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doi:10.1016/j.jacc.2005.07.015 2005

  1. 1. Task Force 1: General Experiences and Training Hugh D. Allen, J. Timothy Bricker, Michael D. Freed, Roger A. Hurwitz, Tim C. McQuinn, Richard M. Schieken, William B. Strong, and Kenneth G. Zahka J. Am. Coll. Cardiol. 2005;46;1382-1384; originally published online Sep 22, 2005; doi:10.1016/j.jacc.2005.07.015 This information is current as of July 22, 2010 The online version of this article, along with updated information and services, is located on the World Wide Web at: Downloaded from by on July 22, 2010
  2. 2. Journal of the American College of Cardiology Vol. 46, No. 7, 2005 © 2005 by the American College of Cardiology Foundation, the American Heart Association, Inc., ISSN 0735-1097/05/$30.00 and the American Academy of Pediatrics Published by Elsevier Inc. TASK FORCES Task Force 1: General Experiences and Training Hugh D. Allen, MD, FACC, FAHA, FAAP, Chair, J. Timothy Bricker, MD, FACC, FAAP, Michael D. Freed, MD, FACC, FAHA, FAAP, Roger A. Hurwitz, MD, FACC, FAAP, Tim C. McQuinn, MD, FAAP, Richard M. Schieken, MD, FACC, FAHA, FAAP, William B. Strong, MD, FACC, FAAP, Kenneth G. Zahka, MD, FACC, FAAP INTRODUCTION three months. The continuity outpatient clinic should begin early in fellowship and continue throughout training, pref- The goals of pediatric cardiology training include acquiring erably on a biweekly basis. Both inpatient and outpatient the cognitive and procedural expertise required to provide experiences should include exposure to the management of high-quality care to children with cardiovascular disease, the adult patient with congenital heart disease. acquiring the academic skills to make meaningful scholarly There are many ways for general inpatient and outpatient contributions to the specialty, and, importantly, to develop practices to be organized. In the delivery of high-level the capacity for ongoing self-education beyond the years of inpatient and outpatient care the pediatric cardiologist must formal training. demonstrate effective team leadership, accurate and efficient The general training of pediatric cardiology fellows builds medical record keeping, sensitivity to medical ethical issues, on the general clinical and academic skills acquired during an ability to communicate with and support patients and residency training. The pediatric cardiology fellow should be their families through stressful decisions and experiences, given broad exposure to clinical activities in pediatric cardiol- and show strict compliance with federal regulatory statutes. ogy inpatient and outpatient care, pediatric cardiology inpa- The general inpatient and outpatient training environment tient and outpatient consultations, and in preventive cardiol- for pediatric cardiology fellows must provide full opportu- ogy. The academic skills of formal presentation, small-group nity for observation, acquisition, and application of these teaching, literature review, data analysis, and study design are skills by the trainee. also components of the general training guidelines. During the course of inpatient and outpatient activities the pediatric cardiology fellow will become familiar with a CLINICAL TRAINING core knowledge base, as outlined in Table 1, at a minimum. A fundamental goal of clinical training is to acquire bedside diagnostic skill and the ability to provide high-qualilty consultative inpatient and outpatient pediatric cardiology DIDACTIC CONTENT care. The core skills of history-taking and physical exami- The Core Curriculum nation are the only means for correctly initiating diagnostic and management options appropriate to the individual The program should offer courses, seminars, workshops, patient, and these must be heavily stressed at all points of and/or laboratory experiences to provide appropriate back- patient contact. Pediatric cardiology fellows should be ground in basic and fundamental disciplines related to the observed by faculty while performing key portions of the heart and cardiovascular system. A lecture series encompass- history and physical examination, and to also have the ing a core curriculum in clinical and basic science topics opportunity to observe faculty perform history-taking and must be provided for pediatric cardiology fellows. It should physical examination, so that meaningful discussion of be designed so that the spectrum of topics presented will be useful strategies and techniques may develop. Consulta- completed at least once in the three years of accredited tion services, general inpatient wards, and outpatient fellowship training. Pediatric cardiology fellows should clinics all provide excellent opportunities for such inter- contribute formal presentations of selected topics in the action. core curriculum, both to strengthen their knowledge base The pediatric cardiology fellow must have the opportu- and to develop formal presentation