About the Fellowship
The fellowship at Children's Hospital Los Angeles is a three-year program for a career in academic pediatric cardiology. The purpose of the training program is to provide fellows with a firm foundation for understanding normal and abnormal cardiovascular conditions, including a strong emphasis on the pathophysiologic basis of congenital and acquired cardiovascular disease. The program’s goal is to prepare fellows for careers as academic pediatric cardiology consultants to provide optimal care for pediatric patients (from the fetus to the young adult) with cardiovascular disease.
The program provides a balanced and structured experience in the care for
- Inpatient units
- Cardiothoracic Intensive Care Unit (CTICU)
- Ambulatory cardiology clinic
- Cardiac catheterization laboratory
- Non-invasive cardiology (i.e. echocardiography, electrocardiography, magnetic resonance imaging and electrophysiology ).
Fellows are afforded progressive responsibility commensurate with their level of training and experience.
The Division of Cardiology cares for children with heart or blood vessel problems that may not require surgery. Children’s Hospital Los Angeles is ranked among the top hospitals in the nation for heart care on the U.S. News & World Report Best Children's Hospitals List. We are a recognized leader in state-of-the-art evaluation, diagnosis and treatment for all forms of heart disease.
Learn More about the Training Program
- Inpatient and Outpatient Services
- Electronic Medical Records
- Support Facilities
- Educational Program
- Teaching Experience
- Subspecialty Fellow Policies
- Research and Scholarly Activity
- Evaluation of Pediatric Cardiology Fellows
The Cardiothoracic Intensive Care Unit (CTICU) is a 25-bed dedicated unit. In addition, there are separate Neonatal and Pediatric Intensive Care Units where patients with cardiac disease may be admitted. Cardiac patients who do not require ICU care are admitted to the 30-bed Cardiovascular Acute Unit. The nursing personnel are experienced in caring for infants and children with cardiopulmonary disease. The unit also has a telemetry capability for continuous monitoring of cardiac rhythm.
The Echocardiography Laboratory of the Division of Cardiology has a digital imaging and database capacity system that is integrated with the Children's Hospital Los Angeles electronic medical record (KIDS). The Division of Cardiothoracic Surgery currently maintains its own, independent surgical database that is available for inquiry by the cardiology division.
All of the following facilities are available:
- Diagnostic and interventional cardiac catheterization laboratories. Over 400 cardiac catheterization procedures are performed annually. There are 2 fully-equipped biplane cardiac catheterization laboratories. Diagnostic and interventional cardiac electrophysiology procedures are performed in one of the biplane laboratories equipped for electrophysiology. Approximately 150 pediatric radiofrequency ablation procedures are performed annually.
- Diagnostic imaging including conventional radiography, cardiac MRI, CT angiography and nuclear radiology.
- Comprehensive clinical laboratory facility that performs all routine and special analyses of blood, urine, blood gas analysis, blood chemistry, coagulation studies and blood cross matching.
- A comprehensive blood bank that is equipped to meet the demands of our large cardiac surgery program. Nearly all of the blood used for transfusion at Children's Hospital Los Angeles is obtained from our own institutional donor program.
The Fellow is exposed to the full spectrum of pathology from minimal to that requiring the highest intensity of care. The experience encompasses pre and postoperative care as well as a broad spectrum of acute and chronic congenital and acquired cardiovascular conditions.
Older adults with congenital heart disease transitioned to the Adult CHD program at USC Keck Medical Center. Fellows are afforded the opportunity to arrange a four week elective in Adult Congenital Heart Disease.
Patients admitted to the inpatient cardiology service are under the direct supervision of the attending cardiologist while consultative services are provided to inpatients on other services. All such patients are available to the cardiology Fellows.
- Noninvasive technology
- The echocardiology lab
- Invasive techniques
- Resuscitation techniques
- Technical and other skills
Preoperative and Postoperative Care
Fellows participate in the care of pre and postoperative patients undergoing both closed and open-heart procedures. Fellows are assigned to the Cardiothoracic Intensive Care Unit for 3 months over the first 2 years of residency. During that period they work under the direct supervision of the attending CTICU attending in close collaboration with the cardiology and cardiac surgical attending and alongside pediatric critical care Fellows and congenital heart surgical fellow. Cardiology Fellows gain a broad experience in current surgical techniques, particularly neonatal cardiac surgery, mechanical ventilation, cardiopulmonary bypass and hypothermia. They receive instruction and gain management expertise on the use of acute and chronic pharmacologic agents to support cardiovascular function including intravenous inotropes, vasodilators, antiarrhythmic agents, beta agonists and antagonists, diuretics, sedatives and analgesics.
