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  • 1. 1 Program Requirements for Fellowship Education in Pediatric Cardiology 2 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 7 8 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. 12 13 I. Duration and Scope of Training 14 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. 21 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. 25 26 II. Faculty 27 28 A. Pediatric Cardiologists 29 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) 35 36 B. Other Physician Teaching and Consultant Faculty 37 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. 42 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.
  • 2. 47 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 54 available. 55 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) 60 61 III. Facilities and Resources 62 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. 66 67 A. Inpatient Service/Outpatient Services 68 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. 72 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. 76 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. 83 84 B. Cardiac Data Base 85 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. 90 91 C. Support Facilities 92
  • 3. 93 The following facilities must be available: 94 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 98 facilities 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 104 echocardiograms 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 110 ablation 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 123 ablation. 124 125 IV. Educational Program 126 127 A. Clinical Experience 128 129 1. Patient Population 130 131 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
  • 4. 138 acquired heart disease and in chronic, acute and emergency 139 situations. 140 141 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. 144 145 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. 149 150 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: 155 156 a. Noninvasive techniques 157 158 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. 164 165 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. 169 170 b. Invasive techniques 171 172 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. 180 181 c. Resuscitation techniques 182
  • 5. 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. 188 189 d. Technical and other skills 190 191 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 200 safety. 201 202 2. Preoperative and Postoperative Care 203 204 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. 218 219 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. 222 223 3. Pediatric Cardiology Clinic 224 225 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
  • 6. 228 fellows to provide continuity and follow-up care for all patients 229 under their care. 230 231 4. Other Clinical Experiences 232 233 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 245 transplantation. 246 247 B. Curriculum 248 249 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. 253 254 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. 259 260 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. 266 267 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. 273

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