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D15222 Clinical Fellowship BRO

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  • 1. FELLOWSHIP TRAINING PROGRAM IN PEDIATRIC CARDIOLOGY Indiana University School of Medicine James Whitcomb Riley Hospital for Children
  • 2. TABLE OF CONTENTS Philosophy...........................................................................................................1 Goals....................................................................................................................1 Medical Inpatient Service .............................................................2 Outpatient Clinics..........................................................................2 Cardiac Catheterization .................................................................3 Electrophysiology...........................................................................3 Exercise Physiology........................................................................3 Echocardiography ..........................................................................4 Research .........................................................................................4 Faculty..................................................................................................................5 Clinical Programs ................................................................................................5 Educational Programs.........................................................................................6 Schedule and Responsibilities...........................................................................6 Supervision .........................................................................................................7 Benefits ...............................................................................................................7 Living in Indianapolis .........................................................................................7 Applications/Information ...................................................................................9 Individual Faculty ..............................................................................................10
  • 3. FELLOWSHIP TRAINING PROGRAM IN PEDIATRIC CARDIOLOGY Indiana University School of Medicine James Whitcomb Riley Hospital for Children PHILOSOPHY Cardiology was one of the first clearly defined subspecialties to develop in pediatrics and the second to establish formal subspecialty board certification. During its existence, this discipline has seen extraordinary changes that are continuing at a rapid pace. The practice of pediatric cardiology is increasingly demanding. The cardiologist must continue to have excellent bedside skills as well as expertise in pharmacologic therapy, non-invasive imaging, cardiac catheterization and interventional cardiology, arrhythmia manage- ment, exercise physiology and post-operative care. In addition, GOALS arrhythmias, and time spent in active clinical or basic progress and growth in a research. Interested fellows The goal of our program is to pro- subspecialty is dependent may take a fourth year of vide a personalized environment upon active work in basic and training in order to extend their which will permit and encourage applied research. research experience or develop the fellow to become a well- expertise in areas such as The clinical cardiology service rounded pediatric cardiologist interventional catheterization, at Riley Hospital is a busy one. with excellent clinical and labo- electrophysiology, noninvasive However, strong participation in ratory skills and have a basis on imaging or basic research. clinical care by the faculty and which to build a career in patient pediatric house staff is traditional. care, research and teaching. We We hope the following infor- This permits us to tailor fellow accomplish this through a three- mation will provide you with assignments according to the to four-year program, balancing a sense of the clinical and individual training needs of the extensive clinical exposure to a research opportunities available fellow and not according to broad spectrum of congenital and at Indiana University and Riley service needs. acquired heart defects and cardiac Hospital for Children. 1
  • 4. Medical Inpatient Service Responsibilities include rounds with the pediatric cardiology team, management of inpatients with an attending's supervision, admitting new cardiology patients to various units and teaching basic cardiology topics to residents and medical students. In addition, fellows receive calls from referring hospitals and physicians, and provide referring physicians with follow-up and discharge information. Night call is shared among all fellows. By the end of the first year, fellows will have learned acute medical manage- ment of infants and children will acquire the experience on the medical center campus. who suffer from congenital and necessary to manage patients This clinic serves as a consultation acquired heart disease, how independently after completion clinic for pediatric outpatients to interpret various imaging of training. with murmurs, chest pain and modalities for the diagnosis and other common