Cardiology Fellowship Experience :: Nationwide Children's Hospital

Cardiology Fellowship Experience

Inpatient Cardiology Experience

The inpatient unit is a 25 bed step-down unit. A team consisting of housestaff and medical students dedicated to the inpatient care of the cardiac patient is supervised by the fellow, nurse practitioner and the cardiology attending. All postoperative cardiothoracic surgical patients are on the cardiology medical service when they are transferred from the intensive care unit to the cardiology floor. The fellow on service will directly supervise the pediatric residents and rotating medical students. The fellow will also be the consultant to other non-ICU services. In doing so, the fellow will learn his/her role as a consultant. The fellow will provide communication to the primary care physician. Issues of cost effective care and managed inpatient health care will be addressed on this rotation.

  • Average number of consults per year = 3,958

  • Average number of discharges per year = 584

  • Average number of open heart surgeries per year = 233

  • Average number of overall cardiothoracic surgeries per year = 429

  • 25-bed Heart Center inpatient unit

  • Telemetry

  • 24-hour full disclosure monitoring with monitoring technician present

CT-ICU Experience

The fellow will participate directly in management of cardiac patients in the cardiac intensive care unit. The vast majority are patients who had recent cardiac surgery.  All patients admitted to the Cardiothoracic intensive care unit are managed by the cardiac intensivist (8 faculty on staff). The management is a team approach coordinated by a cardiac intensivist with collaboration with cardiothoracic surgeons and cardiologists.  The fellow benefits from the interaction of a multidisciplinary team involving faculty of various backgrounds.

Rounds are held twice daily with a formal huddle performed prior to the morning rounds. The fellow will work directly with the team in postoperative management.  There are two rotations in the CT-ICU.  One rotation is as the primary fellow in the CT-ICU being responsible for all patient care within that unit under the supervision of the cardiac intensivists.  The second rotation allows the fellow to act as a cardiology consultant in the CT-ICU, PICU, and NICU where one is responsible for all cardiac related issues and care plans associated with patients in all of these venues.

The fellow is encouraged to spend time in the operating room observing surgery, assist in preoperative and postoperative assessment of the patient and help make a smooth transition from the intensive care unit setting to the ward. The fellow will gain experience with management of multisystem organ dysfunction, use of inotropic agents, postoperative arrhythmias, temporary pacemaker function and ventilators.

  • 20-Bed CT-ICU

  • 26-Bed Pediatric Intensive Care Unit

  • 77-Bed Neonatal Intensive Care Unit

  • Average number of Open Heart Operations per year: 233

  • Average number of overall Cardiothoracic Surgeries per year: 429

  • 24-hour full disclosure monitoring

  • Mechanical Circulatory Support

  • Electronic medical record system

  • Arrhythmia Monitoring with 24-hour Full Disclosure Monitoring

Cardiac Catheterization

The goal of this rotation is to provide the experience and instruction in the technologies, indications, and limitations for cardiac catheterizations and therapeutic interventional procedures. The fellow is involved in all aspects of care for the patient referred for cardiac catheterization.   The fellow will present selected cardiac catheterization cases at the weekly case management conferences. Interventional catheterization including septostomy, valvuloplasty, angioplasty, stents, coil embolizations, and Melody valve implantation account for the majority of cases. As the fellow develops increasing skills within the cardiac catheterization suite, he/she will be provided with increasing participation during the procedure.

  • Average number of Cardiac Catheterizations per year = 612

  • Average number of Interventional Catheterizations per year = 416

  • Two Biplane State of the Art Digital Hybrid Catheterization Laboratories

  • Direct Connection to Operating Room for real-time consultation between Surgeon and Cardiologist

  • Simultaneous ICE and 3-D TEE

  • Innovative Combined Surgical and Catheterization approach for Complex CHD:Hybrid Procedures. 

