What to Expect
Kaiser Permanente is an integrated health care system caring for >4.5 million members of diverse ethnic and socioeconomic backgrounds across Northern California. As a hub site for cardiac surgery and advanced cardiovascular care, fellows will have exposure to a wide range of cardiovascular pathology including complex coronary artery disease, advanced heart failure, valvular heart disease with a robust structural heart program, and peripheral vascular disease. Kaiser Permanente San Francisco medical center is a tertiary care cardiac referral center for all Kaiser Permanente Northern California patients.
- Emphasis on coronary interventions across the full year; ~4 weeks of structural heart and vascular exposure integrated
- Exposure to the spectrum of ischemic syndromes (stable angina, ACS, STEMI/NSTEMI, cardiogenic shock)
- Experience includes native coronary, graft interventions, complex anatomy (including CTO)
- Training in circulatory support (IABP, Impella) and peri-procedural management
- Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT), integrated into case workflows for lesion assessment and stent optimization; fellows are expected to meet the ACGME minimum of ≥25 intracoronary imaging procedures
- Coronary physiology assessment using fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and coronary flow reserve (CFR) for functional lesion evaluation; fellows are expected to meet the ACGME minimum of ≥25 intracoronary physiology procedures
- Coronary microvascular dysfunction (CMD) and coronary functional testing, including assessment of the index of microcirculatory resistance (IMR) and coronary flow reserve in patients with non-obstructive ischemia
- Diagnosis and management of ischemia with non-obstructive coronary arteries (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA)
- Advanced coronary techniques including rotational and laser atherectomy, intravascular lithotripsy (balloon lithotripsy), and drug-coated balloon angioplasty for calcified and complex lesions
- Radial-first access approach with training in both radial and femoral arterial access and closure techniques
- Contrast-minimization PCI strategies for patients with advanced chronic kidney disease
- Structural heart procedures including TAVR, transcatheter mitral/tricuspid interventions, and PFO/ASD closure during dedicated structural heart block
- Exposure to peripheral vascular interventions and basic endovascular techniques
- Pericardiocentesis for hemodynamically significant pericardial effusions
- Right heart catheterization with full hemodynamic profiling, including assessment of pulmonary hypertension and valvular gradients
- Endomyocardial biopsy for transplant surveillance and myocarditis evaluation (as available)
- Access to state-of-the-art radiation protection systems
Clinical Responsibilities
- Pre-round 7–8 AM: review scheduled cases and obtain informed consent for assigned patients.
- Cath lab starts at 8 AM. Fellows work in assigned lab with attending and supervise/teach diagnostic cath skills to general cardiology fellows.
- IC fellows act as primary operator for PCI with graded supervision.
- Post-procedure: responsible for documentation, orders, and handoff to responsible teams
- Collaborate with Cath NPs for pre-/post-procedural management in an interdisciplinary fashion.
Call & STEMI Coverage
- Home call is Q2 (every other night)
- Respond to STEMI activations and assist with emergent PCI under attending supervision
Supervision & Autonomy
- All procedures are directly supervised by an attending interventional cardiologist; autonomy increases with competence.
- High-risk procedures remain directly supervised throughout the fellowship.
- Fellows learn varied techniques from a faculty group of 15 interventional cardiologists.
Curriculum & Didactics
- Core Curriculum: monthly didactics on interventional topics
- Cine Review: weekly morning review of cases and angiograms with faculty and fellows
- Cardiac Catheterization/Clinical Case Conference: weekly multidisciplinary case review with non-invasive cardiology and cardiac surgery
- Journal Club: fellow-led; present 1–3 high-impact articles per session
- Morbidity & Mortality (M&M): quarterly protected conference reviewing complications and quality metrics
- Quality Improvement Project: each fellow completes at least one structured quality improvement or research project during the year, in keeping with ACGME scholarly activity requirements