symptoms and management of heart disease Outpatient Clinics complaints, as well as for continuity and when to refer patients for Throughout the 3 years of training care of patients with congenital or cardiac surgery. During the second fellows manage a biweekly acquired heart defects. A Pediatric and third year of the fellowship, Pediatric Cardiology clinic Cardiology faculty member is avail- these skills are refined and fellows affiliated with the county hospital able as consultant to help fellows with diagnostic or treatment strategies. In addition, fellows accompany staff at satellite clinics in the community to gain outpa- tient clinical assessment skills and experience. Early in the first year and at the end of their third year, fellows spend at least a 1-month rotation in the Riley Pediatric Cardiology outpatient clinics. By the end of their training, fellows should be skilled in the performance of a complete cardiovascular examination, the interpretation of common out- patient diagnostic modalities, and understand appropriate outpatient management of common pediatric cardiac problems. 2
  • 5. Cardiac Catheterization at the Krannert Institute of In addition, fellows may initiate Fellows spend six months Cardiology/Indiana University arrhythmia-related research projects. on the Catheterization Laboratory School of Medicine. These have A position is available for fourth- rotation over three years. included the use of an “atrial year fellows to obtain intensive Approximately 400 procedures basket” catheter for ablation of electrophysiology training. (not including Electrophysiology/ atrial flutter in Fontan patients. Ablation procedures) are Currently 175-200 patients with Exercise Physiology performed each year. These various types of pacemakers/ Experience through the cardiovas- include the full spectrum of AICD’s are followed through our cular exercise physiology laboratory diagnostic and interventional program. During the EP rotation, is part of the electrophysiology procedures. Currently used trainees participate in outpatient and arrhythmia rotation. The occluder devices include arrhythmia visits, pacemaker exercise stress laboratory performs CardioSeal and Amplatzer clinics, intracardiac electrophysiol- approximately 150 tests annually. Occlusion devices. Trainees are ogy studies and radio-frequency Metabolic measurement of oxygen assigned to assist and perform procedures under the guidance of a staff physician. With each successive rotation through the lab, fellows assume more responsibility for performing procedures. All fellows attend angiography review sessions and participate in cardiac catheterization and pre-surgery conferences. Fellows participate in approximately 150 catheterization procedures during their training. By the completion of the fellowship, trainees are able to plan, perform and interpret a complete diagnostic study. Interested fellows may extend interventional catheteriza- tion training during a 4th year. Electrophysiology ablation procedures. Fellows uptake and carbon dioxide output There is an active electrophysiology also gain experience with the is performed in the majority of and arrhythmia service with electrocardiographic interpretation patients. Fellows will attend and be approximately 175 tilt tests, 200 of complex arrhythmias on supervised in the interpretation of twenty-four hour ECG tests, 6,000 standard electrocardiograms, exercise testing for a wide range of ECG’s, and 60 radio frequency 24-hour ambulatory monitors, children with both cardiovascular catheter ablations done annually. transtelephonic monitors and the and non-cardiovascular diagnoses. There is early implementation acute and chronic management In addition, fellows will attend of new ablation techniques of patients with arrhythmias. Over lectures/discussions on basic exer- performed in collaboration with the course of the 3 year fellowship, cise physiology and the principles of adult cardiology researchers 3 months are spent on this rotation. exercise testing and interpretation. 3
  • 6. should be familiar with the instrumentation and physics of echocardiography, proficient in the performance and interpretation of 2D, pulsed, continuous wave and color Doppler examinations. Fellows can spend an additional focused year developing further echocardiography skills and knowledge in transesophageal and fetal echocardiography. Opportunities to pursue related clinical research projects are available, employing various echocardiographic modalities. Research The trainee will spend the equivalent of at least one year during the 3 year fellowship By the end of the fellowship, indications and interpretation in activities related to a clinical trainees should know the of transesophageal and fetal or laboratory research project. indications and contraindications echocardiography. Fellows Exploration of a “topic” for research to exercise testing in children, also present echo derived endeavors begins during the first and be able to interpret basic anatomical and physiologic year. Fellows should acquire a cardiopulmonary exercise data at pre-surgical conferences. depth of understanding in an area data. The exercise physiology By the fellowship's end, trainees of research, learn specific research laboratory also offers fellows the opportunity to design and carry out research projects. Echocardiography About 7,000 transthoracic, 700 fetal and 250 transesophageal echocardiograms are performed annually. Fellows spend six months during the fellowship on this rotation. Fellows learn basic fundamentals of Echo-Doppler studies, necessary skills to perform complete 2-dimensional and Doppler echocardiograms, and attend daily reading sessions. During the second and third years there is introduction to principles, 4
