Program Length/Available Positions
Program Length: 3 years
First Year Positions: 3
Total Number of Positions: Nine
Fellowship Participates:
ERAS: Opens January
NRMP - MATCH
Accepts: J1 & H1 Visa
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Names:
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Specialty
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Shukri David, M.D.
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Cardiology
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Reda Berger
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Cardiology
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Issac Grinberg, M.D.
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Cardiology
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Christian Machado, M.D.
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Echocardiography
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Ronald Miller, M.D.
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Electrophysiology
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Non-Invasive Lab
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Wassim Nona, M.D.
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Program Director
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Mohammad Qureshi, M.D.
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Abhinav Raina, M.D.
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Nuclear Cardiology
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Mark Rasak, D.O.
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Cardiology – Invasive
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Souheil Saba, M.D.
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Cardiology – Nuclear Cardiology
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Delano Small, M.D.
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Cardiac Care Unit
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Jamal Zarghami, M.D.
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Interventional Cardiology
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Marcel Zughaib, M.D.
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Interventional Cardiology
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Introduction
Providence Hospital is a 419-bed community hospital providing tertiary care in Oakland County and to the population of the Detroit Metropolitan Area. An accredited cardiovascular training program has been in existence since 1975. In 1985, the hospital embarked on the "Cardiac Enhancement Program" which resulted in a marked increase in all types of cardiovascular services and the institution of a cardiac surgical program in 1989. Providence Hospital is the center for a very active EMS program comprising the cities of Southfield and Oak Park and therefore accepts a large number of cardiovascular emergencies. A 15-bed cardiac care unit averages more than 1300 admissions annually, In addition, there is a 26-bed intermediate cardiac care unit as well as a fully monitored 24-bed intermediate intensive care unit. A 10-bed cardiac surgical unit and 27-bed intermediate cardiac surgical unit were opened in October 1991.
A 7-bed chest pain unit was opened in March 1992 and serves to expeditiously treat patients with cardiac emergencies who are triaged to this unit. Two fully equipped catheterization laboratories-one less than two years old, the other a state of the art Siemens Hicor lab are actively utilized in diagnostic and therapeutic procedures. In 1997, more than 2,000 diagnostic catheterizations and more than 500 percutaneous transluminal coronary angioplasties will be performed.
The noninvasive cardiology section comprises an EKG Department performing more than 50,000 electrocardiograms annually, an exercise laboratory where routine and nuclear stress tests as well as exercise MUGA tests and stress echocardiograms are performed, The Echocardiography Section performs an average of 4,000 echocardiograms annually including transesophageal echos.
The Nuclear Medicine Section provides services for myocardial scans, left ventricular function analysis, peripheral vascular nuclear studies, perfusion and ventilation lung scans and other isotope tracer studies. It is equipped with three single photon emission computed tomography units. In addition, nuclear magnetic resonance imaging is available.
A state-of-the-art cardiac rehabilitation unit has been added and will be expanded. Providence Hospital offers a three-year training program in cardiovascular diseases. The first two years are devoted to clinical experience and experience in the Cardiac Catheterization Laboratory.
First year rotations are generally divided into clinical, cardiac catheterization laboratory, and noninvasive laboratory. During the clinical/CCU rotation, the fellows are expected to participate in all aspects of care in the Cardiac Care Unit, They will function as resource to the medical residents assigned to the Cardiac Care Unit. The fellows will round with the Director of the CCU (or his associate) daily at 7:00 a.m. They will examine all CCU patients with the CCU residents. They will supervise and assist in all invasive procedures (Swan-Ganz catheter placement, pacing Swan-Ganz catheters, emergency pacemakers, cardioversions, arterial lines, pericardiocentesis) with the house staff assigned to the CCU. The fellows are available to the house staff for problem cases. They will answer consultations as assigned by the senior attendings.
Fellows on the clinical rotation will also be available for emergency procedures arising elsewhere in the hospital or in the emergency room. The fellows participate in all scheduled cardiac conferences.
Cardiology consultations required by the Academic Service will be answered by the fellow on the Clinical Service and reviewed with the attending cardiologist on call. This is an important teaching experience and the attending cardiologists will review the consult in detail and discuss diagnostic and therapeutic plans. Cardiac patients admitted from the Cardiac Clinic will be the primary responsibility of the fellow on the clinical cardiology rotation and will be managed in close consultation with the attending cardiologist, During this rotation, the trainee is expected to gain expertise in the evaluation, diagnosis and management of the broad spectrum of common cardiac disorders such as congestive heart failure, acute myocardial infarction and ischemia, unstable angina pectoris, arrhythmias, valvular heart disease and cardiomyopathies. The fellow is expected to gain competence in the management and decision making required in these patients. The fellow is also expected to master interpretation of data obtained by pulmonary artery catheterization as well as understanding the indications for and evaluations of temporary and permanent pacing. The fellow on call will be able to assist in all emergency procedures occurring during off hours and to provide consultation service to the resident staff concerning cardiac patients. The fellow is responsible for apprising the attending physicians of any pertinent data or changes in a patient's condition. The clinical fellow is also expected to provide consultation and emergency assistance in medical problems, such as cardiac arrhythmias, occurring in postoperative cardiac surgical patients.
