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Summary
Carilion Clinic-Virginia Tech Carilion School of Medicine Cardiovascular Disease fellows are not only able to obtain core fundamental skills, but by providing significant elective rotation experience, we enable fellows to tailor their training to develop unique skills and aptitudes.
About the Residency or Fellowship
Virginia Tech Carilion Partnership
The Virginia Tech Carilion School of Medicine (VTCSOM) started in 2010 and is a research intensive program current with 42 students per year. VTCSOM was officially recognized as the ninth college of Virginia Tech in 2018. The Fralin Biomedical Research Center at VTC is undergoing expansion, creating new and exciting research opportunities.
Mission Goals Strengths

Our goal is to educate and train fellows in all aspects of cardiovascular medicine, preparing them for successful careers in either private practice or academia. Our program has high clinical volumes and advanced technologies, including TAVR, state-of-the-art interventional procedures and robust imaging modalities. During their third year, fellows have ample opportunity to choose electives, allowing them to expand and tailor their expertise and to prepare for subspecialty fellowships.

Message From Leadership

Our fellowship is strong and deep. We have trained exceptional private practice and academic cardiologists.

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David Sane, M.D.
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David Sane, M.D. 
Program Director 

Dept Spec Program Size
4 cardiovascular disease fellows per year
32 Carilion Clinic cardiology faculty
4 Salem VA Medical Center faculty
Dept Spec Subspecialties
Adult Structural Heart (with unaccredited fellowship)
Advanced Imaging
Clinical Lipidology
Electrophysiology
Heart Failure
Interventional Cardiology (with accredited fellowship)
Dept Spec Population Served
More than 1 million in central and southwest Virginia and parts of West Virginia
Dept Spec Teaching Opportunities
Lay public
Medical students
Residents
Fellows, including those from other specialties
Dept Spec Locations
Carilion Roanoke Memorial Hospital
The Salem VA Medical Center
Carilion Clinic Cardiology Outpatient Clinic
Dept Spec Fellowships
Interventional Cardiology (with accredited fellowship)
Junior Faculty Adult Structural Heart and Valve (unaccredited fellowship)
Dept Spec Board Pass Rate
94% ABIM
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Overview

Welcome, prospective fellows. The Virginia Tech Carilion Cardiovascular Disease Fellowship program is a university-based cardiology fellowship program. We provide a comprehensive, ACGME-accredited, 3-year training program in general cardiology. We have a competitive program that accepts four general fellows per year. There are additional advanced training opportunities in interventional and structural cardiology.

Since our program inception in 2011, the general cardiology fellowship program has undergone consistent, focused refinement to improve the experience of trainees and offer a world-class clinical, didactic and research training experience. We have a 26-member primary teaching faculty that is committed to fellow education. The environment at Carilion is one of collaboration, strong work ethic, mentoring and dedication to patient care. Both fellow- and faculty-guided didactics occur daily to help fellows cement knowledge, ask questions and prepare for boards. Fellows are assigned faculty mentors during their first year to help them reach their full potential and achieve their career goals.

We are the primary teaching hospital for the Virginia Tech Carilion School of Medicine. Our fellows function as team leaders and are expected to devote time to teaching both medical students and residents. Furthermore, a minimum of one month per year is dedicated to research with opportunities available for both clinical and basic science research, including at the respected Fralin Biomedical Research Institute at VTC.

Clinical training occurs at our modern outpatient Crystal Spring clinic and imaging center, at Carilion Roanoke Memorial Hospital and at the Salem VA Medical Center. Along with robust outpatient and inpatient clinical training, there are high volumes in diagnostic imaging and procedures. There is ample exposure to basic and advanced echocardiography, nuclear cardiology including PET, cardiac CT, cardiac MRI, cardiac catheterization, complex coronary and peripheral intervention, structural intervention and advanced EP procedures. The varied case mix and high volumes encountered during the 3-year training program allow the fellow to graduate with confidence. Our graduates will have acquired a skill set that will be instrumental in general cardiology practice or as a springboard to further advanced training.