skills. General areas nity to provide not only inpatient and outpatient consulta- to be covered in the core curriculum include those listed tion services but also direct patient care in both inpatient in Table 1. and outpatient settings. There must be a continuity of care Additional Conferences in the outpatient clinic so that fellows can begin to appre- ciate the course of pediatric cardiac disease over time and its Preoperative conferences with the cardiovascular surgical cumulative impact on individual patients and their families. service are essential. Journal clubs are a recommended The combined time commitment of the general inpatient element of an academic environment and provide an excel- and inpatient consultation services should be no less than lent venue for participatory evaluation of study design and Downloaded from by on July 22, 2010
  3. 3. JACC Vol. 46, No. 7, 2005 Allen et al. 1383 October 4, 2005:1382–4 Task Force 1: General Experiences and Training Table 1. Core Knowledge Base Anatomy and physiology of congenital heart defects (e.g., tetralogy of Fallot, hypoplastic left heart syndrome, ventricular septal defect) Cardiac, autonomic and noncardiac causes of syncope and near-syncope Cardiac MRI/CT Cardiac sequelae of chronic hepatic disease Cardiac sequelae of chronic renal disease Cardiac sequelae of HIV/AIDS Cardiac sequelae of obstructive sleep apnea Cardiac sequelae of oncologic therapy Cardiomyopathy, heart failure, and transplantation in the pediatric patient Cardiopulmonary bypass Cardiovascular pharmacology Cardiovascular physiology and anatomy Cardiovascular sequelae and follow-up in Marfan, William, DiGeorge, Turner, and Noonan syndromes Cardiovascular sequelae of pregnancy and the impact of congenital heart disease Cardiovascular sequelae of rheumatologic disease Cardiovascular sports medicine Care of the single ventricle patient Cellular electrophysiology (e.g., action potentials and ion channels) Chest pain Clinical electrophysiology (e.g., mechanisms of arrhythmias, pacemakers, ablative therapy) Coagulation and anticoagulation Diagnosis and management of arrhythmias Diagnosis and management of elevated pulmonary vascular resistance Diagnosis and management of intravascular/intracardiac thrombosis Diagnosis and management of left-to-right shunt lesions Diagnosis and management of patent ductus arteriosus in premature infants Diagnosis and management of right to left shunt lesions Diagnosis and management of valvular heart disease, including artificial heart valves Diagnostic evaluation of heart murmurs Differential diagnosis and management of cardiac tumors Differential diagnosis and management of pericardial effusion and pericardial tamponade Embryonic, fetal, and postnatal cardiovascular development Endocarditis Exercise testing Fetal/neonatal/perinatal cardiovascular physiology Genetics of cardiovascular diseases of childhood Hyperlipidemia Hypertension Kawasaki disease Medical ethics Normal cardiovascular anatomy and physiology, including exercise physiology Obesity Pericarditis and pericardial effusions Physics of echocardiography and Doppler analysis Physiology and natural history of congenital heart disease Population health Preventive cardiology, including prevention of adult acquired heart disease Quality assurance and process improvement methodology Rationale, expectations, and methods of screening for congenital heart disease in neonates with trisomy of chromosome 21, 18, or 13 Rationale, expectations, and methods of screening for congenital heart disease infants of diabetic pregnancies Rationale, expectations, and methods of screening for congenital heart disease in the presence of neonatal emergencies such as gastroschisis, omphalocele, congenital diaphragmatic hernia, or cardiorespiratory failure leading to extracorporeal membrane oxygenation Rheumatic fever Risk factors in childhood and adolescence Segmental cardiac analysis Statistics and study design data analysis. Quality assurance evaluation and morbidity/ contributors might include neonatology, cardiothoracic sur- mortality conferences should be held periodically. Multidis- gery, adult cardiology, cardiac pathology, physiology, phar- ciplinary clinical and research conferences are highly desir- macology, pulmonology, intensive care, cardiac anesthesiol- able; according to the strengths of the institution, ogy, cardiovascular radiology, clinical genetics, molecular Downloaded from by on July 22, 2010