Fellows are provided the opportunity for long-term follow-up of cardiac surgical patients in the pediatric cardiology clinic. Fellows are responsible for the preparation and presentation of patients at the weekly Cardiac Surgery/Cardiology case conference. All patients scheduled to under surgery during the following week are presented, including clinical, echocardiographic and cardiac catheterization data. The attending surgeons and cardiologists discuss the cases. In addition, difficult management problems are presented at the conference for interdisciplinary discussion and management planning.
Pediatric Cardiology Clinic
Fellows attend the pediatric cardiology clinic ½ day/week at Children's Hospital Los Angeles under the direct supervision of the Division of Cardiology faculty. This provides the fellow with an ambulatory cardiology continuity experience for the 3 years of training. Furthermore, this 1:1 faculty to fellow ratio affords the fellow a more personal and intimate educational experience with a senior cardiologist.
The training program at Children's Hospital Los Angeles offers seminars, lectures and conferences that provide a satisfactory background in basic cardiovascular anatomy and physiology. Lectures by the faculty include anatomy and physiology, embryology, pathology, pharmacology, immunology, genetics and nutrition/metabolism.
The pediatric cardiology fellows prepare and present the weekly cardiac surgery-cardiology conference, cardiac catheterization conference. They prepare and present the monthly cardiac pathology conference and are responsible for a review of the pathologic anatomy as well as presentation of specimens. Fellows also present a current article of interest at a monthly journal review conference attended by faculty and fellows. Fellows are also expected to complete a course in biostatistics provided by The Saban Research Institute of Children's Hospital Los Angeles.
Pediatric cardiology fellows are given the opportunity to teach and assume administrative responsibilities. Cardiology fellows on the inpatient cardiology service are responsible for teaching and directing pediatric fellows and medical fellows on the cardiology elective. They are also the prime "teachers" for the monthly cardiac pathology conference.
Administrative responsibility for the yearly service schedule as well as the "on-call" schedule is the responsibility of the 2nd and 3rd year cardiology fellows with the approval of the program director.
The policies and procedures for cardiology fellows are fully compliant with the general Policies of the "parent" Pediatric Fellow Policies at Children's Hospital Los Angeles. They are each "on call" in the hospital (CTICU) 1 weekday night and 2 weekend days per month. During the remaining weeks, they are on "beeper call" 1 weekday night per week. The average number of "on call" nights/weekend days is 5-6 per month. The program complies with the ACGME guidelines on fellow duty hours. Fellows are not scheduled for more than 80 duty hours per week, averaged over 4 weeks. At least one day in seven is free of patient care responsibilities, averaged over a 4-week period. Fellows are not "on-call" more frequently than every third night, averaged over a 4-week period. There is a 24-hour limit on on-call duty, with up to 6 additional hours for continuity/transfer of care and educational activities. Fellows are assigned no new patients after 24 hours and do not participate in new cardiac procedures, e.g. do not participate in new cardiac catheterization procedures after being on-duty in the hospital for 24 hours. When fellows take call from home, only the time spent in the hospital is counted toward the daily 24-hour and weekly 80-hour duty hour limit.
- Fellows are entitled to 3 weeks vacation (15 work days) plus appropriate time to attend one national cardiology meeting (AHA, ACC, AAP, APS-SPR) or nationally recognized training course per year.
- Requests for vacation days must be submitted sufficiently far in advance to assure appropriate coverage of divisional activities. In general, vacation requests should be submitted to the program director at least 2 months in advance. Vacation times must be posted into the master fellow rotation schedule.
- Vacations should be scheduled during echo, cath, research or elective months and should not be scheduled during inpatient general cardiology or CTICU rotations. If scheduling of vacation during inpatient rotations is unavoidable, the fellow is responsible for arranging for appropriate daytime, night and weekend coverage. Approval of the request is contingent upon coverage. The fellow will be required to “make up” the days off at another time.
- Vacation days requested less than 2 months in advance will be approved only on a case-by-case basis and depend upon coverage arrangements.
- Only one fellow will be allowed to take vacation at a time.
Scholarly activities are a fundamental part of the training program in pediatric cardiology.
