic stress testing in over 2,500 patients each year undergoing either myocardial perfusion imaging or radionuclide ventriculography. State-of-the-art multihead single-photon emission computed tomography (SPECT) equipment is available for all clinical studies. In addition, whole-body positron-emission tomographic instruments are available for diagnostic and research studies.
Clinical trainees rotate through the Nuclear Cardiology Service and are responsible for performing and interpreting stress tests. Trainees also provide medical clearance for patient studies, review tests with the attending cardiologist, and interpret results of imaging studies with faculty members with expertise in this field. Conferences and teaching sessions explore the physiologic and pathophysiologic response to exercise; techniques for assessment of myocardial perfusion, metabolism, and function; and the diagnostic and prognostic applications of stress testing and imaging studies.
Cardiovascular MR and CT
The Advanced Cardiac Imaging Program at Stony Brook has both 1.5 and 3T cardiac MR scanners and three 64-slice MDCT scanners. One of the three 64-slice MDCT is located within the Emergency Department and is active in performing cardiac CTA for the evaluation of low to intermediate risk patients with acute chest pain. In May 2009, a brand new and dedicated Advanced Cardiac Imaging training center will be opened at Stony Brook for physicians and technologists seeking basic and advanced training in cardiac MRI and CTA. The center is equipped with dedicated workstations and teaching materials for both cardiac CT and MR training. The training program will offer SCMR and SCCT level I, II, and III training and credentialling opportunities and CME credits for physicians and physicians-in-training as well as for CT and MR technologists on a regular basis. The Advanced Cardiac Imaging Program is currently collaborating with the Stony Brook's Center of Wireless and Information Technology (CEWIT) in the development of state-of-the-art technology for image compression, segmentation, and transfer. Others research projects include software development for cardiac MR quantitative analysis, computed-aided diagnosis for coronary CTA, and multi-center clinical trials on the assessement of cardiac viability and remodelling using cardiac MRI and the accuracy of coronary CTA in patients with stable chest pain.
The Clinical Electrophysiology Service performs in- and outpatient evaluation and management of cardiac arrhythmias. A multidisciplinary approach is used to provide care for patients with ventricular arrhythmias, supraventricular tachycardias, preexcitation syndromes, atrial fibrillation/flutter, derangements in sinus node automaticity, disturbances in atrioventricular conduction, syncope, and other abnormalities. The Stony Brook University Hospital Heart Center includes two dedicated electrophysiology laboratories with state-of-the-art equipment, as well as telemetry units in which computer-assisted automated equipment is used to monitor patients with complex arrhythmias.
Therapies for specific cardiac arrhythmias include investigational and conventional antiarrhythmic drugs, implantable pacemakers and defibrillators, and catheter ablation procedures for complex atrial and ventricular arrhythmias. Because of its unique stature as a clinical and investigational unit, the Arrhythmia Service offers patients the opportunity to participate in cutting-edge trials that evaluate new applications for approved devices as well early access to the latest developments in device technology.
Accurate diagnosis of electrophysiologic abnormalities is crucial to the success of therapy. A combination of programmed electrical stimulation, multichannel catheter mapping and tilt table testing is used to identify arrhythmogenic mechanisms, assess which therapies are likely to be effective, locate sites of abnormal tissue for ablation, and assess the efficacy of therapy. A major focus of interest is ablation of atrial fibrillation and ventricular tachycardia. Fellows will be exposed to the latest technology to facilitate these procedures, including 3D mapping systems with image integration, intracardiac ultrasound, and remote catheter navigation.
The Arrhythmia Service also evaluates patients who may be at high risk for life-threatening ventricular arrhythmias. These include patients recovering from myocardial infarction or those with nonischemic cardiomyopathy who may later develop sustained ventricular tachycardia or fibrillation. Risk assessment involves conventional tests of cardiovascular function as well as the interpretation of ECGs with advanced signal-processing techniques.
Arrhythmia Service attending personnel make daily teaching rounds that focus on management strategies for patients with or at risk for development of tachyarrhythmias or bradyarrhythmias. ECG rhythm strips and recordings from Holter monitors are reviewed during these rounds. In addition, several regular clinics are conducted for patients with arrhythmias and for those with pacemakers or implantable defibrillators. Analysis of pacemaker function and programming are performed in the arrhythmia clinic, with additional pacemaker surveillance available through a telephone monitoring service. Trainees have a broad exposure to indications for and effects of various antiarrhythmic drugs, radiofrequency ablation, high-resolution electrocardiography, sophisticated pacemakers, and the newest technology in implantable cardioverter-defibrillators.
