Fellowships

The Department of Anesthesiology offers a 12-month fellowship in cardiac anesthesiology. The program consists of three components:

• Training in cardiac anesthesiology: This component includes preoperative assessments, induction techniques in cardiac anesthesiology, the particular hemodynamic aspects of different cardiac pathologies, the principles of extracorporeal circulation, blood preservation techniques and indications for transfusion. Fellows develop this expertise through daily exposure to patients in the operating room.

• Training in perioperative ultrasound: The training goals for perioperative ultrasound are available from the following site: http://www.anesth.umontreal.ca/MMD6500/. At the end of the fellowship, the candidate should be able to independently perform transesophageal echocardiograms in the operating room and be qualified to write a perioperative transesophageal echocardiography exam of the National Board of Echocardiography. The candidate should be able to perform at least 300 transesophageal echocardiograms (advanced level) and review at least 50 echocardiograms from the examination bank.

• Research training: During the fellowship, the candidate is expected to become involved in the group's research activities and to publish at least one research article or literature review in cardiac anesthesiology.

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The Adult Congenital Heart Disease Centre offers three types of fellowships: clinical with an imaging option, clinical with an interventional cardiology option, and clinical with an electrophysiology option. These fellowships last 12 to 24 months. Candidates who choose a 24-month fellowship may also complete a master’s degree in biomedical sciences at Université de Montréal (which involves 0.5 days/week of courses at the university).

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The Interventional Cardiology Service offers a 24-month fellowship that focuses on clinical care, teaching, research and the development of new technologies. The Montreal Heart Institute's Interventional Cardiology Service is one of the most active of its kind in North America. The service's 15 expert physicians provide a full range of cutting-edge diagnostic exams and therapeutic procedures to patients who suffer from atherosclerosis and myocardial, valve and congenital pathologies. The basic goal of the program is to give candidates exceptional training that will help them meet their career goals and compete in all areas of the international scene. The program is structured so that fellows spend the first year learning routine therapeutic and diagnostic techniques and the second year perfecting and acquiring skills in one of the following fields: structural procedures (valve or non-valve); peripheral vascular procedures; cutting-edge imaging techniques (invasive or non-invasive); animal and/or basic research; a master's in biomedical sciences (a PhD is possible over three years); or clinical research. The service organizes two educational meetings per week. The fellowship meets the certification requirements for the Area of Focused Competence (Diploma) Program in Interventional Cardiology of the Royal College of Physicians and Surgeons of Canada as well as the requirements of Université de Montréal. By the end of the fellowship, all candidates will have greatly exceeded the American College of Cardiology's minimum requirements for the number of procedures performed.

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The Department of Surgery offers a 12- to 24-month fellowship to doctors who have already obtained specialty certification in cardiac surgery in their home country. The rotations mainly take place in operating rooms, where candidates are exposed to valve, coronary, aortic, transplantation and mechanical heart implantation techniques as well as minimally invasive and transapical valve procedures. Clinical exposure also includes rotations in surgical intensive care (including on-call duty in this unit), preoperative consultations and postoperative care. Candidates who choose a 24-month fellowship may also complete a master’s degree in biomedical sciences at Université de Montréal. A number of members of the Department of Surgery are very active in research and available to supervise research (e.g., cardiac arrhythmias, pathologies of the aorta and aortic valve, coronary endothelial function). All candidates have the opportunity to take part in clinical research projects. Teaching activities that include scientific presentations, wet labs, reading clubs and practice tests take place every Thursday afternoon.

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The Echocardiography Service offers a 12- to 24-month fellowship. The Montreal Heart Institute's echocardiography laboratory is one of the most active of its kind in Canada and its staff are experts in the assessment of valve disease, adult congenital heart disease, genetic cardiomyopathy, stress echocardiography, 3D echocardiography and echocardiography in complex percutaneous procedures (ASD or VSD closures, reduction of periprosthetic leaks, septal ablation, percutaneous valve replacements, atrial appendage occlusions, etc.). The laboratory is equipped with 9 echocardiography systems, and each year staff conduct over 12,000 transthoracic echocardiograms, 1250 transesophageal echocardiograms, and 500 to 600 stress tests. Each fellow takes an active role in clinical activities. To facilitate learning, the laboratory also has a transthoracic and transesophageal echocardiographic simulator, and a simulation learning program is created for each candidate depending on his or her level of training. Fellows are highly encouraged to participate in research projects. A number of research opportunities are also possible (cardiomyopathy and genetics, heart failure, cardiac resynchronization, valve disease, adult congenital heart disease, etc.). Candidates who choose a 24-month fellowship may also do a combined ultrasound/MRI fellowship. By the end of the fellowship, all candidates will have greatly exceeded the requirements of the American College of Cardiology, the Canadian Society of Echocardiography and the Canadian Cardiovascular Society for the number of transthoracic and transesophageal echocardiograms performed. The Echocardiography Fellowship at the Montreal Heart Institute meets the certification requirements of the Area of Focused Competence (Diploma) Program in Echocardiography of the Royal College of Physicians and Surgeons of Canada.

