Vascular Medicine Training Program - Clinical Rotations

Northwestern’s clinical curriculum will train physicians to provide comprehensive, well integrated care of the vascular medicine patient.  The curriculum is designed to achieve a broad exposure to inpatient and outpatient problems commonly encountered in vascular medicine.  Physicians will be trained both in the management of acute problems in vascular medicine and in the practice of secondary prevention to maintain optimal health.  Secondary prevention and outpatient management of vascular medicine problems will be the focus of a two-month ambulatory block.  The curriculum is consistent with recommendations for achieving clinical competence in vascular medicine, published by the American College of Cardiology/American Heart Association/ and the American College of Physicians Task Force on Clinical Competence. The clinical curriculum is flexible, in order to accommodate trainees with particular expertise, needs, and interests.

The 12-month clinical curriculum consists of month-long rotations.   A standard clinical core track is shown in the table below.  Throughout the clinical curriculum, trainees will spend ½ day per week in their longitudinal vascular medicine clinic.

Inpatient vascular surgery service. (2 months)  This service, lead by training program co-director Dr. Pearce, includes a well integrated vascular medicine consult service.  Five vascular surgeons staff this service. Trainees will learn the indications for operative therapy of specific vascular diseases, including abdominal aortic aneurysms, lower extremity arterial diseases, and cerebrovascular disease.  The rotation includes training in the management and prevention of peri-operative complications of the surgical patient.  Typical consults include aneurysms, peripheral arterial disease, renal artery stenosis, gangrene, lower extremity ulcers, and subclavian stenosis.  Trainees will round every morning with the vascular surgery team and perform consultations, staffed by vascular surgeons. 

Non-invasive vascular laboratory. (2 months) Northwestern’s non-invasive vascular laboratory is certified by the Inter-societal Commission for the Accreditation of Vascular Laboratories (ICAVL) in all five areas of non-invasive testing.  Dr. Pearce oversees the non-invasive vascular laboratory rotation along with Donna Blackburn RN, Vascular Laboratory Clinical Instructor, a certified vascular laboratory technician.  This rotation includes the following components; a) didactic sessions on the physics of vascular ultrasound measurement; b) hands-on non-invasive testing and c) interpretation of test results.  Vascular medicine trainees will maintain a log book of procedures performed during this rotation. 

Cardiology (Lead Faculty: Mihai Gheorghiade, MD, Professor of Medicine). (2 months) The cardiology consult service receives 6 to 10 consults per day.  The vascular medicine trainee will typically have 1 to 2 new vascular medicine consults per day on the cardiology service.  Trainees preferentially evaluate patients with vascular diseases and will follow them longitudinally.  Many of these consults are peri-operative evaluations. Exposure to other common cardiac issues on the cardiology service, such as acute coronary syndromes, will also be of value to the vascular medicine trainee, since cardiac disease is prevalent in patients with vascular disease. 

Stroke unit (Lead Faculty:  Mark Alberts, MD, Professor of Medicine). (1 month)  Northwestern Memorial Hospital (NMH) admits over 600 patients each year with stroke or TIAs.  NMH is one of the few hospitals in the U.S. that is certified by JCAHO as a certified Primary Stroke Center.  Most stroke patients are cared for on the dedicated Stroke Service, in the Stroke Unit, which is staffed by a board-certified neurologist with special training in cerebrovascular disease.  Vascular medicine trainees round daily with the Stroke Service, which consists of the attending neurologist and housestaff physicians in neurology. 

Hematology rotation (Lead Faculty: Ana Zakarija, MD Instructor, Division of Hematology). (1 month) The non-oncologic hematology rotation, led by Dr. Zakarija, combines inpatient and outpatient clinical experiences in non-oncologic hematologic clinical problems related to vascular medicine.  The hematology service receives approximately 3 to 6 consults per day.  Approximately 2/3 of these consults are problems related to venous thrombosis, including deep venous thrombosis, pulmonary embolism, and hypercoagulability.  The vascular medicine trainee staffs their daily consults with the hematology attending physician, follows their inpatients longitudinally, and rounds with the hematology attending physician daily.  The hematology rotation also includes two half days per week in the outpatient hematology clinic, working with one of Northwestern’s four hematology attending physicians. 

