Our inpatient service involves all aspects of care of newborns, infants, children, and adults hospitalized with congenital heart or acquired heart disease, as well as adults with congenital heart disease. These patients include individuals admitted for cardiac surgery, convalescing patients returning from the Pediatric Cardiothoracic Intensive Care Unit (PCICU) postoperatively, newborns with congenital heart disease born at our institution or transferred from other institutions, and patients admitted electively or in an emergency for the management of cardiac problems such as congestive heart failure, cardiac allograft rejection, or arrhythmia management.
The inpatient service team includes a pediatric cardiology attending, a pediatric cardiology fellow, pediatric residents, and fourth-year medical students rotating on the service for one month. The team is responsible for pediatric patients with cardiac problems hospitalized in the neonatal intensive care unit (NICU), the pediatric intensive care unit (PICU), and the pediatric inpatient floors, and adults with congenital heart disease on medical, surgical, or obstetrical floors. The team is also responsible for consults in any of the aforementioned areas as well as in the newborn nurseries and the pediatric emergency room.
The inpatient service team makes daily teaching rounds during which all patients are examined and all relevant laboratory data including electrocardiograms and chest roentgenograms are reviewed. Typically, these rounds require two to three hours per day. The team discusses each patient's problems and devises the proposed diagnostic and/or therapeutic plans. As the pediatric cardiology fellows progress through their training, they receive greater responsibility in leading the rounds and making clinical decisions about the patients. Consultations are carried out either by the fellow with subsequent bedside review by the faculty member or jointly by the fellow and faculty member, depending both on the nature of the consultation and the level of the fellow. Clinical emergencies such as unstable newborns with congenital heart disease or children with low cardiac output are managed jointly.
During this rotation, fellows have opportunities to perform certain procedures such as cardioversion of tachyarrhythmias (with both adenosine and direct current), placement of central lines, and emergent pericardiocenteses. The fellow is also responsible for interpreting all pediatric electrocardiograms performed on inpatients. These interpretations are all reviewed by the faculty member and discussed further as warranted.
In addition to the impromptu discussions related to issues arising on clinical rounds, formal didactic sessions are held. The pediatric cardiology fellows are assigned topics for brief discussions, often triggered by interesting patients on the service. In addition, the faculty member and fellows are expected to spend time instructing the more junior members of the team in basic pediatric cardiology such as the physical examination, physiology/pathophysiology of common congenital heart lesions, and interpretation of the pediatric electrocardiogram. As before, the fellow assumes increasing proportions of these teaching responsibilities as s/he advances.
During the in-service rotation, the pediatric cardiology fellow learns about interfacing with numerous other services, both medical and non-medical. A nurse clinician, social worker, and child life specialist provide input and require feedback from the in service team in the care of patients, as well as in discharge disposition. The fellow is responsible for regularly discussing the patients with these integral members of the teams, thereby learning about relevant important issues such as arranging home care, certain technical aspects of both public and private health care coverage, and the importance of the psychosocial issues in the care of children undergoing traumatic procedures or suffering from chronic illness.
The fellows also interact with referring pediatricians, both pediatricians and pediatric cardiologists. This interaction provides the fellow with opportunities to understand his/her role as a consultant at a referral center and to learn how to assist referring physicians in stabilizing sick patients at distant locations.
The pediatric cardiology fellow interacts with physicians from numerous other pediatric subspecialties. These interactions provide instruction in the proper role of the pediatric cardiologist in the care of patients with a variety of problems and also in the role of other specialists in the care of children with congenital heart disease.
Finally, the pediatric cardiology fellow interacts with physicians from adult medical services, including adult cardiologists and obstetricians. The fellow and faculty member on the inpatient service provide consultation on adults with congenital heart disease including newly presenting patients, those with chronic problems (e.g., heart failure, arrhythmias), and pregnant women with corrected or palliated congenital heart defects. In addition, the fellow participates in the management of fetuses with congenital heart disease, heart failure, and/or arrhythmias, in conjunction with the high-risk obstetrical service.
Icahn School of Medicine
One Gustave L. Levy Place
New York, NY 10029
Advanced Imaging Fellowship
November 1, 2012
October 1 - December 15, 2012