Inpatient Service and Consultation
Under the supervision of faculty and staff, the fellow is responsible for the clinical management of hospitalized patients. This includes service on the general Cardiology floor, as well as the consultation services in the NICU, PICU and throughout the hospital. These services include patients with newly diagnosed congenital heart disease, pre- and post-operative patients as well as those with acquired heart disease, arrhythmias and more. The fellow is also responsible for the supervision of the pediatric residents. Four months during the first year and two and a half months during the second and third years is spent on this rotation.
Fellows gain knowledge of general cardiology thorough a continuity experience in the outpatient clinic. Half day clinics every other week afford the fellow an opportunity to get to know the patient and family and to serve as their primary point of contact. The clinic encounters are staffed and supervised by faculty members. Interested individuals may choose to complete a one month elective in outpatient cardiology supervised by cardiology faculty.
Fellows complete an Echo Boot Camp during their first month in the program. After this immersion experience, new fellows are better prepared to perform and interpret echocardiograms early in their training. During the first year, four months are spent in the Echo Lab with an additional two months over the next two years. Second-year fellows spend time performing transesophageal echocardiograms. Fellows are expected to be able to acquire and interpret images as well as write a comprehensive report of the findings. Supervision is provided by faculty as well as experienced pediatric sonographers. Additional expertise can be obtained in fetal echocardiography, transesophageal echocardiography, ventricular function assessment and MRI in the third year of training.
Cardiac Catheterization and Interventional Cardiology
Initially, fellows assist and observe procedures to become familiar with the equipment and to gain basic knowledge of the cardiac catheterization service. Under faculty supervision, fellows eventually are able to actively participate in performing cardiac catheterizations, angiograms and related procedures and present the catheterization data and features of the case at the weekly Heart Center conference. Fellows spend two months during the first year and two months during the second year on this rotation.
Cardiovascular Intensive Care Unit
The CVICU experience includes the management of patients in the pre- and post-operative settings. Fellows are expected to perform procedures such as line placement and intubation and, under the supervision of an intensivist, staff the unit during the day and overnight. Fellows complete four months in CVICU, two of which are during the first year of training.
While completing the electrophysiology rotation, fellows interpret ECGs and 24-hour ambulatory Holter monitors before reviewing them with one of the faculty electrophysiologists. During this period, fellows also participate in management of inpatients with arrhythmias, perform and interpret intracardiac electrophysiologic studies and participate in pacemaker implantations and ablations. Additional time is spent in the electrophysiology clinic to learn the management of common arrhythmias in the outpatient setting. One month per academic year is spent on this rotation.
Each fellow is assigned a total of 12 research months and expected to have published a manuscript in a peer reviewed journal by the end of training. However, many fellows complete the program with multiple first-author publications. In addition to participation in a dedicated clinical research curriculum, fellows are mentored by faculty members involved in investigation in all aspects of pediatric cardiology. The completed work is often presented at various national and international meetings, for which funds are provided.
Heart Failure and Transplant
Baylor College of Medicine and Texas Children's Hospital has a robust Heart Failure and Transplant Service. The fellow works with attendings to treat patients on the general cardiology floor, in the CVICU and in the first-of-its-kind Heart Failure Intensive Care Unit. There is also time spent in the heart failure clinic to better understand the management of patients in the outpatient setting. Fellows spend one month during their fellowship assigned to the Heart Failure and Transplant service.
Adult Congenital Heart Disease
As it is in much of the country, the Baylor College of Medicine Adult Congenital Heart Disease program is rapidly expanding in patient volume. While not a required rotation, interested fellows have the option to complete an elective rotation on the ACHD service working along side the faculty and subspecialty fellows to treat patients. Research opportunities in ACHD are plentiful as are opportunities to collaborate between hospitals within the Texas Medical Center.