ACC/AHA/AAP RECOMMENDATION: TASK FORCES
Task Force 1: General Experiences and Training
Hugh D. Allen, MD, FACC, FAHA, FAAP, Chair,
J. Timothy Bricker, MD, FACC, FAAP,
Michael D. Freed, MD, FACC, FAHA, FAAP,
Roger A. Hurwitz, MD, FACC, FAAP,
Tim C. McQuinn, MD, FAAP,
Richard M. Schieken, MD, FACC, FAHA, FAAP,
William B. Strong, MD, FACC, FAAP and
Kenneth G. Zahka, MD, FACC, FAAP
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Introduction
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The goals of pediatric cardiology training include acquiring the cognitive and procedural expertise required to provide high-quality care to children with cardiovascular disease, acquiring the academic skills to make meaningful scholarly contributions to the specialty, and, importantly, to develop the capacity for ongoing self-education beyond the years of formal training.
The general training of pediatric cardiology fellows builds on the general clinical and academic skills acquired during residency training. The pediatric cardiology fellow should be given broad exposure to clinical activities in pediatric cardiology inpatient and outpatient care, pediatric cardiology inpatient and outpatient consultations, and in preventive cardiology. The academic skills of formal presentation, small-group teaching, literature review, data analysis, and study design are also components of the general training guidelines.
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Clinical training
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A fundamental goal of clinical training is to acquire bedside diagnostic skill and the ability to provide high-qualilty consultative inpatient and outpatient pediatric cardiology care. The core skills of history-taking and physical examination are the only means for correctly initiating diagnostic and management options appropriate to the individual patient, and these must be heavily stressed at all points of patient contact. Pediatric cardiology fellows should be observed by faculty while performing key portions of the history and physical examination, and to also have the opportunity to observe faculty perform history-taking and physical examination, so that meaningful discussion of useful strategies and techniques may develop. Consultation services, general inpatient wards, and outpatient clinics all provide excellent opportunities for such interaction.
The pediatric cardiology fellow must have the opportunity to provide not only inpatient and outpatient consultation services but also direct patient care in both inpatient and outpatient settings. There must be a continuity of care in the outpatient clinic so that fellows can begin to appreciate the course of pediatric cardiac disease over time and its cumulative impact on individual patients and their families. The combined time commitment of the general inpatient and inpatient consultation services should be no less than three months. The continuity outpatient clinic should begin early in fellowship and continue throughout training, preferably on a biweekly basis. Both inpatient and outpatient experiences should include exposure to the management of the adult patient with congenital heart disease.
There are many ways for general inpatient and outpatient practices to be organized. In the delivery of high-level inpatient and outpatient care the pediatric cardiologist must demonstrate effective team leadership, accurate and efficient medical record keeping, sensitivity to medical ethical issues, an ability to communicate with and support patients and their families through stressful decisions and experiences, and show strict compliance with federal regulatory statutes. The general inpatient and outpatient training environment for pediatric cardiology fellows must provide full opportunity for observation, acquisition, and application of these skills by the trainee.
During the course of inpatient and outpatient activities the pediatric cardiology fellow will become familiar with a core knowledge base, as outlined in Table 1, at a minimum.
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Didactic content
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The Core Curriculum.
The program should offer courses, seminars, workshops, and/or laboratory experiences to provide appropriate background in basic and fundamental disciplines related to the heart and cardiovascular system. A lecture series encompassing a core curriculum in clinical and basic science topics must be provided for pediatric cardiology fellows. It should be designed so that the spectrum of topics presented will be completed at least once in the three years of accredited fellowship training. Pediatric cardiology fellows should contribute formal presentations of selected topics in the core curriculum, both to strengthen their knowledge base and to develop formal presentation skills. General areas to be covered in the core curriculum include those listed in Table 1.
Additional Conferences.
Preoperative conferences with the cardiovascular surgical service are essential. Journal clubs are a recommended element of an academic environment and provide an excellent venue for participatory evaluation of study design and data analysis. Quality assurance evaluation and morbidity/mortality conferences should be held periodically. Multidisciplinary clinical and research conferences are highly desirable; according to the strengths of the institution, contributors might include neonatology, cardiothoracic surgery, adult cardiology, cardiac pathology, physiology, pharmacology, pulmonology, intensive care, cardiac anesthesiology, cardiovascular radiology, clinical genetics, molecular genetics, tissue engineering, stem cell biology, or developmental biology. In all of these conferences, pediatric cardiology fellows should be provided with active roles appropriate to their level of knowledge and training.
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Teaching and evaluation skills
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It is a fundamental responsibility in academic medicine that those with the most experience must teach. The pediatric cardiology fellow will often be the most clinically experienced house officer on a team of residents, interns, and/or medical students. The fellow in that setting should be expected to provide lectures/seminars to the team of house officers. The pediatric cardiology fellow should also be allowed the opportunity to practice clinical leadership, organizational skills, and impromptu educational activities as appropriate to his/her demonstrated level of knowledge and training. There should be occasion for observation and critique of these skills by the attending physician as well as demonstration of these skills to the fellow by the attending.
Pediatric cardiology fellows should develop formal evaluation of trainees and training skills during their fellowship. To do so, they should participate in feedback to residents, students, and cardiology attendings throughout their rotations regarding their own educational and technical progress and the progress of other team members. Accurate self-evaluation is the most valuable skill of all and should be nurtured in all phases of pediatric cardiology training.
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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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Introduction
Clinical training