Pediatric Cardiology Fellowship

Each fellow completes 14 weeks of clinical training in the Cardiac Intensive Care Unit (CICU) over the course of the fellowship. During the rotation, a senior pediatric cardiology fellow and a pediatric critical care fellow share clinical responsibilities and call coverage.
The CICU fellow participates in the comprehensive cardiology and critical care management of patients with surgical and medical cardiac conditions. Clinical responsibilities, including call, are structured to comply with ACGME duty-hour requirements and average fewer than 80 hours per week.
A cardiac intensive care attending physician provides direct supervision of patient care, leads daily multidisciplinary rounds, and is available for supervision while on call. Fellows receive progressive training in cardiac pathophysiology, perioperative and postoperative management, cardiovascular and critical care medicine, hemodynamic monitoring, and critical care procedures.

Each fellow completes 28 weeks of clinical training in the Non-Invasive Imaging Laboratory over the three-year fellowship. Fellows receive comprehensive instruction in cardiovascular imaging, with an emphasis on transthoracic echocardiography, as well as exposure to transesophageal echocardiography, fetal echocardiography, and cardiac cross sectional imaging.
Training is provided through hands-on experience under the supervision of cardiac sonographers, senior pediatric cardiology fellows, and faculty specializing in echocardiography and cardiac CT and MRI. Fellows develop proficiency in image acquisition, interpretation, and integration of imaging findings into clinical decision-making.
The fellow assumes an active role in the laboratory by performing transthoracic echocardiographic examinations and interpreting anatomic, Doppler, ventricular function, and hemodynamic studies under faculty supervision. Exposure to transesophageal echocardiography includes participation in perioperative, catheterization, and diagnostic examinations, while fetal echocardiography training focuses on the evaluation of normal and abnormal fetal cardiovascular anatomy and physiology. Fellows also gain introductory experience in the indications, acquisition, and interpretation of congenital cardiac MRI studies.
In addition to clinical training, fellows participate in a biweekly echocardiography conference led by senior fellows and faculty, which provides structured instruction in imaging techniques, congenital heart disease, hemodynamic assessment, and advanced echocardiographic interpretation.

Each fellow completes 24 weeks on the inpatient cardiology service over the course of the three-year fellowship. During this rotation, the fellow serves as the primary cardiology trainee responsible for the evaluation and management of patients admitted to the cardiac inpatient unit and for providing inpatient cardiology consultation services throughout the hospital.
The fellow leads the multidisciplinary inpatient team, which includes advanced practice providers, pediatric residents, and medical students, and assumes an active role in both formal and informal teaching. Responsibilities include developing diagnostic and management plans, coordinating patient care with consulting services, participating in multidisciplinary rounds, and facilitating communication with patients, families, and the healthcare team.
The fellow also evaluates and manages inpatient cardiology consultations from the emergency department, neonatal intensive care unit, pediatric intensive care unit, cardiac intensive care unit, and other hospital services, with progressive responsibility based on level of training.
All clinical activities are directly supervised by the attending pediatric cardiologist assigned to the inpatient service. Through this rotation, fellows gain experience in the diagnosis and management of a broad spectrum of congenital and acquired heart disease while developing leadership, communication, and teaching skills essential for independent practice.

Each fellow participates in a weekly half-day continuity ambulatory cardiology clinic throughout the three-year fellowship. Clinics are supervised by one or more attending pediatric cardiologists who provide direct supervision, teaching, and graduated clinical responsibility.
During each clinic session, fellows evaluate patients referred for outpatient pediatric cardiology consultation, including those with suspected or confirmed congenital and acquired heart disease, arrhythmias, syncope, chest pain, hypertension, cardiomyopathies, and other cardiovascular conditions. Fellows formulate diagnostic and management plans, interpret diagnostic studies, counsel patients and families, and coordinate ongoing care under faculty supervision.
The continuity clinic provides fellows with longitudinal experience in the outpatient management of pediatric cardiovascular disease. Fellows establish and maintain continuity with patients requiring ongoing follow-up, including those with simple and complex congenital heart disease, and continue the care of patients initially evaluated during previous inpatient rotations or hospitalizations.
This longitudinal experience enables fellows to develop proficiency in outpatient evaluation, clinical decision-making, interpretation of cardiovascular testing, patient and family counseling, preventive cardiology, and coordination of multidisciplinary care while fostering increasing independence in ambulatory pediatric cardiology practice.

