For Medical Professionals
Pediatric Cardiology Fellowship
- Overall Programmatic Goals and Objectives:
Miami Children’s Hospital’s Cardiology and Heart Surgery program is ranked among the best in the nation according to the 2013-2014 US News and World Report. The fellowship program’s goal is to train our fellows to be well rounded, patient centered physicians that will become the future leaders in our field of pediatric cardiology. The objectives of the fellowship are to train our fellows to be (1) well versed in all aspects of cardiology (cardiac anatomy, cardiac physiology, non-invasive cardiac imaging, cardiac catheterization, electrophysiology, cardiac critical care medicine, inpatient and outpatient cardiology), (2) empathetic professionals that use a patient centered approach, and (3) to find a career in cardiology that excites them and pushes them to innovate the field. The program’s educational content includes an extensive curriculum filled with interactive lectures and conferences as well as block rotations in non-invasive imaging (echocardiography and cardiac MR), cardiac critical care medicine, cardiac catheterization and electrophysiology, inpatient / outpatient cardiac service and research. In all of the clinical areas, the fellows are supervised by faculty which allows the fellows to have progressive autonomy through direct and indirect supervision. The faculty and fellows both regularly evaluate the program and each other to help improve the program, the faculty and the fellows. As a referral tertiary care center, the fellows are exposed to a large volume of cardiac patients with a varying mix of pathology, complexity, and volume. The Research Institute provides the infrastructure for research support including regulatory function and IRB. The GME provides the institutional support for the educational activities such as the common fellowship curriculum, faculty development, Grand Rounds and other hospital wide conferences that supplement the division-specific conferences.
- Cardiac Intensive Care:
Each fellow has five clinical rotations in the CICU over the course of the fellowship. (A senior CICU fellow and a critical care fellow share responsibilities and call while rotating in the CICU.) The fellow in the CICU is responsible for the cardiology and intensive care management of the cardiac surgical and cardiac medical patients. In addition, the fellow is responsible for presenting the CICU patients in the Wednesday morning CICU Grand rounds each week. The clinical commitment is less than 80 hours/week including call. One attending intensive care staff is responsible for providing direct supervision of patient care and teaching during daily rounds and while on call. Fellows receive training in cardiac pathophysiology, cardiology and intensive care management, and critical care monitoring and procedures.
- Non-Invasive Imaging:
Each fellow has seven clinical rotations in the non-invasive lab over the three year fellowship. Fellows learn echocardiography (mainly transthoracic and some tranesophageal / fetal echo) as well as some cardiac MR through hands-on experiences guided by cardiac sonographers, senior cardiology fellows, and cardiology attendings specializing in echocardiography and cardiac MR. In addition, a weekly didactic on echocardiography is presented by the senior fellows and attending cardiologists for the fellows’ education. The fellow takes an active role in the laboratory performing echocardiographic scanning and also echocardiographic interpretation of anatomic, doppler and ventricular function studies.
- Cardiology Service:
Each fellow has six clinical rotations on the cardiology service over the course of the fellowship. The fellow leads and teaches (informally and formally) a team of pediatric residents and medical students in the management of patients on 2NE (cardiac inpatient floor) and the ambulatory cardiology clinic. The fellow also assists the surgical team (including nurse practitioners) in the preoperative ambulatory visit and the postoperative care of the cardiac patients convalescing on the floor by assuming the role of the consulting cardiologist and/or the primary medical doctor. Additional clinical responsibilities include cardiology consults throughout the hospital, interpreting EKGs and 24 hour holter monitors, and assisting in cardiopulmonary and exercise stress tests. Supervision of all clinical responsibilities is provided by the attending cardiologist assigned to the particular area of the cardiology service.
- Ambulatory Cardiology Clinic:
Each fellow is assigned to a weekly half day clinic, which is supervised by at least one attending cardiologist. Fellows evaluate, treat and plan the medical care of patients referred to the clinic for outpatient evaluation. The fellow also provides continuity of care to those patients with simple to serious cardiac problems that necessitate further follow up in the ambulatory cardiology clinic. Fellows see patients assigned to their clinic day and/or patients that they assumed from a previous inpatient clinical rotations. The follow up appointments are scheduled by the fellow in the EMR with the assistance of the physician support staff. The fellow accomplishes this task by looking at their schedule to see what day that he or she has clinic during a particular month and having the physician support staff mark the appointment in the EMR and contact the fellow upon the patients return to clinic.
Each fellow has four rotations in catheterization/electrophysiology. The responsibilities of the fellow include preparation of the case, review of informed consent with the patient's family on the day of the procedure or the day prior to the procedure, presentation of the case at morning conference, performance of the catheterization with a staff physician, and analysis and review of the data at the end of the day. As the rotation progresses, the fellow learns to obtain a complete set of hemodynamics, saturations and angiographic data in a safe and expedient manner. Training in catheterization of the newborn infant and interventional procedures will also be taught throughout the rotations. One day a week, the fellow will also be responsible for assisting the attending electrophysiologist in intracardiac electrophysiology studies, ablations and intraoperative procedures. In addition, the fellow will assist the EP attending with consults on inpatients and selected outpatients with arrhythmias.
The Division of Cardiology maintains that experience in cardiovascular research is an essential component of fellowship training in cardiology. Fellows have 12 months of research over the course of their fellowship. Fellows are expected to get involved in a research project during their fellowship, under the guidance of one of the faculty. Such projects, either new or ongoing, will often be of the chart review type, and may form the basis for a future prospective study for those fellows interested in clinical research. Fellows need to identify a research mentor from among the faculty by the end of their first year. The faculty assists the fellows in identifying projects, resources, and mentors. A scholarship oversight committee (SOC) is assigned to each fellow to biannually monitor and review the fellow’s progress throughout fellowship training. During the first half of the second year, the fellow is expected, with appropriate guidance, to write and submit an IRB proposal for a research project which: (1) addresses an important question; (2) applies available state-of-the-art techniques to answering that question; and (3) is practical within the time and other constraints of the fellowship. By the end of the fellowship, each fellow should have been intimately involved with a research study such that has given the fellow an opportunity to produce a meaningful research product as determined by their individual SOC. Preferably each fellow produces a meaningful product like a manuscript that is either ready for submission or has been submitted and accepted for publication in a peer review journal.
In addition, the research fellow is responsible for reviewing and presenting a current or relevant journal article in the monthly fellow journal club.