We encourage you to explore our program using this website. Please contact us for any additional information.

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How to Apply
Admission Requirements

All application materials must be submitted through the Electronic Residency Application Service (ERAS). Our program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). We participate in the National Residency Matching Program (NRMP) for Cardiovascular Disease Fellowships.

Applications are accepted during the July medical subspecialty application period. We accept applications through the end of August of each year.

Requirements for Application

  • Excellent oral and written communication skills
  • Board eligibility/certification in internal medicine (ABIM or American College of Osteopathic Internal Medicine; this requirement implies having successfully completed steps 1, 2 and 3 of the USMLE and/or Complex Exams)
  • Three letters of recommendation (one must be from the applicant's residency program director)
  • An updated copy of the applicant's curriculum vitae
  • Prior research experience is desirable but not a requirement
  • Preferably, completion of residency within the last five years

For International Graduates

J-1 visas are sponsored

Contact

David C. Sane, M.D.
Program Director, Cardiovascular Disease Fellowship
Virginia Tech Carilion School of Medicine
Graduate Medical Education Program
P.O. Box 13367
Roanoke, VA 24033-3367

Ido Heletz, M.D.
Associate Program Director, Cardiovascular Disease Fellowship

Morgan Morris
Program Manager
Cardiovascular Disease Fellowship and Interventional Cardiology Fellowship


Virginia Tech Carilion School of Medicine
Graduate Medical Education Program
P.O. Box 13367
Roanoke, VA 24033-3367
Phone: 540-224-1008
Fax: 540-527-1039

carilioncards@carilionclinic.org

Admissions Links
Curriculum
Curriculum

Consults Rotation

Fellows rotate for 12 weeks on the general cardiology consult service. The team consists of one fellow and attending with occasional medical students or residents joining as an elective. The general consult service provides consultation for all other adult services in the hospital and frequently includes ICU and surgical patients. Clinical decision making is often challenging with active cardiac conditions occurring in the setting multisystem illness. The census generally ranges from 10 to 20 patients. This is an excellent time for one-on-one mentorship with a faculty member and chance to formulate differential diagnosis, plans of care and review of imaging or catheterization films together.

Cardiology Inpatient Rotation

Fellows rotate for 12 weeks on the cardiology inpatient service during their first year.  The team consists of one fellow and attending, two internal medicine residents, and one advanced care provider (ACP). This cardiology service cares for patients with primary cardiac complaints. Patients arrive by direct admission, through the ER, or as transfers from other facilities. Chest pain evaluation, non ST elevation MI, arrhythmias, congestive heart failure, and valvular disease are managed commonly. The census ranges usually from 15-25 patients.  Along with attending guidance, fellows help to direct rounds, make clinical decisions, coordinate care and supervise and teach other members.

EP Consults Rotation

Fellows rotate for 12 weeks on the EP consult rotation throughout three years. The team consists of one fellow and one core EP faculty member per week. The fellow is responsible for presenting the EP consults during morning table rounds to various EP faculty members. Sometimes opinions differ, and this is often a time for teaching. General plans for patient care are formulated and bedside rounds occur afterwards. The census ranges from 5-15 patients. The service provides specialized EP consultation. Common requests include evaluation for pacemaker and ICD candidacy, atrial fibrillation, complex arrhythmia such as VT storm, management of device therapies, and EP procedural complications. The fellow will become facile with ECG interpretation and device interrogation. There is ample time for self-study. Fellows present an EP case conference once per month.

CCU Rotation

Fellows rotate for 12 weeks on the CCU beginning the second year. The CRMH CCU has 12 beds. The team consists of one attending and fellow, three residents (usually one ER and two internal medicine), medical student, CCU pharmacist, and pharmacy resident. On this rotation, things that are frequently managed are STEMI patients, critical patients post-PCI, various causes of cardiogenic shock, serious arrhythmias, and mechanical complications of MI. The team rounds twice daily and serves as primary for most patients in the unit. It follows those patients until discharge to provide continuity of care. The team also does consults for other patients in the CCU who are on non-cardiology services when requested. The fellow leads in evaluating new admissions, directing care on rounds, teaching other team members, and performing or supervising bedside procedures including central lines, arterial lines, temporary pacemakers, and Swan-Ganz catheters. The fellow will also gain experience with indications and management of mechanical circulatory support including IABP and Impella.

