In 2005, the Children’s Heart Center at the Department of Pediatrics and Adolescent Medicine at the American University of Beirut Medical Center established the only Pediatric Cardiology Fellowship Program in Lebanon.
Pediatric Cardiology is the study of the hearts with congenital malformations and acquired diseases in the pediatric age group. In many centers around the word it spans to include the care of grown up with congenital heart disease. In general Pediatric Cardiology is composed of multiple clinical subspecialty areas.
Changes in the practice of Pediatric Cardiology over the last decade have necessitated a revisit of work patterns, training and required expertise. Pediatric Cardiologists need to be trained in the evaluation and treatment of children with congenital or acquired heart disease as well as grown-ups with structural heart disease, disorders of cardiac rhythm and conduction, in addition to, deep understanding of cardiac and circulatory system and the related hemodynamics. The specialty provides care of patients from fetal life to adulthood. It is a facet of a complex integrated multidisciplinary structure that entails very close collaboration with other pediatric subspecialties, Cardiothoracic Surgery, Adult Cardiology, Obstetrics, Radiology Psychiatry and Pathology.
The practice of Pediatric Cardiology requires extensive skills in cardiac imaging including but not limited to Echocardiography and Doppler Ultrasound, MRI and CT imaging, as well as, diagnostic invasive methods such as cardiac catheterization. In addition, the Pediatric Cardiologist must be familiar with Electrophysiology: the treatment of arrhythmias, the indications for and management of pacemakers. Currently, therapeutic cardiac catheterization such as balloon septostomy, angioplasty, valvuloplasty, valve implantation and occlusion of anomalous vessels and device closure of congenital cardiac defects, is part and parcel of any pediatric cardiology program.General Objectives:
The primary aim of the program is to train and graduate general pediatric cardiologists. Graduates of the program are expected to have the clinical and procedural expertise to manage patients with congenital heart disease. The graduates would be capable of:
- Providing direct care for patients with congenital heart diseases, both in the inpatient and outpatient settings.
- Providing cardiology consultation services for inpatient and outpatient pediatric patients.
- Providing appropriate follow for infants, children, adolescents and adults with congenital heart disease.
- Managing acquired heart diseases in children and adolescents, to include but not limited to disorders of cardiac rhythm and conduction abnormalities in infancy and childhood.
- Assisting with the management of post-operative patients both in the immediate and convalescence stages.
- Interpreting and performing non-invasive as well as invasive hemodynamic cardiac evaluations and imaging; including but not limited to echocardiography and angiography.
- Interpreting nuclear perfusion scans, cardiac CT scans and CMR.
Program graduates are expected to develop good understanding and acquire modest expertise in various areas of congenital heart diseases during the three years or levels of training. The list below includes the various rotations of the training program:
- Inpatients services
- Outpatients clinics
- Non-invasive cardiology including Echocardiography and exercise testing
- Cardiac Catheterization, hemodynamic evaluation and angiography
Admission to Pediatric Cardiology Fellowship Program at the Children’s Heart Center, AUB-MC is in accordance with the ACGME Program Requirements for Graduate Medical Education in Pediatric Cardiology (please refer to the statement published and ACGME approved focused revision: September 30, 2012; effective: July 1, 2013)
Selection of candidates will depend on his/her satisfaction of the selection criteria at a personal interview conducted by the training committee and following open label deliberation in the presence of the hospital and department GME Program Coordinators
Number of Candidates for Each Level:
The maximum number of acceptable candidates will be determined by the number of the attending physicians participating in the program. The program will currently accept one new fellow per year and will have a maximum of the following fellows: Year 1:1; year 2: 2; year 3:3.Duration:
The training program is designed to run over a period of 3 years divided as block rotations. During this period the candidate will be involved in various available services and training/teaching facilities.Research and Scientific Foundation:
Candidates are expected to actively participate in the academic activity by performing literature review presentations, journal clubs etc. as well as participations in the local and international conferences.
Candidates are expected to perform clinical or basic research during their training either on their own or by their contribution to an ongoing research. Opportunities for research will be available for the trainees to be involved in, not only within the pediatric cardiology division but also within the other clinical programs at the institution. It is anticipated that there will be a focus on one or more specific clinical or basic science research project. The fellow will be expected to develop skills in literature review, formulating a hypothesis and goals, developing a research plan including a study design and protocol, data collection, presentation of results and risk-benefit analysis of data. It is expected that about 4-6 months of time will be devoted to research during the three years of training.Candidate Evaluation:
Pediatric cardiology fellows will have formal evaluation of their training skills. This will be done through participation in regular feedback from attending physicians and other house staff about their own educational and technical progress throughout their rotations.
Elements of Evaluation:
- Knowledge of history taking and comprehensive physical examination.
- Ability to arrive to an appropriate differential diagnoses.
- Appropriate decision making and safe management of patients.
- A sound level of professionalism and ethical conduct
There will be close monitoring of the Fellow’s progress throughout the three-year training by:Logbook:
Documentation of training experiences in a logbook or training record is mandatory. The logbook will mainly include a log of echocardiograms and cardiac catheterizations performed including the age of patients, diagnosis and outcome of any procedure. The trainee will accept personal responsibility for maintaining the logbook, which will be audited every three months by the program director. The logbook will remain the property of the trainee and must be produced at the annual assessments. It will be countersigned as appropriate by the educational supervisors to confirm the satisfactory fulfillment of the required training experiences and acquisition of the competencies that are enumerated in the curriculum.Evaluation Form:
Assessment of individual competencies will be carried by specific designated Attending every six months. In addition, each fellow will have a mentor specified for help in guiding and accessing the fellow’s progress. The Program Director at the Children’s Heart Center will meet with the attending physicians to provide a continuing assessment of individual Fellows, which will be conveyed to the Fellows. The formal and more detailed assessment of the Trainee’s program at the completion of the first and second year will focus on identifying lack or inadequate skills, knowledge and experience so that any training deficiencies in the Trainee or Program can be identified and formally modified or strengthened by having suitable elective rotations as needed.End of Year Promotion Examination:
Candidates will sit for a promotion examination in the form of a yearly MCQ exam which will be provided for the fellows for monitoring of their fund of knowledge and their progress in interpretation of data and clinical decision making.
If there is major concern about the fellow’s progress, expertise and if the fellow fails the yearly exam, the program director will meet with the pediatric cardiology staff and discuss the need to have the trainee repeat the year. Failing the second attempt the trainee will be dismissed from the program.End of Program (Final) Examination:
There will be a final sub-specialty examination upon completion of training. The components of this final examination will include a:
- Written examination in the form of MCQ over two hours.
- Oral examinations in the form of five clinical scenarios with twenty minutes discussion for each case.
Having passed the final examination the candidate will be awarded: “American University of Beirut Fellowship in Pediatric Cardiology”