Year I

Clinical rotation

The fellow is responsible, together with an attending, for the provision of clinical consultative services for all inpatients, surgical patients and emergencies during a two- to four-week block period and for the teaching of students and residents.

Outpatients

Outpatients are seen daily, and the fellow will participate in the evaluation of these patients together with the attending, sharing in the evaluation of the noninvasive testing and in the formulation of management plans. Fellows are assigned to a specific clinic day and proctor to allow for continuity of care.

Intensive care skills

While on the clinical rotation, the fellow will spend time in the neonatal and pediatric intensive care units. Fellows will share in the management of the postoperative cardiac patients and of the acutely ill neonate with heart disease. Patient care is managed in collaboration with the intensivists and cardiac surgeons.

Electrophysiology

Rotation on the electrophysiology service takes place during years one and two. The fellow participates in pacemaker clinic and outpatient assessment of arrhythmia patients — including Holter and event recorder assessment, tilt table and stress testing — and invasive procedures. Division faculty also participates in placement of intravenous pacemakers and automatic implantable cardioverter defibrillators (AICD).

Pathology

Six 2-hour sessions per year are conducted by a highly qualified congenital heart disease pathologist, with a rotating two-year curriculum. In addition, reviews of cases are conducted as they arise.

Noninvasive testing

A fully equipped echocardiography laboratory is the site for training of fellows in the interpretation of two-dimensional echocardiography imaging and Doppler studies, as well as detailed quantitative studies of systolic and diastolic function. The fellow is trained to interpret and perform high-quality studies using these techniques. Fetal echocardiography, transesophageal echocardiography and 3-D echocardiography are highlighted as well. The laboratory performs approximately 6,000 echocardiograms annually. Dobutamine echocardiography stress testing is available. Training in magnetic resonance imaging is available through a collaboration effort between pediatric cardiology faculty and radiology faculty.

Invasive laboratory

A newly constructed, dedicated pediatric catheterization laboratory is the setting for this training. Training in diagnostic and interventional cardiac catheterization techniques and angiography is a major component of our fellowship program. The fellow is expected to gradually become proficient in cardiac catheterization and the obtaining of data, its interpretation and its significance. Additional training is provided to fellows with a focused interest in interventional techniques, such as pulmonary and aortic valvuloplasty, arterial dilatations and myocardial biopsy, stent placement and device closures of patent ductus arteriosus (PDAs) and atrial septal defect (ASDs). The training is enhanced by the weekly patient management/postcatheterization conferences.

Electives

Elective time can be arranged in our department and in others within the school of medicine. Some examples are electrophysiology, pathology, NICU, PICU, anesthesiology, cardiac surgery, adult cardiology, genetics and any of the basic science laboratories.

Teaching sessions

I. Conferences

• Ward rounds (daily)
• Clinical service conference (weekly)
• Management conference/cath conference (weekly)
• Didactic teaching conference (weekly)
• Echo conference (weekly)
• Journal Club (monthly)
• Morbidity and mortality conference (monthly)
• Research/academic conference (monthly)
• Cardiac catheterization conference (monthly)
• Pathology conference (six times per year)

II. Research design

A two-week course in research design is offered through the Johns Hopkins Bloomberg School of Public Health and attended by our fellows. Fellows are expected to identify a research interest and to develop a research proposal during the first year. Selected fellows may apply to the graduate training program in clinical investigation, a collaboration between the Johns Hopkins University School of Medicine and school of public health.

Year II

Second-year fellows will continue to gain experience in the clinical areas with the emphasis on increased responsibility of patient care. There will be a major emphasis during year two on carrying out a research project based on the proposal developed in year one.

Year III

The purpose of year two is to refine clinical skills and complete research projects. The third year schedule is designed to strengthen areas of expertise based on the fellow’s career goals and the faculty’s evaluation of the fellow’s knowledge.

Year IV

A provisional fourth year for continuing research is offered for those fellows wishing to further pursue their chosen area of clinical or basic pediatric cardiology research. The fellow is expected to seek research funding for this year from one of several available sources. Alternative plans are available; for example, a two-year laboratory experience followed by years three and four devoted primarily to clinical training.

Research areas

The research areas available include both basic and clinical projects. Trainees are encouraged to reach out beyond the division into other divisions or the basic science departments of the medical school. Research is currently ongoing in many areas, including:

• Innovative interventional techniques in the treatment of congenital heart disease
• Biochemistry of myocardial contraction in the developing heart
• Fetal echocardiography
• Electrophysiology, clinical or basic
• Hyperlipidemia
• Genetics of congenital heart disease
• Connective tissue disorder
• New 3-D and echocardiographic imaging
• Clinical outcomes

Coursework

Coursework is available within the Johns Hopkins University as well as within the basic science departments of the Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health.