Echo Rotation

Fellows rotate at CRMH for at least eight weeks during the three years. The echo lab is quite busy, and roughly 30-50 echos are performed daily. This rotation includes time dedicated to learning scanning with experienced echo techs, stress test supervision, independent echo review, and time for self-study. Typically the afternoons are spent reviewing studies with non-invasive faculty where teaching occurs and feedback on interpretation is provided. Beginning in the second year, fellows begin performing TEES. We typically perform 4-10 TEEs per day, allowing fellows to quickly acquire the minimum number required and many for solid comprehension by graduation. More elective months in echo can be done depending on career goals.

CHI (Congenital, Heart Failure, Advanced Imaging) Service Rotation

Fellows rotate for 12 weeks in the CHI service beginning their second year. This service is currently a non-admitting consultative service with two heart failure and one adult congenital attendings. The fellow will see challenging hospitalized advanced heart failure patients and any adult congenital patient for whom an inpatient consult is requested. The fellow is also expected to regularly attend the outpatient heart failure clinic and adult congenital clinic, learn heart failure procedures such as right-heart catheterization with vasodilator challenge, become familiar with mechanical circulatory support devices, and supervise cardiopulmonary exercise stress tests. Fellows are expected to present interesting cases encountered in the rotation in case conferences. Additional time in the rotation is spent gaining exposure to advanced cardiac imaging modalities, including cardiac CT and cardiac MRI. The fellow will supervise scanning with radiology techs and later read with expert faculty in the afternoon. This will fulfill Level I training in advanced imaging. For fellows who wish to achieve Level II in either cardiac CT or cardiac MRI, a training pathway can be devised to achieve individual goals.

Cardiac Catheterization Rotation

Fellows rotate for a minimum of eight weeks in the cardiac catheterization labs at CRMH. They learn the basics of femoral and radial vascular access, diagnostic angiography, left ventriculography, right heart catheterization, temporary pacemaker placement, and participate in PCI. The lab at RMH is active with 4,413 diagnostic angiograms performed yearly and 1,828 PCI procedures. There are also 2 structural interventional cardiologists who perform the full spectrum of structural procedures including TAVR, mitral clip, ASD closure, alcohol septal ablation, and others. There are two interventional cardiology positions and an additional structural fellowship position available. General fellows who are interested in interventional cardiology usually achieve around 400 diagnostic angiograms, well above the number required for Level II training.

Outpatient Continuity Clinic

Fellows spend one afternoon session per week at the Crystal Spring office seeing outpatients in the general cardiology clinic. The clinic is well organized and efficient. The schedule consists of four to eight patients assigned to each fellow. Attendings are free of other duties during fellow clinic time, and they alternate staffing patients with two general fellows in an afternoon. There is a mix of new and follow-up patients, with many patients the fellow has already cared for in the hospital setting. Each fellow works closely with a single attending throughout the three-year training program, creating a great opportunity for mentorship and long-term patient continuity. At the clinic there is also full echo lab, stress testing (exercise and pharmacologic), a D-SPECT nuclear camera, vascular studies, tilt table testing, Holter and event monitors, and dedicated staff for implantable device checks. General radiology, including a CT scanner and a Carilion Clinic core lab, are available in the same building, allowing efficient access to testing.

Salem Veterans Affairs 

Fellows spend 8 to 12 weeks a year at the Salem VA. It is a Veterans Affairs hospital that is about 15 minutes from Roanoke Memorial Hospital. They offer our fellows rotations in the cardiac catheterization rotation and an imaging rotation. They have four staff cardiologists. Two are trained in interventional cardiology and one is trained in cardiac MRI.

