Fellowship Experience

 

Outcomes Data

Our multidisciplinary team model at The Heart Center enables our team to constantly monitor quality of care and patient safety pre- and post-surgery to assure the best possible outcomes.

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The inpatient unit is a 24-bed step-down unit. Morning rounds are held daily with a multidisciplinary team consisting of senior residents, nurse practitioners, medical students, pharmacists, dieticians and social workers dedicated to the inpatient care unit. The team is supervised by the fellow and the cardiology attending. All postoperative cardiothoracic surgical patients are cared for by the cardiology medical service when they are transferred from the intensive care unit to the cardiology unit. In addition to immediate postoperative patients, the fellow will be involved in the care of patients of all ages with congenital and acquired heart disease, complex arrhythmias and heart failure. The fellow on service will directly supervise the pediatric residents and rotating medical students. They will participate in resident and medical student teaching. 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 discharges per year = 810
• Average number of open heart surgeries per year = 260
• Average number of overall cardiothoracic surgeries per year = 430
• 24-bed Heart Center inpatient unit
• Telemetry
• Electronic medical record system
• Arrhythmia Monitoring - 24-hour full disclosure monitoring with monitoring technician present

Consultative Services

The cardiology consultative service provides cardiac care throughout the hospital, including our NICU, PICU, ED and our active BMT and Oncology services. This service serves as the primary point of contact for all cardiology sub-specialties, ensuring a mixture of complex congenital NICU co-management, active involvement in both EP and heart failure management outside of the cardiology units, and acute care and resuscitation of cardiac patients in the ED. In addition, the fellow will get experience assessing general cardiology issues including Kawasaki, rheumatic heart disease, and endocarditis among many other diseases. Fellows spend two months on the consult service during the second and third years with a gradation of responsibility to eventually acting as an attending on their third year service-time. The consultation team consists of two full time nurse practitioners, fellow and attending cardiologist.

• Average number of consults per year = 1,110
• 74-bed Pediatric Intensive Care Unit
• 146-bed Neonatal Intensive Care Unit

CT-ICU Experience

The fellow will participate directly in management of patients in the cardiothoracic intensive care unit. The CTICU cares for patients of all ages, from prostaglandin-dependent newborns to adults with CHD, with approximately 80% surgical patients and 20% cardiac medical patients. They will be involved in the care for patients pre and post heart transplantation and heart/lung transplantation. All patients admitted to the CTICU are managed by the cardiac intensivist (nine faculty on staff). The management is a team approach coordinated by a cardiac intensivist with collaboration from cardiothoracic surgeons and subspecialty cardiologists as needed. The fellow benefits from the interaction of a multidisciplinary team involving faculty of various backgrounds, APNs, RN, RT, Pharmacy and nutritionist.

Rounds are held twice daily with a formal huddle performed prior to the morning rounds. There are two fellow roles in the CTICU. During the first few rotations, the fellow will assume the role of primary managing provider for their assigned patients in the CTICU responsible for all medical issues under the direct supervision of the cardiac intensivists. As they progress, they will assume a more supervisory role over a larger number of patients.

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, mechanical circulatory support modalities (including ECMO and VADs), and ventilators.

• 20-bed CTICU
• Average number of open heart operations per year = 260
• Average number of overall cardiothoracic surgeries per year = 430
• 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 and weekly catherization review conference. Interventional catheterization including septostomy, valvuloplasty, angioplasty, stents, coil embolization, atrial and ventricular septal device closure and transcatheter valve implantation. 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 = 550
• Average number of interventional catheterizations per year = 340
• 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 3D TEE
• Innovative combined surgical and catheterization approach for complex CHD: hybrid procedures

Echocardiography/MRI

The primary goal of this rotation is to develop competence in the use of two-dimensional and Doppler transesophageal echocardiography in the evaluation of patients (neonates through young adults) with suspected or proven heart disease. The fellow will gain the skills to both perform and interpret echocardiograms during this rotation. The attending physicians along with experienced teaching pediatric echocardiography technicians will supervise the fellow performing the examinations. As the fellow’s skills progress, they will get exposure to increasing complex and challenging patients. As senior fellows, they will have the opportunity to be involved in our very active fetal echocardiographic program including counseling of families after significant findings. They will also participate in all transesophageal echocardiograms in the operating room, interventional catheterizations, and outpatients. They will also have exposure to cardiac MRI/CT throughout their training with the option for more in-depth training if interested.

