Department of Pediatrics - Cardiology Fellowship

Curriculum: Year 1

The first year is devoted primarily to developing clinical interests.

A strong, integrated program, the Children's Heart Center takes a collaborative team approach to improve quality and outcomes, providing pediatric cardiology specialty care to more than 5,000 infants, children, adolescents, and young adults each year. Services include: initial diagnostic consultation, transthoracic and transesophageal echocardiography, exercise testing, electrophysiologic testing, diagnostic and interventional cardiac catheterization, postoperative consultation, and long-term follow-up care. Through this team approach, daily input from the surgeon, attending cardiologist, the child's cardiologist, nurse practitioners, social workers, floor nurses and floor physicians is sought to maximize the quality and consistency of the child's care. In the outpatient setting, patients being considered for surgical or interventional procedures are discussed in the Clinical Management Conference to foster input from each of these providers in a formal manner.

Outpatient Service

Outpatient clinics are held daily in the Children's Heart Center. In the general cardiology clinics, children with suspected cardiac disease and those with existing disease, both preoperative and postoperative, are evaluated and cared for.  Each fellow will attend a half-day clinic each week for the three-year period of fellowship. Thus, under the guidance of the attending cardiologist, the fellow will follow his/her own patients for the duration of the program. In his/her clinic, the fellow will be responsible for the complete work-up of the patient, discussions with the family, and reviewing the findings with the attending cardiologist.

Subspecialty clinics are also held during these ten clinics. The cardiology fellow will have the opportunity to participate in these clinics. Subspecialty clinics include: adults with congenital heart disease, cardiogenetics, electrophysiology, fetal cardiology, hyperlipidemia & hypertension and pulmonary hypertension.

Inpatient Service

While assigned to the Inpatient Service, the fellow will be responsible for all cardiology patients on the inpatient pediatric floors, the Pediatric Cardiac Intensive Care Unit, and the Neonatal Intensive Care Unit. The fellow will consult with the attending cardiologist regarding these patients. The team has direct responsibility for these patients. The fellow will make daily work rounds on all cardiology patients and cardiac surgery patients and will assist and supervise the residents and students in their evaluations of the patients under their care. In addition, the fellow will be responsible for both formal and informal teaching of residents and students associated with cardiology patients or consults.

Congenital Heart Surgery Service

When the fellow is assigned to the surgery service, he/she will make rounds with our surgeon. Most surgical patients are admitted through Same Day Admission and go to the Pediatric Cardiac Intensive Care Unit following their procedure. When discharged from the hospital, the patient will return either to the fellow's clinic or to their cardiologist's clinic for follow-up care.

Diagnostic Cardiac Testing

The Pediatric Cardiology echocardiography, exercise and electrocardiography/pacemaker laboratories are located in the Children's Heart Center ambulatory suite. All patients, both inpatient and outpatient, except those in the NICU or PCICU, come to the outpatient suite for their studies. The fellow is responsible for the performance and initial interpretation of studies while on the subspecialty service. After completion of a study, the fellow, working with the supervising cardiologist, correlates the data and prepares a report for the medical record and the referring physician.

The Catheterization Laboratory is on the ground floor of the Hospital. While on the Catheterization service, the fellow will perform and interpret hemodynamic, angiographic, and interventional studies, correlate the data, present the data at Clinical Management conference, and prepare the medical record report with the attending cardiologist.

The Pediatric Electrophysiology Service provides a mix of inpatient and outpatient services. Inpatient services include consults and invasive procedures (EP studies, ablations, device implants). The latter take place in the Electrophysiology Laboratory on the ground floor of the Hospital. Outpatient services include EP clinic and Device clinic. During the first year, fellows become proficient in the diagnosis and management of common pediatric arrhythmias, including use of temporary epicardial wires and transesophageal pacing. In the second and third years, fellows learn the indications and basic principles for invasive EP testing, catheter ablation, and permanent pacing/defibrillator implantation; in addition to interrogation and programming of pacemakers and implantable defibrillators (ICDs).

Research

During the beginning of the first fellowship year the fellow will chose, in conjunction with a mentor and the program director, a Scholarship Oversight Committee (SOC). The committee will guide the fellow in determining a research project and meet with the fellow on a regular basis to evaluate the fellow’s research progress. The fellow will begin to design a research plan to be followed in the second and third year. Research may be either clinical or basic science investigation. If interested, fellows can apply for the T32 Fellowship Training Grant.