  • 7. CLINICAL PROGRAMS Riley Children's Hospital (www. rileyhospital.org) is the pediatric tertiary care hospital for the state of Indiana. Riley Hospital has catheterization and non-invasive facilities dedicated exclusively to pediatric use. All pediatric cardiac surgery is done at Riley Hospital. We have a busy pediatric cardio- logy service with approximately 500 cardiac catheterizations (diagnostic, interventional, biopsy, and electrophysiologic), 7,000 echo-Doppler studies, 6,000 EKG tracings, 400 open heart surgeries and 200 closed heart surgeries performed annually. Outpatient techniques and generate questions about their study. Additional goals FACULTY visits total 100-120 weekly. Another include the submission and 20-30 patients are seen weekly at The section of pediatric cardiology satellite clinics throughout the acceptance of at least one first- includes 10 faculty members. author, peer-reviewed manuscript. state. Daily in-patient census and All are full-time members of the consults average 20-30. This ample Preparation of a research grant Pediatric Department of Indiana and presentation of findings at a experience will allow the trainee University. Though each faculty to become competent in the national meeting are encouraged. member has general cardiology A clinical project can be done in clinical management of a wide skills, personal interest and variety of both common and cooperation with and under the academic pursuits include cardiac guidance of a pediatric cardiology uncommon cardiac conditions. catheterization and interventional faculty or a faculty person of an cardiology, nuclear cardiology, allied specialty. A basic science echo-Doppler, fetal echo, exercise project can be arranged in one stress testing, arrhythmia diagnosis of the research laboratories of and management, transplant care, the Indiana University Medical and physiologic/hemodynamic Center including: adult electro- research. There is close liaison with physiology; radiologic imaging; cardiovascular surgery, radiology, myocardial metabolism and pathology, and cardiovascular cardiac cell physiology; molecular anesthesia. There are also good genetics; and developmental working arrangements with molecular biology. The fellow neonatology, intensive care and will be supported by the pediatric all pediatric subspecialties, general cardiology division during pediatrics, adult cardiology, and this research. basic sciences. 5
  • 8. EDUCATIONAL interactive teaching session with alternating focus on echo reading, SCHEDULE AND PROGRAMS ECG and arrhythmia interpretation, RESPONSIBILITIES and angiography or nuclear In addition to the regular inpatient The pediatric cardiology fellowship interpretation attended by all rounds and continuum of inpatient program is a three year program. fellows and directed by a faculty and outpatient teaching, several Two years will be devoted to member. There are also weekly additional cardiac/cardiovascular learning and practicing the skills pediatric grand rounds and conferences are held regularly. of clinical care and one year to pediatric patient management These include a weekly topics research. During the first year, the conferences. The trainee conference, a monthly mortality/ fellow develops skills in history participates fully in these and pathology conference and a taking, physical examination and occasionally presents material weekly surgery conference. A Core clinical management in both of his/her own. Pediatric Curriculum series is presented in-patient and outpatient settings cardiology fellows attend one weekly by fellows, covering basic and becomes knowledgeable in or two national meetings or cardiology principles and concepts electrocardiography, echo-Doppler, major national courses. in depth. There is a weekly nuclear cardiology, exercise stress 6
  • 9. testing, and cardiac catheterization. as a "dissertation committee". to attend at least two courses Principles of cardiac catheterization This committee will help decide if or conferences during the are learned, and the fellow per- a fellow has satisfied clinical and training period. forms diagnostic catheterizations. research requirements to qualify for In the second year the fellow sub-board certification. In addition perfects catheterization skills, to the major research efforts, each LIVING IN INDIANAPOLIS including those of interventional fellow is expected to perform, Indianapolis, the nation's twelfth catheterization and electrophysio- present, and submit for publication largest city, is known as the logy. During electives in the first clinical projects, with a faculty Crossroads of America. With a and beginning of the second year, advisor/collaborator. metropolitan