MUSC Heart and Vascular Center

Adult General Cardiology Fellowship

Director: Daniel Judge, M.D., Professor of Medicine

Length of Program: Three-year program following successful completion of Internal Medicine Residency.

About the Program

The Medical University of South Carolina (MUSC) has been training leaders in cardiology for more than fifty years. The goal of this ACGME-accredited program is to provide outstanding training in cardiovascular medicine through structured and systematic instruction in the science and art of cardiovascular disease.

Competition for the fellowship positions is intense, we receive over 500 applications annually, we interview approximately 50 candidates, and just six or seven fellows are selected (19 total fellows over 3 years). These fellows are some of the brightest and most promising physicians in the country. Graduates of the three-year General Cardiology Fellowship program currently have a 100 percent pass rate on their cardiovascular disease boards. Appointments in clinical cardiology, cardiovascular research or in a combined program are available for three to four-year training periods. Clinical and research activities primarily take place at the Medical University of South Carolina’s Ashley River Tower and the Ralph H. Johnson VA Medical Center.

Monthly assignments during the fellowship provide intensive clinical training, including rotations in the cardiovascular ICU, echocardiography, coronary angiography, nuclear imaging, clinical electrophysiology, advanced heart failure & transplant, imaging (CT angiography, cardiac MRI, PET), adult congenital heart disease, preventive cardiology, and general consultative cardiology. Each fellow participates in a continuity clinic on a weekly basis. The third fellowship year is tailored to the needs and long term goals of each individual fellow. Each general cardiology fellow is expected and encouraged to participate in clinical or basic research, under the mentorship of the faculty.

  1. To provide outstanding training in all aspects of clinical cardiovascular disease.
  2. To educate post-doctoral fellows in the breadth and depth of cardiovascular research, its interpretation, and its application in clinical practice.
  3. To facilitate further training in advanced subspecialties of cardiovascular disease for those fellows who choose to pursue more training.
  4. To ensure competency in the ACGME core requirements for training in cardiovascular disease.
  5. To provide ample opportunities for clinical fellows to develop the technical skills for all aspects of general cardiovascular disease practice.
  1. Imaging Conference – Weekly on Monday
  2. Cath Conference – Weekly on Tuesday
  3. Cardiology Boards preparation lectures – Twice monthly on Wednesday
  4. M&M Conference – Monthly on Thursday
  5. Cardiology Grand Rounds – Weekly on Thursday
  6. Heart Failure – Twice monthly on Friday
  7. Electrophysiology – Twice monthly on Friday

Note: Due to the COVID19 pandemic, all education conferences are provided with the option of virtual participation.

The first two years focus on the core requirements for COCATS level one and two for cardiovascular disease. We tailor the third fellowship year to the needs and long-term goals of each individual fellow. Each fellow also participates in a continuity clinic on a weekly basis, either in the Ashley River Tower or in our affiliated VA Medical Center. Each fellow is expected and encouraged to participate in clinical or basic research, under the mentorship of the faculty.

Block

1

2

3

4

5

6

7

8

9

10

11

12

13

Year 1:

AHFTC

CVICU & GC

VA Cath

ART Cath

Echo

Echo

CVICU & GC

NF & GC

Nuclear

AHFTC

Echo

NF & GC

VA Cath

Year 2:

Consult

NF &GC

Nuclear

EP

NF & GC

Elective

Consult

Cath

CVICU & GC

EP

Cath

CVICU& GC

Prevent, ACHD

Year 3:

Echo

Elective

VA Cath

Elective

VA Consults

Vascular

Elective

VA Consults

Imaging

VA Echo

VA Cath

Elective

VA Echo

 

The clinical program offers a broad experience in cardiology with particular emphasis in the following areas:

  • Bedside cardiovascular physical diagnosis and monitoring techniques including electrocardiography, Holter monitoring, and treadmill stress testing
  • Diagnostic electrophysiology, Pacemaker, ICD implantation, and ablation procedures
  • Echocardiography, including M-Mode and 2-Dimensional, conventional and color flow Doppler, and Transesophegeal Echocardiography
  • Nuclear cardiology including PET, MUGA, and nuclear stress perfusion testing
  • Coronary care techniques including electronic pacing and use of Swan-Ganz catheters, thrombolytic therapy
  • Cardiac catheterization including hemodynamic evaluation of myocardial and valvular function, endomyocardial biopsy, and coronary arteriography
  • Interventional procedures – percutaneous coronary angioplasty and balloon valvuloplasty, coronary and peripheral stent insertion, and pericardiocentesis
  • Pre and post-operative management of cardiovascular surgical patients, especially those undergoing heart surgery and heart transplantation
  • Cardiac Rehabilitation for the post myocardial infarction and the post-operative cardiac surgical and vascular surgical patients
  • Adult congenital heart disease
  • Preventive cardiology
  • Women's cardiac health issues
  • Clinical research
  • Basic research

