Pediatric Cardiology Residency

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The educational mission of the Pediatric Cardiology Training Program is to provide subspecialty residents with broad clinical experience, factual knowledge, technical skills, and clinical judgment to effectively manage patients independently from fetal life to adulthood for congenital heart disease. By managing acquired heart disease in children and adolescents, residents are able to enhance their skills and to promote their involvement in research during their training. This is achieved by a progressive delegation of increasing responsibility in the clinical area, non-invasive laboratories and invasive laboratories, delegation of teaching roles, and exposure and participation in research. The trainees will receive didactic instruction, clinical exposure to patients with mild and serious heart disease in both surgical and medical settings, plus assignments for didactic teaching and research projects.

This experience is enhanced by incorporation of support services, social, ethical and preventive aspects.

ACGME Accredited: Yes
Residents or Fellows per year: 2
Duration: 3 years
Postgraduate Training Required: No
U.S. Citizenship Required: No, we also accept J-1 and H-1B visas.

Residents/Fellows who have graduated our program in the last 10 years obtained faculty positions at:

  • Miami Children’s Hospital
  • Cedar-Sinai
  • Children’s Mercy Hospital
  • University of Florida Hospital
  • University of Mississippi
  • Minneapolis Children Hospital
  • University of Tennessee
  • Mayo Clinic 

Teaching Hospitals

  • Jackson Memorial Hospital
  • Joe DiMaggio Hospital

Requirements
This program follows the requirements outlined by the American Board of Pediatrics for Sub-Specialty Certification.

GENERAL ELIGIBILITY CRITERIA FOR CERTIFICATION IN THE PEDIATRIC SUBSPECIALTIES (AMERICAN BOARD OF PEDIATRICS 2006)
In addition to the training requirements, which are specific to each of the pediatric subspecialties, the following are required of candidates seeking certification in the pediatric subspecialties of adolescent medicine, cardiology, critical care medicine, developmental-behavioral pediatrics, emergency medicine, endocrinology, gastroenterology, hematology-oncology, infectious diseases, neonatal-perinatal medicine, nephrology, pulmonology, and rheumatology. Each candidate must be familiar with specific subspecialty training requirements as well as the policies stated in the current Booklet of Information.

Certification by the American Board of Pediatrics (ABP)
An applicant must be currently board or board eligible in general pediatrics to be accepted for a pediatric subspecialty certifying examination.

Licensure
An applicant must have a valid (current), unrestricted license to practice medicine in one of the states, districts, or territories of the United States or a province of Canada in which he or she practices or have unrestricted privileges to practice medicine in the US Armed Forces. If licenses are held in more than one jurisdiction, all licenses held by a physician should meet this requirement.

An applicant who is practicing the subspecialty abroad exclusively may be exempted from this license requirement upon presentation of proof of licensure in the country in which he or she practices. Candidates who practice or plan to practice abroad exclusively must submit a letter, in addition to the licensure, stating this fact. A copy of the license must accompany the application material.

Verification of Training
An applicant will be asked to list the program(s) where fellowship training occurred as well as the name(s) of the program director(s). The ABP will provide a Verification of Competence Form to the program director(s) for completion. (Note: For new subspecialties, alternatives to the usual training requirements, such as practice experience, will be acceptable as criteria for admission to the examination. Candidates should refer to the specific subspecialty eligibility criteria for details.) The role of the program director in the certification process is to verify completion of training, evaluate clinical competence including professionalism, and provide evidence of the trainee's meaningful accomplishment in research or scholarly activity.

An applicant must have the Verification Form(s) on file at the ABP in order to be admitted to the subspecialty examination. If an applicant's training is not verified or if the applicant receives an unsatisfactory evaluation in any of the competences (with the exception of professionalism alone), the applicant will be required to complete an additional period of subspecialty fellowship training before reapplying. The director of the program where the additional training occurred must complete a separate Verification of Competence Form. If the unsatisfactory evaluation is in professionalism only, the applicant will be required to complete an additional period of fellowship training or, at the program director's recommendation and at the ABP's discretion, a period of observation may be required in lieu of additional training. A plan for remediation must be submitted for review and approval by the ABP.
The specific requirements for each rotation are found under Core Curriculum (Orientation booklet). The guidelines for procedure numbers are also included in the section (Training Requirements JACC 46:1380, 2005).

Application Deadline 
Application starts December 1. Interviews will begin in February, March, and April.

Completed application, submitted via ERAS includes:

  • Completed application, including photograph
  • Curriculum Vitae (CV)
  • Personal statement
  • Medical school transcript
  • USMLE Scores
  • Letter of recommendation from the Pediatric Residency Program Director
  • Three additional letters of recommendation
  • ECFMG certificate (international graduates only)
  • Pediatric Residency Completion Certificate (upon entering program)
  • Should have passed Step 3 to be considered for interview

First Year
The subspecialty resident receives two months of clinical inpatient service and one month of cardiac ICU. It includes responsibilities for medical and surgical patients as well as consultations. There are two months of non-invasive experience which includes treadmill and other stress studies and tilt studies. There are three months of rotation in imaging which includes two-dimensional, color flow imaging, spectral Doppler, M-Mode and contrast echo, as well as transesophageal echo, fetal and stress echocardiography. Fellows will also have exposure to cardiac MRI and CT scan during these months. There are two months cardiac catheterization/electrophysiology and one month of protected research.

