The patient care experience will encompass age groups from the fetus and newborn through adults with congenital heart disease. A major foundation of the training program is instruction in the preparation of a detailed history and performance of a complete physical examination relevant to the cardiovascular system. Additional areas of training are outlined below. All facets of training will be geared to encompass specific ACGME General Competencies listed below, in italics (ACGME Outcome Project, 9.28.99)
Provide well-rounded education to pediatric cardiology fellows – starting them on a path to a successful career best suited for them (academic, research, or clinical) as well as enabling them to lead and influence the next generation of physicians.
The program’s vision is to be a leading pediatric cardiology fellowship, within the nation, that provides education and skills necessary in providing state-of-the-art patient care, as well as research skills that will enable subspecialty fellow(s) to contribute to the progress of the program. Program aims include the following:
- Demonstrate proficiency in all areas of patient care in pediatric cardiology that is appropriate, effective for evaluation and treatment, and for promotion of health.
- Develop in depth knowledge about up-to-date pediatric cardiology, biomedical, clinical, and pediatric scientific information and consistently apply this knowledge to patient care – preparing all fellows to pass subspecialty board certification exam on the first attempt by 2021.
- Develop and enhance interpersonal and communication skills that enables to establish and maintain professional relationships with patients, families, and other members of the health care team.
- Develop and strengthen professional skills, adhere to ethical principles, and demonstrate sensitivity to a diverse patient population.
- Develop an awareness of and responsiveness to the larger context and system of health care and demonstrate the ability to effectively call on system resources to provide care that is of optimal value.
- Develop the ability to investigate and evaluate their patient care practices, and appraise and assimilate scientific evidence to improve their patient care practices.
Specific goals and objectives of the training program in this area include proficiency in the following:
- Preparation of a detailed history and physical examination relevant to the cardiovascular system
- Performance of a complete cardiovascular physical examination
- Establishing a differential diagnosis based on the history and physical examination
- Appropriate use and performance/interpretation of noninvasive tests (x-ray, ECG, echocardiography, Doppler ultrasound, ambulatory ECG, exercise testing, cardiac MRI)
- Develop skills in transthoracic and transesophageal echocardiography
- Developing plans for treatment, monitoring, and follow-up
- Understanding of the natural history of congenital and acquired heart disease and appropriate plans for counseling and follow-up
- Ability to provide appropriate information to referring physicians or home care agency
- Incorporation of preventive cardiology into the overall care plan for the child and the family
Invasive Techniques: Cardiac Catheterization Laboratory
The goals and objectives of training in the cardiac catheterization laboratory are as follows:
- To understand the indications, risks, and limitations of diagnostic and therapeutic cardiac catheterization
- To be able to effectively communicate the rationale, techniques, and risks/benefits of catheterization to the patient and family
- Obtain skills necessary for insertion and manipulation of intravascular and intracardiac catheters and to understand the uses for the various types of catheters
- To understand the principles and techniques necessary to calculate flows, resistances, cardiac function, and severity of stenoses by catheterization methods
- Understand the uses of appropriate angiography techniques and selective angiography
- Learn basic principles and techniques of standard interventional therapeutic techniques (balloon atrial Septostomy; balloon valvuloplasty)
- Understand the function of the recording and angiographic equipment used in the catheterization laboratory
The goal of the electrophysiology training for the fellows in the Division of Pediatric Cardiology at the University of Florida is to provide a comprehensive background of the electrophysiologic mechanisms of arrhythmias in order to understand the approach to the management of arrhythmias in the pediatric patient.
