Cardiology Service

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information

I About The Programme

Name of Programme

General Paediatric Cardiology Fellowship and Observership

Overview

The aim of the programme is to provide a comprehensive course in paediatric cardiology so that the trainee can achieve the basic knowledge and skills expected of a general paediatric cardiologist and practice as one. The trainee will learn normal and abnormal cardiac anatomy, physiology and haemodynamics. He/she will develop skills in clinical cardiology and echocardiography, as well as exposure to cardiac catheterisation. He/she will be able to develop a plan of management and confidently look after children with cardiac disease. This includes medical treatment and recommendation for appropriate interventional or cardiac surgical management.

This programme is a specialty training. Fellows will see cardiac patients and referrals from general paediatrics and specialties like Haematology and Oncology, Children’s Emergency, Neonatology as well as from the Neonatal and Children Intensive Care Units. Fellows will be rotated to do tag-on calls to take referrals, and to look after Cardiology/Cardiothoracic patients in the Children’s Intensive Care and the Cardiac Step Down Unit.

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Aim of Programme

A significant proportion of the training in paediatric cardiology will be clinical hands-on and procedure-based. This implies that the training would take into consideration the need for familiarisation of common cardiac procedures. The ability to master echocardiography techniques and make meaningful interpretation in order to complement other knowledge in formulating management plans is essential. Being able to assist in performing cardiac catheterisation would auger well for the paediatric cardiology fellow who may wish to consider further specialisation in this field in the future.

Duration of Programme

Clinical Fellowship: 6 month or 1 year
Hands-Off Observership: maximum of 28 days
Clinical Observership: up to a maximum of 6 months

Number of Training Places

1 to 2 Fellows every 12-24 months

Learning Outcomes

After completing the programme, Fellows will be able to:

• take a good clinic history, perform a proper cardiac examination and come to a clinical diagnosis;
• interpret electrocardiograms, perform a complete echocardiographic examination, arrive at anatomic and haemodynamic diagnosis, and come up with a management plan;
• interpret haemodynamic data and angiograms of diagnostic cardiac catheter study;
• interpret cardiac CT scans and cardiac MRIs;
• have a good understanding of cardiac surgical procedures, able to recommend appropriate surgical treatment plan, as well as manage post-cardiac surgical patients and associated complications and sequelae;
• communicate and explain clearly the condition, treatment plan and prognosis to parents and patients.

The Fellow would also have participated in research, and present or publish a research paper.

Content Areas

The activities include:

• daily morning and afternoon ward rounds;
• outpatient clinic – 4 sessions per week;
• performance and interpretation of echocardiography – transthoracic, transoesophageal and epicardial. The Observer and Fellow will be led through normal as well as structural and functional abnormalities of the heart. The Fellow will have daily hands-on practice to develop echocardiographic skills and appropriate interpretation, leading to accurate diagnosis. This will include appreciation of cardiac haemodynamics and structural defects of premature babies in neonatal intensive care, neonates, children and adolescents. Transoesophageal echocardiography is done in the intensive care, cardiac catheterisation laboratory and during cardiothoracic surgery in the operating theatre. Epicardial echocardiography is only done in the operating theatre.
• Fetal echocardiography (optional)
  
• reading and report of 12 lead ECG, transtelephonic ECG and 24-hour ambulatory ECG;
• assessment and treatment of rhythm abnormalities in neonatal and Paediatric population;
• exercise treadmill – monitoring of patient during stress tests and reporting of studies;
• interpretation of cardiac CT/ MRI;
• observe and assist in diagnostic and interventional cardiac catheterisation;
• management of acute cardiac emergencies;
• management of cardiology and cardiothoracic surgical patients in the intensive care units (CICU, NICU), cardiac step-down unit and general wards;
• long term management of paediatric cardiac patients and transition to adult congenital heart follow up;
• understanding cardiothoracic surgical procedures and techniques.
  

Training Methods

• The Fellow will be supervised closely and daily interaction and teaching will be conducted by the consultant during the ward rounds and clinic sessions.
• Electrocardiogram: daily
• Transtelephonic and 24-hour ECG reporting: ad hoc
• Exercise treadmill stress test: weekly
• Echocardiography: daily
  
• Journal readings and presentation of topics: weekly
• Daily cardiac intensive care and step-down unit rounds are conducted by the consultant, and Fellows are expected to know all the patients, present their findings and discuss the management of the patients with the consultant.
• The Fellow will present at the weekly cardiology/cardiothoracic conference (2-3 hours). Presentation includes patients who have undergone diagnostic and interventional cardiac catheterisation, patients listed for cardiac surgery as well as cases for discussion from the clinics or wards. This is a teaching conference and Fellows will be quizzed on cardiac anatomy, physiology and management. Comments will be made on the presentation so that the Fellow will have better in depth understanding of the topics.

Note that the Observer or Fellow will not be rotated through other departments or hospitals.

Past and Present Fellows

Some of our past fellows are:

Team of Experts

The Cardiology Service Fellowship Programme is managed by the following experts:

II Assessment and Evaluation

Aims of Assessment

Fellows are required to continually demonstrate the following six competencies throughout the programme:

(A) Patient Care
(B) Medical Knowledge
(C) Practice-Based Learning and Improvement
(D) Interpersonal and Communication Skills
(E) Professionalism
(F) Systems-Based Practice

There is no summative assessment.

Evaluation Process

General overall grading system

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competency-based knowledge, skills and performance that Fellows must demonstrate throughout the programme.

If, after spending some time in the specialty, the Fellow feels that paediatric cardiology is not suited for him/her, then he/she may choose to terminate his/ her training after discussion with the supervisor.

III Target Audience and Eligibility Requirements

Target Audience

Qualified paediatricians who have gone through postgraduate training in paediatrics are most welcome.

Pre-requisite/Eligibility Requirement(s)

Candidates must have:

• a post-graduate paediatric qualification, e.g. Master of Medicine in Paediatrics, MRCPCH or equivalent;
• completed general paediatric traineeship or residency.
  

IV Other Information

Course Fees

Course fee will be determined upon application.

Funding

Candidates should be self-funded or have funding from external sources/institutions.

Certification

A certificate of fellowship will be awarded upon completion of the programme.