Education & Training
Thank you for your interest in the Pediatric Cardiology Fellowship Program at the Children’s Hospital at Montefiore (CHAM), the University Hospital for Albert Einstein College of Medicine. The fellowship is a three-year program accredited by the Accreditation Council for Graduate Medical Education that provides comprehensive training in all aspects of clinical cardiology, education and research.
The primary goal of the program is to advance fellows' clinical, administrative and research expertise to fully prepare them for academic careers. General and subspecialty board-certified pediatric cardiologists provide the core training of the program, with additional teaching offered by the wide range of pediatric medical and surgical experts at CHAM.
Clinical Experience
The majority of clinical experience is provided at the nationally recognized Pediatric Heart Center at CHAM. For more than 50 years, Montefiore and its heart team have been pioneering some of the most innovative advancements in the field of cardiology. The highly specialized multidisciplinary team performed the first hybrid procedure in the state of New York and the first pediatric heart transplant in the Bronx. The patient population represented at CHAM's Pediatric Heart Center spans the entire range of pediatric cardiovascular conditions. We treat children with congenital and acquired heart disease from the local area of New York City throughout the New York tri-state region and beyond. All fellows train with state-of-the-art equipment and collaborate with divisions of cardiothoracic surgery, critical care, neonatology, maternal-fetal medicine, radiology, genetics and other appropriate experts and specialists. The Pediatric Heart Center facilities include the region's only hybrid catheter surgical lab, spacious treatment and consultation rooms, multiple echocardiography imaging rooms and a new telecommunications system to review up-to-the-minute echocardiograms, magnetic resonance imaging (MRI) and computed tomography (CT) scans. The pediatric critical care unit has a capacity of 26 beds.
Cardiology fellows at the Children’s Hospital at Montefiore have a robust and unique mentorship program that includes career mentoring, research and scholarly activity mentorship and non-invasive imaging/echocardiography mentorship. Cardiology fellows are assigned unique faculty members at the beginning of training to monitor their progression with performance and interpretation of echocardiograms. Additionally, program directors and fellows choose appropriate faculty members that align with career and research goals to set them on the right path towards productive academic careers.
The pediatric cardiology fellowship at the Children’s Hospital at Montefiore is unique to the region. A lack of dependence on trainees for clinical workflow allows each fellow to tailor fellowship to their individual interests. After completion of required rotations, each fellow can pursue additional sub-specialty rotations that align with their career goals. This aspect of the fellowship at CHAM has resulted in a wide variety of post-graduate fellowships and careers including general pediatric cardiology, non-invasive imaging, adult congenital heart disease, pulmonary hypertension, critical care and electrophysiology.
Graduated Fellow Positions (starting in 2013):
- Academic Appointment: Children’s Hospital at Montefiore/Albert Einstein College of Medicine
- Academic Appointment: Mt Sinai – Kravis Children’s Hospital
- 4th year Non-invasive Imaging Fellow: Mt Sinai – Kravis Children’s Hospital
- 4th year Non-invasive Imaging Fellow: University of Texas – Houston Medical School
- 4th year Adult Congenital Heart Disease Fellow: Ohio State Medical Center
- 4th year Pulmonary Hypertension Fellow: Morgan Stanley Children’s Hospital – New York Presbyterian
- 4th year Pediatric Electrophysiology Fellow: Texas Children’s Hospital
- Critical Care Fellowship: Cohen Children’s Medical Center
- Critical Care Fellowship: NYP/Weill Cornell Medical Center
Curriculum
Fellows enjoy rich and varied educational opportunities during the three-year training program. Daily conferences encompass a core lecture series, case conferences, journal clubs and research presentations. Further enrichment is available through Grand Rounds, cardiac catheterization conferences and airway conferences, as well as a broad range of teaching series and lectures provided at Albert Einstein College of Medicine.
Typical Weekly Lecture Schedule:
- Monday AM: Echo conference
- Monday PM: Division grand rounds, monthly QI and M&M conferences
- Monday PM: Cardiac surgery and catheterization conference
- Tuesday AM: Monthly MRI case conference and heart failure/transplant conferences
- Wednesday AM: Review of Congenital Cardiovascular Surgical Textbook and Cardiac Pathology alternating
- Thursday PM: Cardiac catheterization teaching conference
- Friday AM: Echo conference and EP conference alternating
Rotations:
Inpatient service & consult:
The inpatient cardiology service includes primary management of cardiology patients on the inpatient cardiology floor, co-management of cardiology patients in the pediatric intensive care unit and cardiology consult service throughout all departments within the Children’s Hospital at Montefiore and neonatal intensive care units at Weiler and Wakefield Hospitals. Fellows are expected to participate in inpatient rounds, provide teaching to pediatric residents and medical students and perform inpatient consultations with supervision from the pediatric cardiology attending.