Second Year
Two months of clinical service and one month of cardiac ICU and two months of rotation in imaging. There are two months of cardiac catheterization/electrophysiology, one month non-invasive and three months of protected research time.

Third Year
There are two months of clinical inpatient service, one month rotation in imaging, two months of cardiac catheterization and six months of protected research time.

Summary of Clinical Inpatient Experience
The daily pediatric cardiology census consists of six to 10 patients in addition to the consult service of six to 10 patients daily. Medical and surgical patients are cared for in the general pediatric areas, the critical care unit and the newborn intensive care unit.

Annual number of inpatient visits was 3,000.

Operating rooms are specifically designed for management of infants and children with congenital, acquired heart disease and transplant.

Each pre-operative patient is evaluated by a team consisting of a cardiovascular surgeon, attending pediatric cardiologist, subspecialty resident, and anesthesiologist. The cardiology subspecialty resident is responsible for the evaluation of the patient along with the cardiac surgical resident and is further responsible for the review of the past history, non-invasive studies, cardiac catheterization and angiographic data. Each patient is reviewed at a formal CV conference.

The surgical experience includes a total of two months of concentration on surgical patients where responsibilities include observation in the operating room and performance of transesophageal echocardiograms and experience in the critical care unit for management of post-operative patients in conjunction with the surgical and cardiac intensive team.

The subspecialty residents are also responsible for pre-operative evaluation, operative observation and post-operative follow-up of cardiac transplant patients. They are expected to be familiar with the various immune suppressive agents and proper management. The pediatric heart transplant program was established in 1991. It is complimented by a strong Division of Transplantation with extensive immunologic support.

For those inpatients for whom consultations have been provided, it is expected that the resident will follow these patients closely and be familiar with the various underlying problems that impact the cardiac status, for example: neonates with persistent fetal circulation, diaphragmatic hernia, hyaline membrane disease; pulmonary patients with chronic lung disease and asthma, nephrology patients with hypertensive heart disease, end-stage renal disease and lupus erythematosis; hematological patients with sickle cell anemia, leukemia, and drug induced cardiomyopathy; gastroenterology patients, post liver transplant and infectious disease patients with AIDS cardiomyopathy and endocarditis.
All of these patients are the responsibility of the subspecialty resident in conjunction with faculty oversight.

The neonatal intensive care unit is a busy service where a special unit is identified for babies with cardiac disease. The responsibility for the evaluation and management of these babies rests upon the cardiac resident and neonatal resident with faculty supervision. These infants are followed regularly by the cardiology service along with the neonatal service for decisions regarding management and care. The subspecialty resident is responsible for all consultations on the newborn unit.

The Residents also attend Electrophysiology service at Joe DiMaggio Hospital for one month during the second and third year of training.

Supervision: Every patient is reviewed and examined by a faculty member after the evaluation or conjointly with the evaluation by the resident. Our consultation and follow-up visits are recorded in the Electronic Medical Record (EMR).

Rounds: There are daily rounds with the faculty member and the hours vary from two to six depending upon the census.

Logs: All procedures must be logged with New Innovations on a daily basis by the Resident.

There are approximately 3,000 outpatient visits yearly. Residents are required to attend, evaluate and manage outpatients in the weekly cardiac clinic at Jackson Memorial Hospital and they can also join the faculty in Cardiology clinic. All of the residents are supervised by faculty and each patient is evaluated by the faculty member with appropriate documentation.

Residents are responsible for consulting on patients in the emergency room and this accounts for approximately 100 consultations per year. The emergency department is located in our primary teaching hospital, Jackson Memorial Hospital. There is faculty oversight on location for 90% of the patients seen in the emergency room, with faculty oversight off location for 10% (phone, fax of EKG, etc in off-hours).

Additionally, those residents who are rotating on the non-invasive service have the opportunity and responsibility to attend the arrhythmia and pacemaker clinic weekly where approximately 100 children with pacemakers and defibrillators are followed. This is primarily a learning experience for the fellows initially, but, as experience is gained in the use of pacemakers and defibrillators, more responsibility is given to the trainees.

All clinics are with faculty oversight.

Board Exam Requirements
Board certified or board eligible in general Pediatrics.

Research
Clinical research and Translation at Jackson Memorial Hospital. 

Call
Hospital call once a week and from home call once a week.

Alixe Marcial
Phone: 786-486-6677

Prospective Residents

Physicians Services / Housestaff Office
Jackson Memorial Hospital
East Tower Room 1004
1611 NW 12th Avenue, Miami, Florida 33136
Phone: 305-355-1122
Fax: 305-355-1123

Graduate Medical Education Office
Jackson Memorial Hospital
Institute 118B
1611 NW 12th Avenue, Miami, Florida 33136
Phone: 305-585-4310
Fax: 305-585-4309

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