ACGME Fellowship Training Program

Overview

The subspecialty training program is a three-year program, integrating clinical care, teaching and research experience at all levels. The program is continuously reviewed and revised to reflect changes that occur in the field of pediatric cardiology. As the general goal of our training program is to prepare fellows for a career in an academic environment, fellows will find themselves being exposed during any given week or month to basic science, clinical research, and clinical care, as they will be for the rest of their career. It is the philosophy of our program that fellows should develop the habit of integrating their clinical and investigative lives from the first day of their cardiology training.

During the first year, the trainee will gain a solid foundation in general clinical pediatric cardiology. Although this year is primarily clinical, time is also provided for the trainee to become familiar with both clinical and basic science research environments, choose a research mentor, review the appropriate literature, and begin to develop a scholarly project. House staff teaching is also emphasized.

The second year includes additional clinical training and increased teaching and clinical responsibilities, with increased emphasis on subspecialty cardiology: interventional catheterization, electrophysiology, transesophageal echo, and transplantation. This year allows the trainee an opportunity to gain more in-depth experience in areas of clinical cardiology of special interest to him/her. Research training is given increased emphasis and the trainee is expected to begin a research project during the second year and is also encouraged to complete an application for extramural fellowship support for the third year (although receipt of such support is not a prerequisite for continuation into the third year of training, the preparation of a grant application is regarded as an important component of the training experience).

During the third year of training, the primary focus is research, although continued participation in selected clinical programs and continuity of care experiences is provided. Over the course of the three-year training program, the trainee will assume increasing responsibility for both clinical care and scientific investigation commensurate with his/her academic progress and the assessment of the program director.

Clinical Training

The clinical portion of the training program is oriented towards a multi-disciplinary approach to the pediatric patient with cardiovascular disease. The fellow will learn to evaluate the needs of these patients from several viewpoints: acute care, long-term follow-up and prevention. A collaborative approach is emphasized, drawing on all assets of the Department of Pediatrics as well as appropriate resources from the Departments of Cardiovascular Surgery, Anesthesiology, Radiology, Pathology, Pharmacology, Molecular and Cellular Physiology, Psychiatry, and Social Services. The excellent working relationship with the Division of Cardiology in the Department of Medicine affords both pediatric and adult cardiology trainees a lifetime perspective on cardiovascular disease.

In the first year of training fundamentals of clinical cardiology are emphasized. Trainees will be encouraged to follow patients longitudinally from initial clinical visit through diagnostic evaluation, pre- and post- operative care, and long-term follow-up. Experience in managing new referrals and in the long-term follow-up care of children with heart disease will be gained in the three times weekly Pediatric Cardiology clinics, the twice weekly Pediatric Heart Transplant Clinic, and the weekly Pacemaker and Arrhythmia Clinic. An additional clinical program in conjunction with the Cardiology Division of the Department of Medicine is the clinic for adults with congenital heart disease. These clinical experiences will emphasize skills in physical examination, out-patient management, preventative care, electrocardiography, ambulatory ECG monitoring, outpatient exercise testing and radioisotope scanning. Fellows will gain in-patient experience by managing patients in conjunction with the attending cardiologist on the pediatric wards of Lucile Packard Children's Hospital and in the Pediatric Intensive Care Unit, the Cardiovascular Intensive Care Unit, and the Neonatal Intensive Care Unit. Trainees will participate in the management of medical pediatric cardiology patients as well as pre- and post-operative cardiovascular surgical and heart transplant patients. The fellow will learn to coordinate patient care with the cardiovascular surgeons and the pediatric cardiac intensive care specialists. Attendance in the operating room for selected surgical procedures and assistance with intra-operative echocardiographic studies will enhance the trainee's appreciation of the operative management of congenital heart defects. Trainees will develop skills in both non-invasive and invasive diagnostic modalities through participation in the activities of the Pediatric Echocardiography Laboratory, the Magnetic Resonance Imaging Center, the Cardiac Catheterization Laboratory and the Pediatric Electrophysiology Laboratory. The importance of integrating non-invasive and invasive data and of basing diagnostic and therapeutic decisions on sound physiologic and pharmacological principles is particularly emphasized. All procedures will be carefully supervised by the cardiology attending. In the catheterization laboratory, performance and interpretation of cardiac catheterization and angiography, electrophysiologic studies, radiofrequency and cryoablation, pacemaker/ICD implantation, myocardial biopsies, balloon angioplasties, and pharmacological studies is stressed. The fellow will advance from routine studies to more complex cases and interventional techniques.

Teaching Program

Clinical teaching in the division combines individual instruction, daily attending rounds, scheduled formal conferences and informal sessions. A list of the scheduled teaching conferences of the division is attached. The fellow also attends autopsies on pediatric cardiac patients and becomes familiar with the pathology of congenital and acquired heart disease of childhood. The clinical training experience is in part individualized to the experience and interests of the fellow. Arrangements can be made for electives in cardiovascular surgery, pediatric intensive care and cardiovascular anesthesia. Additional learning opportunities are afforded through the conferences of the Department of Pediatrics and the Cardiology Division of the Department of Medicine. The fellow is expected to participate in the teaching of medical students, house staff, and nursing personnel and to develop teaching skills by presenting regularly at both clinical and research conferences. Trainees will learn aspects of medical administration and interactions with third party payers and social service agencies. Emphasis is be placed on consideration of the ethical issues of medical care and on social and community responsibility. Trainees will participate in monthly meetings with the fellowship training program director and be given the opportunity to participate in decision-making regarding the development of the program.

Research Training

An active research program has been integrated into the fellowship training experience. Opportunities exist for both clinical and basic science research supervised by the faculty members of the division. The aims of this research experience are to enhance the trainee's understanding of the pathophysiology of cardiovascular disorders; to introduce the fellow to the methods of scientific investigation; and to give the fellow a background in the literature of basic cardiovascular research and the ability to objectively evaluate the published data of others. Opportunities also exist for extensive collaboration with numerous excellent research laboratories at Stanford.

The fellow will be exposed to the research environment early in the training experience. At the beginning of the fellowship, the fellow will meet with each faculty member in the division and choose a research sponsor. During the first year elective time is available during which the fellow is encouraged to participate in an on-going project in his sponsor's laboratory. At this point, the faculty advisor will choose a Scholarship Oversight Panel, consisting of members of the division and other faculty from outside of the division, who possess appropriate expertise in the area of interest. With assistance of the advisor and the committee, the fellow will begin to develop an individual scholarly project. During the second year specific blocks of time are devoted towards research investigation and the fellow is expected to begin to concentrate on his/her own project. Trainees are encouraged to write a formal research proposal in the form of an application for extramural support. This will afford the fellow the opportunity to clarify his/her research aims and to learn the practical aspects of attaining research funding. During the third year, significantly more time will be devoted to research. Trainees will have the opportunity to study biomedical statistics at the Stanford Medical School and will also have the opportunity to take additional basic science courses as necessary.

Fellowship Director

Jeffrey Feinstein, M.D., M.P.H.

Administrative Contact

Emily Johnson
Fellowship Coordinator
Phone: (650) 725-9906 or (650) 723-7913
Fax: (650) 724-4922

Lupe Romero-Villanueva
Advanced Fellowship Coordinator
Phone: (650) 721-6849 or (650) 723-7913
Fax: (650) 725-8343