Patient care


Fellows will deal with patients of all pediatric age groups as well as adults with congenital heart disease in the variety of clinical settings at Rush University Children’s Hospital, based upon specific rotation. This will include providing care for patients in the following areas:

  • General in-patient wards
  • Intensive care units, both pediatric/cardiac ICU and neonatal ICU
  • Consult service for the inpatient setting
  • Pediatric cardiology outpatient area
  • Echocardiography Laboratory
  • Cardiac Catheterization Laboratory
  • Pediatric cardiovascular surgery suite


Fellows will be supervised by pediatric cardiology faculty members on service in the variety of rotations. Faculty members are on service and call for one week at a time. Faculty members will be involved in all aspects of fellow learning during all rotations. Faculty members are responsible for patient care and supervising all fellows’ activities during their training. In supervising fellows, the following measures are followed:

  • Supervising faculty member must review expected responsibilities of fellows starting the rotation.
  • Supervising faculty member must review with fellow both responsibilities and areas in which fellows will be evaluated during the first 3 days of rotation.
  • Supervising faculty member must discuss with fellow expectations of clinical duties and performance at onset of rotation. This is based on level of training and areas in which improvement is sought.
  • Faculty member and fellow must discuss learning process and progress of fellow midpoint and at end of rotation. The mid-rotation evaluation is informal, while that at end of rotation must be through a meeting with documentation of evaluation and discussion during meeting.

Learning experiences

Fellows will learn the following aspects of patient care in all rotations:

  • Assessment of patients with congenital heart disease and children with heart diseases
  • Formulate differential diagnoses
  • Order appropriate investigative studies.
  • Perform and interpret all modes of echocardiography
  • Perform and interpret diagnostic cardiac catheterization
  • Understand indications, procedure and complications of interventional cardiac catheterization procedures
  • Understand indications, procedure and complications of cardiac surgical procedures

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Medical knowledge

Throughout the years of fellowship, fellows attend structured didactic teaching 3 times per week. A total of 130 lectures are given every year. Attendance of all lectures is monitored and mandatory regardless of clinical responsibilities. Fellows are expected to attend at least 80% of all lectures.

In addition to the didactic lectures outlined above, the clinical rotations have built in teaching provided through the following venues:

One-on-one learning sessions with supervising faculty member. This is delivered during rounds and/or thereafter during the day. Each week will provide three learning sessions. These learning sessions will include the following topics:

  1. Presentation and management of congenital heart disease:
    • Shunt lesions: atrial and ventricular septal defects and patent ductus arteriosus
    • Obstructive lesions: aortic and pulmonary stenosis, coarctation of the aorta and outflow tract obstruction
    • Cyanotic congenital heart diseases: tetralogy of Fallot, single ventricle lesions, malposition of great vessels and anomalies of pulmonary venous return
  2. Acquired heart diseases: Kawasaki, rheumatic heart disease and collagen diseases.
  3. Arrhythmias in the: de novo and post-operatively

Case scenarios and multiple choice questions for case scenarios. These are provided through online educational website to be completed by fellows throughout clinical rotation

Reading materials include:

  • Pediatric cardiology textbooks provided to fellows
  • Lists of recent and classic published articles are provided to fellows for each rotation
  • In-house generated teaching material provided on Rush’s pediatric cardiology teaching website

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Practice-based learning

Self evaluation

To achieve a lifelong habit of practice, the following aspects are built into each inpatient rotation:

  • At the end of each four-week rotation, fellows are asked to evaluate their performance and behavior during the rotation and how that could have impacted others. These self evaluations are kept in the fellows’ files.
  • At the onset of subsequent rotation (next level), they are asked to review their self evaluation from the previous rotation (level) and indicate how to improve/modify/add to their learning experience in the rotation they are about to start, based upon their previous experiences. The new set of goals and objectives are discussed with their mentors and again documented in their self evaluation forms, and kept in their files.

Online resources

During inpatient rotation, fellows are instructed and then assessed by supervising faculty on the use of available technology for patient care and education. Specific examples are:

  • Epic: an online data management system for Rush University Medical Center including patient data, flow sheets, medications, laboratory results, etc.
  • Library online resources which includes Medline/Ovid/PubMed, up-to-date, etc.
  • Radiology and echocardiography online images and reports.

Online module

An online learning tool provides the opportunity for fellows to accomplish critical self learning. The online module contains clinical cases spanning the full spectrum of education in pediatric cardiology. These case scenarios test fellows’ knowledge, critical thinking, as well as awareness of professional standards and impact of care on patient as whole, such as long term care, cost of care, etc.

Morbidity and mortality conference

Fellows will prepare, under supervision of assigned faculty member for the section’s monthly morbidity and mortality conference. Fellows will present cases and discuss factors leading to M&M and possible alternative means through which this could have been avoided.

Multidisciplinary conference

Fellows will present patients in-house during the weekly multidisciplinary patient discussion conference under the supervision of faculty member on service. Presentation will include patient history, diagnosis, results of investigative studies, diagnosis and therapeutic course.

