Specialty Experiences
Fellows in their first and second year of training spend three months each on the inpatient, catheterization and the non-invasive services and 2 months on research. Research is scheduled in blocks of 2 consecutive months to allow the fellow sufficient time to develop their research without the interruption of clinical demands. They manage ambulatory patients on a year-round basis. The third year of the fellowship is dedicated to the pursuit of research, with minimal clinical responsibility required. An optional 4th year may be completed, dependent upon the fellow's area of research or clinical interest. Fellows have the responsibility to develop and coordinate both their yearly rotation schedules and their monthly call schedules.
Clinical Training
Clinical education and experience is provided by a busy pediatric cardiology inpatient service, as well as an active outpatient service that allows fellows to follow patients starting in their first year of postgraduate training. Progressive responsibility is added for performance and analysis of cardiac catheterizations, interventional catheterizations, electrophysiological procedures, and the full range of non-invasive diagnostic modalities. Supervision provided by faculty in each of the areas is appropriate to the level of training and the demonstrated skill of the fellow.
On the inpatient rotation fellows evaluate and care for all surgical and medical patients admitted to the cardiology service. Fellows manage patients pre-operatively, and are actively involved in the management of all post-operative patients in the cardiac intensive care unit. Fellows on the inpatient service also consult on patients presenting in the emergency room, and evaluate emergency medical and surgical cardiac cases admitted to the hospital.
The catheterization service provides fellows with opportunities to evaluate patients prior to the procedure, discuss upcoming procedures and family concerns with patients and their families, perform catheterizations, evaluate the studies with the faculty mentor, and present the catheterizations in the combined pediatric cardiology-surgery catheterization conference. In addition to diagnostic hemodynamic catheterizations, fellows learn to perform and analyze interventional procedures and electrophysiologic studies. They gain experience in radiofrequency ablation, transesophageal pacing, and pacemaker insertion in the cardiac catheterization laboratory.
The non-invasive service includes all non-invasive diagnostic modalities. Fellows perform studies as appropriate and evaluate the results with the faculty mentor. Fellows are trained in all echocardiographic modalities, including M-mode, 2-Dimensional, Doppler Flow and Color Flow studies, stress echocardiography, transesophageal echocardiography and fetal echocardiography. Fellows are responsible for reading electrocardiograms during the non-invasive rotation. During the non-invasive rotation, time is spent learning sophisticated exercise techniques, pacemaker analysis and management, electrocardiography, vectorcardiography, and non-invasive methods for arrhythmia diagnosis and management.
Development of Teaching and Presentation Skills
The development of teaching and presentation skills is integral to all facets of our program. Fellows work extensively with residents and medical students on all the clinical services. They present cases in all conferences, and learn communication and teaching techniques both within the hospital setting, but also in communicating to referring pediatricians about their patients. Fellows play integral roles in the teaching of medical students during the annual small group sessions and labs for second and third year medical students.
Education about medical affairs
Bimonthly breakfasts with the program director have been used to keep the trainees informed about changes in faculty and hospital as well as to get overall feedback about the program. These discussions involve a broad scope of issues related to the delivery of health care. One journal club a year is devoted to articles from the journal "Health Affairs."
Library Facilities
Library and computer access is available within the division of pediatric cardiology. A complete library with electronic journals and tele-conferencing is available in the hospital and is accessible at all times.
Relationship to other Programs
The transition from the role of the pediatric resident to the pediatric cardiology trainee is among the most dramatic for all specialities. While most pediatric residents develop a foundation in the clinical cardiac examination, the trainees must be able to use their clinical skills with confidence and accuracy for daily aspects of patient care. Mastery of the technologic aids available requires considerable time and hands on experience with close faculty supervision. For this reason pediatric cardiology patients are under the direct care of the cardiology trainee and the faculty members. The interface with the other services is key to a successful pediatric cardiac program not only from the standpoint of clinical care, but also education. The pediatric cardiology trainees have an extremely close working relationship with the intensive care faculty and fellows. The close relationship with the surgical service is evidenced by our shared conferences and office space. A fruitful area of collaboration occurs with anesthesia in the cardiac catheterization laboratory. In the ambulatory setting, the multi-disciplinary cardiovascular genetics clinics provide an excellent opportunity to discuss one of the most rapidly changing fields in medicine today. The trainees are central to the patient care process and they have a prime responsibility for resident and medical student education at the bedside and in the ambulatory setting.
Evaluation
We have revised the evaluation form to facilitate the monthly evaluations of the fellows. These will be completed by the attending staff before the trainee moves to the next rotation. They will be signed by both the faculty reviewers and the trainees. The program director will review all evaluations on a semi-annual basis and the trainees will be reviewed by the entire faculty before the program director meets with the trainee. Clinical and technical skills will be assessed by direct observation of the trainee while performing examinations or procedure.
The trainees will be required to complete the faculty evaluation form on a monthly basis. The results of the evaluation will be shared with the individual faculty member. Overall comments about the structure and success of the program are usually addressed at the bimonthly breakfasts with the program director. Recommendations are brought back to the biweekly faculty meeting for discussion.
Mail the completed application to:
Department of Pediatrics
Division of Cardiology
RB&C 6011
11100 Euclid Avenue
Cleveland, OH 44106