Patients with cardiovascular problems are referred from sites throughout the Southeastern United States, with an expanding base of new referrals. Approximately 4,000 diagnostic and therapeutic heart catheterizations are performed each year. Patients may be referred to the cardiac clinics or admitted to one of two teaching hospitals utilized in the training program. The University Hospital and the Veterans Administration Hospital are both full service hospitals with well-equipped invasive and noninvasive laboratories.

Research is an integral part of the program. Many research opportunities are available. The Cardiology Division has had an NIH-funded T32 Training grant for many years, and this may provide an additional 1-2 years of funded research for those who may be interested.

Areas of current research in our division include:

  • Global cardiovascular health
  • Basic and molecular aspects of heart failure, ischemia, and aortic aneurysms
  • Genetics in cardiovascular disease
  • Hypertrophic Cardiomyopathy
  • Atrial Fibrillation
  • Novel electrophysiology devices and ablation strategies
  • Right ventricular physiology and pulmonary hypertension
  • Heart Failure with Preserved Ejection Fraction
  • Optimal approaches to chronically occluded coronary arteries
  • Preventive cardiology and lipid disorders
  • Cardio-oncology

 

Rotations

Goals and Objectives

  1. Develop skills at the bedside that can be correlated with invasive and noninvasive studies.
  2. Know when to order appropriate invasive and noninvasive studies.

  3. Understand the management of acute events, i.e. acute coronary syndromes.

  4. Know when and how to use cardiovascular drugs.

Understand decision making: when to do cardiac cath, when to consider invasive procedures, when to order stress test.

Education Content

  1. Mix of diseases: All types of cardiovascular problems – coronary disease, cardiomyopathy, valvular disease, pericardial diseases, arrhythmias, congestive heart failure.

  2. Procedures/CCU Management: All procedures will be entered into the Apollo computer database systems and a report will be generated for each procedure. (Swan Ganz, Intubations/respiratory parameters, cardioversion/defibrillation, pacemakers, pericardiocentesis). 

Ancillary Educational Material

Throughout the rotation, the attending cardiologist provides the cardiology fellow with important reading material (recent publications, classic journal articles, etc.) that should supplement their educational experience on the inpatient service. Time is set aside on a daily basis to make sure that service needs do not interfere with formal education. In addition, educational time is provided to ensure that the fellow’s experience is not diluted by the attending focusing his/her educational efforts only at the level of the resident and students.

Goals and Objectives

  1. Be able to interpret electrocardiograms and realize that it is a simple, useful, and non-invasive test.
  2. Understand and show that the EKG may enable one to arrive at a diagnosis at times without the need for more expensive procedures, thus being cost effective.

 

Goals

Our goal is to teach fellows the physiology and pathophysiology of cardiac conduction and arrhythmias. At the end of this rotation, they should understand the theoretical concepts of all arrhythmias. They should be able to conceptually take care of cardiac patients with arrhythmias so they can be stabilized, order appropriate diagnostic tests, and initiate treatment. Investigational or experimental research projects are encouraged during this rotation.

Objectives

The objective of this rotation is to give the general fellow an overview regarding concepts of arrhythmias so they can order appropriate diagnostic tests and initiate effective therapies..

Program Description

The in-hospital phase of the program is carried out by the Heart Center floor nurses and the program dietitian. It includes patient education, counseling by the dietitian, and supervised activity.

The post discharge phases are held in the Gazes Research Institute (GRI), Room 117 (Phase II and Phase III) and the Citadel gymnasium in Deas Hall (Phase IV and the Adult Fitness program) fellow assigned. In the early phase (II), patients are monitored by telemetry as well as by visual monitoring and blood pressure recordings. After completing Phase II, telemetry monitoring is discontinued and Phase III begins. After a few months, the patients are graduated to Phase IV and have the options of attending the exercise sessions at the Citadel gymnasium at 6:30 a.m. or at the GRI between 4 p.m. and 6 p.m. or exercising on their own. Dietary counseling and education regarding atherosclerosis, symptoms of risk factors for coronary artery disease, benefits and techniques of exercise, safety precautions, and stress management are carried out. The patient’s medications are reviewed. Vocation rehabilitation counseling is available.

