The fellow is expected to participate in this dedicated ACHD rotation for 11 blocks. The outpatient service evaluates approximately 140 patients per month. The fellow is expected to participate in all outpatient clinics with adult congenital faculty members. This outpatient clinic includes outreach sites in the Bay Area and the transition and transfer clinic for adolescents and young adults at LPCH. There will be a dedicated half-day session clinic per week for 20 blocks where the fellow sees his/her own patients independently under the supervision of an adult congenital faculty member. The consultative evaluation will require the review of prior clinic visits, electrocardiogram, imaging studies, invasive testing and operative notes. Subsequent presentation to the faculty at the end of every ACHD clinic provides the opportunity for in-depth discussion of pathophysiology, differential diagnosis, physical examination, and review of pertinent objective data. This also includes review of all outpatient echocardiograms.
The inpatient service cares for approximately 3-6 patients per week. The fellow provides ACHD consultative services to multiple services in SHC and LPCH, including coronary care unit at SHC, medical inpatient unit, obstetrical service, cardiac intensive care unit at LPCH, and post-cardiac surgical patients. Inpatient management will include but not be limited to pregnancy, arrhythmia, heart failure, pulmonary hypertension, and pre and post cardiac surgical and noncardiac surgical management in the adult with CHD. The fellow is responsible for accepting transfers from our network hospitals for acute medical or surgical care. Finally, the fellow will prepare for the weekly inpatient cardiology and cardiac surgical conference.
The fellow acquires advanced methods of diagnosis including two-dimensional and three-dimensional, Doppler, transesophageal and stress echocardiography and MRI/CT in adults with CHD. During the 2 blocks of ACHD imaging and 11 blocks of ACHD inpatient/outpatient consultation, the trainee is expected to perform and interpret 150 transthoracic and 25 transesophageal echocardiograms and review an additional 150 transthoracic and 25 transesophageal echocardiograms. Because there are 2 pathways for entry into the ACHD fellowship (pediatric and adult pathways), these echocardiograms maybe supplemented by further review of general pediatric congenital or adult cardiovascular echocardiograms to achieve the competency for each trainee. The trainee is expected to review 50 MRI/CT in adults with CHD. Each fellow is expected to keep a procedure log of all imaging studies and major diagnosis of congenital heart disease in MedHub.
The fellow has an opportunity to be exposed to a variety of different types of catheterization procedures at Stanford. In an average month, this laboratory performs 300 coronary diagnostic and interventional procedures, 100 myocardial biopsies, 30 pediatric diagnostic and interventional catheterizations, 50 peripheral vascular procedures and a variety of other specialized procedures. The trainee is expected to perform and interpret 10 diagnostic and 20 interventional catheterizations and review an additional 10 diagnostic and 20 interventional cases. Because there are 2 pathways for entry into the ACHD fellowship (pediatric and adult pathways), these catheterizations maybe supplemented by further review of general pediatric congenital or adult cardiovascular catheterizations to achieve the competency for each trainee. Each fellow is expected to keep a procedure log of all catheterizations studies and major diagnosis of congenital heart disease in MedHub.
This unit offers a broad experience in the care of critically ill patients with surgical and non-surgical disease in CHD. During this time, the trainee is expected to participate in the pre-operative and medical management of congenital heart disease.
These rotations offer an opportunity for a fellow to further amplify their skillset in a particular field through an elective. The ACHD fellow may choose from a variety of rotations within the pediatric and adult cardiology fellowship depending upon their interest and background training. For instance, a pediatric cardiologist may choose further rotations in the SHC coronary care unit, heart failure/transplant service, or adult electrophysiology service. An adult cardiologist may choose further rotations in LPCH with pediatric echocardiography, electrophysiology or cardiothoracic surgery. The fellow also has an opportunity to rotate through the pulmonary hypertension service.
Fellows are expected to develop an independent research project during the fellowship. The fellow is strongly encouraged to meet with each faculty member in the adult congenital heart program to discuss ongoing projects. Research may range from basic science to purely clinical research. Faculty from not only the adult congenital heart program but also within the Divisions of Cardiovascular Medicine and Pediatric Cardiology may act as mentor. The trainee is expected to select a research mentor and create a timeline of a research project by the end of month 4. The identified research mentor will guide the fellow regarding methodology, data collection, data interpretation, analysis and manuscript preparation during their 2 year fellowship but the fellow will have dedicated time for research in 6 blocks. Monthly review of research timeline will occur with the research mentor. Presentation of the research at the local or national level is expected of the fellow.