Curriculum

The program is designed for three years of clinical and research training. A number of fourth year opportunities are offered as well. In the first year, the trainee rotates through the first five services listed below. The second and third year involve rotations through clinical areas with more responsibility on the part of the trainee and 12 months of research. The exact division of time is decided between the trainee and his/her faculty advisor. Formal course work and lectures are included within the training program. A core curriculum for cardiac morphology, clinical cardiology, and basic science is covered yearly. The fellowship includes a one month "Research and Academic Skills" course at the beginning of the second year.

Trainee Rotations Research Program Didactic Teaching Conferences Visitors Instruction and Experience in Teaching Publications and Presentations Scientific Meetings Advanced Degrees

Daily Outpatient Clinics (Continuity experience for fellows with designated clinic mentor). The fellow first evaluates the patient, including the interpretation of laboratory data, then presents the findings and interpretations to one of the full-time staff who in turn examines the patient for final discussion and approval of the fellow's examination. The length of the outpatient service varies with the clinical experience and the needs of the trainee, but is usually one month in the first year and longitudinal follow-up of patients in two clinic days per month over the remainder of fellowship. These longitudinal clinics will consist of both “new” patients along with patients the fellow has previously managed.


Echocardiography Laboratory. Instruction and experience are provided in the use of ultrasonic diagnostic techniques. With staff supervision, the fellow performs and interprets the studies. Four months are spent on this rotation in the first year. By the end of the first year, fellows will be able to do a complete transthoracic echocardiogram on any type of heart defect. A weekly echocardiography conference is held in conjunction with the adult cardiology service from Methodist Hospital. Fellows may develop additional expertise in fetal echocardiography, transesophageal echocardiography, ventricular function assessment, and MRI in the third year of training.


Inpatient Service. The fellow has the responsibility, with staff supervision, for the clinical management of the hospitalized patient. The fellow supervises the pediatric residents in the inpatient care of the patients. Approximately 50 of the 456 beds in Texas Children's Hospital are occupied by cardiac patients. The medical care of the preoperative and postoperative patients includes responsibility for the patients in the dedicated cardiac intensive care unit as well as the neonatal/pediatric intensive care units. Four months during the first year and two months during the second and third year are spent on this service.


Cardiac Catheterization Laboratory. One of the staff is present and responsible for each procedure. The fellow initially assists and learns the use of the equipment, then, with supervision, performs cardiac catheterizations, angiocardiograms, electrophysiologic studies and related procedures. The fellow presents the catheterization data and angiographic material as well as the features of the case at catheterization conference. Two months during the first year and three to four months during the second and third year are spent in this rotation.


Electrophysiology. One month during the first year of fellowship and at least one month during the second year are usually spent on this rotation. The fellow interprets each ECG and 24-hour ambulatory ECG and reviews with one of the faculty electrophysiologists. During this period the trainee also participates in management of patients with arrhythmias, performing and interpreting intracardiac electrophysiologic studies, participating in pacemaker implantations for the cath lab performing radiofrequency ablations, using investigational antiarrhythmic agents and assisting in operating room mapping for ablation of arrhythmia.


Exercise Laboratory. The trainee participates in exercise testing and reviews results with staff and the exercise physiologist during outpatient or catheterization rotations.


Research. Investigative studies are encouraged and expected of the trainee during clinical rotations and, in addition, various periods are set aside each year (for a total of 12 months during the 3 years of training). The fellows will have published a manuscript in a peer review journal during their fellowship (more information available in G).


Harris County Hospital.  The second and third year fellows function as consultant for two or three months, under staff supervision, at the city-county hospital, and at three other large nursery services. Teaching responsibility and consultant management reside with the fellow, working directly with a faculty member.

The fellows are offered research training and experience in the following disciplines. It is not required that the applicant have a background in research.

Physiology. Human and animal hemodynamic and pharmacologic studies are offered within the Pediatric Cardiology Section and in collaboration with the Department of Physiology and Biophysics and the Section of Cardiovascular Sciences, Department of Medicine.


Myocardial Biology. Research and training in the techniques of myocardial biology, emphasizing cardiac development, are offered by the Section of Cardiovascular Sciences. Studies of the effects of development and various hemodynamic stresses on subcellular organelles, as well as biochemical genetics studies, are currently under way.


Clinical Research. This may be conducted in the Texas Children's General Clinical Research Center, an eight bed facility for physiologic, pharmacologic, biochemical and metabolic studies. Other investigations of patients, including review of prior experience and prospective studies, are conducted outside the GCRC.


Electrophysiology. Clinical intact animal and microelectrode studies are in progress to investigate mechanisms of arrhythmias in children and developmental changes in animal models. Numerous opportunities for clinical research exist as well.


Epidemiologic Research. Studies can be carried out on the epidemiology of congenital and acquired heart disease through the University of Texas School of Public Health, the Epidemiology Branch of Baylor College of Medicine's DeBakey Center, or the Texas Children's Preventive Cardiology Clinic.


Clinical Hemodynamic Research. The current areas of research include generation of heart sounds, comparison of heart valve motion and blood flow, intracardiac blood flow, valvular regurgitation, pulmonary vascular impedance and the pharmacologic evaluation of drugs.


Therapeutic Cardiac Catheterization. Improvements in the ability to treat congenital heart disease during catheterization are under investigation in animal models and in application to human use with long term follow-up.


Echocardiography. Clinical and basic science opportunities are available.


Nuclear Magnetic Resonance Imaging. Projects are in place with application of NMR to imaging of the pediatric heart and in tissue characterization.