All patients referred to the program are examined by the Medical Director and usually an exercise stress test is carried out to observe the patient’s response to exercise and to obtain data on which to base the exercise prescription. Psychological evaluation of the patient is carried out by questionnaires.

The program is certified jointly by the South Carolina Medical Association and the South Carolina Chapter of the American Heart Association and re-certified every three years. The safety of patients is assured by the fact that a nurse and exercise director, who is trained in Advanced Cardiac Life Support, are at the exercise location in the Gazes Research Institute and that a designated physician is within five minutes walking distance of this site. The cardiology fellow assigned to the program is the designated physician and will be available for this purpose during the hours of program operations currently 7 a.m. to 12 p.m. and 4 p.m. to 6 p.m. on Monday, Wednesday and Friday. This will require that the physician be on campus by 7 a.m.

Goals

To familiarize the cardiology fellow with the concepts of cardiac rehabilitation, its benefits, and the structure and operation of a formal program.

Objectives

To have the cardiology fellow become knowledgeable in:

  1. The evidence for benefit from a formal cardiac rehabilitation program

  2. Patient assessment and risk stratification

  3. The response of the cardiovascular system to exercise

  4. Prescribing an exercise program and the value of different types of exercise

  5. Problems related to special categories of patients, for example: cardiac transplantation patients, the elderly, or handicapped

  6. Risk factors for coronary artery disease and appropriate management for those which can be modified

  7. The psychological aspects of coronary events and psychological assessment of patients.

  8. Safety issues

  9. The structures of a formal cardiac rehabilitation program including the staff, space and equipment required, and the details of the education component

  10. The finances of a program in general terms

  11. The criteria for certification of cardiac rehabilitation programs in South Carolina

Goals

During this rotation, cardiology fellow will enhance his/her clinical skills and knowledge in the area of consultative cardiology. The fellow will additionally achieve advanced skills in the interpretation of 12-lead EKG’s and 24-hour Holter recordings.

Objectives

  1. The fellow will demonstrate the ability to respond appropriately and accurately to cardiology consultation requests, together with an ability to supervise the work of residents and medical students assigned to a consultation team.

  2. The fellow will demonstrate familiarity with all regularly encountered 12-lead EKG patterns; an understanding of physiologic mechanisms for arrhythmias and an ability to recognize all arrhythmias regularly encountered on 12-lead EKG’s and 24-hour Holter recordings. The fellow will also demonstrate an advanced ability to recognize normal EKG variants.

Educational Content

Mix of Diseases – Diseases frequently encountered include coronary artery disease, cardiomyopathy, congestive heart failure, hypertensive cardiovascular disease, valvular heart disease, arrhythmias, and peripheral vascular disease. Less frequently, the fellow will participate in the management of patients with pericardial disease, pulmonary heart disease, endocarditis, and cardiac manifestations of connective tissue disease.

Objective

The objective of this rotation is to provide the cardiology fellow with an education experience that provides instruction in all aspects of ultrasound utilized in assessing cardiovascular anatomy and function. The training in echocardiography will be integrated closely with the educational experience in clinical cardiology to include physical diagnosis, cardiovascular catheterization and intervention, surgery, and pathology.

Educational Content

The adult echocardiography laboratory performs more than 12,000 echocardiographic studies, approximately 500 transesophageal studies, and approximately 1,000 stress echocardiograms per year. The fellow will receive exposure to the entire spectrum of acquired and congenital heart disease in adult patients.

Background

Our advanced heart failure team includes nine advanced heart failure and transplant cardiologists and four cardiac surgeons. We have seen tremendous growth in transplant and LVAD implant volumes over the last several years. As the only heart transplant center in South Carolina, we performed 23 transplants in FY19 and 39 transplants in FY20. We have averaged 35-40 durable LVAD implants per year over the same period. We are a Blue Cross Center of Distinction for Heart Transplantation, Optum Center of Excellence (COE) and LifeTrac 'Select' Adult Heart Transplant Center. Our MCS program is certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and received the Vanguard Award from STS INTERMACS

Goals

The goal of the Heart Failure/Transplant Service rotation is to educate the cardiology fellow in the diagnostic and prognostic modalities available for the patient initially presenting with congestive heart failure and to allow the cardiology fellow to develop expertise in the treatment of congestive heart failure including the use of conventional medications and more aggressive modalities such as intravenous inotropes, intraaortic balloon counter pulsation and left ventricular assist devices. A further goal is to educate the fellow, in a more general way, in the care of the postoperative heart transplant patient specifically exposing the fellow to the management of postoperative hemodynamics, routine clinical follow-up and the myriad of complications that can occur in the immunosuppressed patient.

