1 Program Requirements for Fellowship Education in Pediatric Cardiology
3 Underlined text - Revisions/additions to the existing requirements.
4 Strikethrough – Deletions of text.
5 (SPPR) – Requirement that has been deleted in this document because it is contained in
6 the Program Requirements for the Subspecialties of Pediatrics
9 Programs must comply with the Program Requirements for Residency Education in the
10 Subspecialties of Pediatrics and with the following requirements. The specialty
11 requirements may exceed the common requirements.
13 I. Duration and Scope of Training
15 An accredited program in pediatric cardiology must be 3 years in duration.
16 (SPPR) The purpose of a training program is to provide the pediatric cardiology
17 fellow with the foundation for understanding normal and abnormal cardiovascular
18 conditions, with a focus on the pathophysiologic basis of cardiovascular disease,
19 and to prepare them to provide optimal care and consultation for pediatric patients
20 with cardiovascular disease.
22 An accredited program must include properly balanced, well-organized, and
23 progressive responsibility for the care and study of patients on inpatient services,
24 in intensive care units, and in ambulatory centers.
26 II. Faculty
28 A. Pediatric Cardiologists
30 There must be at least four pediatric cardiologists who provide sufficient
31 time to the program to ensure its educational and research quality and to
32 provide adequate supervision of cardiology fellows. They must be
33 certified in pediatric cardiology by the American Board of Pediatrics or
34 have equivalent qualifications. (SPPR)
36 B. Other Physician Teaching and Consultant Faculty
38 Appropriate board certified pediatric intensive care personnel must be
39 available for the special and constant care needed by patients in the PICU.
40 Fellows also must be provided access to scientists who are actively
41 engaged in cardiovascular research.
43 Staff from other disciplines, including cardiovascular radiology,
44 cardiothoracic surgery, adult cardiology, anesthesiology, pathology, and
45 genetics, and those with knowledge in the care of adults with congenital
46 heart disease should be readily available.
48 Special staff expertise should be available in electrophysiology, exercise
49 physiology, invasive and interventional cardiac catheterization procedures,
50 preventive cardiology, and echo cardiography, including transesophageal,
51 Doppler, and fetal ultrasonography echocardiography. In addition special
52 staff expertise in other non-invasive diagnostic modalities such as cardiac
53 magnetic resonance imaging (MRI) and/or CT angiograms should be
56 Fellows should be taught to work with and utilize the special skills of
57 pediatric cardiovascular nurses, intensive care nurses, catheterization
58 laboratory technicians, operating room personnel, social workers, and
59 psychologists. (SPPR)
61 III. Facilities and Resources
63 It is preferable that all facilities be within the primary institution. Where a special
64 facility is shared by several local institutions in the interest of cost and efficiency,
65 the program director may arrange for a fellow to rotate to that facility.
67 A. Inpatient Service/Outpatient Services
69 Facilities should include space in an ambulatory setting for optimal
70 evaluation and care of outpatients and an inpatient area with a full array of
71 pediatric and related services staffed by pediatric faculty and fellows.
73 An active inpatient pediatric cardiology service is essential to the
74 educational program. It should provide all the diagnostic and treatment
75 services characteristic of a comprehensive children's facility.
77 There must be an intensive care unit in each center in which patients with
78 heart disease are cared for under the supervision of the training program
79 staff and are available to the fellows. In these units there must be
80 preoperative and postoperative patients with heart disease, as well as
81 appropriate personnel and equipment to allow provision of the special and
82 constant care needed by these patients.
84 B. Cardiac Data Base
86 Clinical data, including data from inpatients, outpatients, and patients
87 undergoing catheterization and/or surgery, should be cross-indexed to
88 allow rapid evaluation and analysis of the assembled information,
89 including age, diagnosis, and outcome morbidity and mortality.
91 C. Support Facilities
93 The following facilities must be available:
95 1. Diagnostic imaging facilities that include cardiac MRI and/or CT
96 scanning and nuclear cardiology
97 2. Diagnostic and interventional cardiac catheterization laboratory
99 3. A graphics laboratory with facilities for recording the standard
100 electrocardiogram and 2-D and Doppler echocardiograms An
101 echocardiography laboratory with facilities for performing and
102 interpreting standard transthoracic 2-D and Doppler
103 echocardiograms, fetal echocardiograms, and transesophageal
105 4. A non-invasive electrophysiology laboratory with facilities for
106 performing and interpreting standard electrocardiograms,
107 ambulatory electrocardiograms, and exercise electrocardiograms
108 5. Access to a clinical cardiac electrophysiologic laboratory for
109 invasive intracardiac electrophysiologic studies and catheter
111 64. Laboratories to perform routine analyses of blood and urine to
112 determine blood gas values, to perform blood chemistry, and
113 coagulation profiles blood clotting studies, and to type and cross-
114 match blood
115 75. An operating room designed for pediatric patients who require
116 cardiopulmonary extracorporeal circulation. and The area must be
117 equipped with appropriate monitoring devices, defibrillators, and
118 cardiac pacing devices
119 86. A blood bank closely affiliated with the center that is equipped to
120 meet the demands of cardiac surgery
121 7. Access to a clinical cardiac electrophysiologic laboratory for
122 invasive intracardiac electrophysiologic studies and catheter
125 IV. Educational Program
127 A. Clinical Experience
129 1. Patient Population
131 The experience must encompass age groups from the fetus and
132 newborn through young adulthood, and must include exposure to
133 adults with heart disease, particularly congenital and rheumatic
134 heart disease. The fellow must be exposed to pathologic conditions
135 ranging from mild, to those requiring extensive or continued
136 intensive care. There must be both pre- and post-surgical and
137 medical experience with a broad spectrum of congenital and
138 acquired heart disease and in chronic, acute and emergency
141 Patients admitted to the inpatient service should be under the direct
142 or indirect supervision of the subspecialty program staff and must
143 be available to the fellows.
