Nicolas Mead, DO, program director
The Geisinger Cardiovascular Disease Fellowship is an ACGME-accredited three-year program at Geisinger Medical Center that provides training for internal medicine residency graduates planning careers in clinical and academic cardiology since its initiation in 1974. The program curriculum, patterned after the recommendations for training as established by the American College of Cardiology, covers all aspects of noninvasive and invasive clinical cardiology and offers substantial academic opportunities for teaching and research. Clinical conferences, grand rounds, research seminars and journal clubs supplement the core clinical teaching.
The fellowship in cardiovascular diseases is a comprehensive and intensive program during which fellows will be expected to:
- Achieve clinical excellence in the diagnosis and management of a broad range of cardiovascular disorders
- Gain complete familiarity with diagnostic techniques and imaging equipment essential to current cardiology practice
- Understand the underlying pathology of cardiovascular disease
- Acquire the knowledge and experience for certification by the Subspecialty Board on Cardiovascular Disease
- Participate in scholarly educational and research activities
Our curriculum provides opportunities in a variety of noninvasive and invasive cardiovascular techniques and procedures as well as inpatient and outpatient clinical settings. Our inpatient care focuses on evaluation and treatment of acute cardiac illness, diagnostic evaluation and management of non-acute cardiac problems, and consultative service to other hospital services. Our outpatient ambulatory care clinic focuses on the evaluation of new patients referred by non-cardiologists as well as follow-up of patients discharged from our inpatient cardiology services. Our outpatient services also include electrophysiology clinics, heart failure clinic, and an adult congenital heart disease clinic.
Our diagnostic and therapeutic services curriculum gives fellows the opportunity to actively participate in these services provided throughout the cardiology department. These include the use of three cardiac catheterization laboratories, a dedicated electrophysiology laboratory and pacemaker clinic, an exercise laboratory providing a range of services in usually in combination with an imaging modality such as echocardiography or nuclear myocardial perfusion studies, a fully digital state of the art echocardiographic laboratory, cardiac imaging, and a vascular laboratory elective.
Every academic year in the Cardiovascular Disease Fellowship is divided into 13 four-week rotations. During the first two years, fellows gain familiarity with all the major areas of clinical activity and acquire special training in non-invasive and invasive laboratory skills. In addition, first-year trainees are assisted in starting a mentored hypothesis-driven research project. At the conclusion of the second year, most fellows will select an area of interest within cardiology (interventional cardiology, electrophysiology, noninvasive imaging, general and preventive cardiology, congestive heart failure) for special focus during their third year. Research is a mandatory part of the fellowship training program at GMC and each fellow is provided with at least six months of protected time to complete one or more research projects.
The majority of rotations are completed at Geisinger Medical Center in Danville. Approximately one to two rotations per year can be expected to be completed at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., a one-hour drive from Danville. Rotations currently available at GWV include cardiac catheterization, electrophysiology and imaging. This provides for an opportunity to work with different faculty and gain exposure to different techniques as well as see a different array of disease acuity and pathology. Housing is provided at GWV at no cost to the fellows during these rotations.
The Interventional Cardiology Fellowship program
The interventional cardiology fellowship provides comprehensive training that prepares the fellow for certification. The program was accredited in 1999 and has graduated one fellow per year since then. All of our fellows have passed the interventional boards. The fellowship provides experience in coronary intervention (including complex stenting, rotational atherectomy, IVUs, intermediate lesion assessment, endothelial dysfunction testing), atrial septal defect and PFO closure, valvuloplasty, and peripheral and carotid intervention. Additionally, access and exposure to new devices (such as new stent platforms and the left atrial occlusion device) is provided through an active clinical trial program.
The cath lab performs more than 1,100 PCI per year, and fellows participate in well over 500 PCI. Fellows perform direct STEMI PCI with some of the fastest door-to-balloon times in the country. Dedicated interventional faculty, trained at Geisinger, Mayo, Duke, Cornell and William Beaumont, provide one-on-one mentorship for every case. The interventional faculty believe this fellowship offers clinical experience as good as any in the country.
Fellows in the interventional training program work 4.5 days per week in the cath lab, performing PCIs on-the-spot as patients with STEMI or coronary disease are identified. Fellows are the principal operator from day one. Fellows perform at least 500 interventions over one year. As the year progresses, fellows are allowed to choose and participate in the most complex and challenging cases, including peripheral interventions.
Didactic lectures on interventional catheterization topics are held every Tuesday morning. Over the course of one year, the full breadth of interventional cardiology is addressed. Fellows are invited to join the general cardiology fellows for their conferences as well.
Consultations regarding intervention are frequently provided during every workday. Fellows are encouraged to participate in the decision-making process regarding the risks, benefits, and techniques of potential management strategies for cath lab patients. Experience in outpatient management of intervention patients is provided in the Intervention Clinic one half day per week.
In its role as an academic medical center, GMC is a significant contributor to ongoing research in the field of cardiology as well as many other areas of medical science. Unique cardiac research programs at GMC include the areas of advanced non-invasive cardiovascular imaging, cardiac epidemiology, outcomes and decision-analysis, therapeutic catheterization and devices, echocardiography, electrophysiology, and cardiovascular genomics. The Department of Cardiology participates in many single and multi-center trials, with opportunities for gaining experience in basic cardiovascular molecular techniques at the Sigfried and Janet Weis Center for Health Research, located on campus.
Fellows are encouraged to become involved with clinical research projects, either retrospective or prospective projects including randomized trials, typically projects relating specifically to a particular area of interest to that fellow. For example, abundant research opportunities in interventional cardiology have recently led to publications on PFO closure, IVUS, STEMI PCI, cardiovascular genomics, and drug-eluting stents. Each year, the interventional fellow presents an abstract at a national meeting of the ACC, AHA or SCAI.