Objectives
The Medical University of South Carolina Advanced Heart Failure and Transplant Cardiology Fellowship seeks the following for its trainees:

  1. To provide them with knowledge and experience necessary for the provision of outstanding clinical care for patients with advanced heart failure, including medical management of advanced heart failure therapies such as cardiac transplantation and mechanical circulatory support, as part of a multi-disciplinary team.

  2. To develop their skills for providing appropriate care including obtaining the history, performing a physical exam, and using appropriate diagnostic tests for patients with advanced heart failure.

  3. To provide them with expertise in the evaluation of all stages of heart failure, including ACC/AHA stages A through D.

  4. To ensure that they demonstrate competency in the ACGME core requirements, including patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

  5. To develop the skills necessary for the assessment and management of immunosuppression after cardiac transplantation, including early post-operative induction, chronic maintenance, assessment and treatment of acute allograft rejection, and treatment of chronic allograft rejection, including assessment for toxicity and complications of these therapies.

  6. To produce evidence of scholarly productivity in the fields of cardiomyopathy, heart failure, cardiac transplantation, or mechanical cardiac support

 

Objectives

Obtain an understanding of the role of radionuclide diagnostic tests in evaluating the patient with cardiovascular diseases

Obtain an understanding of radionuclide imaging from the standpoint of the type of disease processes evaluated, and understanding of the technology available and how it meets the diagnostic needs of the patient in this particular circumstance, and an understanding of radionuclides from the standpoint of nuclear physics, radiation, biology, radio pharmacy and radiation safety.

Develop an understanding of the role of nuclear cardiology in the care of patients with suspected cardiovascular disease.

Obtain the necessary credentials to satisfy the Nuclear Regulatory Commission standards which are acceptable for licensure for the handling of radionuclides at the state level.

Obtain experience in exercise and pharmacological stress testing.

This is one of the core rotations essential to the education of the cardiology fellow. The responsibilities of the cardiology fellow vary somewhat, depending on the nature of the case (diagnostic cardiac catheterization vs. interventional procedure) and whether the patient is an inpatient (in which case the cardiology fellow will have primary responsibility for the precatheterization work-up and, in concert with the attending, arranging disposition for the patient).

Goals

  1. The fellow should understand the indication for the diagnostic and/or therapeutic procedure.  The fellow must know the technical aspects of the procedure and the potential complications of the procedure, in order to obtain informed consent from the patient. The fellow should learn how to achieve informed consent, without unduly alarming the patient, and to document in the patient chart that informed consent has been received for the procedure.

  2. The fellow will learn to interpret hemodynamic and angiographic data produced during the catheterization procedure.

  3. The fellow will integrate data generated within the cardiac catheterization procedure with non-invasive data to produce a correct and cost effective patient management decision.

Objectives

  1. The initial rotation emphasizes proper patient selection and procedural techniques for patients undergoing a wide variety of potential procedures.

  2. Other activities expected of the first-year cardiology fellow include temporary cardiac pacing under fluoroscopic guidance, pericardiocentesis, and Intra-Aortic balloon insertion.

  3. Safety is emphasized. This includes knowledge of how to avoid contrast toxicity, and unnecessary radiation exposure.

  4. Proper record keeping is essential. The fellow should be able to express his/her interpretation of cardiac catheterization data in a form appropriate for the permanent medical record and for transmission of this data to other physicians, nurses, and health care professionals.

  5. Presentation at formal cardiac catheterization conferences requires that the cardiology fellow incorporate published data into their decision-making process and have a thorough understanding, through presentation to colleagues, of complex cases.

 

How to Apply

The Program participates in the Electronic Residency Application System (ERAS) and NMRP for the screening and selection of qualified candidates. All candidates must pass USMLE Step 3 Exam (or COMLEX step 3) before entering program and provide documentation. Candidates are screened based upon variety of criteria including:

  • Clinical experience
  • Academic record and productivity
  • Personal Statement
  • Letters of Recommendation (3)
  • Interview

All specialty and subspecialty residents must have passed the USMLE Step 3 Exam (or the equivalent COMLEX Step 3 exam) before entering any MUSC GME program. We accept candidates who are United States citizens, permanent residents (Green card holders), or with J1 visas.


