Adult Congential Heart Disease Fellowship Program Curriculum
There are two pathways of the core curriculum. The pathway depends on the previous training of the applicant.
The first year of the program is designed to train the pediatric cardiologist in Adult Cardiology or train the adult cardiologist in the principles of Pediatric Cardiology. Time is spent in the beginning on Inpatient Cardiology rotations and Adult Cardiology outpatient clinic rotations. Afterwards, rotations in each of the other cardiac subspecialties is pursued. The Adult Congenital outpatient cardiology clinic experience occurs on Thursdays throughout each rotation to give a consistent experience in managing these patients.
For the trainee with an Adult Cardiology background, time will be spent in the Pediatric Cardiology outpatient clinic and Pediatric Cardiology consult rotations to help gain insight into unrepaired Congenital Heart Disease and the perspective of the Pediatric Cardiologist.
For the trainee with a Pediatric Cardiology background, plenty of time will be spent on gaining familiarity with the management of acquired heart disease.
Fellows will be expected to organize a monthly ACHD didactic conference containing topics relevant to Adult Congenital Cardiology and General Cardiology certification. A holographic projector is used for cardiology teaching during conferences.
The second year of fellowship continues through each of the cardiac subspecialties and allows the fellow more independence in completing Adult Congenital consultations. Multiple selections for elective rotations are available to augment previous experience. Additional rotations are available at outside institutions but must be arranged with the program director as far in advance as possible.
Rotations at a glance
Cardiac Intensive Care (CCU)
Medical Director — Jay Shake, MD
The Cardiac Intensive Care rotation is designed for the fellow to develop expertise in the acute and chronic medical management of adults recovering from congenital and coronary surgery. While on this rotation, fellows will learn the fundamentals of postoperative management.
Fellows participate in daily morning rounds with the Intensive Care practitioners, residents and critical care attending, reviewing physical findings, laboratory results and management plans for each patient. The fellow will educate other learners on the team and provide daily management plans for the postoperative patient in concert with the CT surgery team.
Fellows spend one month in the ICU in the first year, and those who are interested can seek out additional months. Adult Cardiology fellows will spend time in the Pediatric Intensive Care Unit learning how postoperative pediatric cardiac surgery differs from Adult cardiac surgery.
Inpatient Cardiology Consult Service
Medical Director — Thomas Skelton, MD
Faculty — rotating (both Adult and Pediatric Cardiology)
The goal of the consult service rotation, undertaken in both years, is to ensure that the fellow develops the skill to provide Adult Cardiology, Pediatric Cardiology, and Adult Congenital cardiac consultative services. Emphasis will be placed upon adult congenital patients and the experience in the Pediatric Cardiology division is to help familiarize the ACHD fellow with the original pathophysiology that ACHD patients started out with. All inpatient ACHD consults will be directed to the ACHD fellow except on weekends and nights, where the consult will be initially staffed by the general cardiology fellow on call and the ACHD fellow will complete the consult the next day.
The task of integrating information from all sources will be emphasized, to create the best possible care plan for the adult congenital inpatient. The fellow will assess at least 10 pregnant women with adult congenital heart disease throughout the fellowship. The fellow will participate in the postoperative cardiac management of at least 20 congenital surgeries, and at least 10 non-cardiac surgeries.
The fellow is challenged to learn how a congenitally malformed heart first manifests as an infant, and its implications decades down the line as an Adult congenital patient. Fellows will be rotating alongside Adult Cardiology Fellows (PGY4-6).
Medical Director — Jimmy Hamilton, MD
Fellows are able to select this rotation as an elective. Fellows gain experience with:
- Electrocardiographic interpretation of complex arrhythmias on standard electrocardiograms
- 24-hour ambulatory (Holter) monitors
- Transtelephonic monitors
- Acute and chronic management of arrhythmia patients
- Intracardiac electrograms
Trainees participate in daily arrhythmia rounds, all outpatient arrhythmia visits, pacemaker clinic, EP consult service, intracardiac electrophysiology studies and operative and catheter ablation procedures. Fellows will be rotating alongside Adult Cardiology Fellows (PGY4-6).
Medical Director — William Campbell, MD
Faculty — William Campbell, MD; Gabriel Hernandez, MD; Steve Hindman, MD; Michael McMullan, MD; Kellan Ashley, MD
Fellows are expected to attend all adult congenital cardiac catheterizations, and potentially assist with the procedure if interested. Additional experience in peripheral intervention, Mitraclip, and transcatheter aortic and pulmonic valve implantation can be arranged if interested, in conjunction with the interventional cardiology fellows.
