Pediatric Cardiology Fellowship

1. Basic principles of cardiac ultrasound.
2. Appropriate use of echocardiogram probes in patients of various age groups from fetus to adults.
3. Three-dimensional anatomy and architecture of the cardiovascular structures in the thorax and abdomen.
4. Segmental diagnosis of cardiac problems using echocardiographic images.
5. Standard transthoracic echocardiography plane images.
6. Ability to perform transthoracic two-dimensional echocardiograms and acquire reasonably good quality 2D images in all the standard planes in a normal heart.
7. Basics of color-flow imaging, spectral Doppler mapping and M-mode echocardiography.
8. Performance of transthoracic echocardiograms in complex congenital heart defects through observation.
9. Performance of transesophageal echocardiograms and learning the various imaging planes through observation.
10. Performance of various pharmacological and non‐pharmacological stress tests through observation.
11. Ability to interact well with the faculty and staff in the echocardiography laboratory in order to optimize and strike a balance between learning echocardiogram skills, and obtaining optimum patient care with the least amount of disruption to patient management.
12. Indications of various types of echocardiograms in the practice of pediatric cardiology.

Responsibilities and Educational Methods:
First-year fellows should closely observe the techniques of obtaining and recording echocardiogram images from the faculty and echocardiogram technologists in the initial phase of the first year. Additionally, fellows should acquire hands-on experience in performing 2D echocardiograms in all standard planes in children with normal cardiac anatomy; learn about interpreting the echocardiogram images by participating every day in the reporting sessions of the faculty; obtain prior history and do physical exams on patients for stress tests, as well as being present with faculty for the tests and organize/review studies with faculty prior to the weekly case management conferences.

The goals for the second-year fellow are to understand/acquire the following:
1. Application of 2D imaging, color flow mapping, Doppler and M-mode echocardiography in children.
2. Competence in utilizing the above modalities to perform complete echocardiography in normal hearts and mildly complicated cases.
3. Ability to assess the ventricular systolic and diastolic function using the various echocardiogram modalities.
4. Basics and complexity of tissue Doppler imaging and obtaining tissue Doppler images and data.
5. Competence in understanding the various transesophageal echocardiography imaging planes, and observing/performing TEEs in less-complicated cases.
6. Ability to acquire images in standard TEE planes in less complicated cases.
7. Ability to interpret and report on most transthoracic echocardiograms including 2D, Doppler and color Doppler, except in the most complex cases.
8. Performance of complex fetal echocardiograms by the faculty/technologists, through observation.
9. Various indications for stress tests in children, and acquire the ability to identify variations from the normal response during the stress test.

Responsibilities and Educational Methods:
Second-year fellows should perform transthoracic echocardiograms in uncomplicated and mildly complicated cases; interpret and report uncomplicated and mildly complicated echocardiograms and be present for stress tests. Fellows should also be present with faculty during the reporting sessions (especially for complex cases and for the cases performed by the fellow) and organize and review studies with faculty prior to the weekly case management conferences.

The goals for the third-year fellow are to acquire the ability to perform the following:
Complete transthoracic echocardiographic studies even in the most complicated/complex cases.
2. Complete transesophageal echocardiograms even in complex cases.
3. A minimum of 25 hands‐on fetal echocardiograms while obtaining basic images.
4. Interpretation of all fetal echocardiogram images.
5. All types of exercise stress tests, including interpretation and reporting.

Responsibilities and Educational Methods:
Third-year fellows should be hands on with the performance of transthoracic echocardiograms as much as possible; interpret and report all transthoracic, transesophageal and fetal echocardiograms performed by the fellow; participate in the echo reporting sessions with attending physicians; participate and interpret stress test results and have a prior review of the case echocardiograms with faculty for discussion in the weekly case management conference.