Curriculum

The Pediatric Cardiology Fellowship training program at the Icahn School of Medicine at Mount Sinai dedicates 24 months to clinical training, and 12 months to scholarly activities and research.

Fellows are encouraged to teach residents and students on elective cardiology rotations when on service and during outpatient clinics. As a fellow, you’ll be required to teach at least two didactic sessions to pediatric residents under supervision, and give at least two talks to Cardiology faculty and fellows. You are also encouraged to participate in weekly didactic and core curriculum reviews and monthly journal club sessions. Other didactic aspects of the fellowship curriculum include:

  • Monthly catheterization and electrophysiology didactics
  • Bimonthly core curriculum didactics
  • Echo didactics and case discussions inclusive of fetal and MRI didactics, two to three times a week
  • Monthly Cardiovascular Pathology didactics
  • Monthly heart failure transplant didactics
  • Monthly critical care didactics
  • Monthly questions and content review
  • Monthly Cardiology Morbidity and Mortality meetings

Rotations

During the program, you’ll rotate through each of the subspecialty disciplines listed below:

 

First Year

Second Year

Third Year

Inpatient Service

2

2

2

Pediatric Cardiothoracic Intensive Care

3

2

1

Cardiac Catheterization

3

3

0

Non-invasive Imaging

2

1

3

Research

2

4

6

Pediatric Cardiothoracic Intensive Care Rotation

The Pediatric Cardiothoracic Intensive Care (PCIC) rotation introduces fellows to caring for pediatric cardiac patients postoperatively, as well as to the role of the pediatric cardiologist intraoperatively. As a fellow, you’ll learn the pathophysiology of the cardiac lesions as well as management of the various surgical procedures.

During twice-daily bedside rounds (approximately two hours per day), the differential diagnoses of various clinical problems are discussed in a system-based approach. Faculty, fellows, and physician assistants also make daily rounds with cardiothoracic surgeons (approximately one-half hour per day). Through these interactions, fellows learn about the collaborative approach to the management of pediatric cardiac patients postoperatively.

In addition to evaluating and caring for patients, fellows have opportunities to perform certain subspecialty procedures during this rotation. These procedures include placement of central venous and arterial lines percutaneously, placement of chest tubes, cardioversion with adenosine, overdrive pacing, and direct cardio version and intubations. Fellows also learn about cardiopulmonary resuscitation of postoperative patients, management of extracorporeal membrane oxygenation (ECMO), and assist device for patients being bridged to transplant.

In addition to their other responsibilities, fellows also spend a portion of the PCIC rotation in the operating suites, observing pediatric cardiothoracic surgical procedures. This gives fellows the opportunity to learn about congenital heart defects in vivo, anesthetic approaches to cardiac surgery in patients with congenital heart disease, and various aspects of cardiopulmonary bypass. During this rotation, fellows are also responsible for presenting cardiothoracic surgical conferences. Fellows also are expected to respond to beeper calls during their time covering the ICU. Beeper calls are from home, unless the patient’s condition requires your physical presence.

Fellows are integral to patient safety and Quality improvement initiatives in the ICU and are also part of the psychosocial and multidisciplinary rounds, family meetings, and palliative care meetings. This rotation is supervised by Drs. Seiden and SahuLee. 

Non-Invasive Rotation

The non-invasive cardiology rotation includes echocardiography, exercise physiology studies, and Holter monitoring. The majority of the non-invasive rotation time is spent in the Pediatric Echocardiography Laboratory. There is an intense, hands-on course for fellows starting in their first year in the first two weeks of July. This allows fellows to get introduced to concepts of imaging and develop familiarity with imaging equipment. Skills are taught using one-on-one interactive curriculum on “live volunteer models.” Fellows are encouraged to do hands-on imaging under direct supervision initially and usually by six months into their first year a majority of fellows are independently performing complete, focused echocardiograms. The goal is for all fellows to be able to independently identify, diagnose, and come up with a management plan following imaging of normal, simple and complex, and acquired congenital heart disease. After their second year, once fellows become competent in transthoracic echocardiography, they can also learn fetal and transesophageal imaging skills. At the end of each rotation fellows are required to give a talk to all imaging staff, and are actively involved in the CQI process in the echolab. Additionally, they are encouraged in their third year to participate in cardiac MRI procedures.

Inpatient Rotation

Our inpatient service cares for newborns, infants, children, and adults hospitalized with congenital heart or acquired heart disease. 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), pediatric emergency room, newborn nurseries, pediatric inpatient floors, and adults with congenital heart disease on medical, surgical, or obstetrical floors.

The inpatient service team makes daily teaching rounds, during which all patients are examined and all relevant laboratory data are reviewed. Typically, these rounds require two to three hours per day. As you progress through your training, you’ll receive greater responsibility in leading the rounds and making clinical decisions.

During this rotation, you’ll have the opportunity to perform procedures such as cardioversion of tachyarrhythmias, placement of central lines, and emergent pericardiocenteses. The fellow is also responsible for interpreting all pediatric electrocardiograms performed on inpatients. All interpretations are reviewed by the faculty member and discussed as necessary. The fellow on this rotation also assists in stress tests and accompanies Dr. Rica Arnon to departmental and hospital-wide quality improvement meetings.

Outpatient Rotation

Fellows are required to attend one of three ambulatory half-day pediatric cardiology clinics held weekly at The Mount Sinai Hospital. These clinics include referral and follow-up service for all types of heart problems, including congenital and acquired heart disease. Each clinic is supervised by a pediatric cardiology faculty member who reviews all findings with the fellow. Emphasis is placed on developing detailed history-taking for outpatient cardiac problems, as well as physical examination skills. These outpatient clinics serve a mix of patients with congenital and acquired heart problems, including those typically encountered in the office setting (evaluation of murmurs, chest pain, or syncope).

Senior fellows have the option to participate in the weekly Pediatric Heart Transplantation Clinic and the Cardiovascular Genetics Clinic held in the Pediatric Cardiology Office Practice.  Senior fellows may also participate in the outpatient pediatric cardiology clinic at Mount Sinai Faculty Practice Associates.

Cardiac Catheterization and Electrophysiology Rotation

During the cardiac catheterization rotation, the fellow is responsible for caring for pediatric patients prior to, during, and after cardiac catheterization inclusive of those scheduled for EP studies and pacemaker placement, etc. With the oversight of the catheterization faculty, the fellow creates a plan for the catheterization that includes the proposed sedation, venous and arterial access sites required, the hemodynamic data to be collected, the appropriate angiography, and any proposed interventions.

During the month of the cardiac catheterization rotation, the assigned fellow participates in every catheterization performed. Depending on the experience and skill level of the particular fellow, the catheterization faculty member will allow the resident increasing responsibility during the case. In the first year, fellows are expected to review all patient data and indications, are responsible for obtaining consents, and are expected by the end of their fellowship to have the knowledge required to know appropriate indications, complications, interpretation of angiograms and hemodynamic data and post cath management and patient disposition. After the catheterization procedure, the fellow is responsible for the post-procedure care. The fellow is also responsible for reviewing and reporting all of the data from the procedure.

Quality Improvement and Patient Safety Measures

In addition to providing clinical care, fellows are deeply involved in quality improvement initiatives and follow measures to ensure patient safety. Our PCICU fellows are involved with ICU MERS reviews and are exposed to other ongoing PCICU monitors. Fellows also participate in ongoing quality improvement initiatives in the ECHOLAB including quarterly presentations focused on imaging and reporting errors, as well as comparative analysis between different modalities. Fellows on service attend monthly Pediatric M&M and quality improvement interdepartmental meetings alongside Dr. Arnon.