Fellows participate in weekly joint Interventional-CT surgery conference and are expected to lead the discussion on adult congenital patients and provide initial management plans.
Medical Director — Ervin Fox, MD
Faculty — Rotating
During the echocardiography laboratory rotation, fellows acquire the knowledge and skills necessary to correctly perform and interpret transthoracic and transesophageal echocardiography. Fellows will participate in a minimum of 150 transthoracic echocardiograms and a minimum of 20 transesophageal echocardiograms. The experience will be shared with the general cardiology fellows. The primary task of the ACHD fellow is to develop proficiency in echocardiographic diagnosis of Adult Congenital Heart Disease (rather than General Cardiology diagnostics).
Fellows will improve their skills in various technical modalities including M-mode, 2D, Doppler and color flow imaging, conduct proper probe selection, and to correctly diagnose all major adult congenital heart disease via echocardiography.
A monthly didactic echocardiography laboratory conference and daily teaching sessions conducted by faculty will provide multiple opportunities for learning. The fellow will be expected to teach the general cardiology fellows the fundamentals of adult congenital echocardiography. Additional training is available in CT, MRI, and Tc99 SPECT if desired for achievement of COCATS level II certification. Enough echocardiography volume is available to achieve Echo board certification status at the end of fellowship as well as ACHD board certification if desired.
Heart Failure, Heart Transplant, and Pulmonary Hypertension
Medical Director — Charles Moore, MD
Faculty — Gabriel Hernandez, MD; Craig Long, MD; Lampros Papadimitriou MD
The goal of the Cardiomyopathy/Heart Failure/Transplant rotation is that at the end of the fellowship, the fellow has the required knowledge, skills and attitudes to effectively evaluate and initiate management of adults with cardiomyopathy and heart failure, and patients who have undergone cardiac transplantation. This rotation is available as an elective. The fellow will:
- Learn to competently obtain a complete history and physical examination for the heart failure patient and heart transplant patient
- Participate in new consults and outpatient clinic
- Enhance knowledge of multidisciplinary care within Heart Transplant, mechanical support, and the entire process from heart failure evaluation to outpatient care of the heart transplant patient/ heart failure patient with outpatient mechanical support
Outpatient Adult Congenital Heart Disease Clinic
Medical Director — William Campbell, MD
Faculty — William Campbell, MD; Michael McMullan, MD
Each fellow will learn how to competently obtain a history and physical examination of the patient with Adult Congenital Heart Disease. They will then interpret the findings in the context of the major pathophysiology at hand, and incorporate additional data such as CT and MRIs. The clinic is all day every Thursday and the fellow will be expected to participate fully in the Pediatric Cardiology transition process with new referrals. Some clinics will be shared with general cardiology fellows, residents, and medical students, and the ACHD fellow will be expected to lead the learning process when they are present.
Fellows are required to see all inpatient adult congenital consults that occur during clinic for the best continuity of care. Fellows will assess at least 30 ACHD patients with pulmonary hypertension, at least 30 patients with heart failure related to congenital heart disease, at least 30 patients with atrial arrhythmia, and at least 15 patients with ventricular arrhythmias. The adult congenital fellow will interpret at least 50 congenital cardiac catheterizations, and at least 50 cardiac MRIs. Additional training is available in CT, MRI, and nuclear if desired for achievement of COCATS level II certification (the core imaging requirement is greater than 50 cardiac MRIs). Enough echocardiography volume is available to achieve Echo board certification status at the end of fellowship as well as ACHD board certification if desired. External rotations are available in larger centers however these must be arranged as soon as the fellow expresses interest in the opportunity for the purposes of institutional agreements and credentialing in out of state facilities.
Fellows are required to attend as many didactic conferences as possible. Unless otherwise indicated, the conferences are open to multiple departments.
Fellows are encouraged to attend annual professional meetings in order to meet and learn from expert faculty in the field and to network with alumni and peers:
- February - Southern Society of Clinical Investigators
- March — American College of Cardiology (ACC); Department of Medicine Research Day
- April — International Society for Heart & Lung Transplantation (ISHLT)
- May - Heart Rhythm Society (HRS); Society for Cardiovascular Angiography and Interventions (SCAI); International Pediatric Transplant Association (IPTA)
- June — American Society for Echocardiography (ASE)
- November — American Heart Association (AHA)
- December — Pediatric Cardiac Intensive Care Society (PCICS)