During the clinical service, the fellow is also expected to answer consultations (as mentioned above), which are to be discussed in detail with the attending cardiologist assigning the consultation, This is an important teaching experience required to obtain clinical judgement concerning the management of various cardiac problems-especially in the evaluation of cardiac patients undergoing surgical procedures. Consultations may be assigned by the fellow and performed with the medical resident rotating on the Cardiology Service or senior student doing a cardiology elective. The fellow is expected to provide a teaching experience to the senior medical students doing an elective rotation on the Cardiology Service.
he fellow on call will be available for urgent consultation in the Emergency Department where he will evaluate patients with suspected acute myocardial infarction for possible thrombolytic intervention therapy. He will direct such therapy when indicated, after consultation with the attending cardiologist on call. He will evaluate patients for possible emergency cardiac catheterization and interventional therapy in consultation with a senior invasive cardiologist.
In the noninvasive laboratory, the fellow will participate in the interpretation of electrocardiograms and review them on a regular basis with the attending assigned to read EKG’s during this period. The fellow will perform treadmill exercise tests as well as nuclear exercise tests in conjunction with the attending cardiologists and gain experience in the interpretation of the data obtained.
At the end of the rotation, the fellows are expected to have a strong working knowledge of all the procedures mentioned above. In addition, the fellow is expected to go over electrocardiograms interpreted by the medical students and residents and to provide teaching to those individuals regarding the interpretations. Problem cases are to be discussed with the attending staff. Transesophageal echos are performed in the department as well as intra operatively.
Research
Clinical as well as laboratory research is strongly encouraged during the cardiology fellowship. Fellows are encouraged to develop a research project with the cooperation of a senior attending. Select here for detailed information regarding Cardiovascular research.
Cardiology Clinic
The Cardiology Clinic is held once weekly. The fellows have an opportunity to provide longitudinal follow-up of patients with a variety of cardiac pathology, They are expected to manage those patients in consultation with the Director of the Cardiology Clinic. They are to schedule and perform noninvasive and invasive procedures indicated on their patients. This is an extremely valuable experience preparing the fellows for their future role as attending cardiologists.
Conference and Meetings
Fellows are encouraged to submit original presentations both for regional and national meetings. Providence cardiology fellows have presented a number of original clinical studies at such meetings as the Associates of the American College of Physicians Meeting, the Regional Chapter of the American College of Physicians Meeting and a number of poster and oral presentations have been accepted at the Chapter Meeting of the American College of Cardiology. In addition, papers were presented at a number of national meetings.
Teaching Activities
Clinical Teaching Rounds are performed daily at 7:00 a.m. in the CCU by the CCU Director or his associate. All fellows are expected to participate, if available. Teaching rounds in the CCU are conducted by a senior attending cardiologist three times weekly. Fellows on clinical rotations are expected to attend as well as other fellows, if not busy with other activities.
Advanced EKG Conference is conducted weekly from 4:00 to 5:00 p.m., Section Chief Rounds are conducted Monday afternoon from 2:00 to 4:00 p.m. and fellows are expected to attend and present interesting cases.
- Cardiac Catheterization Conference alternating with Journal Club is conducted weekly on Tuesdays 12:00 Noon to 1:00 p.m.
- A Basic Science Conference is conducted on Wednesdays 5:00 p.m. - 6:00 p.m.
- A Basic EKG Course takes place on Thursday 4:00 p.m. to 5:00 p.m.
- Cardiovascular Conferences which cover a variety of topics in cardiology take place biweekly on Fridays 12:00 Noon to 1:00 p.m.
- Cardiac Cardiology Grand Rounds occur at least once a month at 8:00 a.m. These are usually provided by an outside, nationally known speaker.
Performance Evaluation
Cardiology fellows are evaluated monthly by the attending cardiologists supervising their rotation. The evaluation reports are collected and reviewed by the members of the Evaluation Committee for Cardiovascular Diseases consisting of the Section Chief, Director of the Catheterization Laboratory and Program Director/Director of the Cardiac Clinic. Informal discussions are held with each fellow apprising him of his evaluations, strong points and weak points. Suggestions for improvement in particular areas are made as needed. The fellows are asked to evaluate the performance of the teaching faculty biannually.
The Providence Cardiology Program has been extremely successful over the years, training a number of well-qualified cardiologists who are certified both in the primary specialty of internal medicine and the subspecialty of cardiovascular diseases. It is our goal to continue the excellence of this program.
Future Goals
Providence Cardiology Program expects to expand further, especially in increasing the volume of cases requiring interventional procedures, Introduction of laser procedures to the interventional program is planned. New echocardiographic methods such as intracoronary echocardiography have been added. A rotation in a peripheral vascular laboratory has been arranged to provide exposure to diagnostic methods in peripheral vascular disease such as duplex Doppler studies for carotid artery stenosis, peripheral arterial studies and peripheral venous studies.
Program Director
Wassim Nona, MD
Program Director - Cardiovascular Disease Fellowship
Providence Hospital and Medical Centers
Department of Graduate Medical Education
16001 W. Nine Mile Road
Southfield, MI 48075
phone: (248) 849-7129
fax: (248) 849-3854
