Training in pediatric cardiology spans 3 years. The first and second year are mostly clinical, while the second year of training is predominantly dedicated for research. Fellows attain increasing responsibility and autonomy in clinical rotations as they progress through their years of fellowship. During early rotations fellows are supervised extensively as they attain skills and knowledge to become more independent. Fellows are given increasing responsibilities as they prove their increasing skills and knowledge, upon which they assume a guiding and supervising role to junior fellows, pediatric residents and medical students. An important goal in training fellows is making them increasingly self-sufficient so as to achieve independence in functioning as future pediatric cardiologists.
In-Patient Care
Details: Fellows provide care to
pediatric cardiology patients on the in-patient service. These
patients include those in the wards, NICU and emergency room as well
as in-patients
on other services requiring pediatric cardiology consultation.
Fellows rotating through this service work with the in-patient attending
and the team of pediatric residents caring for these patients. The
pathology encountered by fellows in this rotation include the entire
spectrum of congenital and acquired pediatric cardiology diseases, these
patients tend to be in stable or semi stable conditions, more critical
patients are admitted to the Cardiac ICU. Pediatric cardiology
patients admitted to the floor (4th and 5th floors of Comer Children's
Hospital) are cared for by the Maroon Pediatrics Residents team in conjunction
with the pediatric cardiology fellow and attending. Patients
admitted to the floor are either transferred from the CICU as they become
more stable, or are children with pediatric cardiology ailments who
require hospitalization for minor or intermediate type problems such as;
arrhythmia, adjustment of medications, or the performance of minor diagnostic and
therapeutic measures. NICU patients are all newborn children with
congenital heart disease. The main role of the pediatric cardiology
team in this setting is to provide an accurate diagnosis and establish a treatment plan leading to repair or discharge. Consults from
the emergency room and other services vary in their scope. The goal is
to provide a diagnosis and management plan to children with cardiac problems
as a secondary issue.
Educational Goals: Provide fellows with
exposure to pediatric cardiology problems in an in-patient setting. The spectrum of pathology encountered in this rotation
spans the entire spectrum of congenital and acquired heart diseases,
including those with complex cardiac anatomy. The objective of this
rotation is management of patients who are stable or semi-stable with
emphasis on transitioning care from in-patient to out-patient.
Number of rotations: 8 in-patient
rotations spread throughout the 3 years of fellowship training.
Fellows are given increasing independence and supervisory role to
pediatric residents and medical students as they progress in seniority in
their fellowship training.
Supervision and Assessment:
Pediatric cardiology fellows performing in-patient rotations are
supervised by the attending on service. Three attendings function as
in-patient attendings, with one such attending being on service 75% of the
time to provide consistency and continuity of care. Fellows are
assessed at the end of each rotation through an electronic evaluation
system (New Innovations) which allows fellows and faculty to assess each
other in an anonymous fashion. Faculty provide direct guidance
throughout the rotation and fellows are encouraged to continually provide
feed back regarding rotations.
Cardiac Intensive Care (CICU)
Details: Fellows provide care to
pediatric cardiology patients in the CICU. These patients are those
with congenital and acquired heart disease who are in critical or unstable
conditions. Fellows rotating through this service work with the CICU
team of physicians, surgeons and nurses caring for these patients.
The pathology encountered by fellows in this rotation include the entire
spectrum of congenital and acquired pediatric cardiology diseases, many of
these patients have undergone surgical repair of congenital heart
disease. Unlike other rotations, fellows take in-house calls while
in the CICU. Call frequency is 1 in 4 and the 80 hour work week is
strictly enforced.
Educational Goals: Provide fellows with
exposure to pediatric cardiology problems in the unstable and critically
ill children with congenital heart disease.
Number of rotations: 4 CICU rotations
spread throughout the 3 years of fellowship training. Fellows are
given increasing independence and supervisory role to pediatric residents
and medical students as they progress in seniority in their fellowship
training.