145 An accredited program must have an annual patient population,
146 including patients less than 1 year of age that is sufficient in
147 number to enable each fellow to become skilled in the following
148 techniques fundamental to the practice of pediatric cardiology.
150 Training in history taking and physical examination must be the
151 cornerstone of the training program. This must include family
152 history that is a critical aspect of the evaluation of pediatric
153 patients with suspected cardiovascular disease. Programs must
154 include training in at least the following fundamental skills:
156 a. Noninvasive techniques
158 The program must provide education in clinical diagnosis
159 with special emphasis on roentgenology,
160 electrocardiography, echocardiography, exercise testing,
161 ambulatory electrocardiography, and magnetic resonance
162 imaging. Each fellow must perform and interpret a
163 minimum of 300 pediatric echocardiography studies.
165 The program also must provide sufficient experience for
166 fellows to acquire skill in the interpretation of
167 electrocardiograms, ambulatory ECG monitoring studies,
168 and exercise stress testing with ECG monitoring.
170 b. Invasive techniques
172 Experience and instruction must be provided in the
173 techniques and understanding of the indications for and
174 limitations of diagnostic cardiac catheterization, selective
175 angiocardiography, electrophysiologic testing, therapeutic
176 catheterizations and pacemaker implantation. During the 3
177 years of training each subspecialty fellow must participate
178 in a minimum of 100 catheterizations and 10 pediatric
179 intracardiac electrophysiologic studies.
181 c. Resuscitation techniques
183 Experience and instruction in the techniques, indications,
184 contraindications, complications and interpretation of
185 pericardiocentesis, thoracentesis, cardiopulmonary
186 resuscitation, mechanical ventilation, cardioversion, and
187 temporary pacing are required.
189 d. Technical and other skills
191 The fellows must be taught the use of relevant electronic
192 equipment, recording devices, and other equipment
193 necessary to perform cardiac catheterization,
194 echocardiography, ambulatory ECG monitoring, and
195 electrophysiologic studies. The fellows should be exposed
196 to the basics of implantable pacemaker and cardioverter
197 defibrillation function and the interrogation and
198 programming of these devices. In addition, the program
199 must instruct the fellows in the fundamentals of radiation
202 2. Preoperative and Postoperative Care
204 Participation in the care of preoperative and postoperative care of
205 patients having both closed and open cardiac surgery, in close
206 cooperation with the cardiothoracic surgical staff, is required.
207 Fellows must participate in cardiac catheterization conferences in
208 order to develop the knowledge required in decision making, and
209 planning for corrective cardiac surgery. Fellows must have
210 sufficient exposure to or and instruction in current surgical
211 techniques, mechanical ventilation, methods of cardiopulmonary
212 bypass, and hypothermia to develop an adequate understanding of
213 these surgical techniques. The fellow should be instructed in the
214 management of postoperative patients and postoperative
215 complications, both immediate and delayed. Opportunity for long-
216 term follow-up observations of both preoperative and
217 postoperative patients must be provided.
219 Fellows should participate in consultations or conferences in which
220 the medical and surgical staffs evaluate the results of surgery and
221 the patient's cardiac status before discharge from the hospital.
223 3. Pediatric Cardiology Clinic
225 There Fellows must be attend a regularly scheduled pediatric
226 cardiology clinic that is supervised by one or more members of the
227 cardiology staff. Time and space in this clinic must be available for
228 fellows to provide continuity and follow-up care for all patients
229 under their care.
231 4. Other Clinical Experiences
233 The program must provide instruction and clinical experience with
234 rheumatic heart disease, collagen vascular diseases, infective
235 endocarditis, Kawasaki disease and other infectious, vasculitic and
236 metabolic conditions. Instruction should also include clinical
237 experience in assessing the genetic basis of heart disease. Fellows
238 should be instructed in the etiologic and risk factors in
239 hypertensive and atherosclerotic heart disease, including
240 hyperlipidemic states, and should gain experience in the
241 prevention, diagnosis, and management of patients with these
242 cardiovascular problems. The fellow should understand the
243 indication for cardiac transplantation and the basics of
244 immunosuppression, natural history and complications of
247 B. Curriculum
249 The program must should offer engage fellows in courses, seminars,
250 workshops, and/or laboratory experience that to provide an appropriate
251 background in basic cardiac physiology, cardiac pharmacology, and other
252 fundamental disciplines related to the heart and cardiovascular system.
254 The fellow must receive instruction in cardiovascular pathology that
255 includes structured educational experiences to including examineation of
256 specimens demonstrating the various types of congenital cardiovascular
257 anomalies. Conferences involving current pathological material must be
258 held regularly and must be closely correlated with clinical experience.
260 There must be instruction in embryology and anatomy of the normal heart
261 and vascular system, clinical morphologic correlations, and potential
262 deviations from normal. Normal and abnormal cardiovascular and
263 cardiopulmonary physiology and metabolism should be taught, as well as
264 fundamentals of cardiovascular pharmacology, including mechanisms of
265 drug action, therapeutic indications, and side effects.
267 Conferences must be held on clinical diagnosis and therapy on a regular
268 basis, including evaluation, cardiovascular research, and clinical
269 morphologic correlations. Multidisciplinary conferences should include
270 physiology, pharmacology, neonatology, anesthesiology, critical care,
271 cardiothoracic surgery, cardiac radiology (such as MRI) cardiovascular
272 radiology, cardiothoracic surgery, and adult cardiology.