Pediatric Cardiology Fellowships

Introduction

photograph of a child holding their hands up next to their face, the hands are covered in colorful fingerpaint

The Division of Pediatric Cardiology at OHSU, directed by Dr. Laurie Armsby, includes thirteen physicians, two nurse practitioners, four fellows, nurses, technicians and administrative staff. Expertise in  the subspecialties of Interventional Cath, EP, Echo, MRI, Heart Failure, Pulmonary Hypertension, Dyslipidemia, Heart Transplant, and Adult Congenital Heart Disease are represented in our faculty. We provide the highest quality care to children with heart disease referred to our center from throughout the Pacific Northwest.

Dr. Irving Shen together with Dr. Ashok Muralidaran and Richard Reed perform all state-of-the-art pediatric cardiac surgical procedures with the exception of heart transplantation. The surgical team are actively involved in all aspects of peri-operative care and fellow education.

The Pediatric ICU, wards, OR, echo lab and clinic are located in Doernbecher Children's Hospital, a free-standing academic Children's Hospital providing the widest range of health care services for children in the region. Doernbecher connects via bridge to OHSU Hospital where the ED, NICU, Cath Lab, Cardiac MRI, and Adult services are located.

Fellowship program

photograph aerial view of Baird Hall and the fountain from the direction of the old library auditorium on Marquam Hill campus

The primary goal of our Fellowship Training Program is to provide you with a solid and comprehensive foundation of knowledge and experience. You will be exposed to all aspects of pediatric cardiology, and work at a pace which is appropriately challenging, yet facilitates the educational opportunity in each experience. One of the outstanding strengths of our program is that we are able to "tailor" your training in a way that best suits your anticipated career direction, while at the same time providing a solid foundation of the fundamentals required by the Sub-Board of Pediatric Cardiology. 

We are proud that our program produces exceptionally trained graduates with the skills and opportunities to become leaders in any aspect of the field.

See current program fellows

See previous program fellows

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 24 months of clinical rotations, and 12 months of research. Fellows are provided 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. We also offer fourth year subspecialty fellowships in cardiac catheterization, echocardiography, and research.

Typical Schedule Consult (m/yr) Echo (m/yr) Cath (m/yr) Elective (m/yr) Research (m/yr)
1st Year 3.5 4.5 2 0.5 1.5
2nd Year 3 0 1 0 8
3rd Year 2.5 3 2 2 2.5
  1. Train fellows to be exemplary in the clinical care of pediatric patients with cardiac disorders as well as to prepare fellows to become future leaders in our field. Our education model is based on daily mentorship in a multidisciplinary, collaborative environment.
  2. Provide comprehensive training in diagnosis and management of patients in both the ICU, inpatient, consult and outpatient cardiology settings.
  3. Fellows should have graduated responsibility as they demonstrate competence at each level in the various subspecialties (non-invasive imaging, cardiac catheterization, electrophysiology, heart failure, pulmonary hypertension, adult congenital, transplant, and outpatient) while nurturing personal well-being and individualized academic pursuits.
  4. Train fellows in the methods of clinical and laboratory research to help develop a rigorous scholarly approach to both patient care and research endeavors.
  5. Upon graduation, our fellows are prepared to have varied careers within pediatric cardiology as primary clinicians, clinician/educators, clinician/researchers or pursue further subspecialty training in pediatric cardiology.

OHSU has an outstanding medical school and pediatric residency program. There are many opportunities available to our fellows for teaching, either in didactic sessions, or patient-based teaching on the inpatient service. Each fellow is assigned at least one noon conference to present to the pediatric residents over the course of fellowship. Each fellow also prepares and presents a pediatric grand rounds talk, with faculty mentorship, on a clinical topic or interesting clinical case. In addition, the fellows are integral in the teaching of residents and medical students on the Pediatric Cardiology Rotation, and provide teaching to residents in the PICU, DNCC and ward. 

