Clinical Service includes Device Clinic, Consult Service, and Outpatient Clinic (see individual subsections for details). Depending on the number of fellows, distribution between these settings will vary. Typically, when assigned to a 'Clinical Service' week you will be in the Device Clinic for the AM and PM, and see consults before/between/after clinics. In the case of urgent consults, the staff can cover the clinic while you evaluate them.
Often, there will be one cardiology resident (C1-C3) and 1-2 elective medical students or residents. The cardiology residents have specific rotation objectives including time spent interrogating devices, interpreting Holters, and attending clinics, but often will help see consults as well. The elective students/residents are generally assigned primarily to the consult service. It is expected that you will find opportunities to teach the residents and medical students. If there is downtime, there are practice exams available under the Junior Teaching tab that you can use at your discretion.
The Fellow assigned to Clinical Service will be on call in the evenings and on the weekend following a Clinical Service week (this may vary based on scheduling). While on call, the Fellow must remain within 30 minutes of the Heart Institute in order to be able to respond to emergencies. The Fellow must ensure that UOHI Switchboard (aka the Bunker) is able to reach them by pager or phone. On weekends, you are expected to see and discharge any post-procedure patients from the prior day who were admitted overnight (you must check the Reference Center for any patients admitted under EP staff). If there are issues with these patients, first try to contact the staff who performed the procedure directly. If unable to, then communicate with the on-call EP staff. Additionally, you may be called for advice or urgent consultation. Some examples include problems with pacemakers/ICD’s requiring urgent intervention (ie: multiple shocks; appropriate or inappropriate, runaway pacemaker, etc); VT/VF storm; recurrent hemodynamically unstable arrhythmia requiring multiple external shocks. Consultation to EP should come only from the On-Call Cardiology Resident of Staff; other calls should be redirected to them first. Any calls for EP from outside hospitals should also be directed to the on-call resident. Occasionally, the On-Call Nurse Coordinator may call about concerns from a patient with a device or who had a recent procedure. If the Fellow has any questions or concerns, they should contact the On-Call EP Staff.