  4. 4. 1384 Sanders et al. JACC Vol. 46, No. 7, 2005 Task Force 2: Pediatric Training Guidelines for Noninvasive Cardiac Imaging October 4, 2005:1384–8 genetics, tissue engineering, stem cell biology, or develop- critique of these skills by the attending physician as well as mental biology. In all of these conferences, pediatric cardi- demonstration of these skills to the fellow by the attending. ology fellows should be provided with active roles appropri- Pediatric cardiology fellows should develop formal ate to their level of knowledge and training. evaluation of trainees and training skills during their fellowship. To do so, they should participate in feedback TEACHING AND EVALUATION SKILLS to residents, students, and cardiology attendings It is a fundamental responsibility in academic medicine that throughout their rotations regarding their own educa- those with the most experience must teach. The pediatric tional and technical progress and the progress of other cardiology fellow will often be the most clinically experi- team members. Accurate self-evaluation is the most enced house officer on a team of residents, interns, and/or valuable skill of all and should be nurtured in all phases medical students. The fellow in that setting should be of pediatric cardiology training. expected to provide lectures/seminars to the team of house doi:10.1016/j.jacc.2005.07.015 officers. The pediatric cardiology fellow should also be allowed the opportunity to practice clinical leadership, organizational skills, and impromptu educational activities APPENDIX as appropriate to his/her demonstrated level of knowledge The authors of this section declare they have no relation- and training. There should be occasion for observation and ships with industry pertinent to this topic. Task Force 2: Pediatric Training Guidelines for Noninvasive Cardiac Imaging Endorsed by the American Society of Echocardiography and the Society of Pediatric Echocardiography Stephen P. Sanders, MD, FACC, Chair, Steven D. Colan, MD, FACC, Timothy M. Cordes, MD, FACC, FAAP, Mary T. Donofrio, MD, FACC, FAAP, Gregory J. Ensing, MD, FACC, Tal Geva, MD, FACC, Thomas R. Kimball, MD, FACC, FAAP, David J. Sahn, MD, MACC, FAAP, Norman H. Silverman, MD, FACC, FAHA, Mark S. Sklansky, MD, FACC, Paul M. Weinberg, MD, FACC, FAAP INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY Noninvasive imaging, including echocardiography and Echocardiography, as used in this document, includes two- magnetic resonance imaging (MRI), is a primary means for dimensional imaging of the heart and related structures, elucidating the anatomy and physiology of childhood heart M-mode echocardiography for assessment of chamber size disease. Competence in performance and interpretation of and function, color M-mode and Doppler tissue and flow echocardiography and MRI is now essential to the practice mapping, pulsed and continuous-wave spectral Doppler of pediatric cardiology. Depending upon one’s individual flow analysis, and other variations of these basic modalities career goals, varying levels of expertise may be expected to used to assess the structure and function of the heart and be achieved during fellowship training. This document related organs, including new technologies such as three- defines the levels of knowledge and expertise that pediatric dimensional echocardiography as they become available. cardiology trainees should acquire in echocardiography and MRI during training, and it offers guidelines for achieving Facilities and Environment these levels of competence. The pediatric echocardiography laboratory should serve a Training guidelines have been previously published for hospital with inpatient and outpatient facilities, neonatal and pediatric echocardiography (1), fetal echocardiography (2), pediatric intensive care units, a pediatric cardiac catheteriza- and pediatric transesophageal echocardiography (3). Those tion/interventional laboratory, and an active pediatric cardiac documents were reviewed and considered during prepara- surgical program. The pediatric echocardiography laboratory tion of these guidelines. The guidelines presented here differ should be under the supervision of a full-time pediatric in some instances from previous recommendations because cardiologist-echocardiographer qualified to direct a laboratory, this task force recognizes that training programs have and whose primary responsibility is supervision of the labora- changed significantly over the decade since the last guide- tory. The laboratory must perform a sufficient number of lines were promulgated. pediatric transthoracic, pediatric transesophageal, and fetal Downloaded from by on July 22, 2010
  5. 5. Task Force 1: General Experiences and Training Hugh D. Allen, J. Timothy Bricker, Michael D. Freed, Roger A. Hurwitz, Tim C. McQuinn, Richard M. Schieken, William B. Strong, and Kenneth G. Zahka J. Am. Coll. Cardiol. 2005;46;1382-1384; originally published online Sep 22, 2005; doi:10.1016/j.jacc.2005.07.015 This information is current as of July 22, 2010 Updated Information including high-resolution figures, can be found at: & Services Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Competence and Training Statements g_statements Rights & Permissions Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: Reprints Information about ordering reprints can be found online: Downloaded from by on July 22, 2010