Fellowship Program
Pediatric Cardiology
Oregon Health & Science University
Division of Pediatric Cardiology
Sample Fellows Curriculum
Fellowship Composition and Framework
The first year fellow classes alternate between one and two fellows, to maintain a total of four pediatric cardiology fellows at all times. The three-year curriculum, covered in detail below, consists of 20 months of clinical rotations, and 16 months of research and elective. Fellows are given 4 weeks of vacation each year. We are able to accommodate flexibility within the schedule to adjust to individual preferences or requests; including the ability to cluster research rotations or electives.
Typical schedule |
Consult |
Echo |
Cath/ICU |
Elective/Research |
1st year |
3 |
3 |
3 |
3 |
2nd year |
3 |
0 |
1 |
8 |
3rd year |
3 |
3 |
1 |
5 |
Overview of Clinical Rotations
I. Clinical Consultation Service. (All Pediatric Cardiology Staff).
Each month one of the fellows is assigned to the in-patient Consultation Service for the calendar month. The in-patient service includes cardiology and CT surgery patients on the pediatric ward, pediatric intensive care unit (PICU), neonatal intensive care unit and interventional recovery unit. Requests for pediatric cardiology consults are also the responsibility of the Consult Service fellow and staff. Members of the in-patient Consult service generally include a pediatric cardiology fellow, attending staff (rotating weekly), nurse practitioner and pediatric residents and/or medical students.
In-patient rounds begin in the PICU. Ideally the fellow will have seen the patients prior to the attending rounds. Consults, which come in throughout the day, are seen first by the fellow and/or medical student and subsequently with the faculty. With time and experience the fellows gain an increasing role in making the primary decisions involved in patient care and communicating among other providers and with the patients and families.
Fellows are encouraged to become the primary cardiologist for new patients with which the fellows become involved with during the inpatient service. Whenever possible these patients are followed by the fellows in their continuity clinics.
II. Echocardiography. (Under the direction of Dr. Minette and staffed by Drs. Rice, Shaughnessy, Reller, Droukas, and Silberbach).
The echocardiography lab is staffed by six faculty and seven technicians. The lab performs ~ 4600 transthoracic, 200 transesophageal and 290 fetal echos per year. The fellows learn echo in various settings, including seven echo rotations, night and weekend call, ICU rotations (intra-operative TEE), catheterization procedures (device placement), Medical/Surgical conference preparation and presentation of studies, and additional exposure through elective rotations or research. Fellows learn the difference between adequate and incomplete studies, and also develop the skills to communicate the results of the study to patients, physicians and cardiac surgeons.
The echo rotations provide hands-on training from the beginning, supervised by technicians who are exceptional and enthusiastic teachers. In addition the fellows read their studies with the attending staff. The specific learning objectives during these rotations include an understanding of the indications for echo, the pertinent data to be collected in each type of study, the physical principles of image formation and flow velocity measurements, and the technical skills of obtaining high quality images.
By the end of the first several echo rotations, the fellows will be able to independently perform a complete standard pediatric study. Early on the fellows are expected to perform a minimum of two studies per day, this number increases with experience. In addition, the fellow is expected to read (with the attending staff) each of his/her studies performed during the day. The fellow should also be available to assist in conscious sedation of patients. Once the skills of transthoracic echo are substantially developed, the fellows will have an increasing role in TEE and prenatal studies. All studies done during call will be supervised by either an echo technician or faculty, until the fellow is independently performing these studies at a high level. The studies are all reviewed by the fellow and echo staff the following morning.
A valuable educational experience involves the preparation and presentation of echos at the weekly Medical/Surgical conference. The fellow reviews all studies to be presented at conference with the echo attending assigned each week. Relevant images are selected and presented at the conference in preparation for surgery.
III. Cardiac Catheterization. (Under the direction of Dr. Grant Burch; staffed by Drs. Burch and Armsby).
The program has a dedicated pediatric cardiac catheterization laboratory, which schedules patients 4-5 days per week. The interventional faculty have expertise and experience in all aspects of post-natal interventional procedures. Fellows perform a minimum number of procedures recommended for Board eligibility, beyond that the number of procedures performed is determined by the individual fellow's level of interest.
First year fellows are assigned a rotation in the cardiac catheterization laboratory early in the first year. The rotation is intended as a closely supervised orientation. A second rotation, designed for concentrated training at a higher level, is scheduled later in the first year. Occasionally fellows use elective time for additional intensive experience in the cath lab. Beyond these rotations fellows are expected to spend approximately 2-5 days per month doing cath procedures, except during consult and PICU rotations. During those months, the on-service fellow is given first priority toward participating in catheterizations performed on in-patients.
IV. PICU/Surgical Rotation. (Under the direction of Dr. Laura Ibsen, staffed by Drs. Braner, Ellenby, Kirby, Tegtmeyer and Steelman as well as the attending cardiologist on service and cardiothoracic surgeons).
The Pediatric Intensive Care Unit (PICU) is a combined medical/surgical ICU located in the Doernbecher Children's Hospital adjacent to the OR and Echo lab. There are currently 24 pediatric ICU beds, staffed by seven attending intensivists, residents and medical students. The development of a pediatric ICU fellowship is underway.