Each fellow is assigned a Scholarly Oversight Committee during the first nine months of fellowship. This committee will consist of three faculty members including: pediatric cardiology associate program director in charge of research (Dr. Kathryn Holmes) or pediatric cardiology faculty and at least one faculty member outside the division. This body will meet with the fellow once during the first year and biannually thereafter. The fellow will present his/her research activities to the committee, which will provide constructive feedback and will monitor the activity to ensure that it meets the scholarly activity requirements of the American Board of Pediatrics.    Each fellow will select or be assigned a research mentor late in the first year of fellowship. This mentor should be able to commit adequate time to supervise the fellow's research project and assure the fellow's success with their project(s). This fellow mentor assignment may change during fellowship if the relationship is not functioning optimally. 

Fellows are asked to provide regular evaluations of the conferences, rotations, faculty and the program itself. These are written evaluations, which are compiled and saved in a completely anonymous and confidential format. The program director will meet with all the fellows as a group at least twice each year;ideas, suggestions, requests and grievances are all seriously considered and acted upon. The fellows have a significant role in the continuous process of evaluation, refinement and improvement of the fellowship program.  The faculty meets bi-annually to provide meaningful, constructive milestone based evaluations of each fellow's performance and progress. These evaluations are then reviewed with the fellow by the program director and the clinical competency committee chair on a bi-annual basis. Separate skills evaluations, primarily involving echocardiography, catheterization and electrophysiology are provided to the fellows on an annual basis.

In-Patient Cardiology Service

Under the direction of Dr. Armsby, staffed by Drs. Armsby, Balaji, Holmes, Huang, Kelly, Madriago, Minette, Ronai, Shaughnessy, Silberbach as well as cardiac intensivist McCammond.

A fellow is assigned to the in-patient Cardiology Service for two weeks. The in-patient service includes cardiology and CT surgery patients on the pediatric ward, pediatric intensive care unit (PICU), and neonatal intensive care unit. Consultations are also covered throughout the clinics, wards, ICUs and ED. 

The in-patient Cardiology Service team includes a pediatric cardiology fellow, attending (rotating weekly), resident, and/or medical students, and nurse practitioners. In-patient rounds begin in the PICU at 7:30am. Ideally the fellow will have seen the patients and reviewed the overnight events prior to rounds. Rounds are multidisciplinary and involve the CT surgeon, PICU attending and residents, cardiology attending and fellow, nursing, pharmacy, social services, discharge planning and others. The PICU resident presents each patient on rounds, the fellow listens to the presentations, corrects or emphasizes data, provides a more thorough explanation of echo or cath findings and assists the resident in creating an assessment and plan. The exception to this is that for critically ill patients, or neonates, on the morning following the first post-operative night the fellow will present the patient. With time and experience the fellow will be given an increasing role in making the primary decisions involved in patient care and leading cardiac PICU/NICU rounds. 

At the conclusion of rounds the fellow presents a brief summary of the patient going to surgery on that date. This includes a brief history, summary of pertinent pre-operative data, indications for surgery, planned operation and potential issues post-operatively. 

Consults coming in throughout the day are seen first by the fellow and/or medical student and subsequently with the faculty. 

Fellows are encouraged to become the primary cardiologist for new patients on the inpatient service. Whenever possible these patients are followed by the fellows in their continuity clinics.

Echocardiography

Under the direction of Dr. Madriago and staffed by Drs. Holmes, Huang, Kelly, Minette, Ronai, Shaughnessy and Silberbach.

The echocardiography lab is staffed by eight faculty and seven technicians. The lab performs ~ 5000 transthoracic, 200 transesophageal and 300 fetal echos per year. The fellows learn echo in various settings, including echo rotations, night and weekend call, catheterization procedures (device placement), Medical/Surgical conference preparation and presentation of studies, elective rotations and research. Fellows learn the difference between adequate and incomplete studies, and develop the skills to interpret and communicate the results of studies to patients, physicians and cardiac surgeons. 

The echo rotations provide hands-on training, supervised by technicians who are exceptional and enthusiastic teachers. 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 necessary to obtain 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. Once the skills of transthoracic echo are substantially developed, the fellows will have an increasing role in TEE and fetal 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.

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 cath. All fellows perform a minimum number of procedures (50) recommended for board eligibility, beyond that the number of procedures is determined by the 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. Fellows may use elective time for additional intensive experience in the cath lab. Beyond these rotations fellows are expected to spend approximately one day per week doing cath procedures, except during inpatient service rotations. During those months, the fellow is given first priority toward participating in catheterizations performed on in-patients. 

