VM Fellowship Clinical and Educational Structure

A Vascular Medicine Fellowship is most effective as an integrated multidisciplinary program. The goal of fellowship training is to develop a vascular medicine specialists with expertise in the diagnosis and treatments across the wide diverse spectrum of vascular disorders.¹ There are specific objectives that have been developed as detailed in the Vascular Medicine Advance Training document and may be tailored to specific program elements. The key program elements include the clinical and didactic or educational experiences designed to allow trainees to meet these objectives. All trainees who complete a program are eligible to take the American Board of Vascular Medicine Examination offered through the Alliance for Physician Certification and Advancement (APCA).² In addition, fellows will gain expertise in the interpretation of non-invasive vascular imaging modalities and are eligible to take the Registered Physician in Vascular Interpretation Certification examination offered through APCA.³

Overall Objectives of Vascular Medicine Fellowship

A Vascular Medicine Fellowship Program has the following objectives:

Diagnose, coordinate, and prepare treatment of all vascular disorders, including peripheral artery disease, cerebrovascular disease, aortic diseases, renal and mesenteric artery disease, vasculitis, vasospastic disease, acute and chronic venous disease, lymphatic diseases, wound care as well as other less common vascular diseases.
Identify and treat disorders that contribute to vascular disease, such as dyslipidemia, hypertension, diabetes, and hypercoagulable states.
Define the epidemiology, pathology, pathophysiology, clinical presentation, natural history, and therapeutic options relevant to each vascular disease.
Demonstrate expertise in the noninvasive vascular laboratory, including interpreting duplex ultrasound and physiologic tests of peripheral arteries and veins.
Acquire basic interpretation skills of other imaging modalities, including magnetic resonance and contrast angiography.
Recognize the indications for and potential outcomes of invasive diagnostic procedures, catheter-based treatments, and vascular surgery.
Develop independent decision-making and leadership skills for vascular disease and vascular practice.
Gain knowledge of vascular care through discussion on rounds and by independent reading.

Clinical Experiences (Rotations and Clinic)

The clinical experience is often designed as rotations and longitudinal clinic practice with the goal of acquiring the understanding and ability to execute the following objectives can be part of the multidisciplinary training. There are many possible ways to design the clinical training experience with varying rotations depending on the institution. In addition, the training often overlaps with other specialties and involves the trainee spending time with these specialties. Here are several examples of possible rotations with the experience and anticipated educational outcomes:

Vascular Medicine and Related Specialties (such as Cardiology, Hematology, Rheumatology, Endocrinology, Neurology, Nephrology, etc…)

This rotation is designed to focus on understanding and managing various arterial and venous diseases, including peripheral artery disease, venous thromboembolisms, prothrombotic disorders, venous insufficiency, vasculitis, wounds, and lipedema. There is an emphasis on the systemic effects of vascular risk factors and guideline-established care. The rotation typically involves performing consultations on patient with vascular issues in the inpatient and/or outpatient settings.

The outcome is to gain an understanding of the pathology, clinical manifestations, and natural history, and skills in evaluation and management of:
- peripheral artery disease, renal and mesenteric artery disease, extracranial cerebrovascular disease, aortic disease, and other arterial diseases.
- chronic venous thromboembolisms.
- pulmonary hypertension and pulmonary embolisms.
- prothrombotic disorders including inherited and acquired hypercoagulable states.
- chronic venous insufficiency and lymphedema.
- vasculitis and associated disorders.
- wounds and associated disorders.
- lymphedema and lipedema.
- diabetes mellitus, hypertension, dyslipidemia, and smoking cessation associated with vascular disorders.

Vascular Diagnostic Laboratory

This rotation is designed to learn about the performance, interpretation, and use of physiological vascular diagnostic studies and vascular duplex ultrasound examinations to evaluate venous thrombosis, peripheral artery disease, aneurysms, arteriovenous fistulas, and neurovascular compression syndromes. The experience includes time within a vascular diagnostic laboratory to gain hand-on experience and a robust interpretation experience.