Supervision and Assessment:
Fellows are supervised and assessed by the faculty members of the
CICU. These attendings include pediatric cardiologists, pediatric
intensivists and anesthesiologists as well as pediatric cardiovascular
surgeons.
Echocardiography
Details: Fellows perform selected
echocardiograms from the in-patient population. Fellows start their
echo rotations with didactic study of the principals of echocardiography,
followed by supervised procedure sessions mentored by faculty and experienced
sonographers, until they are comfortable performing studies
independently.
Educational Goals: Learn thoroughly the
principals of echocardiography, ability to independently perform
transthoracic, trans-esophageal and fetal echocardiography.
Number of rotations: 6 echo rotations
spread throughout the 3 years of fellowship training. Fellows are
given increasing independence as they progress in seniority in their
fellowship training.
Supervision and Assessment:
Fellows are supervised and assessed by echocardiography faculty
members. Fellows and faculty review all studies performed by fellows
daily to provide guidance and critique. Ongoing assessment as well
as monthly assessment through New Innovations are provided for the
fellows.
Cardiac Catheterization / Electrophysiology
Details: Fellows
participate in all diagnostic and therapeutic cardiac
catheterizations. They have a greater role in diagnostic procedures
than with therapeutic procedures. As the fellow advances in
training they are expected to be independent when performing cardiac
catheterizations, particularly those of diagnostic nature. Every
Thursday, fellows join the electrophysiology lab to participate in
invasive EP studies.
Educational Goals: Be able to perform
independently both, diagnostic catheterization procedures and simple therapeutic
procedures with good understanding of high end invasive and EP procedures.
Number of rotations: 6 cath/EP
rotations spread throughout the 3 years of fellowship training.
Fellows are given increasing independence as they progress in seniority in
their fellowship training.
Supervision and Assessment:
Fellows are supervised and assessed by cath and EP faculty members.
Fellows and faculty review all studies performed by fellows weekly to
provide guidance and critique. Ongoing assessment as well as monthly
assessment through New Innovations are provided for the fellows.
Out-Patient Continuity Clinic
Details: Fellows provide care to
pediatric cardiology patients on the out-patient service. Fellows
attend one half day clinic with the same attending throughout the 3 years
of fellowship. The faculty member services as a mentor for the
fellow. Fellows accumulate their own patients to see in their
clinics during their fellowship as well as see patietns with their mentor
during these clinic sessions. Fellows are expected to attend all
clinic days regardless of what rotation they are serving.
Educational Goals: Provide fellows with
exposure to pediatric cardiology problems in the out-patient
settings. The spectrum of pathology encountered in this rotation
spans the entire spectrum of congenital and acquired heart diseases,
including those with complex cardiac anatomy. The emphasis in this
rotation is management of patients who are stable.
Number of rotations: N/A
Supervision and Assessment:
Pediatric cardiology fellows performing in-patient rotations are
supervised by the attending on service. One attending function as
out-patient mentor. Faculty provide direct guidance
throughout the rotation and fellows are encouraged to continually provide
feed back regarding rotation.
Research
Details: Fellows discuss in their
first year their research interest with their mentors and design a project
with their mentor leading to completion of this research project and publication of
an original article within their fellowship training
years.
Educational Goals: Learn how to
formulate a research project, develop a hypothesis, design methodology and
complete a research project within time provided.
Number of rotations: 10 months of
research is provided as a single block, in addition, one month during
first year is provided to allow the fellow to choose a project as well as another
month during their senior year to allow completion of their manuscript
writing. The additional 2 months are typically on part-time bases
during one of their clinical rotations.
Supervision and Assessment:
Fellows are supervised and assessed by a research faculty mentor.
Fellows and faculty review all studies performed by fellows daily to
provide guidance and critique. Ongoing assessment as well as monthly
assessment through New Innovations are provided for the fellows.
Electives: Cardiac Pathology & Others
Fellows are provided with 2 week blocks taken from other
rotations to allow them to experience unique rotations such as cardiac
pathology and electives of their choice such as MRI. Fellows discuss
and plan such rotations with their mentors and program director.