Goals and Objectives
- Understand the role of the pediatric electrophysiologist in the management of inpatients with arrhythmia issues
- Delineate pathologic from non-pathologic arrhythmias through telemetry and ambulatory monitoring
- Understand the use of anti-arrhythmic medications guided by analysis of the arrhythmia and its mechanism
- Learn the approach to electrocardiographic interpretation
- Learn the appropriate follow-up to an abnormal electrocardiogram
- Learn the normal variations that occur in the electrocardiogram as a child ages
- Understand the mechanism and treatment of neurocardiogenic syncope
- Learn the approach to a child with palpitations, chest pain, and syncope
- Understand the basics of pacemaker and ICD follow-up and programming
- Understand basic interpretation of intracardiac electrograms
- Delineate different types of arrhythmias based on the intracardiac electrograms
- Understand the role of programmed stimulation in the induction supraventricular and ventricular arrhythmias
- Review the role of intracardiac electrograms in localizing the site of origin of arrhythmias
- Understand the role of radiofrequency ablation in the treatment of supraventricular and ventricular arrhythmias
Pre and Postoperative Care
Goals for this component of training include:
- Learning the indications, techniques, risks, and limitations of emergency therapeutic techniques including cardiopulmonary resuscitation, pericardiocentesis, thoracentesis, cardioversion, and temporary cardiac pacing
- Understanding of the modern principles and techniques of pediatric cardiac surgery including myocardial protection, cardiopulmonary bypass, and circulatory arrest
- Learning the anticipated postoperative course, potential complications, and management of the postoperative patient (both immediate and delayed)
- Understanding the principles and techniques of invasive monitoring of critically ill patients
- Development of working knowledge of commonly used medications in emergency situations and for critically ill patients
Outpatient Clinic Experience
During the course of training, the cardiology fellow will develop experience and proficiency in the following:
- Appropriate assessment and diagnosis of common pediatric problems referred to the cardiac clinic such as evaluation of a heart murmur, chest pain, palpitations, or syncope.
- Appropriate evaluation and follow-up of patients with known congenital heart disease; obtaining skills in medication adjustment, ordering of diagnostic tests, and appropriate timing of admissions, surgical referrals, or return visits.
- Demonstration of an attentive, compassionate, and knowledgeable approach to patients and their families.
- Collegial interactions with other attending physicians, residents, students, and other health care staff.
- Learn the basic requirements of a community practice of pediatric cardiology and administrative issues for the office outpatient setting.
Inpatient Consultation Experience
During the course of training, the cardiology fellow will develop experience and proficiency in the following:
- Appropriate assessment, diagnosis, and treatment of cardiac conditions requiring inpatient management from birth through adult ages
- Obtaining skills in acting in the role of consultant with associated interaction and teaching of students and residents
- Demonstration of an attentive, compassionate, and knowledgeable approach to patients and their families
- Appropriate and collegial interactions with attending physicians, residents, students, and other health care staff
- Understand the fundamentals of study design, basic statistical methods, and critical analysis of data
- Learn the basic approach to the understanding and interpretation of the literature
- Develop an approach to the understanding and interpretation of the literature
- Participate in the design and implementation of a research project, either clinical or basic, including interpretation of results and preparation of abstracts and manuscripts
- Generate at least one abstract presented at a regional or national meeting and at least one original manuscript published or in press
- Know the scientific foundations of cardiovascular physiology, pharmacology, pathology, embryology, and cardiac biology
In keeping with the goals of the ACGME Outcome Project initiative, all of the above training areas will incorporate the appropriate core competencies as described below:
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Fellows are expected to:
- Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
- Gather essential and accurate information about their patients
- Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
- Develop and carry out patient management plans
- Counsel and educate patients and their families
- Use information technology to support patient care decisions and patient education
- Perform competently all medical and invasive procedures considered essential for the area of practice
- Provide health care services aimed at preventing health problems or maintaining health
- Work with health care professionals, including those from other disciplines, to provide patient-focused care
Fellows must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Fellows are expected to:
- Demonstrate and investigatory and analytic thinking approach to clinical situations
- Know and apply the basic and clinically supportive sciences which are appropriate to their discipline
Practice-Based Learning and Improvement
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Fellows are expected to:
- Analyze practice experience and perform practice-based improvement activities using a systematic methodology
- Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health care problems
- Obtain and use information about their population of patients and the larger population from which their patients are drawn
- Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
- Use information technology to manage information, access on-line medical information, and support their own education
- Facilitate the learning of students and other health care professionals
Interpersonal and Communication Skills
Fellows must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patient’s families, and professional associates. Fellows are expected to:
- Create and sustain a therapeutic and ethically sound relationship with patients
- Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
- Work effectively with others as a member or leader of a health care team or another professional group
Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Fellows are expected to:
- Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development
- Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, the confidentiality of patient information, informed consent, and business practices
- Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Fellows are expected to:
- Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
- Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
- Practice cost-effective health care and resource allocation that does not compromise the quality of care
- Advocate for quality patient care and assist patients in dealing with system complexities
- Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know-how these activities can affect system performance