• Average number of echocardiograms per year = 15,200
• Average number of fetal echocardiograms per year = 800
• Average number of cardiac MR/CT per year = 800
• 3D echo acquisition system
• Fetal echocardiograms
• Realtime remote viewing station
• Transesophageal echocardiograms
• Philips and Accuson 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 transesophageal electrophysiologic procedures, intra-cardiac electrophysiologic studies and radiofrequency catheter ablation procedures. Fellows will perform all arrhythmia consults and will participate in pacemaker interrogations and programming. The fellow will participate in pacemaker implants and postoperative follow-up. Fellows will be responsible for interpreting electrocardiograms and Holter monitors. The fellow will be able to review the studies 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 = 16,920
• Average number of Holter monitors per year = 2,790
• 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 3D Electroanatomic Mapping  

Exercise

The goal of this rotation is to understand the role of cardiopulmonary exercise testing in children and young adults. The fellow will participate directly with 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 two months during the first year dedicated for research. During this time, they will meet with the Director of Research and explore the different areas of ongoing research, identify faculty research mentors and begin to solidify a research focus where they wish to proceed in the upcoming years. They will have an additional 10 months devoted toward areas of research (clinical, translational, basic science) and clinical interest. It is expected that the fellow will engage in scholarly activities throughout their training as guided by the fellow’s Scholarship 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 often be a member of the Division of Pediatric Cardiology, however, it is possible that a faculty mentor may be from another division, from another discipline, another department or another college. The Ohio State University and the Abigail Wexner Research Institute at Nationwide Children’s Hospital have a wealth of potential research opportunities in different related fields including cardiovascular development and physiology and the genetics of cardiac diseases. The Research Institute at Nationwide Children's Hospital is housed in three state of the art research facilities.

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 a project to the IRB, and manuscript preparation. The fellows are also encouraged to engage in research activities at the Abigail Wexner Research Institute. This will allow exposure to basic research opportunities.

• Grants administration department for facilitating grant applications
• Dedicated echocardiographic equipment and ingle-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 (if appropriate)

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 all other clinical and research responsibilities with the exception during their CTICU rotation. The continuity clinic is under the direct supervision of our core cardiology faculty members. In their third year, fellows will have the opportunity to participate in outreach clinics and other subspecialty clinics if interested.

Individuals with specific interests in adult congenital heart disease may request a greater emphasis in clinics with the adult congenital cardiologist. Fellows will learn to develop cost-effective outpatient management plans. The fellow will also develop their own patient population through inpatient admissions (new infants with congenital heart disease, admissions from the Emergency Department and consultations). The fellow is responsible for ordering and follow-up of all outpatient testing performed on their patients (e.g. echocardiograms, Holter monitors, transtelephonic monitors, CT/MRI’s). The fellow will be responsible for communicating test results and follow-up on management plans.

Conferences

There are a number of conferences and lecture series for the fellow to attend. At the Didactic Lecture Conference is a lecture series built on core topics in the practice of pediatric cardiology. Attendings, cardiology fellows and guest speakers present the lectures. The topics rotate over a two-year period, allowing the fellow an opportunity to hear each topic at least once during their fellowship.

At the Cardiothoracic Surgery/Case Management Conferences, preoperative and complex catheterization cases are presented by cardiology faculty or fellows. Surgical cases referred from outside institutions are also reviewed. Surgical and catheterization 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 Abigail Wexner Research Institute	Weekly	Optional	Participates as learner

Adult Congenital and Acquired Heart Disease

The majority of children and adolescents with heart disease are reaching adulthood and require ongoing specialized cardiovascular care. Patients with congenital heart disease comprise the majority of this group and continue to have cardiovascular problems that require lifelong subspecialty care. The Heart Center in collaboration with OSU Wexner Medical Center has developed a comprehensive multi-specialty program for the evaluation and care of these adolescent and young adults with heart disease. During their rotation, fellows will participate in the assessment and management of these patients primarily as outpatients in outpatient clinics her at Nationwide Children's as well as at OSU and outreach clinics. In addition to this rotation, fellows will have exposure to adult patients throughout their fellowships on the inpatient, catherization and EP rotations.

• 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