Recommendations for fellowship training in pediatric cardiology

The American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), and the American Academy of Pediatrics (AAP) have joined forces to develop important first-ever recommendations for fellowship training in pediatric cardiology.

Directors of pediatric cardiology fellowship training will now have the ACCF/AHA/ACP Recommendations for Training in Pediatric Cardiology to ensure that fellows in training acquire the skills necessary to provide the best possible care for children with heart disease.

"Pediatric cardiology is complex and multifaceted, composed of different clinical and academic subspecialties that are growing rapidly. The information and knowledge to be absorbed is also growing rapidly. This is why we felt it was so important to define the training needed for a successful career," said Thomas P. Graham Jr., M.D., F.A.C.C., F.A.H.A., chair of the writing committee.

In addition to general pediatric cardiology, the recommendations identify "core" and "advanced" training guidelines. Core recommendations are intended to be common training experiences for all pediatric cardiology trainees regardless of long-term career goals. Advanced recommendations are additional training experiences for trainees intending to develop a clinical or academic area of special competence in pediatric cardiology.

The proposed guidelines make a point of urging pediatric cardiology fellows to pursue the ongoing self-education that this complex specialty demands and stress the importance of continuing investigative research, ideally throughout their entire careers.

Written by top experts in pediatric cardiology, the document lists training requirements in the following areas, each with its own task force: general pediatric cardiology (including inpatient care and consultations); echocardiography and noninvasive imaging; electrophysiology; cardiac catheterization and intervention; cardiac intensive care; adult congenital heart disease; and research participation.

"The field has evolved in the past few years to include many new therapies," said Dr. Graham. "There has been a huge increase in the number of pediatric patients who have interventional catheterization. Complex arrhythmias can now be treated effectively with ablation and other electrophysiological therapies. That is very new. There have been changes in imaging, including MRI and echocardiographic breakthroughs. And for the first time, we now have a section on adult congenital heart disease in our training recommendations."

"Training program directors from around the country were involved in developing the recommendations," added Dr. Graham. "This effort had wide, grassroots support. It was reviewed a number of times by a number of organizations, and we're very happy to be able to publish it for the pediatric cardiology community."

"Such a comprehensive set of training guidelines is long overdue," said Robert H. Beekman III, M.D., F.A.C.C., co-chair of the writing committee. "There are many fellowship training programs and hundreds of fellows, but there were no guidelines as to what the programs should offer, or what the fellows should be looking for." Beekman calls the effort a first by saying, "It's true that pediatric echocardiography has had some training recommendations for a few years, but for the fellowship as a whole, there have never been training guidelines."

Because of the importance of academic research in pediatric cardiology, the guidelines advise that trainees spend at least 18 months, and ideally more, doing research. "The field of pediatric cardiology is absolutely dependent upon research, both basic and clinical, and there is a critical need for us to develop physician-scientists in our specialty to ensure future progress," Dr. Beekman explained.

"Training to become a researcher as well as an excellent clinician won't be easy," Beekman added. "Balancing both of these training goals will continue to be a major issue for educational programs. Pediatric cardiology trainees who also wish to become academic researchers will need at least four years of fellowship to begin the academic process and to finish training in the clinical areas."

The Report of the ACCF/AHA/AAP Recommendations for Training in Pediatric Cardiology is available on the Websites of the American College of Cardiology, the AHA (www.americanheart.org), and the American Academy of Pediatrics (www.aap.org).