population of over the fellow explores possible one million people, Indianapolis avenues of research and formalizes his/her major research activity. The BENEFITS offers the advantages of a city with a diverse, thriving economy end of the second and first half of Salary and standard benefits are combined with small-town the third year is devoted primarily determined by University policy. friendliness known as "Hoosier to performance and completion of Expenses related to presentation Hospitality". a research project, with enhance- of teaching conferences and ment of clinical skills. This latter is The downtown area has become presentation of scientific papers finalized during the last 3-6 months a focal point of the city with the at regional and national meetings of fellowship, which are spent opening of Circle Centre in 1996. will be reimbursed by the Section "electively" in clinical cardiology, This is a major downtown shopping of Pediatric Cardiology. The fellow catheterization laboratory, and mall and entertainment complex. will be afforded the opportunity echo-Doppler. The pediatric cardiology fellow has an excellent opportunity to develop teaching skills. Pediatric residents and third and fourth year medical students regularly rotate through the pediatric cardiology service. They are fully integrated into all patient care and teaching programs. The fellow is expected to participate in the informal teaching. From time to time, fellows will also conduct formal teaching sessions. SUPERVISION Each fellow will meet with the program director and/or division chief at least quarterly for a critique of performance and progress. During the first year, the fellow should choose a "mentor" and personal training director. He/she will serve with the program director 7
  • 10. Downtown landmarks include the are held here yearly. Professional Hardcourt tennis championships, Soldiers and Sailors Monument, sports teams include the Indiana the World Gymnastics Union Station, the Indiana Pacers of the NBA and the Championship and the NCAA Repertory Theater, the Indianapolis Indianapolis Colts of the NFL. Men's Basketball Final Four Zoo in White River State Park and The Triple-A Indianapolis Indians Championship along with many the Eiteljorg Museum of American play baseball in Victory Field, a other sporting events. Indian and Western Art. new downtown stadium. The The Indiana University IHL Indianapolis Ice games are Indianapolis is considered the Natatorium, site of the 1996 readily available to hockey fans. "Automobile Racing Capitol of Olympic swimming and diving Professional soccer is represented the World". In addition to the trials, is conveniently located by the Indiana Blast. Sometimes Indianapolis 500 race held each near the IUSOM campus. Big termed the "Amateur Sports May, the National Hot Rod Ten Conference athletics at Capital of the World", the city has Association's U.S. Nationals, the Indiana University and Purdue hosted the Pan American Games, Brickyard 400 Nascar and the University are within an hour's the National Swimming and Formula 1 U.S. Grand Prix races drive. Recreational possibilities Diving championships, the RCA 8
  • 11. abound at Eagle Creek Park which offers biking, sailing, swimming, fishing and cross-country skiing. Major tennis complexes and over 30 public golf courses are conve- niently located throughout the city. The Children’s Museum and Indianapolis Museum of Art are world renowned. The world's largest Children's Museum features numerous exhibits for children of all ages. Cultural events are offered at Clowes Hall on the Butler University campus, at Verizon Wireless Music Center, at the restored Murat Theater and at the Circle Theater, home of the Indianapolis Symphony Orchestra. The Indianapolis Museum of Art is the seventh largest in the U.S. Other cultural activities include dance and opera companies, professional and amateur theater, jazz clubs, comedy clubs and art leagues and galleries. reasonable and many fellows find Board certification may apply. they can purchase a home. A completed application form, Indiana University-Purdue University including 2 letters of recommen- at Indianapolis (IUPUI; www.iupui. These are only some of the attrac- dation from physicians familiar edu) offers 170 degree programs. tions which make Indianapolis an with the applicant's graduate Part-time or graduate students ideal place to live. The facilities and training, medical school transcript, can complete studies here or at resources are typical of those of a and curriculum vitae should be other local universities such as large city, but without the crowding, sent before consideration of the Butler University (www.butler.edu), congestion and other problems applicant for interview will be the University of Indianapolis that have troubled many large undertaken. Foreign medical (www.uindy.edu) or Marian College cities. The people of Indianapolis graduates should also submit (www.marian.edu). The city also are proud of their community and ECFMG certificate number and has a variety of public, private and treasure it as a great city in which to visa information. For further parochial schools to meet the edu- live, work, play and raise a family. information, application form, cational needs of family members. etc., please communicate with There are affordable new and APPLICATIONS OR Roger A. Hurwitz, M.D., Director renovated apartment complexes downtown and in neighborhoods INFORMATION of Fellowship Training, 126 Riley Research, 702 Barnhill Drive, near Eagle Creek Park as well as Physicians who will have completed Indianapolis, IN 46202-5225, other locations within 20 minutes residency training in a program (ph: 317-274-8906; FAX: 317-274-4022; of the hospitals. House rentals are approved by the American Board e-mail: rhurwitz@iupui.edu). also available. Housing costs are of Pediatrics or will be eligible for www.rileyhospital.org 9
