Cardiology

To provide training and experience in the diagnosis and management of patients with cardiovascular conditions including acute myocardial infarction, ischemic heart disease, congestive heart failure, cardiac transplantation, arrhythmias, valvular heart disease, pulmonary hypertension, preventive cardiology, lipid disorders, peripheral vascular disease, infectious and inflammatory heart disease, and adult congenital heart disease. A key component of this training involves the teaching of the pathophysiology and molecular basis of cardiac disease.

To provide the intellectual environment in the form of didactic lectures, journal clubs, and interactive sessions for acquiring the knowledge, skills, clinical acumen, and professionalism that are essential for the practice of cardiology.

To provide training in an atmosphere that emphasizes outstanding clinical care delivery, humanism, and compassion for patients and their families.

To provide this training in a pure academic environment that promotes and emphasizes basic, clinical, and translational research.

Most importantly, to provide the foundation for training the future academic leaders, physician scientists, and clinical educators in cardiovascular disease.

The cardiology subspecialty residents are an essential part of the division and our faculty is categorically committed to training the academic leaders of tomorrow. The University of Saskatchewan subspecialty residents trained in cardiology will play an essential role in bringing new ideas, energy, and perspective to a specialty whose importance will only increase as the population ages.

The training program was fully accredited after a site visit in December 2015 by the Royal College of Physicians and Surgeons of Canada (RCPSC).  The trainees successfully completing the 3-year training program are eligible for the certification exam in Cardiology from both the RCPSC and ABIM.

Clinical Training

Cardiovascular Ultrasound

The Cardiovascular Ultrasound Laboratory includes both cardiac and vascular imaging including two-dimensional/Doppler echocardiograms, transesophageal echocardiograms, stress echocardiograms and vascular studies (carotids, peripheral) at multiple sites. Fellows spend at least 3 months gaining experience in the performance and interpretation of transthoracic and stress echocardiograms and become familiar with the use of ultrasound as an imaging modality and its clinical utility in hemodynamic assessment. Experience in transesophageal echo is available to those fellows who plan to devote at least 6 months to echo training. Interpretation of vascular studies is covered during the vascular rotation. Formal training occurs through reading with attendings, interpreting and discussing interesting cases presented by a teaching attending, and through an echo syllabus and lecture series.  The fellows’ technical and interpretative skills are tested at the end of each rotation. Fellows with 6 months of echo training are eligible to take the exam offered by the National Board of Echocardiography.

Interventional Cardiology

As one of the preeminent and busiest cardiac catheterization centers in western Canada, the lab performs over 6,000 procedures per year, including over 4,000 coronary and 500 endovascular interventions.  Highly specialized procedures include ASD / PFO closure, adult congenital heart disease procedures, aortic and mitral valvuloplasty, and alcohol septal ablation. University of Saskatchewan’s lab is on the cutting edge of technology and research, and is involved as a center in many important clinical trials.

Fellows rotate through the lab for at least four months, gaining competence in the performance of right and left heart diagnostic catheterizations and pre/post-catheterization evaluations.  Fellows become adept at hemodynamic interpretation and are exposed to a myriad of advanced interventional procedures.  Those interested in specializing in interventional cardiology can tailor their fellowship experience to optimize their time in the lab.

Electrophysiology

Electrophysiology pushes the boundaries of the field and functions on the cutting edge of clinical management and intervention. On the floors and in the clinics University of Saskatchewan electrophysiologists deal with a broad spectrum of arrhythmias, their medical management, interpretation of diagnostic studies and the need to address primary or secondary prevention of sudden cardiac death. In the lab, current and experimental technologies are used to perform a wide array of procedures including ICD and pacemaker implantations, and complex ablations.

Fellows spend at least two months on arrhythmia during which their primary responsibility is to run the arrhythmia consult service. All cases are discussed with the ward attending and presented at EP conference. Fellows are also expected to interpret Holter monitors, signal averaged EKGs and T wave alternans studies, and perform tilt table testing. They are also expected to perform and interpret EP studies, particularly those of patients from the arrhythmia service. Interested fellows may spend one or more months of dedicated time in the electrophysiology lab.  One month is also dedicated to a clinical rotation in procedural electrophysiology at the University of Calgary.

Cardiac Intensive Care Unit

The CCU consists of 10 patient beds, a central monitoring and nursing station, and a room for special procedures (right heart catheterization, transvenous pacing, IABPs). This unit cares for patients with acute coronary syndromes, cardiac arrhythmias, ventricular failure requiring hemodynamic monitoring, severe pulmonary hypertension, decompensated complex congenital heart disease, and post-operative complications among others.

