The Pediatric Cardiology Fellowship at the University of Michigan is committed to training fellows to be excellent clinical pediatric cardiologists first and foremost, while allowing flexibility for every fellow to pursue the area of subspecialty and research which interests them. All fellows, regardless of chosen focus, complete their training commensurate with the requirements of the ACGME, ABP, Department of Pediatrics, and the Pediatric Cardiology Division at the University of Michigan.
The first two years of clinical training are devoted to developing the skills required for clinical care in the major subspecialty areas as well as the inpatient general care service and cardiac ICU. The third year is primarily elective time for the fellow to focus on their scholarly work and their chosen area of clinical subspecialty, while continuing some required rotations in clinical cardiology.
Inpatient Service
First Year
The first year fellows rotate on 2 week blocks as the fellow responsible for patients on the general cardiology unit (11 West Mott) which includes heart failure/transplant patients. The Cardiology fellow leads a team consisting of pediatric residents, interns, and often 1-3 medical students.
The first year fellow also rotates on the consult service (2 week blocks), where they work with a nurse practitioner performing and staffing consults from every unit in the children’s hospital (e.g. NICU, PICU, ER, general pediatrics). Additionally, the consult fellow evaluates the pre-operative patients in clinic, who are undergoing workup prior to their scheduled cardiac surgery, and staffs these patients with the designated cardiology attending.
The first year fellows provide night and weekend coverage as the front line providers of our heart center, covering the general cardiology service 11W (in-house call) as well as consults and phone calls from outside physicians, hospitals, and patients/families. The first year fellow performs all admissions, whether to the general cardiology unit or cardiac ICU.
Coverage is through a night float system for Sunday-Thursday, with weekends covered by a rotating schedule. Fellows go home post call after sign out in the morning.
Second year
The second year fellows rotate on 2 week blocks as the fellow responsible for one of two teams of patients in the Pediatric Cardiothoracic Unit (PCTU), a dedicated ICU for pediatric cardiac medical and surgery patients.
The PCTU fellows are the team leaders as well as front-line providers, as there are no pediatric house staff or medical students in the PCTU (unless on elective rotations). Fellows experience intense and thorough hands-on training in both medical management and procedures of all patients in the cardiac ICU, including pre-operative, post-operative, medical heart failure, transplant, ECMO and VAD patients.
The second-year fellows rotate night and weekend coverage of the PCTU through a night float system for Monday-Thursday coverage, with weekends covered by a rotating schedule. Cardiac surgery nurse practitioners provide assistance to patient care coverage on both daytime and night/weekend shifts.
Third Year
All third year fellows spend 1-2 weeks working as a “pretending” alongside the cardiology attending on the Pediatric Cardiac Surgery inpatient service, which covers all post-operative patients on the general care unit after they are transferred out of the ICU. This service is staffed by a nurse practitioner team with a cardiology attending as their team leader.
There is also the opportunity to rotate as a “pretending” alongside the cardiology attending on the medical cardiology inpatient unit, assisting in management of the medical cardiology team (first year fellow, residents and interns) with patient care.
The third year fellows rotate night and weekend call as the ‘back-up fellow”, where their primary duties include performance of echocardiograms after hours, as well as any urgent cardiac catheterization procedures or complex patient transports.
The third year fellow may also be called in to assist the first or second year as needed for urgent coverage and in particularly busy or high acuity times.
Outpatient Service
General cardiology clinic
Each fellow participates in outpatient general cardiology clinic for a half day a week with the same pediatric cardiology attending throughout the three-year fellowship, providing excellent opportunity for continuity of care.
Fellows will routinely see new consultative patients as well as long-term follow-up of post-surgical patients and other chronic cardiology conditions.
The fellow is responsible for the complete work-up of the patient, including, but not limited to, planning treatment and disposition, explaining the patient’s problem to the family and reviewing the clinical findings with the attending cardiologist.
The fellow prepares the clinic note for the referring physician, and is responsible for follow-up of test results and communication with the patient and family.
Because we believe the continuity clinic experience is so crucial, clinic attendance supersedes all other responsibilities, and fellows attend their clinics even when on other rotations (including ICU and inpatient rotations)
Additional Clinic Opportunities:
- Preventative Cardiology clinic
- Combined Cardiology/Genetics clinic
- Combined Cardiology/Hematology clinic
- Outreach (offsite) General Cardiology clinics
Subspecialty Rotations
Fellows have regular clinical rotations in all subspecialties of Pediatric Cardiology. Each subspecialty has a faculty educational lead who provides detailed goals and objectives for each rotation and year of training, which emphasize gradual skills acquisition and development of autonomy. The fellow will participate in every aspect of care in the subspecialty, including outpatient clinics, inpatient care and consults, and procedures.
Subspecialty areas:
- Adult Congenital Heart Disease
- Cardiac catheterization/interventional cardiology
- Electrophysiology (Including EP lab and Pacemaker/Implantable Cardio-defibrillator Clinic)
- Heart Failure/Transplant (including pulmonary hypertension)
- Noninvasive imaging (including echocardiography and cardiac MRI, fetal and transesophageal imaging opportunities).
- Pediatric Cardiac Intensive Care (see 2nd year fellow inpatient clinical service)
