Heart Function and Transplant Fellowship

Impact of the Fellowship

Heart Failure has become one of most common pathologies seen in cardiology. General cardiologists are expected to have a solid knowledge of heart failure as they are likely to encounter a large number of patients with this condition in their practice; in addition, most benefit from understanding the basics of post-transplant care and mechanical assist devices as patients can present anywhere with complications of such therapies. 

We are proud to offer our patients the possibility of enrolling in clinical trials investigating the role of new, cutting-edge therapies for heart failure. Furthermore, we conduct original protocols within our own institution, in collaboration with the Departments of Epidemiology and Cardiac Surgery. Many medical students, internal medicine residents and cardiology fellows have completed clinical projects under our supervision, which have been presented at national and international meetings and published in peer-reviewed journal.

Impact on the Cardiology Residency Program

With such a wide array of clinical activity in the field of Heart Failure and Transplant, having a dedicated fellowship at McGill University is important in advancing patient care, teaching and research. There are many layers of complexity in the care which is delivered to patients with heart failure, going from basic chronic and acute heart failure syndromes to complex multi-organ transplant and mechanical assist devices; therefore a Heart Failure and Transplant fellowship can be seen as complementary to the Cardiology residency training program rather than in competition.

The Heart Failure and Transplant fellow is expected to be a resource person for the other residency programs. He/she is expected to teach McGill general cardiology fellows and residents from other specialties. With regards to patient care, his/her constant presence on the cardiology, general internal medicine, cardiac and intensive care units during and after working hours, and his/her knowledgeable input regarding patient management can make him/her an important part of our cardiology department with regards to more difficult cases.

Organization of the Rotations and Education Experiences

During the 12 months of training, the trainee will aquire knowledge of basic and advanced medical, device and surgical therapies for advanced heart disease through the following clinical and research activities:

• Three outpatient heart failure clinics, one heart transplant clinic, one combined heart failure/sleep clinic per week. Trainee will have his/her own patients whom he/she will follow over the course of the year with an assigned nurse and attending, with access to a secretary.
• One combined Echocardiography-Heart Failure clinic per week involving mainly optimization of cardiac resynchronization therapy and research echocardiograms
• Learn the process of pre-transplant evaluation, including criteria for listing and required standardized work-up
• Do new consults and round on hospitalized heart failure and transplant inpatients, including patients hospitalized at the Montreal General Hospital
• Post-transplant care with focus on perioperative management, immunosuppressive therapy and treatment of acute cellular or humoral rejection
• Perioperative and follow-up care of patients with mechanical Ventricular Assist Device
• On call responsibility for the heart failure and transplant service with assigned heart failure specialist one in 3 call
• Supervision of residents for issues pertaining to patients hospitalized with Heart Failure, Transplant and Ventricular Assist Devices
• Teaching of residents during CCU teaching sessions or Cardiology fellows academic half-days (didactic sessions or journal clubs)
• Presentation of patients at the monthly multidisciplinary Heart Transplant meeting for evaluation of transplant candidacy
• Attendance at the combined organ transplant meetings (renal, cardiac, pancreas, liver, lung) and at the MAUDE unit meetings when common patients are being discussed
• Participation and presentation in the Heart Function Center bimonthly mortality and morbidity rounds
• Participation in at least two harvests and subsequent heart transplants Performance of post-transplant surveillance cardiac biopsy in the catheterization laboratory (optional)
• Trainee will be expected to complete 2 clinical research projects during the course of the year either on the topic of Heart Failure or Heart Transplant, to present this research at national and international meetings and to publish in peer- reviewed journal. He/she will have access to support from the McGill University Epidemiology Department. Travel, registration and poster printing costs will be covered for abstract presentations.

Curriculum

Trainee will be expected to see at least 5 outpatients per clinic and round on a total of 5 hospitalized patients at any time. The bulk of outpatient cases will consist of new heart failure consults and follow-up, pre-transplant/mechanical heart device evaluations and post-transplant routine follow-ups. Inpatient care will mostly consist of cases with decompensated heart failure, medical cardiac/non-cardiac complications or rejection post-transplant, and patients with post-op mechanical assist device surgery or complications. Outpatient visits include scheduled as well as unscheduled visits.

Finally the Heart Failure/Transplant fellow is encouraged to take charge of his/her own education depending on his intended future site and style of practice. The specific needs of each fellow will be assessed by the Heart Failure teaching faculties and training will be tailored to best suit each individual fellow’s needs.

Service/Education Balance

This is mainly a clinical fellowship with approximately one fifth of the time focused on research. Direct clinical exposure to patients is the best way to learn. The teaching is done around cases, therefore doing clinics and rounding in the hospital on inpatients are the cornerstone of this fellowship. The call burden is not heavy: even if the fellow is frequently on call, actual calls are rare. Since heart transplant is an unexpected and rare event, the fellow needs to maximize his clinical exposure by being on call often. Therefore there is still plenty of time for the fellow to read on his/her own.

How to Apply

Please visit the McGill PGME Website for details