INTRODUCTION
The Childrens Cardiac Clinic and the Division of Pediatric Cardiology were founded in 1931, and Dr. Helen Brooke Taussig was the first director. The Clinic was the first of its kind and became the center for teaching and training over the years. Johns Hopkins has remained in the forefront of pediatric cardiology in clinical care, development of new diagnostic and therapeutic techniques and in research.
PHILOSOPHY AND DECRIPTION
The objective of the program is to train candidates for careers in academic pediatric cardiology. A minimum training period of three years is required for the Sub-Board of Pediatric Cardiology. Additional training is available for those undertaking a supported research program. The basic plan is: a first-year, mainly clinically oriented with a survey of possible research area; a second year, split between clinical work with more responsibility, and the beginning of a chosen research project; and a third year with the major emphasis on research but with continuing clinical responsibilities. Alternative plans may be available for applicants wishing to spend additional time in a research program. The applicants must be in an accredited pediatric residency program. Applicants may begin applying for the cardiology fellowship in their second year of residency. The pediatric cardiology program participates in the National Residency Matching Program.
NARRATIVE
The Division of Pediatric Cardiology is part of the Johns Hopkins Childrens Center, a 200+ bed pediatric facility, which is in turn part of the 1,000-bed John Hopkins Hospital. The Division of Pediatric Cardiology operates in collaboration with the Johns Hopkins Heart Center, the Divisions of Adult Cardiology, Cardiovascular Radiology, Cardiovascular Surgery, Cardiovascular Anesthesiology, as well as Neonatal and Pediatric Intensive Care. The clinical patient areas, the echocardiography lab, and the basic research laboratories are in close proximity to those facilities of other divisions to promote mutual interchange and enrichment.
FELLOWSHIP OUTLINE
Year I
Components of first-year training include:
CLINICAL ROTATION
The fellow is responsible, together with an attending, for the provision of clinical consultative services for all inpatients, surgical patients, and emergencies during 2-4 week block period, and for the teaching of students and residents.
OUTPATIENTS
Outpatients are seen daily, and the fellow will participate in the evaluation of these patients, together with the attending, sharing in the evaluation of the noninvasive testing and in the formulation of management plans. Fellows are assigned to a specific clinic day and proctor to allow for continuity of care.
INTENSIVE CARE SKILLS
While on the clinical rotation, the fellow will spend time in the Neonatal and Pediatric Intensive Care Units. Fellows will share in the management of the postoperative cardiac patients and of the acutely ill neonate with heart disease. Patient care is managed in collaboration with the intensivists and cardiac surgeons.
ELECTROPHYSIOLOGY
Rotation on the Electrophysiology Service takes place during year I-II. The fellow participates in pacemaker clinic; outpatient assessment of arrhythmia patients including Holter and event recorder assessment, tilt table and stress testing, and invasive procedures. Division faculty also participates in placement of intravenous pacemakers and AICD.
PATHOLOGY
Monthly didactic pathology sessions are held with the division throughout the year. Elective periods of at least two weeks in the Department of Pathology are available.
NONINVASIVE TESTING
A fully equipped echocardiography laboratory is the site for training of fellows in the interpretation of two-dimensional echocardiography imaging and Doppler studies as well as detailed quantitative studies of systolic and diastolic function. The fellow is trained to interpret and perform high-quality studies using these techniques. Fetal echocardiography, transesophageal echocardiography, and 3D echocardiography are highlighted as well. The laboratory performs approximately 6,000 echocardiograms annually. Dobutamine echocardiography stress testing is available. Training in magnetic resonance imaging is available through a collaboration effort between Pediatric Cardiology faculty and Radiology faculty.