Molecular Genetics of Cardiac Disease.  The Phoebe Willingham Muzzy Pediatric Molecular Cardiology Laboratory within our section is both independent, as well as being a part of the Baylor College of Medicine Institute for Early Heart Development Research. With the opening of the new research facilities in the fall of 2002, the lab added 9,000 square feet of space. Opportunities in Cell Biology and Medicine at the Institute for Molecular Genetics exist, as well as opportunities in the Department Molecular and Human Genetics.


Transplantation and Transplant Immunology. Efforts to predict and modify rejection after heart transplantation in childhood continues with collaboration between the Cardiac Transplant Service and the Pediatric Immunology Section.  Other projects include mechanical circulatory support and investigations into the etiology of cardiomyopathies.


Nutrition. The Children's Nutrition Research Center of the United States Department of Agriculture which is physically attached to Texas Children's offers the opportunity for utilizing stable isotopes for the study of myocardial metabolism, basic research projects related to nutrition and cardiac function, and atherosclesosis research.


Leukocyte Biology.  The role of white cells in myocardial injury, with cardiopulmonary bypass, and in transplant rejection are all under investigation.


Clinical Cardiovascular Genetics.  The largest cardiovascular clinic in North America, this clinic combines the expertise of members of Cardiology and Molecular and Human Genetics. Multiple clinical and basic science projects are available and under study. 

Basic and Clinical Science Lectures. A weekly seminar is presented in cardiopulmonary physiology, anatomy, embryology, biochemistry, pharmacology, genetics, immunology, statistics, experimental design, and various other topics. Each seminar is presented jointly by either a pediatric cardiology fellow, a member of the basic science faculty, or one of the pediatric cardiology faculty.


Special Seminars and Courses presented by Visiting Lecturers. Courses are given by invited participants in topics such as medical writing and other subjects that are not included under the regularly scheduled basic science or clinical science lectures. 


Research Lecture Series. Lectures are given by individuals from within the section and by invited lecturers.


Research Course. The first month of the second year fellowship is spent at a full-time course introducing statistics, experimental design, instrumentation, computers, writing, and grants.


Health Administration Lectures. A complete series of lectures covering all aspects of administering a pediatric cardiology program is given. 

Cardiac Catheterization Conference (hemodynamic & interventional).  A twice weekly review of previous cardiac catheterization and angiographic data in conjunction with pertinent clinical data is given.


Electrophysiology Conference. This conference is held for one hour every week. Didactic sessions on electrocardiography and electrophysiology are the primary focus in the early part of the year. The basics of intracardiac electrophysiologic studies and pacemakers are taught. Later in the year ECG and EP tracing unknowns are presented and reviewed. 


Surgical M & M Conference. This conference is held one hour per month. 


Echocardiography Conference. This conference is held 1-2 hours per week in conjunction with the adult cardiology section of The Methodist Hospital. During the early part of the academic year, didactic sessions are held concerning echocardiography; later conferences focus on more advanced clinical topics and unknowns.


Pathology Conference. The Department of Pathology presents a review of specimens every week. A museum of congenital cardiac defects is under development for either independent or supervised study by the cardiology trainee and for morphology related projects.


Surgical Conference. The pediatric cardiology staff, cardiovascular surgery staff, and cardiovascular anesthesia staff meet jointly once a week to review upcoming surgical cases. The pediatric cardiology fellows present cases and participate in the discussions.


Case Management Conference. Once weekly the pediatric cardiology staff, fellows, and cardiovascular staff meet to discuss all cases where management issues need to be reviewed.


Red Tag Conference. The echocardiography faculty, fellows, and sonographers meet weekly to discuss interesting cases, presented as an unknown study. Fellows also participate in presenting studies.


Transplant Conference. Review of topics pertinent to transplant.


Surgical Teaching Rounds. Weekly bedside teaching rounds led by the CV surgeons to discuss the medical and surgical aspects of a patient in the CV-ICU.


1. Journal Club. Fellows and faculty meet monthly for dinner and to review selected articles and new topics in pediatric cardiology.


Fellow’s Conference. Fellows meet weekly with faculty advisors to discuss any issues related to the training program. 

Visiting Professors.  World recognized individuals in the field of pediatric cardiology are invited to lecture and to meet formally and informally with the fellows. Recent visitors included: Jane Somerville, M.D., David Nykanen, M.D., Lisa K. Hornberger, M.D., David Sahn, M.D., William Neal, M.D., David Nelson, M.D., David Fulton, M.D., Ian Adatia, M.D., and Tal Geva, M.D. 

The trainee is given teaching responsibility with staff supervision. This includes both informal ward rounds, teaching and formal lectures to medical students, house staff, nurses, and other medical professionals. The basic science and clinical science lectures provide the opportunity to develop lecture techniques and to evaluate those of the other trainees.

Publications by the trainee are expected, not only to share worthwhile information with others, but also to provide a discipline of precise and critical analysis of problems important in the development of the clinical as well as the academic investigator. Publication of research data by the trainee is expected to satisfy the research requirement of the Sub-board of Cardiology of the ABP. The trainee prepares a research proposal and submits this for review by the faculty. Approved projects are carried out under the supervision of one of the clinical or basic science faculty members. Presentations at scientific meetings are encouraged and provide the trainee with the opportunity to attend a national meeting.

Fellows attend and present at national scientific programs such as those sponsored by the American Heart Association, the American College of Cardiology, The American Academy of Pediatrics, The American Society for Echocardiography, The North American Society of Pacing and Electrophysiology, and the Society for Pediatric Research. 

Fellows with specific interest may begin work toward an advanced degree or spend a year as a postdoctoral fellow in one of the basic science departments. Examples include:

Baylor College of Medicine - M.S. or Ph.D. degree
• Physiology
• Pharmacology
• Cell Biology


University of Texas School of Public Health - M.P.H., M.S., Dr.P.H., or Ph.D. degree
• Public Health
• Epidemiology
• Biostatistics