Pediatric Cardiology Fellowship

Goals of Cardiac Catheterization Rotation

• Understand indications for invasive hemodynamic, interventional or electrophysiologic study
• Understand the risks of cardiac catheterization
• Learn to explain the procedure clearly including the extent of the risks and the expected benefits. Obtain informed consent and articulate in the medical record the indications for the study
• Develop clear plans for the conduct of the procedure before entering the laboratory
• Understand the influence of anesthesia on the collection of data.
• Understand the techniques of minimizing blood loss and appropriate anticoagulation.
• Understand all aspects of the equipment necessary to perform the study. This includes the operation of all recording and measurement equipment. Understand the physics of radiation and all the techniques to minimize radiation to the operator and the patient.
• Develop a working knowledge to the various types of wires and catheters and the techniques of catheter manipulation.
• Learn the techniques of pressure and blood flow measurement including the engineering principles behind the measurement. Learn to rapidly interpret the data during the catheterization and make the appropriate calculations from the data.
• Learn the appropriate techniques of angiography including the value of specific injections, the camera angles and the techniques of obtaining diagnostic images. Learn the interpretation of angiograms and the language used to generate a report.
• Learn the basic techniques of interventional catheterization including valvuloplasty, balloon septostomy and coil occlusion.
• Understand the gathering and interpretation of intracardiac electrograms. Learn the basic techniques of RF ablation and device management.
• Recognize complications and manage them effectively to minimize the harm to the patient.
• Generate a complete report, reviewed with the faculty on a timely basis.
• Understand the medical economics of cardiac catheterization including the cost of the supplies and the procedure.
• Learn to present the data clearly and provide your opinion about the data and its utility for patient management.
• Work effectively with the technical staff, nurses and anesthesiologists. Provide an environment where everyone participates for the benefit of the patient.
• Plan your work carefully to ensure that there is time to attend the educational conferences.
• Fill out the faculty assessment form at the end of the rotation. Review the faculty's written assessment of your performance. Ask for constructive suggestions for improvement.

Goals of Non-invasive Rotation

• Understand indications for echocardiography including fetal, transthoracic and transesophageal echocardiography. Understand the indications for exercise testing including treadmill and bicycle studies with metabolic gas collection or echocardiography. Understand the indications for ECG, ambulatory ECG, event monitoring and tilt table testing. Understand the indications for nuclear scans to assess pulmonary blood flow and myocardial perfusion. Understand the indications for cardiac MRI and MRA.
• Understand the risks of transesophageal echocardiography and exercise testing.
• Learn to explain the indication for the tests clearly to the child as well as the family. Include how you will use the information gathered by the test. Obtain informed consent and articulate in the medical record the indications for TEE, exercise testing and tilt testing.
• Develop clear plans for the conduct of the test before beginning the test.
• Understand all aspects of the equipment necessary to perform the study. This includes the operation of all imaging and electrocardiographic equipment. Understand the physics of ultrasound and magnetic resonance for both imaging and flow.
• Learn to perform a complete and orderly echocardiogram including the report in a timely manner. Use each study as foundation for further learning about the specific cardiovascular problem.
• Learn the techniques of fetal echocardiography. Develop an understanding of the natural history fetal structural disease and arrhythmias. Use your understanding of the pre and post natal course to counsel or prepare the parents. Learn the management of fetal arrhythmias.
• Learn the techniques and interpretation of transesophageal echocardiography. Learn to minimize airway compression and the duration of the study while maximizing the useful information.
• Learn the interpretation of heart rate and blood pressure changes with exercise. Interpret ECG changes accurately and learn to manage acute arrhythmias. Understand all aspects of metabolic gas collection. Learn the technique and interpretation of stress echocardiography.
• Learn to interpret MRI and MRA anatomic, functional and flow studies.
• Learn to accurately diagnose hypertrophy, abnormal conduction, abnormal repolarization and arrhythmias from each of the non-invasive modalities.
• Explain the results of the studies to the child and the family clearly.
• Work effectively with the technicians.
• Understand the medical economics of each of the studies.
• Plan your work carefully to ensure that there is time to attend the educational conferences.
• Fill out the faculty assessment form at the end of the rotation. Review the faculty's written assessment of your performance. Ask for constructive suggestions for improvement regardless of how well you appear to be doing.