In addition to performing the catheterization, the fellow is expected to be involved in the pre- and post-catheterization management of the patient and to obtain informed consent from the parents. Prior to the procedure, the fellow should review the available data to formulate an understanding of the indication for catheterization, the data to be collected, and have developed a plan for the procedure itself. With increasing experience and exposure to the procedures, the fellow will be expected to become adept at the basic skills involved. Following the procedure, the fellow is expected to review and interpret the angiograms, interpret the hemodynamic data, calculate flows, shunts and vascular resistances and present the data at the medical/surgical conference.

Elective Rotations These rotations are designed by the fellow and program director according to the fellows' interests and needs. Electives are often utilized to provide intensive clinical experience, 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 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 general EP and Pacemaker clinics and EP procedures 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. Fellows gain proficiency in interpreting electrocardiograms, holter and event monitors during Inpatient service rotations, call and in their out-patient clinics. Fellows are expected to read ecgs, holters and event monitors on the iECG system.VII. 

Magnetic Resonance Imaging

Dr. Michael Silberbach provides the division with expertise in pediatric cardiac MRI. Dr. Craig Broberg, of the Adult Congenital Division, is also expert in cardiac MRI. 

Out-patient clinic

Each fellow attends Friday morning Fellows Clinic twice monthly. 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 Inpatient Service months are assigned to that fellow's continuity clinic. A fellow may schedule appointments for their patients outside of their clinic date when necessary. 

We have a very 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 out-patients. 

The fellows are welcome to attend the following subspecialty clinics: hyperlipidemia, aortopathy (Marfan), Turners, pulmonary hypertension, transplant, inherited arrhythmia and hypertrophic cardiomyopathy. 

Adult congenital heart disease

Drs. Craig Broberg, Luke Burchill, and Abigail Khan care for a large and growing population of adult patients with congenital heart disease. This group actively participates in our weekly Medical/Surgical and Morbidity and Mortality Conferences. Our fellows assist in the cardiac catheterizations on these patients, and their surgeries are performed by our congenital CT-surgeons. The post-operative care is directed by the ACHD group at OHSU. Fellows are required to attend eight ACHD clinics during the three-year fellowship. 

On-call responsibilities

Fellows take call from home one weeknight a week and every fourth weekend. The fellow is on first call for all parent calls, as well as for any in-house calls from the Resident Staff. Physician referral calls will be directed to the faculty attending on call. All cardiology patients being admitted to the hospital for cardiac or non-cardiac related illnesses, and any cardiac patient presenting to our emergency department with a cardiac-issue should be seen and evaluated by the on-call cardiology fellow. 

The on-call fellow should remain in the PICU overnight for all neonatal surgeries, or hemodynamically unstable post-operative patients. In addition, the on-call fellow should be present at the bedside when a patient returns from the operating room, regardless of the time.  

Lastly, it is expected that the fellow on weekend call will have made rounds prior to combined rounds with the faculty attending. 

Scheduling 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 Inpatient Service 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.

A minimum of 9 months of the three-year fellowship training is assigned to 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. 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. Irving Shen and Ashok Muralidaran in cardiothoracic surgery, Dr. Michael Silberbach in cardiac MRI, as well as additional opportunities in the echocardiography or catheterization laboratories. 

Attendance by audit of an NIH-funded program entitled Human Investigations Program (HIP) is required for first year fellows. This course is a focused approach to clinical research training for physicians and allied personnel. The fellow has the option of taking the course for credit (2-year curriculum, tuition free);the time commitment is at least 2 hrs/wk for ~ 26 weeks. An additional 6 wks of this course is devoted to grant writing skills in a small group setting, culminating in a project proposal for submission to an NIH-equivalent funding agency. Fellows must submit a small grant proposal as a requirement for graduation (funding is not required). 

As required by the ABP each fellow will be assigned a Scholarly Oversight Committee comprised of four or more faculty. The fellows will meet with their SOC biannually to review their research activity, providing additional mentorship and support to ensure 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 experience is to provide the fellow opportunity to develop research skills necessary to become a successful academic pediatric cardiologist and to fulfill the Board requirements.