INVASIVE LABORTORY
A newly constructed, dedicated pediatric catheterization laboratory is the setting for this training. Training in diagnostic and interventional cardiac catheterization techniques and angiography is a major component of our fellowship program. The fellow is expected to gradually become proficient in cardiac catheterization and the obtaining of data, its interpretation, and its significance. Additional training is provided in interventional techniques, such as pulmonary and aortic valvuloplasty, arterial dilatations, and myocardial biopsy, stent placement and device closures of PDAs and ASDs to fellows with a focused interest in interventional procedures. The training is enhanced by the weekly patient management/post-catheterization conferences.
ELECTIVES
Elective time can be arranged in our department and in others within the School of Medicine. Some examples are electrophysiology, pathology, NICU, PICU, anesthesiology, cardiac surgery, adult cardiology, genetics and any of the basic science laboratories.
TEACHING SESSIONS
I. Conferences
Clinical Service Conference Weekly
Management Conference / Cath Conf. Weekly
Morbidity and Mortality Conference Monthly
Didactic Teaching Conference Weekly
Ward Rounds Daily
Journal Club Monthly
Echo Conference Weekly
Research /Academic Conference Monthly
Pathology Conference Monthly
II. Research Design
A two-week course in research design is offered through the Johns Hopkins School of Pubic Health and attended by our fellows. Fellows are expected to identify a research interest and to develop a research proposal during the first year. Selected fellows may apply to the graduate training program in clinical investigation, collaboration between the School of Medicine and Bloomberg School of Hygiene and Public Health.
Year II
Second-year fellows will continue to gain experience in the clinical areas with the emphasis on increased responsibility of patient care. There will be a major emphasis during Year II on carrying out a research project based on the proposal developed in Year I.
Year III
A year to refine clinical skills and complete research projects. The third year schedule is designed to strengthen areas of expertise based on the fellows career goals and the faculties evaluation of the fellows knowledge.
Year IV
A provisional fourth year for continuing research is offered for those fellows wishing to further pursue their chosen area of clinical or basic pediatric cardiology research. The fellow is expected to seek research funding for this year from one of several available sources. Alternative plans are available, for example with 2 year laboratory experience, years 1-2 followed by years 3-4 devoted primarily to clinical training.
RESEARCH AREAS
The research areas available include both basic and clinical projects. Trainees are encouraged o reach out beyond the division into other divisions or the Basic Science Departments of the Medical School. Research is currently ongoing in many areas, including:
- Innovative Interventional Techniques in the Treatment of Congenital Heart Disease
Biochemistry of Myocardial Contraction in the Developing heart
Fetal Echocardiography
Electrophysiology, clinical or basic
Hyperlipidemia
Genetics of Congenital Heart disease
Connective Tissue Disorder
New 3D & echocardiographic imaging
Clinical outcomes
COURSE WORK
Course work is available within the John Hopkins University as well as within the Basic Science Division of the Johns Hopkins Medical Intuitions and the Johns Hopkins Bloomberg School of Hygiene and Public Health.
FACULTY
Pediatric Cardiology
Joel Brenner, M.D.
Associate Professor of Pediatrics
Director, Pediatric Cardiology
Anne M. Murphy, M.D.
Associate Professor of Pediatrics
Director of Fellowship Training
Philip J. Spevak, M.D
Associate Professor of Pediatrics
Director of Non-Invasive Imaging
Richard Ringel, M.D.
Associate Professor
Director of Pediatric Catherization Laboratory
Allen Everett, M.D.
Associate Professor
Pediatric Catherization Laboratory
W. Reid Thompson, M.D.
Assistant Professor of Pediatrics
Echocardiography Laboratory
Jane Crosson, M.D.
Assistant Professor of Pediatrics
Director of Electrophysiology
William Ravekes, M.D.
Assistant Professor of Pediatrics
Echocardiography Laboratory
Janet Scheel, M.D.
Assistant Professor of Pediatrics
Director of Pediatric Cardiology Transplantation
Cardiac Surgery
Duke E. Cameron, M.D
Professor of Surgery
Director, Pediatric Cardiac Surgery
Luca Vricella, M.D
Assistant Professor of Surgery
Pediatric Cardiac Surgery
