Clinical Exposure

Scripps cardiology fellowship clinical exposure opportunities in San Diego

Clinical Track for the fellowship program

Scripps cardiology fellowship clinical exposure opportunities in San Diego

The Scripps Cardiovascular Disease Fellowship Program provides a unique balance between clinical exposure and research at a variety of sites. 


The fellowship is medium-sized, the division is large and the patient volume is extraordinary. The ratio works in the fellow’s favor in terms of clinical volume and research opportunities. 


Most fellowships will allow motivated fellows to become Core Cardiovascular

Training Statement (COCATs) Level 2 in at least two of the following: 


  • Nuclear cardiology
  • Echocardiography
  • Transesophageal echocardiography (TEE)
  • Diagnostic angiography


At Scripps, our high clinical volume provides a higher volume/fellow ratio, which allows our fellows to become Level 2 in each of the above just by showing up to their rotations.


At our program, motivated fellows can also be COCATs Level 2 in pacemakers and vascular ultrasonography.

COCATs Requirements

Level 1

Level 2

Level 3

Typical program
  • Basic training
  • All trainees
  • Everyone can do it in a 3 year fellowship
  • Ability to perform or interpret specific diagnostic tests and procedures
  • Able to sit for boards
  • Some can attain this in a 3 year fellowship
  • Requires additional training

Our program
  • Outpatient volume
  • Inpatient volume
  • Electrocardiogram (ECG)
  • Cardiac rehab
  • Stress tests
  • Ambulatory monitoring
  • Nuclear cardiology
  • Echocardiography
  • TEE
  • Diagnostic angiography
  • Pericardiocentesis
  • Pacemakers
  • Implantable loop recorders
  • Vascular ultrasound
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Heart failure
  • Electrophysiology (EP)
  • Interventional

Interventional and structural cardiology

Approximate institutional procedural volumes:


  • 2,500 coronary interventions per year
  • 380 transcatheter aortic valve replacement (TAVR) procedures per year - Second largest TAVR center in California
  • 175 peripheral vascular procedures per year
  • 75 Mitraclip procedures per year - Third largest in California
  • 44 percutaneous atrial septal defect (ASD)/ patent foramen ovale (PFO)/ ventricular septal defect (VSD) procedures per year 
  • We also have very active Left ventricular assist device (LVAD) and mechanical circulatory support (MCS) device programs using Impella devices, tandem heart and extracorporeal membrane oxygenation (ECMO)
  • Antiplatelet therapy during and after percutaneous coronary intervention (PCI)
  • Mitral valve intervention
  • Tricuspid valve intervention
  • Left atrial appendage intervention
  • Novel drug-eluting stents
  • Hyperbaric oxygen for acute ST segment elevation myocardial infarction (STEMI)
  • Post-STEMI stem cell treatment
  • Refractory angina stem cell treatment
  • Drug coated balloons for the treatment of peripheral vascular disease
  • Fellows require 300 caths to achieve COCATs Level 2
  • The average Scripps cardiology fellow performs 400 caths
  • Fellows who wish to pursue a future in interventional cardiology perform 500 caths by graduation

Electrophysiology

  • Most electrophysiology (EP) procedures on the West Coast
  • First LINQ in the US and currently #1 implant site in the US
  • First leadless pacemaker in Southern California
  • First Watchman in California
  • First Lariat in San Diego
  • One of the highest volume device implanter in the US
  • Ablations: 500 per year
  • Watchman: 175 per year
  • Largest Watchman program in the US
  • #1 and #4 Watchman implanters in the US are in our medical group
  • EP Save a Life – San Diego non-profit organization that preforms cardiac high school screening
  • Leadless pacemaker device development
  • Catheter ablation device development
  • Watchman database
  • Left atrial occlusion device development
  • COCATs minimum Level 1: observe device implants
  • Program average Level 1: implant 5-10 pacemakers
  • COCATs 2: 30 pacemakers
  • Program average level 2: 60 pacemakers

Echocardiography

Scripps has the busiest echocardiography lab in San Diego.


  • TTE: 16,000 per year
  • Stress echoes: 3,000 per year
  • TEE: 1,000 per year
  • TEE/Intraprocedural: 400 per year
  • Intra-procedural imaging for structural intervention
  • Exercise hemodynamics
  • Cardio-oncology imaging
  • COCATs Level 2 minimum: 300 interpret and 150 perform
  • Program average: 450 echos
  • Aspirational (motivated fellow): 600 echos

Imaging: Nuclear, CT and MRI

  • Single photon emission computed tomography (SPECT): 3,000 per year
  • Positron emission tomography (PET): 400 per year
  • CT:
  • Last generation Cardiac CT 
  • Perfusion CT
  • Computed tomography fractional Flow Reserve (CT-FFR)
  • Advanced plaque analysis
  • Cardiac magnetic resonance imaging (CMRI)
  • Stress cardiovascular magnetic resonance (CMR)
  • Parametric mapping for cardiomyopathy evaluation
  • CMR myocardial perfusion
  • CMR stress testing
  • Hypertrophic cardiomyopathy
  • CMR T1 mapping
  • Cardiac CT angiography
  • CT perfusion
  • CT low dose radiation protocol development
  • CT FFR using HeartFlow
  • COCATs minimum level 2: 300 nuclear studies and 40 positron emission tomography (PET/Rb) studies
  • Program average: 500 nuclear studies and 80 PET/Rb studies
  • Aspirational (motivated fellows): 600 nuclear studies and 100 PET/Rb studies

Heart failure

  • High-volume cardiogenic shock program with more than 65 ECMOs per year and a full portfolio of Impella pumps
  • First in Southern California to implant HeartMate3 LVAD post-commercial FDA approval
  • More than 100 CardioMEMS (Top 3 volume in the country)
  • First dedicated pulmonary hypertension/ heart failure (PHTN/HF) clinic on the West Coast
  • Only program in San Diego to offer specialized imaging for cardiac amyloid
  • Structural heart program – collaboration between interventional and heart failure had helped bring new devices and trials
  • Infiltrative cardiomyopathy clinic
  • Hypertrophic cardiomyopathy (HCM) clinic – a collaboration with heart failure and imaging 
  • Stem cell trials
  • New implantable hemodynamic device development
  • Hemodynamics in patients with LVADs
  • Cardiopulmonary exercise testing and hemodynamics
  • Pulmonary hypertension and right ventricular function
  • Gene and stem cell therapy for ventricular dysfunction
  • Effects of sacubritril/valsartan on biomarkers
  • Renal US doppler hemodynamics in HF patients
  • ECMO observational study
  • CPET indices in patients with CardioMEMs
  • Liver imaging outcomes in LVADs
  • CardioMEMs and LVAD dual device study
  • Exercise hemodynamics in LVADs/pulsatility index study
  • Hypertrophic cardiomyopathy: CMR vs ECG sensitivity
  • Anti-coagulation therapy for temporary mechanical circulatory support devices
  • LDH in LVAD patients
  • Bariatric surgery in advanced heart failure patients
  • Structural heart devices for treatment for HFpEF
  • Interatrial shunt device in HF patients
  • Splanchnic nerve ablation for treating HFpEF