Fellowship Program Information

The goal of our Pediatric Cardiology Fellowship Program is to prepare physicians for careers in academic pediatric cardiology. We strive to create a training environment that will foster not only quality clinical training, but also rigorous inquiry and mentoring that will lead to development of the next generation of leaders in pediatric cardiology.

Pediatric Cardiology Fellowship Curriculum

In general, the duration of the Fellowship Program is three years. The exact schedule is determined in part by the fellow’s interest and previous experience, but an example is shown below:

Month

1st Year

2nd Year

3rd Year

1

Inpatient Service

Research

Cardiac Intensive Care

2

Imaging

Research

Imaging

3

Electrophysiology

Research

Cardiac Cath Lab

4

Outpatient Clinic

Research

Elective

5

Cardiac Cath Lab

Transplant

Inpatient Service

6

Cardiac Intensive Care

Research

Cardiac Cath Lab

7

Research

Research

Electrophysiology

8

Electrophysiology

Research

Inpatient Service

9

Inpatient Service

Research

Elective

10

Imaging

Research

Cardiac Intensive Care

11

Cardiac Intensive Care

Research

Imaging

12

Cardiac Cath Lab

Research

Electrophysiology

Description of Specific Clinical Rotations

Inpatient Floor-Consultation Service

The fellow is responsible for following all cardiology inpatients and performing consultations. All patients are seen with a faculty cardiologist. Multidisciplinary rounds on the cardiology inpatient floor are held daily with the faculty cardiologist, senior (PL3) resident, two to three interns (PL1), two to three medical students and other staff. All fellows participate actively in teaching discussions with the residents and attending physician. During this rotation, the fellow learns to treat patients with medical cardiology problems (e.g. congestive heart failure, pericarditis, rhythm disturbances, etc), and to care for preoperative and postoperative patients. During the course of the Fellowship, the fellow assumes more responsibility for patient management. All medical records are electronic. The inpatient floor fellow is on-call each weekday night and no more than every fourth weekend each month.

Cardiac Intensive Care Unit

The fellow is responsible for managing all medical and postoperative cardiology patients in the cardiac intensive care unit and will work with the attending cardiac intensivist, the on-service consulting cardiologist, and the cardiac surgeons. During this rotation the fellow becomes skilled in caring for critically ill patients, understanding their physiology, and managing their various complications. There are many opportunities to perform procedures. The fellow will also participate in the care of patients on extracorporeal oxygen membrane oxygenators (ECMO) and ventricular assist devices. The fellow takes six days of night (12 hour shift) call; there is no other night call during this rotation. No fellow is in the hospital for more than 80 hours each week.

Imaging

The primary goal of this rotation is for the fellow to acquire skills necessary for performing and interpreting echocardiographic studies. More than 10,000 echocardiograms (including transthoracic, transesophageal, and fetal studies, of which only 15 percent are normal studies) are performed each year. Fellows should become familiar with the critical questions that the echocardiogram must answer for each defect and should also understand the relationship between anatomy and hemodynamic state. During the second and third years the fellow gains experience in specialized areas such as transesophageal, fetal, and exercise stress echocardiography. The fellow is also exposed to cardiac MRI techniques during these rotations.

Cardiac Catheterization

The Cardiac Catheterization Laboratory is comprised of two angiographic suites. More than 800 catheterizations were performed last year, including a full range of interventional procedures. The interventional physicians are involved in several multi-center clinical trials and have multiple ongoing research endeavors to improve the management of patients with structural heart disease in conjunction with the cardiovascular surgeons. The overall goal is for the fellow to acquire the skills necessary to perform a safe and thorough cardiac catheterization in patients with both simple and complex cardiac anatomy. The fellow should be able to obtain and to interpret the data necessary to make clinical and surgical decisions.

Electrophysiology

During this rotation, the fellow is exposed to all aspects of clinical electrophysiology including: non-invasive studies (ECGs, 24 hour ambulatory ECGs [Holter monitor], event monitoring, atrial electrograms, stress testing and tilt table testing); cardiac pacing (transesophageal, temporary, permanent), including implantation and analysis, and invasive studies including catheter ablation. The fellow will become proficient in interpreting electrocardiograms and 24-hour ECG recordings, performing and interpreting trans-esophageal ECG recordings, and assessing pacemaker and implanted cardioverter-defibrillator (ICD) function. About 13,000 electrocardiograms are performed each year. Over 250 pacemaker patients are currently in active follow-up and 40-50 devices are implanted each year.

In addition, the fellow participates in electrophysiologic studies and catheter ablation procedures. All fellows will learn interpretation of intra-cardiac studies, typically, 80 catheter ablations and an additional 10 electrophysiology studies, are performed annually.

Transplantation

This rotation occurs during the research year (most often the second year) and lasts for four weeks. The fellow will attend transplant clinic and rounds with inpatients who are being evaluated for transplantation, awaiting transplantation, or are post-transplantation.

Clinic Rotation

This rotation occurs during the first year (often when fellows are busy studying for their pediatrics boards). The fellow attends all scheduled clinics thereby learning how the clinic works and how to work with the electronic medical record. In addition to seeing follow-up patients with various types of heart disease, the fellow will become familiar with evaluating common problems in new patients such as chest pain, dizziness and syncope, palpitations, fast heart rate, and hypertension. This prepares the fellow for his/her own continuity clinic as well as for consultations (especially in the emergency room) and patient phone calls.

Beginning the second or third month of the first year, the fellow will have his/her own outpatient clinic one-half day per week. Patients assigned to this clinic will include new patients cared for by the fellow during inpatient rotations, new patients referred for outpatient consultation, and follow-up patients previously seen by the fellow. The goal of this experience is to provide a continuum of patient contact so that the fellow can appreciate the natural history of selected clinical problems and develop a good doctor/patient relationship. As the fellow schedules procedures such as cardiac catheterization, cardiac MRI and surgery for his/her patients, the fellow learns how to advocate for his/her patient and how to navigate the “system”, that is identify/access resources, make referrals, and coordinate services for the patient.

During the course of the Pediatric Cardiology Fellowship Program the fellow will be assigned at various times to subspecialty clinics such as preventive cardiology, obesity, and adults with congenital heart disease. We have very active clinics in each of these areas which are staffed by appropriate subspecialists. Familiarity with exercise testing and nuclear cardiology will be gained through patient care experience and formal lectures. Fellows with particular interests are welcome to arrange more extensive experiences in these and other areas.

Rotation in Research

We do not expect fellows to have a research project defined at the beginning of the Fellowship. A one month rotation during the first year allows the fellow time to explore possible areas of interest. Research may be performed in clinical or basic science areas. A fellow may choose as his/her faculty mentor a person from inside or outside the Pediatric Cardiology Division. In general, the fellow should define his/her project during the first year and spend most of the second year working on the project. In this way, a presentation can be made at a national meeting during the third year and a publication submitted to a peer-reviewed journal before the end of the Fellowship. More importantly, the experience should instill the culture and value of investigative work and lay the foundation for future contributions.

For further information, please see Pediatric Cardiology Research and UT Southwestern Research.

Teaching

Fellows participate in teaching of medical students, residents, fellows, and even faculty. One is not "born" knowing how to teach, thus, training in teaching skills is very important. Fellows receive specific training, and practice preparing and presenting formal lectures, shorter less formal presentations, and small group discussions. Third-year fellows are expected to lead inpatient attending rounds. Additional training is available through the "Effective Teacher" lecture series and UT Southwestern and other resources.