Each fellow completes a total of 16 weeks of training in the Cardiac Catheterization Laboratory. During this rotation, fellows actively participate in all aspects of patient care and procedural preparation. Responsibilities include pre-procedural evaluation and planning for each case, reviewing diagnostic data, and discussing the risks, benefits, and alternatives of the procedure with patients and families while obtaining informed consent under attending supervision.
Under the supervision of an attending interventional cardiologist, fellows participate in the performance of diagnostic and interventional cardiac catheterization procedures.
At the conclusion of each procedure, fellows analyze and interpret hemodynamic data, oxygen saturation measurements, angiographic findings, and procedural outcomes, with emphasis on understanding cardiovascular physiology and integrating catheterization findings into clinical decision-making. Fellows also participate in post-procedural management, including vascular access care, recognition and management of complications, communication of procedural results, and development of ongoing treatment plans.
As the rotation progresses, fellows gain increasing proficiency in obtaining comprehensive hemodynamic assessments, performing angiography, and participating in a broad range of interventional procedures. Structured training includes neonatal and infant cardiac catheterization, transcatheter device closure, balloon angioplasty and valvuloplasty, stent implantation, transseptal techniques, transcatheter pulmonary valve implantation, and other catheter-based interventions, with graduated responsibility based on demonstrated competence and experience. Fellows are expected to present cases during the daily catheterization conference, contributing to procedural planning, review of cardiovascular anatomy and physiology, and post-procedural discussion of findings and outcomes.

Each fellow completes a total of 8 weeks of training in the Electrophysiology rotation. During this rotation, fellows actively participate in all aspects of pediatric cardiac electrophysiology, including the electrophysiology laboratory, inpatient consultation services, and outpatient arrhythmia clinics. Fellows participate in the evaluation and management of patients with congenital and acquired cardiac rhythm disorders under the supervision of the attending electrophysiologist.
In the electrophysiology laboratory, fellows assist the attending electrophysiologist in performing intracardiac electrophysiology studies, catheter ablations, and intraoperative electrophysiology procedures, further broadening their procedural and diagnostic expertise in pediatric cardiology. Fellows gain experience in procedural preparation, interpretation of intracardiac electrograms, and post-procedural management.
Fellows also assist the attending electrophysiologist with inpatient and outpatient consultations for patients with arrhythmias, syncope, palpitations, and conduction abnormalities. Additional responsibilities include the interpretation of electrocardiograms (ECGs), ambulatory rhythm monitoring studies, including 24-hour Holter monitors, and participation in the performance and interpretation of cardiopulmonary exercise testing and exercise stress testing. As the rotation progresses, fellows assume increasing responsibility for patient evaluation, diagnostic interpretation, clinical decision-making, patient counseling, and communication with referring physicians and multidisciplinary care teams under attending supervision.

The Division of Cardiology maintains that experience in cardiovascular research is an essential component of fellowship training in cardiology. Fellows have 12 months of research over the course of their fellowship. Fellows are expected to get involved in a research project during their fellowship, under the guidance of one of the faculty. Such projects, either new or ongoing, will often be of the chart review type, and may form the basis for a future prospective study for those fellows interested in clinical research. Fellows need to identify a research mentor from among the faculty by the end of their first year. The faculty assists the fellows in identifying projects, resources, and mentors. A scholarship oversight committee (SOC) is assigned to each fellow to biannually monitor and review the fellow’s progress throughout fellowship training. During the first half of the second year, the fellow is expected, with appropriate guidance, to write and submit an IRB proposal for a research project which: (1) addresses an important question; (2) applies available state-of-the-art techniques to answering that question; and (3) is practical within the time and other constraints of the fellowship. By the end of the fellowship, each fellow should have been intimately involved with a research study such that has given the fellow an opportunity to produce a meaningful research product as determined by their individual SOC. Preferably each fellow produces a meaningful product like a manuscript that is either ready for submission or has been submitted and accepted for publication in a peer review journal.

In addition, the research fellow is responsible for reviewing and presenting a current or relevant journal article in the monthly fellow journal club.