Clinical Training

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 4 week blocks as the fellow responsible for patients on the general cardiology unit (11 West Mott). The Cardiology floor fellow leads a team consisting of pediatric residents, interns, and often one to three medical students. The fellow and attending round each day with the team to make the care plans for all medical patients, including heart failure/transplant patients.

The first year fellow also rotates on the consult service (2 or 4 week blocks), where they are responsible for performing and staffing consults from every unit in the children’s hospital (NICU, PICU, ER, general pediatrics). Additionally, the consult fellow sees the preoperative patients in clinic, who are undergoing workup prior to their scheduled cardiac surgery, and staffs these patients with the designated cardiology attending.

The first years rotate night call coverage as the front line of our heart center covering the general cardiology service (11W), as well as consults and phone calls from all hospital units and from outside physicians, hospitals, and patients/families. The first year fellow performs all admissions, whether to the general floor or cardiac ICU, and will also go on transport if a physician is needed. The first year fellow is not required to stay in the hospital when on call, and can take calls from home when appropriate.

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 the front-line providers, as there are no pediatric house staff or medical students in the PCTU unless on an elective. Fellows get 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, ECMO and VAD patients.
The second year fellows rotate night call coverage in the PCTU (in-house call). Fellows go home after signing out in the morning post call. At night and on weekends, there is one fellow and one cardiac intensive care attending on call in the hospital for the entire unit. Cardiac surgery nurse practitioners provide assistance to patient care coverage on many nights.

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. The third year fellow will round with the team of NPs and assist in the management plans for the post-operative patients.

For those fellows who are interested, 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 team (first year fellow, residents and interns) with patient care.

The third years 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 backup fellow may also be called in to assist the first or second year as needed in particularly busy or high acuity times.

Outpatient Service

General cardiology clinic

The 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. In his or her assigned clinic, 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 then prepares the clinic encounter in letter form 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 trumps all other responsibilities, and coverage is provided for other clinical rotations when needed. Vacation coverage must be arranged by each fellow through trades with colleagues.

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)