ACHD Fellowship Curriculum
ACHD Outpatient Clinic
The ACHD fellow will participate in outpatient clinics throughout the fellowship. We hold clinics each day of the week at Nationwide Children's Hospital cardiology outpatient clinic and The Ohio State Medical Center Ross Heart Hospital in addition to outreach clinics around Central Ohio. In addition to patients with ACHD, our clinics also serve patients with pulmonary hypertension, connective tissue diseases (Marfan, Loeys Dietz, Turner syndrome, etc.), heart disease in pregnancy, and more. 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 social worker and nutritionist available 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 an elective rotation, the fellow would attend ~3 clinics per week. On elective (i.e. MRI, echo, cath) or inpatient rotations, the fellow would attend 1 full day per week.
Clinic Highlights
- Over 5000 ACHD clinics visits per year; one of the largest in the United States (ACHA Program Directory)
- Primary Clinics located at Main Campus Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center (OSUWMC)
- Outreach ACHD Clinics throughout Ohio
- Combined ACHD EP Clinic
- Combined ACHD/HF Clinic
ACHD Inpatient Consults
The ACHD fellow will provide consultation service 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 with the ACHD attending providing overview and support. The inpatient consult service carries a census at both hospitals (Nationwide Children's and OSU) and on average is 5-10 pts in house each day.
Internal Medicine vs. Pediatric Pathway
Our ACHD fellows are accepted into our program from either an Internal Medicine or Pediatric Cardiology background and as such have areas of strength and areas necessary to gain additional 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.
ACHD Cardiac Imaging
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.
ACHD MRI/CT
Advances in ACHD care led to the ACC/AHA guidelines for the management of ACHD published in 2018. 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. 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.
ACHD Cardiac Catheterization
Depending on the interest of the ACHD fellow, the majority of ACHD cardiac catheterization time will be spent in observation. 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, led by Aimee Armstrong, 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. The ACHD program works closely with ACHD interventionalists who have 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.
ACHD CTICU
The ACHD fellow will spend time understanding and managing (along with the ACHD team) the post-op care for ACHD patients undergoing CT surgery. Fellow involvement may include participation in intraoperative transesophageal echocardiography during ACHD surgeries, as well as post-op care and management either in a consultative role or through rotations in the NCH CT-ICU.
ACHD Electives
We have built into our program sufficient time (at least 6 months) to develop skill and experience in specific areas of ACHD including CMR/CT, echocardiography, pulmonary hypertension, cardiac catheterization and research. Elective planning is individualized based on fellow interest and experience. For example, prior graduates from our ACHD fellowship program have achieved level 3 cardiac MRI training during their fellowship, completed Masters in Education, and developed and participated in an advanced ACHD heart failure curriculum.
ACHD Research
ACHD Research, as part of our program, will be an ongoing process throughout fellowship. Trainees will meet with our faculty 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.