Echocardiography/ MRI

The goal of this rotation is to develop competence in the use of two-dimensional Doppler, M-mode, transesophageal and fetal echocardiography, radiological cardiac imaging in the evaluation of patients (neonates through young adults) with suspected or proven heart disease. The fellow will perform and interpret echocardiograms during this rotation. The attending physicians with pediatric echocardiography technicians will supervise the fellow performing the examinations. The fellow will get exposure to a very active fetal echocardiographic service including counseling of families after significant findings. They will also participate in all transesophageal echocardiograms in the OR, interventional catheterizations, and as outpatient procedures during the rotation.

  • Average number of Echocardiograms per year = 10,994

  • Average number of Fetal echocardiograms per year = 909

  • 3-D Echo Acquisition System

  • Fetal Echocardiograms

  • Realtime Remote Viewing Station

  • Transesophageal Echocardiograms

  • Agilent, Accuson, and GE Echo Machines

Electrophysiology

The goal of this rotation is to give the fellow exposure to the use of non-invasive and invasive techniques in evaluating and treating arrhythmias. The fellow will be involved in all tilt table tests, transesophageal electrophysiologic procedures, intra-cardiac electrophysiologic studies and radiofrequency catheter ablations. He/she will perform all arrhythmia consults, and will participate in pacemaker interrogations and programming. The fellow will participate in pacemaker implants and postoperative follow-up. He/she will be responsible for interpreting ECG's throughout the fellowship. The fellow will be able to review the ECG with the electrophysiology attending. Holter monitors that are requested for arrhythmia service consultation will also be interpreted by the fellow on this rotation.

  • Average number of Electrocardiograms per year = 11,415

  • Average number of Holter Monitors per year = 971

  • Tilt Table Testing

  • EP Lab with 128 Channel Acquisition

  • ICD Implants (Performed in cath lab and OR)

  • EP Lab with state of the art digital flat panel Biplane Fluoroscopy

  • Radiofrequency Cryo Ablation Technology

  • Carto and Ensite 3-D Electroanatomic Mapping

Pathology

The fellow will devote one month during the first year to the study of congenital heart disease pathology. The fellow will work directly with our cardiac pathologist.

Emphasis is given to correlate pathologic specimens to imaging of congenital heart disease. In addition, surgical technique for each type of CHD will be studied. 

Exercise

The goal of this month is to learn the role of cardiopulmonary exercise testing in children and young adults. The fellow will participate directly with all exercise tests. The interpretation of each test will be reviewed with the exercise physiology technician and the pediatric cardiologist responsible for the evaluation.

  • Exercise Lab with Breath-by-breath Analysis, PFT's, Non-invasive cardiac Output

  • Cycle Ergometry, Treadmill, Supine Ergometry

Research

The fellow will have one month during the first year for background research in different areas to evaluate where he/she wishes to proceed in the upcoming year. He/She will have an additional 11 months devoted toward areas of research (clinical, translational, basic science)and clinical interest. It is expected that the fellow engage in scholarly activities throughout their training, but these months are concentrated toward completing set goals as guided by the fellows' Scholarly Oversight Committee.

Under the direction of a faculty mentor, the fellow will develop a research project and/or submit a grant application for a project during the first two years of training. The fellow will complete the project during the second and third years and write a research paper prior to completing the fellowship. The research project can be either in clinical or basic sciences. The fellow is encouraged to develop and complete additional scholarly activities during their fellowship.

The faculty mentor will usually be a member of the Division of Pediatric Cardiology, however, it is possible that a faculty mentor may be ITom either another division from another discipline., another department or another college. The Ohio State University and Children's Hospital's Research Institute have a wealth of potential research opportunities in different related fields including cardiac physiology and genetic related cardiac diseases.

The fellow is expected to attend the Core Competency Lectures which will cover the various aspects of research. These include research design, statistics, preparation of funding grants, submission of project to the IRB, and manuscript preparation. The fellows are also encouraged to engage in research activities at The Research Institute at Nationwide Children's Hospital. This will allow exposure to basic research opportunities.

  • The Research Institute at Nationwide Children's Hospital is housed in two state of the art research facilities.

