Our cardiology fellows rotate through each of the disciplines of pediatric cardiology including adult congenital heart disease, the full spectrum of echocardiography, MRI imaging, electrophysiology, catheterization, clinical ward and intensive care cardiology as well as a weekly outpatient continuity clinic. The fellowship program is also dedicated to an intensive research experience for the fellows. The fellowship is divided into 36 months with 12 blocks of four week rotations. There are 12 months possible for research or elective activities. The fellow has the ability to structure years two and three in a manner that best fits his/her research and career goals.
| Four-Week Rotations | PGY-4 | PGY-5/PGY-6 |
|---|---|---|
| Wards | 3 | 3 |
| Echo | 4 | 3 |
| Cath | 2 | 2 |
| EP | 1 | 1 |
| Research/Elective | 1 | 7 |
| CVICU | 1 | 2 |
| Adult Congenital | 1 | |
| Multi-Disciplinary | 1 |
Wards
Year 1: The fellow becomes familiar with and gains independence in the diagnosis and management of children and adults with congenital heart disease as well as children with acquired heart disease.
Years 2 and 3: In the second, and especially in the third year, fellows become more independent. Over time, they gain experience and acquire the expertise to be able to evaluate and treat these children independent of faculty.
Echocardiography
We have a large echocardiography service which includes transthoracic, three-dimensional, fetal and transesophageal echocardiography. The fellows are exposed to all forms of acquired and congenital heart disease and gain hands-on training to systematically perform a complete transthoracic echocardiogram by the completion of the first year. By the end of their third year, fellows develop basic skills in fetal and transesophageal echo and a working knowledge of three-dimensional echo. Fellows gain valuable experience by presenting echoes at the combined cardiology-cardiovascular surgery conference during their echo rotations. Additional echo exposure and education is available beyond the required rotations.
Catheterization
During year one, fellows learn basic catheter manipulation and the fundamentals of interpretation of the hemodynamic and angiographic evaluation. Fellows are expected to present the patient's catheterization and angiography data at the weekly combined cardiology-cardiovascular surgery conference. By the completion of their second year, these catheterization skills are refined such that, although supervised, most can perform routine hemodynamic catheterizations unassisted. Additional specialized skills are refined and additional time in the catheterization laboratory is available.
Electrophysiology
During the first year, fellows become proficient in the diagnosis and management of common and some of the more complex pediatric arrhythmias including ECG and Holter interpretation, interpretation of transtelephonic evaluations and pacemaker interrogation and management. They perform basic EP related catheterization procedures including venous access and catheter positioning. In the second and third years, fellows advance their training by gaining skills in catheter ablation, and add skills in cardiac pacing including device interrogation and programming. Fellows learn about atrial electrograms and temporary pacing during their EP and cardiac ICU rotations. Additional EP rotations are available for the interested fellow.
Research
In year one, a Scholarly Oversight Committee is identified for each fellow and during the middle of year one, meetings of this committee begin. The committee meets at least twice per year throughout the fellowship in compliance with the recommendations for the Scholarly Oversight Committee as defined by the American Board of Pediatrics. We have a very active faculty from a research standpoint providing diverse research opportunities in basic and clinical research as well as flexibility to perform additional master's level courses through the University of Utah. As part of the Pediatric Heart Network, our research team is actively supported by the National Institutes of Health (NIH) collaborative.
Intensive Care
We have a dedicated CVICU of 16 beds. Fellows gain an understanding of the preoperative and postoperative management of newborns, children and adults with congenital heart disease and children with acquired heart disease. During this rotation, fellows also become expert in ventilator management, intubation, and management of patients requiring inotropic support. During ICU rotations, fellows will also be exposed to complex arrhythmias, heart failure, transplant management and ventricular assist devices as well as extracorporeal membrane oxygenation.
Cardiac MRI
We have a very busy three-member cardiac MRI team and fellows will gain basic knowledge of the indications, MRI imaging planes and protocols in the setting of congenital heart disease. Fellows rotating through the MRI service present MRI's at the weekly combined cardiology-cardiovascular surgery conference.
Adult Congenital Heart Disease
We have an active adult congenital heart disease program with four outpatient locations for the evaluation and management of adults with congenital heart disease. The majority of surgery, catheterization and other invasive and non-invasive testing and procedures for adults with congenital heart disease is undertaken at Primary Children's Hospital.
Multidisciplinary Clinic
The multidisciplinary clinic is designed to expose the fellows to additional clinical aspects of outpatient pediatric cardiology including the diagnosis and management of:
- Heart failure and transplantation
- Pulmonary hypertension
- Adult congenital heart disease
- Aortopathy
- Fetal Cardiology
- High Risk Clinic
- Cardiovascular Genetics
- Electrophysiology
- Inherited Arrhythmia
- Single Ventricle
- U Champ
- HCNP (Neurodevelopment Program)
Electives
Electives can be designed to suit an individual fellow’s interest and can be either in clinical or research disciplines. Fellows in the past have utilized clinical, translational, and basic science opportunities at the University of Utah as well as at Primary Children's Hospital.
Continuity Clinic
Fellows begin continuity clinic as soon as they start their fellowship and see patients one-half day weekly with the same clinic mentor throughout their tenure as cardiology fellows with supervision. They assume responsibility for patient diagnosis and management and assist with the decisions about timing for cardiac surgery. Fellows are encouraged to follow these patients as if they are their primary cardiologist.
Teaching
Throughout the fellowship training, fellows prepare and present lectures to the fellows and faculty as well as to the general pediatric residents and medical students at PCH and the University of Utah. Fellows are also called on to present intermittently at the weekly echocardiography conference. This is a conference attended by echocardiography faculty, technicians and all cardiology fellows. All fellows maintain a teaching portfolio.