Journal club

Fellows rotate in assuming responsibility for this monthly activity. A faculty member is assigned to supervise these sessions. Fellows assigned to this activity choose, after discussion with faculty member, 2-3 articles for the monthly conference. Fellows, after review of articles, present the articles chosen; indicate strengths and weaknesses in methodology, analysis and conclusion. Fellows also indicate other articles published within the past five years which support or refute findings in articles discussed. Journal club conferences are attended by all pediatric cardiology fellows and faculty members. Attendance is recorded.

Clinical application of evidence-based research

Supervising faculty members choose a clinical scenario from actual patient cases during each clinical rotation to stimulate fellows to correlate evidence based published research to clinical care provided. Fellows search the medical literature available through the medical library online Medline system (Ovid). An article is chosen in consultation with the supervising faculty, and then the fellow is requested to provide the following in a verbal report:

  • Evidence-based conclusion in patient management as concluded by chosen article
  • Applicability and exclusions to chosen clinical scenario in general
  • Applicability and exclusion to particular patient being managed, i.e. would the conclusions in the study help these type of patients and why
  • How would this impact patient care, i.e. would the conclusions in the study help this particular type of patient and why

The case scenario and article chosen must be entered by faculty member in fellows’ rotation evaluation.

Access to the online Medline system (Ovid) is taught to fellows during a didactic lecture at the beginning of each academic year by one of the medical school’s librarians. Available online resources, establishing access through the internet and navigating these systems are covered; in addition, means of requesting further help through the library system is provided to fellows through this orientation.

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Interpersonal and communication skills

The following areas of communication are taught, monitored and evaluated during clinical rotations:

Verbal communication

Faculty members serve as models of effective communication with patient/families and other health professionals during daily rounds. Faculty members outline after rounds important and new issues concerning communications. As fellows advance in levels of training, they are requested by faculty members to conduct rounds in the presence of faculty members to observe, assess and critique verbal communication skills of fellows. Critique is conducted discreetly between faculty members and fellows after conclusion of rounds.

Written communication: fellows are requested to formulate daily progress and consult notes for patients. These reports are reviewed, assessed and critiqued by supervising faculty members during daily sessions.

Special circumstances: complaints and praises made regarding fellows are discussed with fellows by supervising faculty member. Concerns of significant impact are reported to program director.

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Lectures addressing medical ethics and professionalism are provided annually to pediatric cardiology fellows through the department of pediatrics. In addition, professionalism is taught, observed, assessed and critiqued through the following venues during clinical rotations:

  • During rounds on patients, faculty members discuss issues relating to this topic as it applies to specific patients. Fellows are asked to identify ethical issues in a given case and methods of dealing with these issues.
  • Review of surveys obtained from patients and families dealing with fellows requesting patient/family concerns regarding ethical and professional conduct of fellows. This feed back is provided to fellows as aggregate during semi-annual evaluations. Fellows are asked to address the issues raised and their plans for remedying such concerns.
  • Any reported violations of ethical and professional conduct by fellows by other medical professionals or family members are addressed immediately. Program director is involved with all such incidences.

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System-based practice

Patient care while in the hospital is put into context of patient care pre-admission, particularly as it relates to prevention and post discharge from hospital as it relates to family’s environment, understanding of disease and cost of medical care. These issues are discussed during rounds, patient care conferences and upon discharge. Fellows are assessed in this aspect as they are able to relate these issues in their notes and presentation of patients during patient care conferences. Rotation evaluations assess this aspect of training.

Incidents of morbidity and mortality must be discussed by faculty member and fellows involved. Patient medical background, steps leading towards unwanted consequences as well as how such complications should be spotted and reversed is discussed and later presented through a multi-disciplinary conference. Fellows and supervising faculty member present data to this conference.

Fellows participate in patient care meetings as well as faculty meetings to address issues relating to structure and procedures within this discipline of patient care. Fellows are encouraged to suggest alternative methodologies.

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Work hours and work environment

The following guidelines, consistent with the ACGME’s common program requirements, delineate the policy that the Rush University Pediatric Cardiology Fellowship Program will adhere to:

Work hours

  • Work hours will be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.
  • As a minimum, fellows shall be provided with one day (a continuous 24-hour period) in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call.
  • Adequate time for rest and personal activities will be provided. This will consist of an 18-hour time period provided after in-house call.

On-call activities

  • Pediatric cardiology fellows are on call one day per four-day cycle. The call is from home call (not in-house). Fellows may stay in-house or return to hospital if needed. In the event they are required to stay in house without being able to return home for 24 hours, then they may, if needed, stay up to four additional hours only. Thereafter, adequate time off consisting of at least 18 hours will be provided.
  • Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to four additional hours beyond the 24 hours (for total of 28 hours) to participate in didactic activities, transfer care of patients, conduct outpatient clinics and maintain continuity of medical care. Residents will leave post-call by 12 p.m.
  • No new patients will be accepted after 24 continuous hours on duty by the fellow on call. A new patient is defined as any patient for whom the fellow has not previously provided care.

Every effort will be made by the program director, faculty and trainees to maintain strict compliance with the above guidelines. This policy is disseminated yearly to all program faculty and staff.

Violations of above policy must be reported though one or all of the following 3 mechanisms:

  1. Program director: Sawsan Awad, MD, via email: or by telephone: (312) 942-0453
  2. Rush University GME office: (312) 942-5495
  3. Rush House Staff Association Executive Committee (312) 942-6000, pagers #4069 or #3062

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