We aim to make your experience as enjoyable and educational as possible. To accomplish all goals, Fellows must be present at the Heart Institute 5 days/week. We will make every effort to balance clinical days with non-clinical days so that you can pursue other academic interests (research, self-directed learning). However, this will be subject to your clinical/learning objectives and progress.
As a Clinical Fellow, it is our goal that you develop and successfully acquire expertise in Cardiac Electrophysiology. To ensure adequate clinical exposure you will be assigned clinical duties in cardiac electrophysiology lab, device clinic, outpatient clinic and ward service. On your assigned day(s), it is expected that you function as junior staff with a major responsibility in the managing outpatients, producing consultation letters, education of residents, performing cardiac electrophysiology procedures and "troubleshooting". Depending on Fellow availability, your individual educational and clinical needs, you will be assigned a share of clinical days.
Cardiac Electrophysiology Lab/Procedure Room
In the cardiac electrophysiology lab, each fellow is assigned to a specific lab with a specific staff. Whenever possible, assignments will be tailored to the learning level of the Fellow (i.e., First year Fellows will be preferentially assigned to non-complex cases to maximize learning).
The lab schedule is available by 3pm on the preceding day. Fellows must review all aspects of all cases for the next day. On the evening prior to the procedure, all scheduled patients admitted to hospital should be seen, consented and orders written. Out patient charts are available (and should be reviewed) in the Day Unit or the PAU the evening before. All previous OR notes should be reviewed. Device clinic chart should be reviewed for patients with existing devices. All patients who go to the lab need a brief note summarizing the history, indications, pertinent lab results, focused physical exam and consent process.
Fellow are must use a standardized consent template in their note indicating that patient understood and agreed to the procedure (see Appendix 1). Also % risks of procedure should be written on consent form (see UOHI EP group pt literature for % risks).
Out patients arrive for cardiac procedures at 7:00 am. Patients scheduled later in the day may arrive later to the Day Unit or PAU. On your assigned clinical day, you are expected to meet with the outpatient and review the history, medications, allergies and pertinent lab tests and consent the patient. The first patient of the day must be consented by 7:30 am.
If there is a possible contra-indication to proceeding with the cardiac procedure, Fellows must as soon as possible contact the responsible Electrophysiology Staff directly to clarify the list order/test indications. Typical examples of need to alter the list order include no beta-HCG in a premenopausal woman, recent anticoagulants, low platelets, possible sepsis, etc.
You are expected to participate in the cardiac electrophysiology case to the best of your ability. The attending physician will be present at all cases but their involvement will vary depending on the learning level of the Fellow. We request that all Fellows report cardiac electrophysiology procedures similarly (see Appendix 2 and 3). All Fellows are expected to follow-up on their patients with procedural complications because this is an important component of Electrophysiology training and patient care. Fellows are to review patients with complications on a daily basis (including weekends) with a summary note in the chart documenting follow-up and any concerns. Patients may be signed off when care for the complication is resolved.
It will be expected that Fellows participate in clinical electrophysiology ward duties. Fellows are responsible for rounding on all patients, seeing new in patient consults and reviewing all patients with the EP staff of the week. It is expected that all new consults will have a consult note typed in EPIC to be cosigned by the EP staff. A list of all patients followed by the inpatient cardiac electrophysiology service is available on EPIC (the 'Green Service' list; you will need to be added to this). Fellows are responsible for keeping the list up to date. The list must be fully updated at the end of each day. Also please do thorough verbal handover to next fellow coming on ward service.
Ward fellows may be assisted by residents or medical students. It is expected that you function as junior staff with a major responsibility in the managing outpatients and education of junior residents. Be sure to check all notes written by residents/students, and add a concise 'EP fellow note' addition as required.
Cardiac Electrophysiology Fellows are not responsible for reviewing cases from the community during the regular workday. These calls from the community looking for advice on EP management should generally be directed to the staff EP physician on call. In the evening and weekends these calls may come to the fellow. Please contact your Staff for advice as needed.
The day in Device Clinic begins at approximately 8:00am. Patients are assessed initially by nurses who will then review with you. Be sure to confirm any arrhythmia episodes or abnormal parameters. Any concerning findings or questions should be reviewed with staff; as you become more comfortable, you can utilize greater independence. If you have a tracing that is interesting but will not affect clinical management, allow the patient to leave and review the tracing with staff at a later time. If there is a backlog of nurses waiting to review, staff should be called in to help relieve the backlog (if they are not already present). These days are often busy, but if there is free time it can be used to read clinical guidelines/reviews or do research.
At the discretion of the Cardiac Electrophysiology program, Fellows will participate in the ambulatory clinic at least 2 full day of clinic/month. Fellows will be assigned between 6-12 new consults and will be responsible for a thorough history, physical medication/lab review, developing a clinical plan and dictating the encounter. In addition, Fellows are also expected to attend a minimum of 6 Inherited Arrhythmia Clinics during the 2 years. These need to be identified by the Fellow and arranged as a clinical activity on the schedule by the Chief Fellow subject to approval by The EP Fellowship Program Director.
Required clinic days will be assigned every 6 months with numbers varying depending on number of assigned service weeks.
Purple clinic counts as 0.5 day clinic.
Every 5-6 consults is considered a half day of clinical work (30 mins per consult)
Non-clinical days should be spent 'onsite' at the UOHI pursuing academia such as research and self-directed learning. It is expected that the Fellow be readily available.