The bulk of post-operative cardiac care is learned during the Consult months and on-call throughout the three years; however, for one month in the first and third years, the fellow will be assigned to the PICU Service. The goals of those months are to provide concentrated experiences with the surgeons in the operating room both observing and performing transesophageal echocardiograms, as well as post-operative bedside care throughout the night for the cardiac patients. In-house call is typically every fourth night during those months. The fellows will gain experience in the techniques of cardiopulmonary bypass, anesthesia strategies for the cardiac patient, hypothermia, cardioplegia, extracorporeal membrane oxygenation, etc. The rotation is also designed as an intensive exposure to the medications, ventilation strategies, assessment and treatment of the peri-operative cardiac patient.
V. Elective Rotations. These rotations are to be designed by the fellow according to his/her interests and needs. Electives are often utilized to provide intensive clinical experience in an area the fellow is interested in pursuing or desires more experience. Additionally, they can be used to explore research interests, identify mentors or-in the second or third years-to complete research projects initiated earlier. The fellow and program director meet prior to the elective to design a meaningful and productive (albeit somewhat relaxing) rotation.
VI. Electrophysiology. The electrophysiology experience is not organized into a single rotation. EP conferences and one-on-one teaching sessions with Dr. Balaji, are given every six weeks. In addition, fellows attend Dr. Balaji's EP clinics at intervals primarily during their elective and research months. Although the concepts and fundamentals of EP studies are presented, fellows are not routinely involved in the EP studies unless there is a specific interest in the subspecialty. Fellows gain proficiency in interpreting electrocardiograms, holter and event monitors during Consult rotations, call and in their outpatient clinics. Fellows often organize electives to provide concentrated study with Dr. Balaji.
VII. Out-Patient Clinic. Each fellow attends Wednesday afternoon Fellows Clinic once every two weeks. These clinics are staffed by two fellows and an attending cardiologist. Every effort is made to provide fellows with as many newly diagnosed CHD patients as possible; in addition, patients with whom the fellow became closely involved during their Consult month are assigned to that fellow's continuity clinic. A fellow may schedule appointments for their patients outside of their clinic date when necessary.
Our division has a long-standing, busy Pediatric Cardiology Outreach Clinic program in which the attending cardiologists and echo technicians attend outreach clinics throughout Oregon on a rotating basis. Fellows are invited to attend these clinics, which provide a rich experience in managing outpatients.
The fellows are welcome to attend the hyperlipidemia clinic (under the supervision of Drs. Laurie Armsby and Jeff Miller). This is a sub-specialty outpatient service, which provides the fellows exposure and research opportunities within the field of preventive cardiology.
VIII. On Call Responsibilities. Fellows take call from home one weeknight a week and every fourth weekend. The fellow is first call for all in-house calls from the Resident Staff, as well as for any parent calls. Physician referral calls will be directed to the faculty attending on call. However, the attending will involve the fellow at the earliest opportunity (e.g. transportation of a new baby to OHSU). All cardiology patients being admitted to the hospital for cardiac or non-cardiac related illnesses (i.e., RSV pneumonitis; acute gastroenteritis in a shunt dependent lesion), and any cardiac patient presenting to our emergency department with a cardiac-issue should be seen and evaluated by the on-call cardiology fellow.
IX. Vacation. Each fellow receives four weeks vacation per year, to be scheduled by the fellow in 1-2 week blocks. Vacations may not be scheduled during consult or PICU months. Only one fellow may schedule vacation at a time. In addition, fellows receive 10 days with pay annually for sick leave. This time is cumulative throughout the fellowship. The vacation, sick leave and maternity/paternity leaves are described in more detail in the Fellow Leave Policy.
RESEARCH
A minimum of 9 months of the three-year fellowship training is assigned to basic or clinical research. The timing of the research year may vary from fellow to fellow during the three years, but the bulk of it will occur in solid blocks during the second and early in the third year. During the second year, clinical responsibility will be minimized. In order to maintain technical and clinical skills, fellows will continue to perform procedures in the catheterization and echocardiography labs, see continuity patients in fellows clinic and serve three months on the Consult service during their second year.
Our Pediatric Cardiology faculty is committed to ongoing research productivity. In compliance with our goals and the requirements of the American Board of Pediatrics, the fellow will be expected to become actively involved in a research project with one or more of the faculty during their research year. Research is also encouraged in collaboration with faculty within ancillary basic science fields, (i.e., cell biology, molecular genetics, or lipoprotein research, etc.) or cross-divisional clinical areas (neonatology, intensive care, metabolism, pharmacology, etc). There is a rich research atmosphere at OHSU, which offers excellent potential resources for research opportunities, including the Heart Research Center under the direction of Dr. Kent Thornburg, Dr. David Sahn's active and prolific echocardiography lab, Dr. Michael Jerosch-Herold in cardiac MRI, and many others.
As required by the ABP each fellow will be assigned a Scholarly Oversight Committee made up of four or more faculty. The fellows will meet with their SOC biannually to review their research activity. This provides additional mentorship and support in ensuring a productive and rewarding experience.
Following completion of the research project, the fellow will be expected to submit the data in abstract form to a national meeting, and to a peer-reviewed journal as a manuscript. In addition to the primary research project, the fellows will be encouraged to be involved with other ancillary clinical projects which can include the writing up of case reports, review articles etc. The overall goal of the research component of the fellowship will be to allow the fellow adequate time for the development of research skills necessary to become a successful academic pediatric cardiologist and to fulfill the Board requirements.