Outpatient Clinic:
Fellows have a half-day clinic per week, including during inpatient and catheterization/invasive EP rotations. During clinic while on inpatient/catheterization rotations, fellows do not have inpatient responsibilities. Individual patients are scheduled directly with the fellows and they have continuity throughout the 3 years. All fellow clinics are held at the Children’s Hospital at Montefiore.
Cardiac Catheterization and Invasive Electrophysiology:
Cardiology fellows participate as the primary assistant in diagnostic and interventional catheterization and invasive electrophysiology procedures. Catheterization procedures include right and left-heart catheterizations, endomyocardial biopsies, atrial and ventricular septal defect closures, patent ductus arteriosus closures, balloon valvuloplasty, Melody valve procedures, coarctation and pulmonary artery stent angioplasty. Electrophysiology procedures include electrophysiology studies, radiofrequency and cryoablation, pacemaker, implantable cardioverter defibrillator (ICD) and implantable loop monitor insertion. Fellows learn the basics of vascular access, catheterization and EP procedures, interpretation of pressure tracings and intra-cardiac electrocardiograms and cineangiography.
Non-Invasive Imaging:
Incoming fellows will have echocardiography orientation including echocardiogram physics and hands-on echocardiogram training. 1styear fellows learn the process of performing an echocardiogram on a patient with a structurally normal heart and focusing on the requirements for a full echocardiogram. As the fellow progresses, he/she will begin to perform more complex echocardiograms and learn the process of reading an echocardiogram. By the end of fellowship, fellows will be comfortable performing a full echocardiogram on the full spectrum of congenital heart disease and recognizing the pertinent findings on an echocardiogram. 2nd and 3rd year fellows assist in presenting echocardiographic studies during cardiac surgery and cardiac catheterization conference.
During 2ndand 3rd years, fellows will participate in the performance and interpretation of cardiac MRI and CT studies. During the 3rd year of fellowship, fellows will learn the process of transesophageal echocardiography and fetal echocardiography including performance, interpretation and family counseling in setting of pre-natal diagnosis of congenital heart disease and delivery planning.
Adult Congenital Heart Disease:
During the 2nd year of fellowship, fellows will have a 1-month rotation with the Montefiore adult congenital heart disease team. The rotation will include seeing ACHD outpatients and inpatient consults in addition to the ability to participate in cardiac catheterization and electrophysiology procedures performed on patients with adult congenital heart disease.
Ambulatory Sub-Specialty Rotation:
Fellows will have a 2-week outpatient rotation during the 2nd year that will cover a range of sub-specialty clinics including: heart failure/transplant, bronchopulmonary dysplasia/pulmonary hypertension, cardiogenetics, Williams syndrome, 22q11, Kawasaki’s disease, muscular dystrophy, cardio-oncology, neuro-development and preventative cardiology.
Non-invasive Electrophysiology:
During the 3rd year, fellows have a 2-week rotation that includes proctored reading of electrocardiograms, ambulatory ECG monitors including 24-hour Holter and event monitors, ECG-only and metabolic stress tests for pediatric and adult congenital heart disease patients and device interrogation of pacemakers, ICDs and implantable loop monitors.
Research:
Fellows receive a total of 12 months of research time spread throughout the 3 years. Two months are assigned for the 1st year with the task of identifying a research focus and establishing a research project with the assistance of the mentor. Three and seven months of research time are allocated in the 2nd and 3rd years respectively.
During the 1st year of fellowship, fellows identify an area of research interest. Scholarly oversight committees (SOC) meet twice yearly and consist of a senior and junior cardiology faculty member and an additional faculty member outside of the division with significant research experience and shared interests. The SOC is responsible for keeping fellows on track to complete their research requirements prior to the completion of fellowship. Statistical assistance is available through collaboration with the Albert Einstein College of Medicine and is funded by the division. 3rdyear fellows are expected to complete and submit a first-author manuscript.