  • Grants Administration Department for facilitating grant applications

  • Dedicated Echocardiographic Equipment and Single-Plane C-arm Fluoroscopy Unit

  • Fully-equipped Operating Rooms for Acute and Chronic Animal Studies

  • Fully-equipped and Staffed Facility for Cellular and Molecular Biology Research

  • Clinical Studies Center: Fully-staffed Nursing Unit for Human Subjects

  • Full and Close Access to Research Being Pursued on the Main Campus of The Ohio State University

Summary of responsibilities

Year 1

1. Identify research project and faculty research mentor
2. Prepare documents for institutional approval for the conduct of research project

Year 2

1. Conduct research/gathering of data
2. Perform data analysis
3. Submission of study in abstract for presentation at scientific meeting (national,
regional, and/or local)
4. Identify prospective research project
5. Develop research project protocol and submit for institutional approval
6. Submit application for local Grant support

Year 3

1. Completion of data analysis
2. Submit manuscript to peer review journal
3. Completion of prospective research project
4. Submission of study in abstract for presentation at scientific meeting (national, regional, and/or local)
5. Identify research interest as part of professional/career development
6. Consider submission of grant for prospective research project (national or regional)

Cardiology Continuity Clinic

Each fellow will have cardiology continuity clinic one half-day per week with consistent faculty mentors for the duration of their fellowship. Continuity clinic is a top priority and takes precedence over virtually all other clinical and research responsibilities. The continuity clinic is under the direct supervision of our core cardiology faculty members.

In addition, the fellow will have one month devoted to the cardiac clinics to gain exposure to other faculty members within the division.  He/She will have the opportunity to participate in the many outreach clinics staffed by one of our pediatric cardiologist. This allows the trainee to learn more than one approach to outpatient management of cardiac disease.

Individuals with specific interests in adult congenital heart disease will have a greater emphasis in clinics with the adult congenital cardiologist. Trainees will learn to develop cost-effective outpatient management plans. The fellow will also develop his/her patient population through inpatient admissions (new infants with congenital heart disease, admissions from the Emergency Department and consultations). The fellow interprets all outpatient testing performed on his/her patient (e.g. echocardiograms, ECG's, Holter monitors, transtelephonic monitors).

Conferences

There are a number of conferences and lecture series for the fellow to attend. At the Didactic Fellowship Conference, the attendings, cardiology fellows and guest speakers are on a rotation to present the lectures. These topics are covered over a 2-year period, allowing the fellow to hear topics at least once.

At the Cardiothoracic Surgery/Case Management Conferences, preoperative cases are presented by cardiology faculty or fellows. Complex patient cases are reviewed and all the cases from the previous week are reviewed. Periodic Journal clubs and business meetings will be scheduled.

Conference Frequency Attendance Role of Fellow
Didactic Conference Weekly Required Participates as learner and presenter
Heart Center Case Management Twice a week Required Conducts conference, presents case and participates in discussion.
Heart Center QI/M&M Monthly Required Participates in presentations and discussion
Fellowship Core Competency Series Monthly Required Participates as learner
Echo Weekly Required Participates in presentations and discussion
Heart Center Research Monthly Optional Participates in presentations and discussion
Nationwide Children's Hospital Grand Rounds Weekly Optional Participates as learner
The Research Institute Weekly Optional Participates as learner

Adult Congenital and Acquired Heart Disease

Children and adolescents with heart disease are reaching adulthood and require ongoing specialized cardiovascular care. Those with congenital heart disease comprise the majority of this group. Despite prior palliative cardiothoracic surgery, many patients continue to have cardiovascular problems that require lifelong subspecialty care. The cardiologists have combined their experience and expertise to develop a comprehensive multi-specialty clinic for the evaluation and care of the adolescent and young adult with heart disease. All fellows are encouraged to assist in the care of these patients.

  • Medical and Surgical Evaluations of over 2,000 Patients with Congenital Heart Disease

  • Genetic and Risk Factor Testing of Patients and their Families with Premature Coronary Artery

  • Pre-pregnancy Cardiac Examinations and Continual Medical Care for Patients with Heart Disease

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