Electrophysiology Fellowship Program at the Los Angeles County Harbor-UCLA Medical Center and the Good Samaritan Hospital in California
To obtain the Electrophysiology Fellowship Application, download the application here.
For More information Contact: Sylvia Roberson at Good Samaritan Hospital 213.977.2239 or email her at: firstname.lastname@example.org
Composition of the Training Program: The 1 year training program in Clincial Cardiac Electrophysiology will comprise the following:
- Didactic Training Program – Didactic teaching in basic electro physiology, pharmacology and pharmacokinetic principles, management of patients with supra ventricular and ventricular arrhythmias, and evaluations of the diagnostic tools to evaluate cardiac arrhythmias.
- Clinical Training Program – Clinical teaching in the safe performance and interpretation of electrophysiologic stimulation studies, radio frequency ablation, intraoperative mapping and electrophysiologic testing of implantable cardioverter defibrillators.
- Research Training Program – In clinical and basic electrophysiology.
IDACTIC TEACHING PROGRAM:
Didactic teaching will be broad based and will be aimed to provide a thorough understanding of the basic and clinical electrophysiology. The didactic training will serve to supplement the knowledge gained as a result of direct clinical experience. The teaching format will include a series of lectures by local and outside faculty members, interactive conferences between faculty and the fellows, and clinical case presentation conferences presented by the cardiac electrophysiology fellows. While the educational content of some conferences may be constant from year to year, others will be more flexible in their educational content.
- Monthly Core Conference
This conference is held weekly and is mandatory for the clinical electrophysiology fellows to attend. It may also be attended by the other cardiology fellows, the visiting research scholars, EP lab staff and medical students. The educational content of this conference is fairly constant from year to year. The conference covers the following:
- Technical and general aspects of electrophysiologic stimulation studies
- Normal and abnormal aspects of the sinus node, AV node and interventricular conduction
- Classification and mechanisms of the supraventricular tachycardias
- Pathophysiologic mechanisms and clinical management of atrial flutter and fibrillation
- Cellular electrophysiologic basis of the cardiac arrhythmias
- Electrophysiologic mechanisms and pathophysiologic substrate of the ventricular tachycardia
- Pharmacologic mechanisms and classification of antiarrhythmic drugs
- Arrhythmogenesis in post myocardial infarction states
- Pharmacologic antiarrhythmic therapy for ventricular arrhythmias
- ICDs in the treatment of ventricular arrhythmias
- Radiofrequency ablation of supraventricular arrhythmias
- Radiofrequency ablation of ventricular arrhythmias
- Ablative therapy for cardiac arrhythmias, evolving indications and technology
- Journal Clubs
The journal clubs are held once a month. The conference is conducted by one of the local electrophysiology faculty who picks up 2 or 3 recently published articles from the peer review journals. The articles are discussed and critiqued by the electrophysiology fellows under the guidance of the faculty. The selected articles deal with different aspects of the basic electrophysiology, clinical pharmacology, noninvasive techniques for evaluation of cardiac arrhythmias and recent developments in cardiac ablative techniques.
- Clinical Case Conference
This conference is held weekly on Thursday mornings at 7:00 AM at Good Samaritan where an interesting case is presented and discussed by one of the electrophysiology fellows. This conference is spearheaded by the cardiac electrophysiology fellows. They are responsible for the clinical presentation and discussion of the pertinent literature.
- Electrocardiographic Conference
This conference is held every Wednesday of the month at 7:30 AM at Harbor-UCLA Medical Center . The conference is attended by both the electrophysiology and the cardiology fellows. This is an interactive conference where the electrocardiograms are presented by one of the faculty and discussed by the electrophysiology and the general cardiology fellows. The aim of the conference is to train the electrophysiology fellows in how to evaluate the complex cardiac arrhythmias and recognize abnormalities produced by electrolyte abnormalities, antiarrhythmic drugs, myocardial ischemia and other cardiac disease processes.
- Cardiac Catheterization Conference
This conference is held three times a month on Friday morning at 7:00 am at Good Samaritan Hospital and every Wednesday at 4:30 pm at Harbor-UCLA Medical Center . In these conferences, interesting electrophysiology cases are presented which may be of interest to general cardiology fellows and the general cardiologist. This is not a mandatory conference but the electrophysiology fellows are encouraged to attend it.
- Noon Medical Conferences and Medical Grand Rounds
At Good Samaritan Hospital and Harbor-UCLA Medical Center, year there are approximately 8 to 12 such conferences which deals specifically with the electrophysiologic aspect of cardiac arrhythmias. The electrophysiology fellows are strongly encouraged to attend these conferences.
CLINICAL TRAINING PROGRAM
The clinical training program includes patient care management, noninvasive studies, implantable cardioverter defibrillators, radiofrequency ablation and antiarrhythmic surgery. The clinical electrophysiology fellows are directly involved in the above activities under supervision of the cardiac electrophysiology faculty. These activities are conducted both for inpatients and outpatients.
Patient Care Management
This includes consultative services and History & Physicals. Each fellow sees approximately 2 to 3 new patients each day. The fellows are exposed to a wide spectrum of disease pathology at Good Samaritan Hospital and Harbor-UCLA Medical Centers . The staff electrophysiologists discuss the case presentations with electrophysiology fellows during teaching rounds.