Electives

During their third year, fellows have ample opportunity to choose electives, allowing them to expand and tailor their expertise, and to prepare for subspecialty fellowships. Fellows have eight elective rotations during the third year, with one to two additional electives each of the first and second years. This allows focused tracks for those interested in interventional cardiology, advanced imaging, or advanced heart failure. This allows fellows to tailor their learning experience at Virginia Tech Carilion.

Didactic Sessions

Our program boasts a robust Fellow Didactic Schedule:

  • Clinical Cardiology Conference – Case-based and didactic lectures include all aspects of cardiovascular pathophysiology.
  • Core Curriculum Conference – Didactic lectures given by attending cardiologist that cover a comprehensive list of cardiovascular milestones.
  • Journal Club  – An article of importance is presented by the fellow with discussion led by a designated faculty member.
  • Research Conference – Planned, ongoing or completed research projects are discussed and presented by fellows and faculty.
  • Interventional Case Conference – Case-based didactic conference emphasizing quality angiography.
  • ACS Conference – Case-based conference designed to identify ways to improve rapid transport and optimal therapy for patients with STEMI and other Acute Coronary syndromes.
  • Best Practices Conference – Didactic presentations designed to review guidelines and critical evidence and identify patients who are not treated according to guidelines. Outcomes data such as the NCDR reports are reviewed.
  • M & M Conference - Cases with adverse outcome are reviewed and discussed.
  • EP Conference – Presentation of all aspects of EP including basic science, physiology, pharmacology, clinical practice, guidelines and interesting cases.
  • E&E Conference –  Echo Conference - Didactic lectures on theory and application of echocardiography as well as case review. Alternating every other week with ECG Conference – typical, interesting and challenging ECGs are presented. Fellows are called upon individually to classify ECGs according to the board-required format.
Schedule and Tracks
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Residency Life
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Residency Life Intro

Living in the Roanoke Valley

Roanoke is a city of 100,000 and metropolitan area of over 300,000 that lies in southwest Virginia between the Appalachian mountains to the West and the Blue Ridge Mountains to the East. It is a scenically beautiful part of Virginia with mountain views all around and ample opportunities for cultural and recreational activity. It is nicknamed the Star City for the neon illuminated free standing star constructed in 1949 and overlooks the city from the top of Mill Mountain. Roanoke is the economic and cultural center of southwest Virginia. The downtown has many ethnic restaurants including in the historic City Market building; a weekly farmers' market; several museums including the Taubman Museum of Art, the O. Winston Link museum and the Virginia Museum of Transportation; and the Mill Mountain Zoo. The Berglund Center convention center hosts concerts, Broadway performances and the Miss Virginia Pageant. Several theaters perform live plays and downtown hosts Opera Roanoke and the Roanoke Symphony Orchestra. The region has four seasons with long summers and relatively mild winters. Summertime is filled with almost weekly ethnic and food festivals. Roanoke has a relaxed and friendly atmosphere with easy travel around town and affordable housing. There are many outdoor opportunities, including a paved greenway that interconnects the city and is perfect for walking, jogging and biking. For the more adventurous, there is world-class hiking nearby, with quick access to the Blue Ridge Parkway and the Appalachian Trail.

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Graduates
Graduates Intro
We are proud that our fellows have been very successful in achieving their career goals. One of our key program aims is to provide ample elective time in the second and third years. This allows fellows to tailor the training towards their desired professional niche in cardiology. Our graduates have found employment in both small and large private practice groups, at hospital-employed systems and in academic positions. A faculty mentor is required and designated early in the fellowship in order to provide mentorship and to help guide career development.
Many of our graduating fellows choose to pursue subspecialty training. We have successfully matched fellows in respected programs across the country in interventional cardiology, electrophysiology and advanced heart failure. Since our program inception, all fellows who have sought to match in a particular subspecialty have been successful. Our own program offers two ACGME-accredited positions in general interventional cardiology and one non-accredited position in structural cardiac intervention.
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Research
Research Year Collection