The level of responsibility assigned to the fellow for a given procedure is commensurate to his/her level of experience with that particular procedure.
Assessment of patients for cardiovascular radiology procedures, supervision of cardiovascular radiology procedures, and follow-up of patients who have had cardiovascular radiology procedures is a shared responsibility of the fellow and supervising attending physician, with the degree of fellow autonomy increasing as greater experience and confidence is gained.
Similarly, the level of didactic training given, and level of staff supervision required, is commensurate to the individual expertise of the fellow in question. With greater facility come greater responsibility and a higher level of didactic teaching.
The CVI fellow is assigned to review the schedule of inpatient and outpatient cases, manage an 'add-on" schedule for urgent outpatients and emergent inpatient and ER cases, and select protocols for these cases in concert with attending radiologists. Fellows are responsible for the initial review of all CV cases and at the later stages of the fellowship, once they are comfortable with basic studies and procedures, take on important teaching roles within our department supervising residents on CV rotations both from radiology and cardiology.
Morbidity and mortality related to interventional procedures in CV radiology are very rare. Common morbidities (such as contrast allergy reactions) are discussed with each patient at the time of the procedure. Emergency numbers are given to each outpatient and inpatients that undergo procedures in our department have access to the medical or surgical services primarily responsible for their care. The department maintains a Quality Assurance program.
We can document, at any time, the number and type of procedures or imaging studies performed or interpreted by any resident, fellow or staff radiologist. The CV radiology program director reviews the type and number of cases performed by the CV radiology fellows at least twice per year.
The program director of CV fellowship will verify that the program meets the level 3 (highest) criteria for credentialing in the practice requirements developed by the Clinical Practice Committee of the Society of Cardiovascular Magnetic Resonance (SCMR):
- A total of 1 year of full time training in CMR
- Supervised interpretation of a total of at least 300 CMR studies representing the range of abnormalities observed in practice, but to include substantial proportions (>25%) of both cardiac and vascular studies. For at least 100 of these, the trainee should perform the analysis and make the initial interpretation.
- Participation in an ongoing quality assurance or improvement program for the laboratory or facility in which he or she is associated
- Continuing Medical Education (ACGME-approved) in CMR for at least 40 hours every 2 years
- Primary interpretation of at least 100 cases per year
Each fellow is evaluated by the faculty of CVI section. Counseling, guidance, and feedback are provided to each fellow twice a year during a one-on-one meeting with the fellow's supervisor and program director. Areas of weakness are identified and approaches to address these weaknesses are suggested at these evaluation meetings. Fellows also evaluate the program in general and the supervisor and other mentors in particular.
At the end of the training, the director of the training program will certify that the requirements at a particular level of skills have been met. The levels of skills needed are determined a priori for each individual fellow depending on their training needs as well as the skills they have already obtained. A certificate of completion of fellowship training in Cardiovascular Imaging is awarded to each fellow at the end of the training period.