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The Electrophysiology Service offers a 24-month fellowship that deals with all aspects of the evaluation and treatment of cardiac arrhythmias. The Electrophysiology Service uses 3 electrophysiology labs to conduct approximately 600 catheter ablations, 200 diagnostic electrophysiology studies, 500 permanent cardiac pacemaker implantations and 400 implantable cardioverter defibrillator (ICD) implantations every year. The ablation program includes the use of complex three-dimensional mapping and navigation systems (ESI, CARTO™, NavX™). The service also has an atrial fibrillation ablation program, an arrhythmia ablation program for patients with congenital cardiopathies, and a biventricular pacemaker program. Fellows work in all clinical aspects of the service and are also involved in many research projects. In addition to taking part in electrophysiology lab activities, candidates must also work in the in-patient and out-patient arrhythmia consultation service, the pacemaker and ICD out-patient clinics, the atrial fibrillation clinic, and the clinic for patients with genetic syndromes. By the end of the fellowship, all candidates will have greatly exceeded the American College of Cardiology's minimum requirements for the number of electrophysiology procedures performed. The Electrophysiology Fellowship at the Montreal Heart Institute meets the certification requirements for the Area of Focused Competence (Diploma) Program in Cardiac Electrophysiology of the Royal College of Physicians and Surgeons of Canada.

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The Department of Medicine offers a 12- to 24-month fellowship in advanced heart failure and heart transplantation. The fellowship is adapted to meet the candidate's specific career goals, and participation in the department's research activities is highly encouraged. The heart failure and heart transplant program at the Montreal Heart Institute (MHI) is one of busiest of its kind in Canada, with over 500 patients actively followed at the heart failure clinic, over 230 patients at the heart transplant clinic, and approximately 20 transplants conducted annually. Program staff are also experts in the evaluation and follow-up of patients who require the implantation of a temporary circulatory assist device and a comprehensive program or long-term ventricular assistance either as a bridge towards transplantation or as a permanent solution (“Destination Therapy”). The MHI also has enviable expertise in cardiac resynchronization. The program is staffed by an interdisciplinary team of cardiologists, heart surgeons, psychiatrists, specialized nurse clinicians, pharmacists, perfusionists, social workers and physiotherapists. Each fellow actively participates in the program's many clinical activities by serving as the first responder for floor consults and conducting out-patient follow-up for heart failure patients both pre-and post-transplantation as well as for patients with ventricular assist devices. The program allows each fellow to develop clinical and research skills in advanced heart failure and heart transplantation in a stimulating academic environment that is internationally recognized.

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The Cardiac Prevention and Rehabilitation Service offers a 12- to 24-month fellowship. During the fellowship, candidates must acquire theoretical and practical knowledge in the field of cardiac prevention and rehabilitation, particularly in exercise physiology and VO2 Max. The candidate must also acquire knowledge in epidemiology and statistics. Candidates who choose a 24-month fellowship may also complete a master’s degree in biomedical sciences at Université de Montréal (which involves 0.5 days/week of courses at the university). The general goals of the program are as follows:

• Conduct cardiovascular evaluations in primary and secondary prevention for at least 2 half-days/week under the supervision of an attending physician (cardiologist or internist).
• Hold office hours under the supervision of a cardiologist for at least 2 half-days/week.
• Participate in 1 half-day/week of stress testing at the Montreal Heart Institute under the supervision of a cardiologist in the Cardiac Prevention and Rehabilitation Service.
• Help monitor exercise in patients with a high or moderate risk of a cardiovascular pathology for at least 1 half-day/week.
• Collaborate on all research projects at the Centre ÉPIC and monitor stress testing and fitness sessions for these projects.
• Create an original research project, submit it to different committees, and carry it out once it has been approved. Write a scientific publication related to the project.
• Master the technique of measuring maximum oxygen uptake (VO2 Max).

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The Cardiac Magnetic Resonance (CMR) Laboratory of the Montreal Heart Institute conducts exams for a vast range of indications, such as cardiomyopathy, coronary disease (tested with stress perfusion studies using adenosine, dipyridamole and dobutamine), and adult congenital cardiopathy. The laboratory has two MRIs: one with a 1.5-Tesla magnet for clinical exams and one with a 3-Tesla magnet for clinical and research exams. Scans are mainly read with the cardiologists. Fellows are involved in planning exams, interpreting scans and writing reports, with gradually increasing independence based on their level of training. Several types of fellowships are available depending on the needs of the fellow and laboratory availability:

1- Fellowships exclusively in CMR with time divided between reading clinical scans and conducting a research project (12 or 24 months).
2- Fellowship combined with 24 months in echocardiography and CMR.
3- Fellowship in CMR research.

For all fellowships (excluding research fellowships), candidates may be cardiologists, radiologists or nuclear medicine physicians; in all cases, candidates are required to have good knowledge of cardiovascular pathologies. Fellows with clinical privileges will perform on-call duty at the hospital either in cardiology or radiology depending on their basic field of training.

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