EP Lab
Electrophysiology (EP) Fellows will be qualified Cardiologists performing 12-24 months of fellowship training in clinical electrophysiology. EP Fellows will be responsible for staffing the EP lab on a rotating basis. Over two years, it is expected that each fellow will be able to run the stimulator and perform a basic EP study independently, become proficient with the use of electroanatomic mapping systems and be comfortable with catheter manipulation for both simple and complex ablation procedures. The fellow on each case will report studies within 24 hours of the study.
The first half of fellowship training will entail mainly SVT ablation to learn fundamentals of electrophysiology and catheter manipulation. The second half will mainly involve complex ablation such as pulmonary vein and ventricular tachycardia ablation. For any given trainee, the transition from simple to complex ablation will be determined by the Program Director and will be decided on an individual basis based on performance.
Procedure Room & Implant Room
Fellows are expected to develop proficiency in implantation of pacemakers and defibrillators. This includes implantation of single and dual chamber pacemakers, biventricular devices, ICD implantation, loop recorder implantation as well as programming and troubleshooting of all arrhythmia devices. There will be some exposure to sub-muscular generator implantation. Fellows will also have exposure to lead extraction. During the course of a year, fellows can expect to be the primary implanter in 150 pacemakers, 35 biventricular systems, 75 implantable defibrillators as well as a variable number of lead extractions (depending on interest).
Clinical
- Fellows will attend Heart Rhythm Clinics on a regular basis. Every Tuesday and Thursday clinic at London Cardiac Institute must have fellow coverage. There will also be regular opportunities to participate in the Inherited Arrhythmia Clinic and CRT clinic.
- Fellows will rotate through weeks on call, involved in the care of arrhythmia inpatients on the ward, and performance of consultations throughout the hospital. On rare occasion, it may be necessary to see consults at Victoria Hospital, at the discretion of the attending physician on call. Duties pertaining to in-patients will be assisted by the Physician Assistant and on-service residents, with the fellow primarily responsible. There will be daily rounds with the attending physician.
- Fellows will be expected to carry the pager on a one in 3-to-5-week rotation, equally shared. The call is consultative to other services in the hospital, and primary call for in-patients on the Heart Rhythm Program. Call will involve weekend rounding and response to pages during night and weekends. First call overnight coverage of the inpatients can be provided by the in-house cardiology resident if there is evening sign out to the covering resident. The on-call fellow will come to the hospital to tend to emergencies in heart rhythm inpatients, new admissions, device interrogations, and arrhythmia-procedure related complications.
The consultant on call for the service will be available to discuss management issues and back up the fellow on call.
Education
- Fellows will be expected to present interesting cases, recent papers or review topics at Wednesday and Friday morning rounds on a rotating basis. These rounds are intended to be spontaneous, lighthearted and educational.
- Fellows will be expected to participate in teaching sessions of medical students and house staff on a regular basis. This includes small group tutorials and presentations at resident rounds.
- Each fellow will have a performance review with the Program Director every six months with an opportunity for bidirectional feedback. This will be reflected in brief written form in the fellow’s file.
Research
Although the ultimate career goal of fellows is highly variable, all fellows will be expected to participate in research.
- During the course of a year, each fellow should identify at least one project. Ideally this would be a prospective project that would include a full research cycle of data collection, abstract preparation and completion of a manuscript.
- Fellows should also avail themselves of the opportunity to: i) do a retrospective study, ii) write a review article with one of the consultants, or iii) write a book chapter with one of the consultants.
- Fellows are expected to present their research progress at rounds on a quarterly basis, and annually at Cardiology Resident Research Day each June.
Conferences
Fellows are expected to attend conferences on a rotating basis. During meetings, at least one fellow will remain in London to cover clinical duties. Priority for attendance at meetings will be given to fellows presenting abstracts. Fellows must notify the Program Director if they plan to attend a meeting. Funding to cover presentation of research on behalf of the London Heart Rhythm Program at meetings will be sought from the Department of Medicine, from educational funding within the Division, and from industry. Scientific meetings will be considered to include the CCS, AHA, ACC, HRS, ESC and Cardiostim. Other meetings attended will be considered on a case-by-case basis, but may require use of vacation time
Vacation
Fellows are entitled to four-weeks' vacation for each academic year. Fellows must submit their vacation requests to the Program Director at least four weeks prior to the desired period of leave. A senior fellow will be designated to make the schedule for the fellows, who must also be notified of vacation time.