Goals of Inpatient Rotation

• Learn the common and usual presentations of heart disease in infants, children, adolescents and young adults. Learn a methodical approach to the use of the history, physical examination and testing to make an accurate diagnosis and assessment of the child's cardiovascular condition.
• Understand the role of other services and consultation to maximize the benefit to the child.
• Understand the natural history of the child's condition and anticipate difficulties.
• Articulate a clear diagnosis and, when this is not possible, develop differential diagnoses and a plan to accurately determine the problem.
• Understand the appropriate use of blood testing and radiology.
• Know the indications for medical management including pharmacologic and nutritional options.
• Know the indications, risks and benefits of each of the surgical approaches to cardiovascular problems.
• Understand post-operative care including the clinical assessment of the child, the interpretation of hemodynamic monitoring data, ventilator management, pharmacologic management and issues of blood loss and clotting.
• Explain the nature of the problem and your plan clearly to the child and the family.
• Work effectively with the nursing, social work, nutrition, child life, and respiratory therapy. Involve the pediatric residents and medical students in the decisions about management and teach them about the child's disease.
• Keep accurate and complete medical records. Complete all medical record tasks in a timely manner.
• Understand the medical economics of each aspect of the hospitalization
• Learn from the faculty and the literature about the pathophysiology, natural history and treatment of each child. Use evidence based medicine to guide your therapeutic recommendations.
• Plan your work carefully to ensure that there is time to attend the educational conferences.
• Fill out the faculty assessment form at the end of the rotation. Review the faculty's written assessment of your performance. Ask for constructive suggestions for improvement regardless of how well you appear to be doing.

Goals of Ambulatory Rotation

• Learn to methodically approach the common reasons for ambulatory referral. Use the history and physical examination as the primary assessment tool. Learn the limitations of clinical evaluation and the appropriate use of testing.
• Understand the natural history of cardiovascular abnormalities and the appropriate timing for and use of medical or surgical intervention.
• Learn the basis of recommendations about activity, SBE prophylaxis, follow-up intervals.
• Inform the child and family of you findings and recommendations. Anticipate their questions and concerns.
• Learn how to keep to a schedule. Alter the future schedule if families have excessive waiting time.
• Communicate with the referring primary care provider in a timely manner. Keep appropriate medical records.
• Understand the medical economics of each aspect of the ambulatory visit.
• Learn from the faculty and the literature about the pathophysiology, natural history and treatment of each child. Use evidence based medicine to guide your therapeutic recommendations.
• Work with the office staff in a collaborative manner.
• Develop fail-safe means of communicating to the family and referring physician the results of tests which are not available at the time of the visit.
• Plan your work carefully to ensure that there is time to attend the educational conferences.
• Fill out the faculty assessment form at the end of the rotation. Review the faculty's written assessment of your performance. Ask for constructive suggestions for improvement regardless of how well you appear to be doing.

Goals of Research

• Use time elective / research time wisely over the first 2 years to clarify your research interests and explore the possible clinical and basic science research opportunities.
• Use hypothesis driven questions for both clinical and basic research. Avoid collecting data and then deciding the question to be asked.
• Exhaustively research the question before beginning the work.
• Comply with all ethical and human subjects issues including confidentiality and informed consent.
• Seek appropriate collaboration to critique and advance your work.
• Meet with your research mentor regularly. Use this time to discuss results, plan new experiments, write manuscripts and grants. Ask for and expect constructive criticism on the progress of your work.
• Learn how to write clear concise manuscripts and grants.
• By the end of your fellowship have a manuscript prepared for submission based on your work.