Four state-of-the-art Siemens cardiac catheterization laboratories are located in a self-contained suite in the Heart Center adjacent to the Cardiac Intensive Care Unit. One of the laboratories is equipped to perform vascular interventional procedures and two of the laboratories are equipped with biplane imaging to facilitate evaluation of complex pediatric and adult patients.
More than 5,000 patients are evaluated and more than 1,500 interventional procedures are performed annually. Patients with a wide variety of heart diseases are seen in the laboratory. Stony Brook University Hospital offers the only full-service interventional program in Suffolk County, with physicians performing balloon angioplasty, intracoronary stenting, intravascular ultrasound, directional coronary atherectomy, rotational atherectomy, mitral and aortic valvuloplasty procedures, septal ablation for hypertrophic cardiomyopathy, ASD and PFO closures, carotid stenting and peripheral vascular diagnostic and interventional procedures. Our Code H program, that offers 24-7 availability of primary percutaneous coronary intervention for acute myocardial infarction, is the busiest in the area.
Attending physicians in the catheterization laboratory participate in a number of multicenter trials of new devices, techniques and drug treatments used in conjunction with cardiac interventions.
The Cardiac Catheterization Laboratory rotation for trainees is intensive, with both first- and second-year fellows participating in the prospective evaluation of all patients, the performance of all procedures, interpretation of results of hemodynamic and angiographic studies, and decisions regarding therapeutic recommendations. A fourth year of training exclusively in interventional cardiology also is available.
The Heart Failure teaching program at Stony Brook University Medical Center is designed to provide outstanding practical and academic training to prepare residents and fellows for diverse and productive careers in Cardiology. For physicians in training, this includes attention to both clinical skills development and personal growth and within a framework of the highest professional values.
The curriculum includes the daily care of patients with cardiovascular disease under direct and indirect supervision of the attending physician, participation in multiple didactic clinical conferences, reading of the Heart Failure syllabus, routine and frequent access of the medical literature, participation in clinical research projects and an understanding of the application of basic science research and techniques to the practice of clinical cardiology.
Skills to be developed include:
- History taking
- Physical examination (including the advanced cardiovascular exam)
- Establishing a hierarchal differential diagnoses
- Indications for tests and procedures
- Performing data interpretation
- Formulation and implementation of care plans
- Follow-up of therapeutic decisions to assess their efficacy
- Mechanisms for risk factor modification
- Teaching and ethical guidance
- Instruction in the professional manner
- Medical ethics involved in cardiovascular care, including end-of-life issues
- Establishing mechanisms for lifelong learning
- The practice of humanism in dealing with patients and their families
These goals are designed to run in concert with the overall goal of the HF program at SBUH which is to provide excellent, compassionate and state-of-the-art care to patients with heart failure and heart failure related disease.
Patients to be seen, across all demographics, include those with:
- Cardiomyopathies (hypertensive, ischemic, valvular, idiopathic, peripartum, toxin-induced, infiltrative and metabolic, etc)
- Right and left heart failure
- Acute or chronic myocarditis
- Diastolic disease
- Complex valvular and coronary anatomy
- Syncope and arrhythmias in the setting of heart failure
- Complex perioperative low output states
- Transplant or ventricular assist device evaluation
- Cardiogenic shock
Upon completion of the rotation, the fellow should be able to develop a strategy to evaluate, diagnose and manage patients with systolic or diastolic dysfunction. This includes the ability to:
- Assess diagnostic modalities for a high-quality and cost-effective management strategy
- Understand practice guidelines governing the heart failure patient
- Actuate therapeutic interventions for patients with congestive heart failure
- Be familiar with review advances in technology
- Identify reversible causes of heart failure
- Identify patients who may benefit for transplantation referral
- Explain etiologies of congestive heart failure
- Discuss the evolving treatment options in congestive heart failure.
- Describe the normal anatomy and physiology of the cardiovascular system
- Perform complete physical exams with particular attention to the cardiovascular system
- Describe the mechanism and usage of medications employed in treating heart failure
Faculty on this service provide consultation in clinical cardiology services for inpatients. The staff includes one cardiology fellow, one senior resident and senior medical students. Trainees accompany the attending cardiologist on patient rounds and are responsible for coordinating day-to-day care for a large number of patients and for instruction of residents in Internal Medicine and medical students.