The cardiology fellow serves as a consultant to the house staff, performs invasive procedures and leads daily rounds with the ward attendings. The fellow is also responsible for the education of residents and medical students through informal teaching and a didactic, structured CCU curriculum. The CCU fellow is also responsible for making triage decisions with respect to the utilization of CCU beds.  Each fellow spends at least two months in the CCU.

Cardiology Consult Service

The consult service is one of the most integral parts of cardiology fellowship. Fellows run the consult service with a large degree of autonomy for at least two months during their clinical years. Each fellow is confronted with a wide variety of clinical questions and management decisions from the Medicine, Surgery, Neurology, Psychiatry and sub-specialty services. In particular, fellows gain experience in pre-operative cardiac risk assessment, perioperative cardiac surgical care, and the evaluation and management of coronary, valvular, myocardial, pericardial and congenital heart disease. Resident and medical student education is an essential part of this rotation. All cases are presented daily to the consult attending.  

Adult Congenital Heart Disease

The Adult Congenital Heart Disease Program is directed by Jefferey Stein, U of S Adult Congenital Heart Clinic provides comprehensive multidisciplinary care covering all aspects of patient management.

During the monthly rotation each Fellow gets in-depth exposure to the entire spectrum of adult congenital heart disease covering anatomy, physical examination, natural history, surgical sequelae, and long term management.  The rotation provides an important opportunity to interpret surgical and catheter interventions, congenital echocardiography, angiography, and cardiac MRI.   Interested Fellows are encouraged to spend additional time in the Program and to pursue a clinical research project.

EKG

Fellows spend one month each clinical year on the EKG rotation during which they are expected to devote a significant amount of time to EKG interpretation independently, each fellow must read at least 3500 EKGs, spread over 2-3 years in order to demonstrate competence.  Ideally this is done at 10 EKG’s / day.  All EKGs are over read by a clinical electrophysiologist who provides constructive feedback. Fellows on this rotation also teach EKG reading to the students and residents on the consult service one afternoon per week.  They are also responsible for cross-coverage of post-call colleagues who are on particular clinical rotations (usually nuclear cardiology, echocardiography). This usually amounts to approximately one day a week. The call system is set up so that fellows on intensive clinical rotations are not post-call during the week and therefore do not require coverage. There is ample time left over for each fellow to pursue additional clinical opportunities and skills (nuclear cardiology, echocardiography, cardiac catheterization, etc.). Fellows are encouraged to establish goals for their EKG month before the start of the rotation to optimize their educational experience.

Clinic

Cardiology clinic provides a unique and gratifying experience. The clinic draws from adiverse population encompassing Northern Saskatchewan. The referral base is drawn from community physicians, medicine residents, and the cardiology ward services at Royal University Hospital. The spectrum of cardiac pathology seen in clinic is extremely broad and truly runs the gamut from atypical chest pain to advanced heart failure, challenging arrhythmias, and complex coronary, valvular and congenital disease.

Clinic sessions are scheduled for one half day per week for at least three years of fellowship training. Each session has a dedicated attending responsible for hearing each case, seeing patients when necessary, teaching, and overseeing diagnosis and management. Clinic patients are often presented in morning report and combined surgical conference; however, the fellow has a large degree of autonomy regarding management and clinical decision making. The longitudinal outpatient experience complements the rest of the fellowship experience and further refines clinical acumen.    

Preventive Cardiology

Fellows spend two weeks attending lipid clinic and both inpatient and outpatient cardiac rehabilitation sessions.

Nuclear Cardiology

Nuclear Cardiology is an active, academically oriented program.  Currently, the Laboratory has two SPECT cameras. In addition to providing clinical evaluations, the Laboratory is involved in the evaluation of new imaging approaches for diagnosis and prognostic assessment of CAD, attenuation correction, and vascular imaging using radionuclides.

Fellows spend at least two months rotating through the lab (level I), receiving subspecialty training in cardiac stress testing and scan interpretation.  Each fellow must become adept at the performance and interpretation of exercise and pharmacologic stress testing.  Fellows are also expected to become familiar with the biophysical and chemical principles underlying SPECT and PET imaging.  Half of each rotation is devoted to instruction in and exposure to advanced cardiac imaging, including cardiac MRI and CT.  All fellows have the opportunity to acquire level II training during a 3 year fellowship. 

Application requirements can be found on the CaRMS site.