 

General Cardiology: Third Year Fellows

Jessica Atkins, M.D.

Jessica Atkins, M.D.

Internal Medicine Residency: Louisiana State University, Chief Resident
Medical School: Medical University of the Americas (Nevis)
Undergraduate: University of Waterloo


Dr. Katrina Bidwell 

Katrina Bidwell, M.D.

Internal Medicine Residency: University of Kentucky
Medical School: University of Kentucky
Undergraduate: Western Kentucky University

Emily Hodskins, M.D.

Emily Hodskins, M.D.

Internal Medicine Residency: Medical University of South Carolina
Medical School: University of Tennessee
Undergraduate: University of Georgia

Jasjeet Khural, M.D.

Jasjeet Khural, M.D.

Internal Medicine Residency: University of Maryland
Medical School: University of Maryland
Undergraduate: University of Maryland

Ryan Sandoval, M.D.

Ryan Sandoval, M.D.

Internal Medicine Residency: University of Texas at Austin Dell Medical School
Medical School: University of Ecuador
Undergraduate: John Carroll University

Ishan Shah, M.D.

Ishan Shah, M.D.

Internal Medicine Residency: University of Virginia
Medical School: Eastern Virginia Medical School
Undergraduate: University of Virginia

General Cardiology: Second Year Fellows

Matthew Evans 

Matthew Evans, M.D.

Internal Medicine Residency: University of Maryland
Medical School: University of Maryland
Undergraduate: University of Maryland

John LeCluyse 

John LeCluyse, M.D.

Internal Medicine Residency: Medical University of South Carolina
Medical School: University of Kansas
Undergraduate: University of Notre Dame

Prabodh Mishra 

Prabodh Mishra, M.D.

Internal Medicine Residency: Medical University of South Carolina
Medical School: Medical University of South Carolina
Undergraduate: Vanderbilt

Tripp Mostertz 

William (Tripp) Mostertz, M.D.

Internal Medicine Residency: Wake Forest
Medical School: Medical University of South Carolina
Undergraduate: Clemson

Sam Powell 

Sam Powell, M.D.

Internal Medicine Residency: Virginia Commonwealth University
Medical School: Medical University of South Carolina
Undergraduate: Clemson

Shane Reighard 

Shane Reighard, M.D.

Internal Medicine Residency: University of Alabama at Birmingham
Medical School: University of South Carolina
Undergraduate: Clemson

Shailee Shah 

Shailee Shah, M.D.

Internal Medicine Residency: Cleveland Clinic
Medical School: NHL Municipal Medical College, Gujarat India
Undergraduate: NHL Municipal Medical College

General Cardiology: First Year Fellows

Dr. Devin Blakinship 

Devin Blankinship, M.D.

Internal Medicine Residency: MUSC, Chief Resident
Medical School: Indiana University
Undergraduate: University of Notre Dame

Dr. Zain Gowani 

Zain Gowani, M.D.

Internal Medicine Residency: Johns Hopkins Bayview, Chief Resident
Medical School: Vanderbilt University
Undergraduate: University of Chicago

Dr. Carson Keck 

Carson Keck, M.D.

Internal Medicine Residency: MUSC, Chief Resident
Medical School: Mercer University
Undergraduate: Georgia Institute of Technology

Steven Maurides 

Steven Maurides, M.D.

Internal Medicine Residency: MUSC
Medical School: MUSC
Undergraduate: Wofford College

Dr. Anderson Obi 

C. Anderson Obi, M.D.

Internal Medicine Residency: Zucker SOM at Hofstra/Northwell
Medical School: University of South Carolina
Undergraduate: South Carolina State University

Brett Tomashitis 

Brett Tomashitis, M.D.

Internal Medicine Residency: MUSC
Medical School: MUSC
Undergraduate: Clemson University

 

2020 Graduates

Mazahir Alimohamed – University of Minnesota, Advanced Imaging Fellowship

Amanda Cai – University of Washington, Adult Congenital Heart Disease Fellowship

Dan Hobbs – Private Practice, Winchester, VA

Leah John - Medical University of South Carolina, Clinical Cardiac Electrophysiology Fellowship

Ahmadreza Karimianpour - Medical University of South Carolina, Clinical Cardiac Electrophysiology Fellowship

Ashley Waring – Medical University of South Carolina, Assistant Professor of Medicine in Cardiology