Continuity Clinic

Fellows develop skills as consultant cardiologists in the outpatient setting and to learn to address chronic cardiovascular disease management issues on a longitudinal basis. The clinics provide exposure to outpatient cardiology practice, including both consultative and continuity experiences, and provide a means for clinical follow-up of patients recently discharged from the hospital. This experience provides an opportunity to follow and manage patients for a full three years in an outpatient setting. Fellows participate in a half-day continuity clinic once a week, alternating each week between the Heart and Vascular Center at the University of Iowa Health Care and the Iowa City Veterans Affairs Health System. Fellows see an average of two or three new patients and three to five return patients. Fellows are directly responsible for care of the patients to which they have been assigned. Fellows perform the initial evaluation, formulate a plan of care, and present the case to the faculty member. Fellows are responsible for ordering and following up on all appropriate studies. At the Iowa City Veterans Affairs Health System, one faculty member is present full-time during the clinic to supervise fellows. At UI Health Care, each fellow works with a single faculty member in general cardiology or a subspecialty for a period of six months, providing a unique view of the practice patterns of a given faculty member. Clinic assignments are made based on fellow preferences and allocation by chief fellow and the fellowship program director.

The patient population at the Iowa City Veterans Affairs Health System currently includes mostly adult men, whereas the patient population at UI Health Care includes both adult men and women. Patients are referred to the Iowa City Veterans Affairs Health System clinic for a wide variety of reasons including routine management of common cardiovascular problems, preoperative evaluations before non-cardiac surgery, evaluations for potential revascularization procedures (surgical and interventional), post-revascularization follow-up, follow-up of recently discharged patients, and referrals for complex cardiovascular problems. Both primary cardiac care and tertiary, consultative evaluations are provided on a routine basis at the UI Health Care clinic. The cost effectiveness of various options in treating outpatient cardiovascular disease is discussed between the faculty member and the fellows. Clinical follow-up of patient outcomes is used for quality assessment with discussions focused toward quality improvement. Fellows are instructed on relevant issues of risk management as pertaining to patients with cardiovascular disease.