I. Overview
Emory’s Cardio-Oncology Fellowship is a one-year fellowship designed for cardiology fellows who plan to specialize in the cardiac care of cancer patients. The mission of the fellowship is to train leaders in cardio-oncology. Graduates will be experts in the screening, prevention, and treatment of cardiotoxicity of cancer therapies, including chemotherapy, radiation therapy (photon and proton-based therapies), targeted therapy, immunotherapy, bone marrow transplant, CAR-T, BiTE, and phase 1 therapies as well as receive training in the assessment and treatment of cardiac amyloidosis and cardiac tumors. The fellowship is based at Emory’s Cardio-Oncology Center of Excellence and leverages a strong collaboration between Emory’s Heart & Vascular Center and Emory’s NCI-designated Comprehensive Cancer Center Winship Cancer Institute. The one-year program is flexible to meet the trainee’s individual needs and career path. The fellowship will consist of immersive clinical experiences primarily in outpatient care and inpatient consults. In addition, fellows are given time and resources to complete a cardio-oncology thesis project during their one-year fellowship. Thesis mentors are available throughout Emory in a broad range of categories, including case reports, clinical reviews, quality improvement projects, health services research, clinical trials, or translational research. The flexible design of the Emory Cardio-Oncology fellowship also permits fellows, if desired, to obtain advanced imaging training in cardiac MRI or cardiac computed tomography.
II. The Cardiology-Oncology fellow will be expected to do the following:
a. Outpatient Responsibilities:
i. Participate in 2-3 days of Cardio-Oncology clinics per week
ii. Opportunities to rotate in sub-specialty oncology clinics
iii. Schedule may be adjusted to meet practice demand as necessary
b. Inpatient Responsibilities
i. Perform inpatient Cardio-Oncology consultation 0.5-1 day per week
c. Call Responsibilities
i. Fellows are not expected to take after-hours primary call as part of their Cardio-Oncology fellowship.
d. Educational expectations
i. Complete a thesis project in Cardio-Oncology on scholarly topic of your choice (case reports, clinical reviews, quality improvement projects, health services research, clinical trials, or translational research)
ii. Participate in all multidisciplinary meetings related to Cardio-Oncology
iii. Attend International Cardio-Oncology Society Webinars
e. Advanced cardiac imaging (optional)
i. If desired, opportunity for additional training (level II) is available for fellows interested in cardiac MRI or cardiac computed tomography
f. Recognition/Certification
i. Graduating fellows will be designated experts in the cardiac care of cancer patients and meet criteria for level III training in Cardio-Oncology
ii. Graduating fellows will meet requirements to apply for board certification by the International Cardio-Oncology Society.
III. Educational Goals of the Rotation
a. Fellows will learn the incidence, presentation, evaluation, and management of cardiovascular toxicities from the entire spectrum of cancer therapy, including chemotherapy, radiation therapy (photon- and proton-based), targeted therapy, immunotherapy, bone marrow transplant, CAR-T, BiTE, and phase 1 therapies
b. Fellows will learn to perform critical risk/benefit decisions in Cardio-Oncology patients by learning the overall prognosis of various cancers in the modern era as well as rapidly evolving treatment options at a quaternary care center for cancer patients refractory to traditional therapy
c. Fellows will learn to perform risk stratification of patients receiving cardiotoxic therapies,
incorporating Cardio-Oncology guidelines and risk calculators
d. Fellows will learn to manage and anticipate the effects of pre-existing cardiac comorbidities
and cardiac risk factors in the setting of cancer diagnoses and treatment
e. Fellows will become familiar with life-threatening cardiac emergencies of cancer therapy, including 5FU-induced coronary vasospasm, TKI-induced malignant hypertension, pericardial tamponade, cytokine release syndrome, and immune-checkpoint inhibitor myocarditis
f. Fellows will understand cardiac screening protocols for monitoring cardiac toxicities from various cancer therapies
g. Fellows will become familiar with appropriate imaging modalities for the cardiac care of cancer patients, including echocardiography, strain imaging, cardiac MRI, cardiac computed tomography, nuclear imaging,
h. Fellows will understand the long-term impact of cancer therapies on cardiovascular health as well as cardiovascular-focused survivorship care
i. Fellows will learn to navigate the emotional and psychological impact of cardiovascular toxicities in cancer patients
j. Fellows will understand the latest assessment and management options in cardiac amyloidosis, including exposure to biomarkers, PYP scans, cardiac MRI, endomyocardial biopsies, clinical trials, and interdisciplinary care.
k. Fellows will understand the interdisciplinary assessment and management of complex patients with cardiac masses through Emory’s Cardiac Tumor program
l. Fellows will understand social and economic disparities of treatment of cardiac disease and cancer in a major metropolitan area with a diverse patient population
IV. Competencies:
• Patient Care: The fellow will become familiar with the entire spectrum of care in cardio-oncology. Patients are seen in consultation and the fellow may interact with oncologists, radiation oncologists, surgeons, other subspecialists, nurses, and staff. The fellow will learn work well in the interdisciplinary care of patients.
• Medical Knowledge: The fellow will be expected to learn the latest guidelines and research that inform the cardiac care of cancer patients. It is expected that the fellow will contribute this knowledge to colleagues and patients when appropriate.
• Practice-based Learning and Improvement: All trainees will be supervised by an attending physician. Trainees will be aware of the limitations of their knowledge and the attending’s role to provide constructive feedback.
• Interpersonal and Communication Skills: The fellow will always demonstrate caring and respect for all patients and families. The fellows may facilitate the learning of students and residents in the clinic.
• Professionalism: The fellows will maintain the highest level of professionalism. The fellow will understand that they are the representatives of Emory Healthcare and the Emory School of Medicine and will be expected to always perform in a professional manner on and off service.
• System-based Practice: The fellow must work well in providing interdisciplinary care to cancer patients. A team-based approach to care, incorporating a wide range of providers and staff, will be critical in ensuring the best outcome for patients with multiple comorbidities.
• Teaching Methods: The primary mode of learning for outpatient and inpatient care will be through direct and indirect supervision of encounters by the attending physician. Fellows will gather data, examine the patient, develop a plan, and present to the attending physician. The fellow may also function as a supervisor for residents and students rotating on the service.
• Conferences: The fellow is expected to participate in multidisciplinary conferences relevant to Cardio-Oncology and the Cardiac Tumor Program
• Evaluation Methods: At the end of each quarter, the fellow will meet the program director for a formal feedback session. The fellow or supervising attending can request additional feedback sessions as needed.
V. Benefits
a. Fellows will receive an annual base salary commensurate with experience and PGY-level
b. Fellows will be eligible for benefits provided by Emory University
c. Fellows will receive training at a quaternary center in cardiac and oncologic care
d. Fellows will have the opportunity to train and live in the social, economic, cultural hub of Atlanta, Georgia
VI. Application Process
• Interested candidates should apply online and include:
A. CV
B. Cover letter, including a brief statement of interest (300 words or less)
C. Contact information for 2 references
D. USMLE transcripts
• Candidates will be selected on a rolling basis
VII. Contact
For questions or additional information, please contact:
Anant Mandawat, MD FACC
Director, Cardio-Oncology Center of Excellence
Heart & Vascular Center
Winship Cancer Institute
Emory University
anant.mandawat@emory.edu