Fellowship Rotations over Three Years

In-patient

Fellows provide care to pediatric cardiology patients in the PICU, NICU and general pediatric floors as well as perform echocardiographic studies for in-patient cases. These patients include those in the wards, PICU, 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 supervising Faculty member in conjunction with 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 Pediatric ICU. Pediatric cardiology patients admitted to the floor are cared for by one of 2 general pediatric teams in conjunction with the pediatric cardiology fellow and attending. Patients admitted to the floor are either transferred from the PICU 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. In addition, 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: Provide fellows with exposure to pediatric cardiology problems in an in-patient setting as well as the art of performing and interpreting echocardiography in pediatrics. 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 and enable fellows to eventually conduct echocardiographic studies independently.   

Number of rotations: 12 in-patient/echo 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/echo rotations are supervised by the attending on service. Four attendings function as in-patient/echo attendings. Fellows are assessed at the end of each rotation through an electronic evaluation system (MedHub) 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 feedback regarding rotations.

Cardiac Intensive Care (CICU)

Details: Fellows provide care to pediatric cardiology patients in the PICU.  These patients are those with congenital and acquired heart disease who are in critical or unstable conditions. Fellows on this service work with the PICU 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 PICU. 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 unstable and critically ill children with congenital heart disease.

Number of rotations: 6 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

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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  

Educational goals: Be able to perform independently both, diagnostic catheterization procedures and simple therapeutic procedures with good understanding of high end invasive and.

Number of rotations: Six 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 MedHub is provided for the fellows.

Out-patient Continuity Clinic

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 patients 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 is out-patient mentor. Faculty provides direct guidance and feedback throughout the rotation and fellows are encouraged to continually provide feedback regarding their clinic time.