ACC/AHA/AAP RECOMMENDATION: INTRODUCTION
Training Guidelines for Pediatric Cardiology Fellowship Programs
Thomas P. Graham, Jr, MD, FACC, FAHA, FAAP, Chair and
Robert H. Beekman, III, MD, FACC, FAHA, FAAP, Co-Chair
Pediatric cardiology is a complex, multifaceted specialty composed of diverse clinical and academic subspecialty areas. It is characterized by rapid growth of subspecialty areas and swift incorporation of new information from the clinical and laboratory sciences. It is important, therefore, to define the fellowship training required to launch a successful career in pediatric cardiology. The following document represents the first broad-based effort to do so.
In 2000, the Society of Pediatric Cardiology Training Program Directors (SPCTPD) embarked on the process of defining fellowship training guidelines. The process itself was broad-based and inclusive. All pediatric cardiology training program directors were invited to nominate members to participate in the training guidelines task forces; in turn, each task force was comprised of all nominated members who agreed to participate. Therefore, all training programs were provided an opportunity to actively participate.
In 2002, the American College of Cardiology (ACC) approved and published the Revised Recommendations in Adult Cardiovascular Medicine Core Cardiology Training (1). As the SPCTPD was concluding its training guideline development, plans were formalized to use a similar process through the ACC Pediatric Cardiology/Congenital Heart Disease Committee and the ACC Training Program Directors Committee. Accordingly, a steering committee was developed with original authors of the Pediatric Cardiology Training Guidelines to form a liaison with the ACC, the American Heart Association (AHA), and the Section on Pediatric Cardiology and Cardiac Surgery of the American Academy of Pediatrics (AAP) to agree on the final guidelines and to publish them widely.
These guidelines are written with the planned goal of serving as a practical resource for directors of pediatric cardiology training programs. We also hope that this document will prove useful to the Residency Review Committee (RRC) for pediatric training programs in the revision of requirements for the accreditation of pediatric cardiology programs. The general requirements, clinical competencies, and oversight for fellows in pediatric cardiology would remain the same as outlined by the Accreditation Council for Graduate Medical Education (ACGME).
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General considerations
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The guidelines proposed in this document address overall recommendations for training in pediatric cardiology and important subspecialties within the field of pediatric cardiology. Although we understand that the pediatric RRC sets minimum standards for accreditation of fellowship programs, this document endeavors to define a more comprehensive set of guidelines for pediatric cardiology fellowship training. Fellowship training guidelines are presented for: general pediatric cardiology (including inpatient care and consultations); echocardiography and noninvasive imaging; electrophysiology; cardiac catheterization and intervention; cardiac intensive care; adult congenital heart disease; and research participation. Each section other than general pediatric cardiology specifies "core" and "advanced" training experiences. Core recommendations are intended to be common training experiences for all pediatric cardiology trainees regardless of long-term career goals. Advanced recommendations are additional training experiences for trainees intending to develop a clinical or academic area of special competence. All guidelines are recommended experiences, and not absolute mandates, as it is recognized that each training program has unique strengths and that clinical and academic variation across training programs provides important diversity for the specialty.
Table 1 summarizes the approximate time commitment (in months) recommended for core training in the task force reports that follow. Variations in these time commitments should be allowed, as pediatric cardiology programs vary widely in size, organization, and emphasis. For example, in some programs, fellows may get considerable cardiac intensive care unit training during their general inpatient experiences and not require a two- to four-month stand-alone rotation. Thus, the training guidelines must provide programs with flexibility to address individual trainee clinical and/or research training needs during a core fellowship of 36 months’ duration.
The training program must possess the faculty expertise, patient volume, and inpatient/outpatient facilities to provide meaningful trainee experiences as outlined in this document. All faculty should be board certified or possess suitable equivalent qualifications. Recommendations for trainee and faculty evaluation are those outlined in the "general and special requirements" as published by the ACGME, and training should take place within a program that is accredited by the ACGME.
A comment about trainee research participation is appropriate. The field of pediatric cardiology is absolutely dependent upon research (basic and clinical) for meaningful progress. There is a critical need for the development of physician-scientists in our specialty to assure such future progress. Therefore, it is key that training programs begin to prepare trainees for a successful investigative career. Such preliminary research training will in most instances require 18 months or more. The balancing of clinical and research training will continue to be a major issue for training programs. It is highly probable that trainees who want to pursue a physician-scientist career will require at least four years of fellowship to begin the academic process and to finish training in the clinical areas. The authors are in complete agreement with the newly published American Board of Pediatrics (ABP) Training Requirements for subspecialty certification concerning scholarly activity, meaningful accomplishments in research, scholarship oversight, and differing pathways to train physician-scientists.
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Appendix
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The authors of this section declare they have no relationships with industry pertinent to this topic.
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References
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- Beller GA, Bonow RO, Fuster V. ACC revised recommendations for training in adult cardiovascular medicine. Core Cardiology Training II (COCATS 2) (revision of the 1995 COCATS training statement) J Am Coll Cardiol 2002;39:1242-1246.[Free Full Text]
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General considerations
Appendix