  • 12. PEDIATRIC CARDIOLOGY FACULTY Randall Caldwell, MD Timothy Cordes, MD Specialty: Pediatric Cardiology Specialty: Pediatric Cardiology Special Interests: Special Interests: Transthoracic Echocardiography, cardiac echocardiography; transplantation, diagnostic transesophageal cardiac catheterization echocardiography; Degree From: fetal echocardiography Indiana University Degree From: School of Medicine Michigan State University Residency: Indiana University Residency: School of Medicine Michigan State University Fellowship: Indiana University Fellowship: Mayo Graduate School of Medicine School of Medicine Faculty Rank: Faculty Rank: Peter Lawrence Phillips Clinical Associate Professor of Pediatrics Professor of Pediatrics Donald Girod, MD Mark Hoyer, MD Specialty: Pediatric Cardiology Specialty: Pediatric Cardiology Special Interests: Cardiac cath- Special Interests: eterization; interventional Interventional cardiac cardiac procedures catheterization Degree From: Degree From: Indiana University Ohio State University School of Medicine College of Medicine Residency: Ohio State Residency: University School Wright-Patterson USAF of Medicine Medical Center/Wright State Fellowship: Fellowship: Ohio State University Children's Hospital and School of Medicine; University of Pittsburgh University of Minnesota School of Medicine Faculty Rank: Faculty Rank: Carleton Buehl McCulloch Clinical Associate Professor of Pediatrics; Professor of Pediatrics Director, Pediatric Cardiology Division John W. Brown, MD Specialty: Pediatric PEDIATRIC CARDIOVASCULAR Cardiovascular Surgery SURGERY FACULTY Degree From: Indiana University School of Medicine Residency: University of Michigan Fellowship: National Institutes of Health Faculty Rank: Professor of Surgery, Chief of the Cardiothoracic Surgery Section 10
  • 13. Robert Darragh, MD Eric Ebenroth, MD Anne Farrell, MD Specialty: Pediatric Cardiology Specialty: Pediatric Cardiology Specialty: Pediatric Cardiology Special Interests: Fetal cardiology, Special Interests: Special Interests: Prenatal interventional cardiac Echocardiography, fetal echocardiography, catheterization, cardiac fetal echocardiography, transesophageal transplantation transesophageal echocardiography Degree From: echocardiography Degree From: University of Pittsburgh Degree From: Loyola University, Chicago Residency: Indiana University Residency: IU Medical Center Children's Hospital of Buffalo School of Medicine Fellowship: Indiana University Fellowship: Children's Hospital Residency: Children's Medical School of Medicine of Buffalo, Children's Hospital Center, Dayton, OH Faculty Rank: of Pittsburgh Fellowship: Indiana University Clinical Assistant Faculty Rank: Clinical Associate School of Medicine Professor of Pediatrics Professor of Pediatrics Faculty Rank: Clinical Assistant Professor of Pediatrics Joyce Hubbard, MD Roger Hurwitz, MD Marcus Schamberger, MD Specialty: Pediatric Cardiology Specialty: Pediatric Cardiology, Specialty: Pediatric Cardiology Special Interests: Nuclear Medicine Special Interests: Prenatal Electrophysiology; Special Interests: fetal echocardiography, arrhythmias, pacemakers, Pediatric cardiovascular transesophageal radio frequency ablation nuclear medicine echocardiography, Degree From: Indiana University Degree From: exercise physiology and School of Medicine Northwestern University exercise stress testing Residency: Indiana University School of Medicine Degree From: School of Medicine Residency: Children's University of Erlangen- Memorial Hospital, Chicago Nuremberg, Germany Fellowship: Indiana University School of Medicine Fellowship: University of Residency: California, Los Angeles University of Missouri Faculty Rank: Clinical Assistant Professor of Pediatrics Faculty Rank: Fellowship: Indiana University Philip Murray Professor of School of Medicine Pediatrics and of Radiology Faculty Rank: Clinical Assistant Professor of Pediatrics Mark W. Turrentine, MD Mark Rodefeld, MD Specialty: Pediatric Specialty: Pediatric Cardiovascular Surgery Cardiovascular Surgery Degree From: University of Degree From: Kansas School of Medicine Indiana University Residency: University of School of Medicine Kansas - Wichita Residency: Washington Fellowship: Indiana University University, St. Louis School of Medicine Fellowship: University of Faculty Rank: Associate California, San Francisco Professor of Surgery Faculty Rank: Assistant Professor of Surgery 11
  • 14. Section of Pediatric Cardiology Riley Research 126 702 Barnhill Drive Indianapolis, IN 46202-5225 www.rileyhospital.org