The cardiac electrophysiologic fellows are exposed to interpretation of the 24-hour ambulatory electrocardiographic monitorings, signal-averaged electrocardiography, exercise testing and in-hospital telemetry monitoring. The cardiac electrophysiology fellow performs the initial interpretation and then discusses it with the staff electrophysiologist. During the course of the year, didactic lectures are scheduled that review the technological, diagnostic and interpretive aspects of the various noninvasive techniques. Each year approximately 2500 exercise tests, 1000 ambulatory electrocardiographic monitorings and 500 signal-averaged electrocardiograms are performed. The fellows are also supposed to review the results of the noninvasive tests and correlate them with the clinical aspects of the case management.
Electrophysiologic Stimulation Studies
During the course of their training, the cardiac electrophysiology fellows become familiar with the indications, interpretation, clinical utility and limitations of the electrophysiologic testing. Under the supervision of the staff electrophysiologists, the electrophysiology fellows learn the anatomy and physiology of cardiac conduction system, technical aspects of inserting venous and arterial catheters, and interpretation of the electrophysiologic tracings. This training experience is supplemented by didactic lectures which cover the technical aspects of the signal recording and amplification, the differences between unipolar and bipolar signals, fluoroscopy equipment and programmable stimulators. At the end of each study, the fellows review the electrophysiologic tracings with the staff electrophysiologist in charge. They are taught as to how to avoid complications and minimize the fluoroscopy exposure time. During the course of the electrophysiologic study, the fellows are frequently interrogated to assess their knowledge of the mechanisms of the arrhythmias and to determine whether they can select an appropriate therapy and monitor its efficacy. The cardiac electrophysiology program aims to have each fellow perform and analyze at least 75 initial electrophysiology studies and 25 follow-up electrophysiologic studies a year.
Radiofrequency Ablative Procedures
The electrophysiologic ablative procedures are performed by a fellow who has had at least 6 months of training in clinical electrophysiology. The first year cardiac electrophysiology fellow is expected to perform at least 25 radiofrequency ablative procedures. It is the responsibility of the staff electrophysiologist to ascertain that the electrophysiology fellow is familiar with the biophysical aspects of energy sources, the extent of myocardial damage, the types of ablative techniques and the mechanisms of cardiac arrhythmias. The cardiac electrophysiology fellow perform ablative procedures under the direct
Internal Cardioverter Defibrillator
The electrophysiology fellows actively participate in evaluating the device performance at the time of its implantation in the operating room and its follow-up testing in the electrophysiology laboratory. They are trained to evaluate the sensing lead signals, capture thresholds and defibrillation threshold. During inpatient and outpatient consultative services they are trained in how to monitor the ICD function, troubleshoot and reprogram the device recognize the end-of-life indicators, and recommend the device replacement. These activities are done both at the inpatient and outpatient level.
The cardiac electrophysiology fellows are directly involved in the intraoperative mapping studies when surgery is undertaken for ventricular and supraventricular arrhythmias. They are also given didactic lectures on how to perform intraoperative mapping and how to determine its clinical utility and limitations.
PROGRAM RESEARCH ACTIVITY
The fellows are encouraged to participate in other ongoing research projects in the department. These including the ongoing multicenter national studies and investigations of newer antiarrhythmic drugs and internal cardioverter defibrillators. The fellows are also encouraged to write the research proposals which may be funded through the local American Heart Association or other local funding agencies. The CCEP residents have access to library services at both Good Samaritan Hospital and Harbor-UCLA Medical Center . The facilities for electronic retrieval of information from medical databases are also available at both sites. The fellows are strongly encouraged to attend the local Greater Los Angeles Electrophysiology Society Meetings which take place on a 6 weekly basis. At this meeting, interesting cases are presented or a lecture is given by a visiting prominent electrophysiologist. In addition, they are expected to attend at least 2 of the 3 Annual Scientific Sessions (American Heart Association, American College of Cardiology or NASPE) a year.
METHODS OF EVALUATION
The electrophysiology fellows are evaluated formally on a 3-monthly basis by the staff electrophysiologists. The aim of this evaluation is to monitor the status of their knowledge, skill and overall performance. Each evaluation is shared with the fellow in a timely manner and a permanent record of the evaluation is maintained for each of the electrophysiology fellows. At the end of the first training, the program director reviews with the fellow the findings of all of the 3-monthly evaluations. The program director and other staff electrophysiologists also monitor the electrophysiology fellows on a regular basis for any mental or emotional problems, drug addition or alcohol related dysfunction. In addition to this formal evaluation, the electrophysiology fellows are informally evaluated by the attending staff electrophysiologist all year around. They are complimented on their strengths, encouraged to rectify areas of potential weaknesses, and counseled appropriately if there are any mental or emotional problems. Both Good Samaritan Hospital and Harbor-UCLA Medical Center programs have appropriate procedures for discipline and redress of grievances, including sexual harassment.
Faculty Evaluation by the Fellows
A written evaluation form (sample copy enclosed) has been developed for evaluation of the teaching staff by the cardiac electrophysiology fellows. This evaluation takes place on a 3-monthly basis and is shared with the electrophysiology faculty. The staff electrophysiologists are dedicated to the supervision and teaching of the clinical cardiology fellows and spend at least 50% of their time in the education and teaching of the fellows. They attend the teaching conferences and conduct in a timely fashion the teaching rounds with the fellows.