The ACHD Fellow will participate in outpatient clinics throughout the fellowship. We hold clinics specific for ACHD each day of the week either at Nationwide Children's Hospital cardiology outpatient clinic or The OSU Ross Heart Hospital. Schedule assignments are determined ahead of each week giving the fellow the opportunity to review charts and prepare for clinic. Our clinic is supported by an ACHD team consisting of the attending ACHD cardiologists, ACHD APN, and ACHD RN. In many of the weekly clinics, we will have a psychologist and nutritionist in clinic with us to see patients upon request. The clinic schedules are typically quite full with an average volume of 70-90 pts per week. In a month not specifically assigned to a rotation, the fellow would attend 2 to 2.5 clinics per week. On rotation, (ie MRI, inpatient, Echo) the fellow would attend 1 full day per week.
The ACHD Fellow will provide consults and round on the ACHD inpatients when available during year 1 of fellowship and provide inpatient support on a more regular basis during year 2. The consult team consists of the ACHD fellow, ACHD APN and the ACHD attending provides overview and support. The inpatient and consult service carries a census at both hospitals (Nationwide Children's and OSU) and on average is 5-10 pts in house each day.
Our ACHD fellows are accepted into our program from either an IM or Pediatric Cardiology background and as such have areas of strength and areas necessary to gain experience and expertise to become an ACHD trained physician. Therefore, we tailor our fellowship for the individual trainee. Those from an IM background will spend additional time in pediatric cardiology (echo lab, cath lab) and those from a pediatric cardiology fellowship will learn IM cardiology principles with time dedicated to IM cardiology rotations (echo lab, inpatient service). This format follows the proposed petition to the ABIM for subspecialty certification for ACHD.
Imaging rotation for the ACHD fellows will provide experience according to the specific pathway (internal medicine vs pediatric). The IM cardiology fellow will spend additional time in the pediatric cardiology echo lab to better understand childhood CHD with unrepaired defects, undiagnosed newborns, recently repaired lesions, and intraoperative TEE. For the pediatric cardiology fellow, additional time will be spent in the adult echo lab to gain experience with ischemic heart disease, analysis of LV wall motion, stress testing, and TEE. The goal of this rotation is to individualize the experience to meet the needs of the ACHD fellow and prepare the trainee for a career in ACHD.
Advances in ACHD care lead to the ACC/AHA guidelines for the management of ACHD published in 2008. Embedded within those guidelines are lesion specific recommendations for the evaluation of adults with CHD. For most forms of moderate and severe/complex CHD, evaluation by Cardiac MRI (CMR) is a Class 1 indication. As such, those caring for adults with CHD must have a strong knowledge base in CMR/CT for ACHD. Our cardiac MRI program at OSU is one the leading imaging labs in the country directed by Subha Raman, MD and controlled by the cardiology division. We have developed lesion specific protocols for ACHD and have faculty trained in ACHD to guide the examination and interpretation. With over 400 scans/year, and specific rotations for the ACHD fellow, comprehension and knowledge in ACHD MRI/CT will clearly improve with greater ability to understand protocols and interpret images. The ACHD Fellow will spend 2 -3 months dedicated to ACHD CMR/CT.
Depending on the interest of the ACHD fellow, the majority of ACHD cardiac catheterization time will be spent in observation. Certainly fellows with advanced skill and interest will have opportunities to be a part of ACHD catheterization interventions. Most of this time will be spent at Nationwide Children's. Our interventional Hybrid catheterization laboratories at Nationwide Children's, directed by John Cheatham, MD provides an environment unlike any in the country. The specific Hybrid labs, first in the US, are the basis for our outstanding outcomes in ACHD interventional procedures. Dr. Cheatham is one of only handful of highly skilled, experiences operators in the US who has developed and performed procedures only a few places in the world have attempted and been successful for ACHD patients. Including transcatheter valve therapy, device closure techniques, covered stent procedures and Hybrid approaches to complex patients, the experience for the ACHD fellow both in the lab and through observation is essential for ACHD training and career development.
The ACHD fellow will spend time understanding and managing (along with the ACHD team) the post-op care for ACHD patients undergoing CT surgery. This is be on the form of post-op consults in the CTICU and the floor unit. The Central Ohio Adult Congenital Heart Disease (COACH) program sends 30-40 patients to the OR each year. The fellow will work with the CTICU team along with the ACHD attending responsible for inpatients consults.
We have built into our program sufficient time (at least 6months) to develop skill and experience in specific areas of ACHD including CMR/CT, echocardiography, pulmonary hypertension, and research. This decision will be discussed with the ACHD, Pediatric Cardiology, and Internal Medicine Cardiology Fellowship Directors prior to the beginning of the second year of ACHD fellowship to map out a plan for year 2.
ACHD Research, as part of our program, will be an ongoing process throughout fellowship. Trainees will meet with Ali Zaidi, MD early in fellowship to gauge interest in particular areas of our current research and determine steps to foster an individualized plan for fellowship ACHD research. Opportunities such as writing reviews, contributing to chapters, and conducting new and innovative research are available and expected. We provide support for the fellow with a research team of study coordinators, IRB specialists, and database personnel.