Radiology (Lead Faculty:  Robert Vogelzang, MD  Professor of Radiology). (1 month) The radiology rotation is divided into four one-week rotations, exposing trainees to a comprehensive curriculum in vascular imaging and endovascular procedures.  The four components of the program are neuro-radiology, non-cardiac vascular radiology, vascular imaging of the abdomen and chest, and endovascular interventions.   

Neuroradiology (Lead Faculty:  Matthew Walker, MD Assistant Professor of Radiology). The trainee is exposed to the basics of protocoling and performing and interpreting vascular imaging studies.  The trainee attends and participates in seven reading sessions (3.5 days at 2 per day) to gain clinical exposure to magnetic resonance angiography (MRA) and computed tomography angiography (CTA) interpretation.  The trainee will also spend 1/2 day in the neuroangiography suite observing conventional catheter angiography techniques. The remaining 1/2 day is spent with an experienced MR and/or CT technologist, observing the acquisition of MRA and CTA studies and discussing some of the nuances related to effectively performing these studies.  At the end of this rotation, the trainee will have a basic understanding of the various techniques and which to order under specific circumstances. 

Vascular Disease of the Lower Extremities (Lead Faculty, James Carr, MD- Assistant Professor of Radiology). Vascular disease imaging of the lower extremities includes instruction on contrast angiography and MRA. Trainees learn the use of these imaging studies to evaluate lower extremity arterial stents and grafts before and after interventional procedures. 

Vascular Disease Imaging of the Abdomen and Chest (Lead Faculty, Frank Miller,  MD- Professor, Director, Body Imaging Section and Fellowship Program, Chief, GI Radiology).  Vascular disease imaging of the abdomen and chest includes instruction on CT evaluation for pulmonary emboli and CT imaging of thoracic and abdominal aortic aneurysms and dissecting aortic aneurysms. Trainees learn appropriate use of CT to evaluate arterial stents and grafts before and after interventional procedures. 

Endovascular interventions (Lead Faculty, Robert Vogelzang, MD- Professor of Radiology). Trainees observe procedures and participate in pre-procedural and post-procedural care of patients undergoing endovascular procedures. 

Inpatient rehabilitation service (Lead Faculty, Mark Huang, MD Director, Medical Records, Rehabilitation Institute of Chicago) (0.5 months).   The inpatient rehabilitation service is located at the Rehabilitation Institute of Chicago (RIC), one block from Northwestern Memorial Hospital. The RIC has been rated the best rehabilitation hospital in the country by U.S. News and World Report for 13 consecutive years.  Most patients on the RIC service have vascular disease (typically stroke or PAD).  Trainees evaluate newly admitted patients and round daily with the RIC inpatient service.  During inpatient rounds, trainees participate in recommendations regarding physical and occupational therapy, psychologic treatment, nursing care, and patient education. Prosthetic and orthotic services are provided as appropriate.

Pathology (Lead Faculty, Dr. Lomasney- Professor, Pathology and Molecular Pharmacology and Biological Chemistry) (0.5 months).  Trainees spend two weeks studying cardiovascular disease pathology.   

Longitudinal Vascular Medicine Clinic.  Vascular medicine fellows will have one half day per week of longitudinal vascular medicine clinic, supervised by Dr. Pearce.  This clinic is held throughout the three years of the program in conjunction with the vascular surgery clinic.  Trainees longitudinally follow patients with PAD, abdominal aortic aneurysm, carotid artery stenosis, renal artery stenosis, chronic venous disease, mesenteric ischemia, vascular malformations, and thoracic outlet problems.

Vascular medicine ambulatory block. (2 months) This outpatient block exposes trainees to a broad range of outpatient vascular medicine problems.  Training includes outpatient management of venous thromboembolism, varicose veins, rehabilitation medicine, lower extremity wounds, and lymphedema.   Secondary prevention of vascular disease is also emphasized as evidenced by clinics devoted to management of dyslipidemia, diabetes, metabolic syndrome, and hypertension.  A sample ambulatory block is shown below.  Candidates spend one half day per week in each clinic.

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