Research Program for Pediatric Cardiology Fellows
Fellows are “expected to engage in specific areas of scholarly activity to allow acquisition of skills in the critical analysis of the work of others; to assimilate new knowledge, concepts and techniques related to pediatric cardiology; to formulate clear and testable questions from a body of information/data to be prepared to become effective subspecialists and to advance research in pediatrics; to translate ideas into written and oral forms as teachers; to serve as consultants for colleagues in other medical or scientific specialties; and to develop as leaders in their field.” (The American Board of Pediatrics, Training Requirements for Subspecialty Certification. January 2004)
“All fellows will be expected to engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis that require critical thinking. Areas in which scholarly activity may be pursued include, but are not limited to: basic, clinical or translational biomedicine; health services; quality improvement; bioethics; education; and public policy. Fellows must gather and analyze data, derive and defend conclusions, place conclusions in the context of what is known or unknown about a specific area of inquiry and present their work in oral and written form to the Scholarship Oversight Committee (see below) and elsewhere,” e.g. regional and national professional society meetings.
Fellows are encouraged to begin thinking about research activities during year 1 and are expected to begin the background work for their research projects during year 2. These activities include discussions and instruction by faculty mentors, background literature search, design of the research protocol and submission of the protocol and consent documents to the IRB (Committee on Clinical Investigations). Each fellow is required to obtain certification from the CCI documenting their education and knowledge in the bioethics of human subjects' research and the regulations governing such research. The fellow is expected to begin their research activities during year 2 and complete the data acquisition and statistical analysis during year 3. Preparation of an abstract for presentation at a national meeting and manuscript for submission to a peer review journal is required. Presentation of their research to the faculty and staff as interim works in progress and following completion of the project is integrated into the conference schedule.
To meet the ABP Subspecialty Board requirements for Cardiology Certification for fellows beginning July 1, 2004 the specific written, “work product(s)” may include:
- A peer-reviewed publication in which a fellow played a substantial role.
- An in-depth manuscript describing a completed project.
- A thesis or dissertation written in connection with the pursuit of an advanced degree.
- An extramural grant application that has either been accepted or favorably reviewed.
- A progress report for projects of exceptional complexity, such as a multi-year clinical trial.
Scholarly activities are a fundamental part of the training program in pediatric cardiology.
The fellow is required to attend the Children's Hospital Los Angeles sponsored course: Fellows’ Course in Scholarship Skills that was initiated in 2004. The course will consist of formal training in research study design, biostatistics, principles of evidence-based medicine, etc. It will combine didactic teaching with interactive learning. The focus will be how to develop, implement, and analyze a research protocol. In addition, the format will foster interaction of fellows from different Divisions, and may even encourage research collaboration across Division lines. Fellows can use their own research studies as "homework" in the course, which will provide them with practice of the skills learned in a format they should be motivated to pursue.
Scholarship Overisght Committee
In compliance with the subspecialty training requirements for fellows, the SOC has been established in the division of cardiology. It includes at least 2 members of the faculty from the division of cardiology and 1 from the division of cardiac intensive care. In addition, the training program director is a non-standing member.
The SOC will:
- Determine whether a specific research project is appropriate to meet the ABP guidelines for scholarly activity.
- Determine a course of preparation beyond the core fellowship curriculum to ensure successful completion of the project.
- Evaluate the fellow’s progress.
- Meet with each fellow early during Year 1 and regularly thereafter.
- The fellow will present the progress on the project.
- Advise the program director on the fellow’s progress and assess whether the fellow has satisfactorily met the guidelines associated with the requirement for active participation in scholarly activities.
Each fellow meets with the program director quarterly. The fellow is provided a verbal and written assessment of performance and suggestions for improvement. The assessment tool is based upon personal knowledge of the program director and input from the cardiology and cardiothoracic ICU faculty. The fellow is given the opportunity to respond both verbally and in writing. The fellow is asked for suggestions on improving the education and training experience. A written evaluation is provided to the fellow for review, comment and signature. The summary is maintained in the fellow's file.
- Evaluation of Pediatric Cardiology Fellow Core Competencies
- Evaluation of Faculty
- Evaluation of the Program
How to Apply
The CHLA Cardiology Fellowship Program is a part of the National Resident Matching Program (NRMP). Our program takes applications via the Electronic Residency Application Service (ERAS). If you are interested in applying for our fellowship program, you will need to apply through ERAS application process. To Apply: ERAS Program
Program Fast Facts
AGME Accredited: Yes
Fellows per year: 2
(if applicable) : Dec. 31, 2014
Duration: 3 years
First year fellow: $56,668
Second year fellow: $58,630
Third year fellow: $61,031
Postgraduate Training Required:
U.S. Citizenship Required: No. J-1 Visa or Permanent U.S. resident for non-U.S. citizens