The emphasis in training is on medical history-taking and on the physical examination, as well as the prescription of relevant diagnostic tests. Trainees on this service enrich their experience in every aspect of cardiology through interaction with the Cardiac Non-Invasive Laboratory, Cardiac Catheterization Laboratory, Cardiac Intensive Care Unit, and Electrophysiology Laboratory.
The pediatric cardiology rotation is designed to expose trainees in cardiovascular medicine to all aspects of this specialty. Recent advances in the treatment of pediatric patients with primary arrhythmias and with congenital heart disease have resulted in the survival of many to adulthood. The primary focus of the rotation is on outpatient evaluation, including appropriate noninvasive diagnostic testing. Strong emphasis is placed on physical diagnosis, echocardiography and magnetic resonance imaging. Trainees participate in regular conferences and inpatient rounds on patients who have undergone surgical procedures. They gain familiarity with the physical features, diagnostic manifestations and appropriate therapeutic approaches for care of patients with congenital heart disease.
The following are major areas of ongoing cardiovascular research by members of the faculty. Please click on mentor's name for more detailed information.
- Intercellular communication of cardiac myocytes and vascular smooth muscle cells by connexins (Peter Brink, PhD)
- Determinants of microvascular blood flow (Molly Frame, PhD)
- Heart failure and cardiomyopathy program (Hal Skopicki, MD, PhD)
- Cellular alterations underlying arrhythmogenesis (Emilia Entcheva, PhD)
- Cardiovascular magnetic resonance imaging (Nat Reichek, MD)
- Electrophysiologic phenotype of excitable cells (David McKinnon, PhD)
- Dynamic characterization of the autonomic nervous system (Ki Chon, PhD)
- Modeling of blood flow in the cardiovascular system (Danny Bluestein, PhD)
- Molecular mechanisms of thrombin-activiated and other protease-activated receptors (Wadie Bahou, MD)
We have five General (3-year) clinical fellowship positions, which are filled through the National Resident Match Program only. We do not fill positions for the regular (3-year) clinical cardiology fellowship outside of the National Residents Match Program.
We are participating in the ERAS application system and no longer accept paper applications. You may access their web site at: http://www.aamc.org/audienceeras.htm Our application deadline is February 15th.
If you are selected for an invitation to interview, you will be notified by e-mail.
Interviews will be conducted from March through May. There will be designated interview dates that applicants may choose from which will be filled as calls are received.
A complete list of REQUIRED attachments are:
- Completed application on the ERAS electronic system.
- Personal Statement – Provide a brief description of your career plans and your goals for the fellowship
- Updated Curriculum Vitae to include: Honors/Awards, Memberships and Publications
- Current Copies of ECFMG Certificates, if applicable. Visa information will be requested if needed once applications are reviewed on ERAS.
- A minimum of three letters of reference sent by designated references on application form. All letters of reference need to be received before a file will be considered for an interview
- USMLE scores – Part I, II, III and
Applications will be processed only after the three letters of recommendation have been received and the file is complete. It is the applicant’s responsibility to make sure these letters are sent.
If you would like to check the status of your application, you may view what documents our program has received on ERAS.
Only U.S. Citizens/permanent residents and J-1 visas sponsored by the ECFMG are considered for clinical training. The institution does not sponsor H visas and we cannot accept applicants with 'pending permanent residency' status. If a J-1 visa holder, the applicant must have adequate time to complete fellowship prior to losing J-1 status (7-year total).
For additional information, inquires should be addressed to the Fellowship Program Administrator:
Phone: (631) 444-7515
Stony Brook University Medical Center
HSC T16-080, Stony Brook, NY 11794-8167.
For more information on the clinical, combined clinical/research, biomedical engineering/clinical or interventional cardiology fellowship programs, please contact:
Noelle Mann, M.D., FACC
Assistant Professor of Medicine
Director, Fellowship in Cardiovascular Disease
For more information on the interventional cardiology fellowship programs, please contact:
William E. Lawson, M.D., FACP, FACC, FSCAI
Professor of Medicine
Director, Heart Center Outcomes Research
Director, Preventive Cardiology
Director, Interventional Cardiology Fellowship Program
We no longer accept mailed applications -- our program participates in the Electronic Residency Application Service (ERAS). You may access ERAS at: http://www.aamc.org/eras.