The outcome is the be able to interpret vascular examinations including:
- Physiological diagnostic studies of the upper and lower extremities at rest and after exercise or provocative maneuvers.
- Vascular exercise testing
- Arterial and venous duplex ultrasound of the upper and lower extremities
- Duplex ultrasound examination of abdominal vessels
- Duplex ultrasound examination of the carotid arteries and testing of the intracranial arteries
- Hemodynamic and imaging studies for diagnosis of neurovascular compression and entrapment syndromes

Advanced Vascular Imaging

This rotation is designed to focus on acquiring knowledge of advanced vascular imaging techniques using computed tomography and magnetic resonance imaging for evaluating arterial and venous disorders, including atherosclerosis, thrombosis, vasculitis, aneurysms, and dissections. This rotation is often performed in collaboration with radiology to allow for an optimal educational experience.

The outcome is to gain a basic understanding of the techniques and clinical use of:
- computed tomographic angiography and venography
- magnetic resonance angiography and venography

Vascular Interventions (Vascular Surgery, Interventional Cardiology, Interventional Radiology)

This rotation is designed to gain knowledge of and experience in the evaluation, management, and interventions for patients with vascular disease. This involves those undergoing vascular surgery and interventions including angiograms, catheter-based interventions, open and hybrid vascular surgical procedures, thrombolytic agents, mechanical thrombectomy devices, venograms, catheter-based venous interventions, and treatment of vascular malformations.

The outcome is to be able to do the following:
- Evaluate coexisting cardiovascular disease, assess risk, and manage adverse cardiovascular events in patients undergoing vascular surgery and interventions.
- Recognize indications for operative intervention, saline features of the operation, anticipated outcome, and potential cardiovascular complications.
- Evaluate the patient’s cardiovascular status, assess cardiovascular risk, and make recommendations regarding perioperative medical management.
- Describe angiograms, catheter-based intervention, and open and hybrid vascular surgical procedures commonly performed.
- Describe advantages and limitations of common surgical methods, and the application of these techniques in conjunction with pharmacotherapy and endovascular procedures.
- Identify indications of thrombolytic agents and mechanical thrombectomy devices.
- Recognize venograms, IVC filter removal, catheter-based venous intervention and treatment of vascular malformations.
- Describe the advantages and limitations of venous interventions and the application of these techniques in conjunction with pharmacotherapy and endovascular procedures.

Education Structure

A Vascular Medicine Training Program should provide trainees with a rich and dynamic educational experience designed to cultivate expertise in vascular medicine through a diverse range of teaching methods both during clinical and other didactic experiences. The clinical experiences will vary but should include both outpatient and inpatient exposure. In the outpatient clinic rotation, fellows will have the opportunity to engage in direct patient care under the guidance of experienced faculty members, honing their clinical skills in assessing and managing a wide array of more typically chronic vascular conditions. Similarly, the inpatient rotations provide fellows with immersive experiences in an acute care settings, allowing them to actively participate in the diagnosis and treatment of complex acute vascular cases alongside multidisciplinary teams.

Participation in clinical, teaching and bedside rounds may further enhances clinical acumen by providing trainees exposure to real-time patient management discussions and fostering collaborative decision-making processes. Formal educational sessions, including lectures and didactic conferences, serve as platforms for in-depth exploration of vascular medicine topics, covering pathophysiology, diagnostic approaches, treatment modalities, and emerging research. Potential interactive sessions led by faculty members offer fellows the opportunity to engage in case-based discussions, problem-solving exercises, and peer-to-peer learning, facilitating a deeper understanding of clinical challenges and evidence-based practices.

In addition to structured learning activities, fellows are encouraged to pursue guided and independent reading, exploring seminal texts, peer-reviewed journals, and online resources to further expand their knowledge base and stay abreast of advancements in the field. Regular interactions with faculty members provides valuable mentorship and guidance, fostering professional growth and facilitating the exchange of ideas. Furthermore, the Society for Vascular Medicine offers a range of educational resources and fellow-specific programs, including conferences, workshops, and online modules, tailored to meet the unique learning needs of fellows and support their professional development in vascular medicine.

Example program schedules

VM Fellowship Clinical and Educational Structure

Overall Objectives of Vascular Medicine Fellowship

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