Consultation Rotation

The consultation services of University Hospitals Cleveland Medical Center and the Louis Stokes Cleveland VA Medical Center are a team consisting of one fellow and an attending physician. There may be both medical residents and medical students on an elective rotation.

Consultation Rotation Goals

The overall goal of the rotation is to enable cardiology fellows to achieve the knowledge, skills and attitudes of competent cardiologists providing consultative care to a diverse patient population. Learning occurs by the bedside, formal attending rounds, review of appropriate diagnostic testing and through participation in divisional conferences. The consult service meets six days per week, Monday through Saturday. On Sundays, the cardiology fellow on-call is available for questions concerning stable patients and handles consultations for unstable patients with the cardiac intensive care unit (CICU) attending physician.

Consultation Rotation Responsibilities

Fellows are responsible for seeing all new general cardiology consults, writing the initial consult and subsequent follow-up notes, reviewing all pertinent diagnostic studies and preparing a formal case presentation with an attending physician, who will formulate a treatment plan to be implemented by the primary team. Evidenced-based treatment algorithms will be emphasized. Fellows will be expected to communicate all aspects of treatment recommendations to the primary team, patient, family and other members of the health care team, as appropriate.

Consultation Principle Teaching Methods

Direct supervision of patient care: An attending physician provides supervision to all members of the cardiology consult team, which includes a cardiology fellow, medical residents and medical students. A fellow provides additional supervision to rotating residents and students.

Case-based learning: Attending physicians are expected to teach during team rounds in addition to discussing routine patient management; teaching time averages 5 hours per week. A fellow is expected to take on a leadership and teaching role on rounds commensurate with his or her experience and knowledge.

Divisional and departmental conferences: Fellows are expected to attend all divisional and departmental conferences while rotating through consult service.

Consultation Clinical Training

Patient characteristics: UH Cleveland Medical Center serves a primary care suburban and local urban population in Cleveland, Ohio, and is also a tertiary care referral center for Northeast Ohio and the University Hospitals Health System. The Louis Stokes Cleveland VA Medical Center is also a tertiary care hospital, providing care to veterans throughout Ohio. The Louis Stokes Cleveland VA Medical Center is the only VA hospital in Ohio to offer cardiac surgery. Patients present with a full spectrum of acute and chronic cardiologic problems.

Patients admitted to UH Cleveland Medical Center come from a broad mix of ethnic and socioeconomic backgrounds. Patient ages range from young adults to the elderly. There is an equal mix of male and female patients. Patients admitted to VA are veterans, typically with complex medical problems and with high acuity of care.

All patients seen during the rotation are inpatients receiving care for acute medical problems. The mix of patients includes consultative care for patients admitted to the medical intensive care unit, surgical intensive care unit, post-operative recovery room, emergency room and patients on general medical and surgical units.

Principal educational materials used: Fellows have a dedicated office with all access computers and a growing cardiology-specific library. All general medicine wards have computers with access to literature searching, online journals, UpToDate and textbooks.

Fellows have 24-hour access to the Core Library located in the hospital. A medical librarian from the Core Library provides assistance in literature searches pertaining to issues discussed there. Therapeutic recommendations should be guided by medical literature with emphasis given to society-written (e.g., ACC/AHA) clinical guidelines and consensus statements.

For More Information

For more information on the Consultation Rotation, please contact:

Barry Effron, MD
Barry.Effron@UHhospitals.org