Weekly conferences

  1. Clinical Sign-in, Mondays: All in-patients and active out-patients on the cardiology service are presented by the weekend fellow on-call. Mandatory.
  2. Medical/Surgical Conference, Fridays:  Our combined cardiology/ cardiothoracic surgery conference reviews all patients scheduled for surgery during the following week. This includes a brief patient history, imaging and catheterization data and a discussion of the planned procedure. Next, patients scheduled for catheterizations during the following week are briefly reviewed. Lastly, patients considered for surgery, or patients with complex clinical issues are discussed. The fellow assigned to the conference month presents all echos shown at the conference. The catheterization data and images are presented by the fellow involved in the procedure, or the faculty if no fellow assisted. Mandatory.
  3. Pediatric Cardiology Fellows Conference, Tuesdays:  A rotating curriculum providing comprehensive coverage of pediatric cardiology topics during the three-year fellowship. Echo, EP, Cath and outpatient cardiology topics are presented weekly by faculty. 
  4. Basic Sciences / Physiology Seminar, Fridays:  This is an excellent educational experience organized by the Adult Cardiology Service and staffed by Adult Cardiology, Basic Sciences, and occasionally Pediatric Cardiology staff. The topics vary on a 3-year rotational basis. Fellows are expected to participate in the review of articles.
  5. "TOFS" Conference, Mondays:  This conference is designed to be a research conference for presenting new or preliminary data. It is attended by fellows, graduate students, and staff from Adult and Pediatric Cardiology, Cardiac Surgery and Basic Science Divisions. The forum offers an excellent exposure to the variety of research being done within the institution.

Monthly conferences

  1. Pediatric and Congenital Cardiology Interventional (Cath/Surgical) Morbidity and Mortality Conference, Monday, 4-5:30 p.m.:  A detailed review of cardiac catheterizations or surgeries.  Patients are presented by the fellows along with a detailed literature review.  Mandatory.
  2. Pediatric Cardiology Journal Club, Tuesday, 12-1 p.m.:  Articles reviewed from major cardiology journals.  Several articles are selected and moderated by a faculty member with fellows presenting the papers. Emphasis is placed on achieving an evidence-based practice of medicine and arriving at a consensus statement among the group members. Mandatory.
  3. Pediatric and Congenital Cardiology Specialty Series, Friday, 12-1p.m.:  Monthly presentations encompassing specific areas of interest and expertise by members of the congenital cardiac program.  Mandatory.
  4. Non-invasive imaging Morbidity and Mortality:  Every other month, patients presented by faculty, fellows, and sonographers along with a detailed literature review.

Application

Required application documents (submitted through ERAS) include:

  • Completion of the on-line ERAS application (including personal statement, curriculum vitae, hobbies, USMLE scores, etc.)
  • Medical Student Performance Evaluation (MSPE) from the dean of your medical school
  • Medical school transcript
  • A letter of verification from the program director(s) of prior residency training, including dates, location and verification of completion 
  • Verification of any previous staff positions
  • Two letters of reference from faculty at your current training program or professional colleagues if not in training (including the evaluation form) 

Evaluation form

Laurie Armsby, M.D.
Pediatric Cardiology Fellowship Program Director
Associate Professor of Pediatrics
Division of Pediatric Cardiology
Oregon Health & Science University
armsbyl@ohsu.edu 

Liz Schultz
Pediatric Cardiology Fellowship Program Coordinator
Division of Pediatric Cardiology
Oregon Health & Science University
503-494-9899
fax 503-494-2824
schulliz@ohsu.edu

Contact us

Laurie Armsby, M.D.
Pediatric Cardiology Fellowship Program Director
Associate Professor of Pediatrics
Division of Pediatric Cardiology
Oregon Health & Science University
armsbyl@ohsu.edu

Liz Schultz
Pediatric Cardiology Fellowship Program Coordinator
Division of Pediatric Cardiology
Oregon Health & Science University
503-494-9899
fax 503-494-2824
schulliz@ohsu.edu

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