Level 3 (advanced) training in invasive cardiology is reserved for fellows who wish to pursue careers in invasive cardiology. For select trainees who have aspirations to a career in invasive cardiology, more intensive training is available. Training at this level involves the commitment of additional unstructured time by the trainee during the third year and a dedicated fourth year in interventional cardiology.
Expectations for this time involve scholarship as well as technical skill acquisition (see research rotation description) and it is assumed that commitment at this level will include meaningful participation either in clinical research trials that are ongoing in the division, or studies initiated by the fellow in collaboration with a faculty mentor. Presentation at a national meeting and/or publication in a peer-reviewed journal is an essential component of this training.
Trainees for Level 3 participate in both interventional as well as diagnostic procedures during the third year of their training. It is assumed that they will have fulfilled the requirements of Level 2 training and will be certified by the laboratory director to perform diagnostic procedures with a minimum of supervision.
By the completion of Level 3 training, they should have performed at least 300 interventional procedures, in 125 of which they have acted as the primary operator. At this point, trainees should have had meaningful exposure to other therapeutic modalities, including intravascular ultrasound, rotational coronary atherectomy, and coronary artery stent placement.
It is important to note that the certification guidelines in Interventional Cardiology by the American Board of Internal Medicine requires at least 12 months of fellowship training in Interventional Cardiology following three years of clinical cardiology training.
Since the institution has two active catheterization laboratory sites, with equivalent expertise and clinical volume, there is at present no bias as to where trainees should gain their experience in invasive cardiology. In fact, there is a theoretical advantage to the trainee in structuring meaningful time in both campuses. This will give the trainee an opportunity to observe slightly different procedural techniques, to become familiar with different equipment and, most importantly, to increase the recruitment pool for ongoing clinical research projects. Of course, time spent must be sufficient so that the laboratory director or his designee can adequately assess the trainee's level of competency.