Fellows will receive extensive training in non-invasive imaging according to standards set forth for a general pediatric cardiologist. The first and second years are dedicated to the basics of transthoracic echocardiography including complete two-dimensional imaging, spectral and color doppler, M-mode and non-invasive assessments of function. Fellows will be trained to be able to perform a complete congenital echocardiogram utilizing all standardized views within the first few months of their first year.
Based on the fellow’s interests, the third year will be spent in developing advanced skills in non-invasive imaging including transesophageal echocardiography, other intra-operative echocardiography, 3-dimensional imaging, and fetal echocardiography. Fellows specifically interested in MRI and CT can further develop those skills in the second and third year, in conjunction with our world-class MRI and CT facilities and faculty.
Fellows will receive immediate exposure in the cardiac catheterization lab beginning in the first months of training. Fellow responsibilities include advanced preparation of the patient’s past medical and surgical history, understanding and presentation of the patient’s underlying anatomy, detailing expected hemodynamic data to be obtained and articulating a plan for obtaining that data. At the conclusion, a summary of the case is reviewed with the attending and a diagram documenting the important data is created.
As the rotation progresses, the fellow will learn to obtain a complete set of hemodynamic, oximetric and angiographic data in a safe and expedient manner. Furthermore, there will be extensive exposure to a wide variety of interventional procedures performed in congenital cardiology including valvuloplasty, angioplasty and stent placement, septal defect occlusion, PDA closure, biopsy and percutaneous valve placement. Presentation of hemodynamic and angiographic data during our weekly surgical conference is performed by the fellows with prior coaching from the attending.
Fellows will receive extensive training in electrophysiology according to standards set forth for a general pediatric cardiologist. They will learn basic ECG interpretation, in addition to electrocardiographic inpatient and outpatient monitoring beginning in the first year. Furthermore, they will also have exposure to post-operative rhythm and device management. The invasive EP experience is spread across the three years of training and gives exposure to radiofrequency and cryoablation, electrophysiologic mapping, and pacemaker/ICD implantation.
Fellows on the inpatient service are charged with running the service and being the primary point person under the guidance of the attending. This includes caring for pre- and post-operative patients in all units of the hospital, managing medical cardiology patients, and performing all inpatient and emergency room consults throughout the hospital. There is extensive time spent in both intensive care units, though dedicated immediate post-operative management is focused on during the ICU rotations.
Time in the cardiac intensive care unit is designed to familiarize the fellow with the intricacies of managing the wide spectrum of cardiac lesion during the immediate and short-term post-operative period. This includes establishing proficiency in vasoactive medications, ventilator management, diuretics, assessment of hemodynamics and establishment of necessary procedural skills. There is dedicated time in the CICU each year, but extensive time is spent in the intensive care unit during the inpatient rotation as well.
Fundamental to all pediatric subspecialties is the training of academic physician scientists. Regardless of the fellow’s future career, they will leave fellowship with a sound understanding of the basics of clinical investigation. Much of the research training will be performed under the guidance of the fellow’s Scholarship Oversight Committee (SOC) who will help form each fellow’s individual academic plan during their three years, including evaluating and mentoring the projects each individual pursues. Furthermore, formal didactic training in statistics, epidemiology and other basics of clinical investigation will be required of all fellows and achievable through a dedicated program in the School of Public Health. Fellows who are interested in obtaining a Master’s Degree in Clinical Investigation during their time may do so with advance notice and discussions with the program directors.