Guiding principles

Fellowship training in Cardiovascular Medicine at Dartmouth Hitchcock Medical Center prepares the fellow to sit for the American Board of Internal Medicine (ABIM) Cardiovascular Disease certifying exam. Achieving this goal involves competency-based training as endorsed by the Accreditation Council for Graduate Medical Education (ACGME) and ABIM, which includes a focus on 6 specific core competencies:

  • Patient care that is compassionate, appropriate, and effective for treating health problems and promoting health
  • Medical knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences, and the application of this knowledge to patient care
  • Practice-based learning and improvement that involve investigation and evaluation of a fellow’s patient care, self-appraisal, assimilation of scientific evidence, and improvements in patient care
  • Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals
  • Professionalism as manifested by a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
  • Systems-based practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

The curriculum is designed to assist the trainee in developing these competencies as described in COCATS 4 (PDF) and form the basis of activities that patients and the general public expect all competent clinical cardiologists to perform and as delineated in the Core Cardiology Training Statement (COCATS 4). These include:

  • Acute cardiac care: Manage patients with acute cardiac conditions
  • Cardiovascular consultation: Evaluate, diagnose, and develop treatment plans for patients with known, with suspected, or at risk of developing cardiovascular disease
  • Cardiovascular testing: Appropriately utilize cardiovascular testing
  • Chronic cardiovascular disease management: Manage patients with chronic cardiovascular diseases
  • Disease prevention and risk factor control: Implement disease prevention and risk factor control measures, addressing comorbidities
  • Lifelong learning: Engage in lifelong learning.Team-based care: Work effectively to promote patient-centered interdisciplinary team-based care

The curriculum

The following components form the basis of the training program in Cardiovascular Disease. In all aspects of the curriculum, Level 1 training is provided during the course of the 3-year fellowship. Fellows are encouraged to seek additional knowledge, skills, and competencies to achieve benchmarks or certification consistent with Level 2 training in many of these areas:

  • Adult congenital heart disease
  • Ambulatory and longitudinal care
  • Arrhythmia, cardiac pacing, and electrophysiology
  • Cardiac catheterization
  • Cardiac imaging (including nuclear, computed tomography, and magnetic resonance imaging)
  • Cardiothoracic surgery
  • Cardiac consultation
  • Critical care cardiology
  • Echocardiography
  • Electrocardiography
  • Heart failure, including advanced therapies
  • Intermediate coronary care
  • Preventative cardiovascular medicine
  • Research
  • Vascular medicine

In addition to the above, all fellows will spend time at the White River Junction Veterans Administration Medical Center (in nearby White River Junction, Vermont), which includes a curriculum oriented toward cardiac consultation, electrocardiogram (ECG) interpretation, echocardiography, and advanced multi-modality imaging.