FELLOWSHIP TRAINING PROGRAMIN PEDIATRIC CARDIOLOGY

Indiana University School of MedicineJames Whitcomb Riley Hospital for Children

TABLE OF CONTENTS

Philosophy...........................................................................................................1

Goals....................................................................................................................1

Medical Inpatient Service .............................................................2

Outpatient Clinics..........................................................................2

Cardiac Catheterization .................................................................3

Electrophysiology...........................................................................3

Exercise Physiology........................................................................3

Echocardiography ..........................................................................4

Research.........................................................................................4

Faculty..................................................................................................................5

Clinical Programs ................................................................................................5

Educational Programs.........................................................................................6

Schedule and Responsibilities...........................................................................6

Supervision .........................................................................................................7

Benefits ...............................................................................................................7

Living in Indianapolis .........................................................................................7

Applications/Information ...................................................................................9

Individual Faculty ..............................................................................................10

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PHILOSOPHYCardiology was one of the firstclearly defined subspecialtiesto develop in pediatrics and thesecond to establish formalsubspecialty board certification.During its existence, this disciplinehas seen extraordinary changesthat are continuing at a rapidpace. The practice of pediatriccardiology is increasinglydemanding. The cardiologistmust continue to have excellentbedside skills as well as expertisein pharmacologic therapy, non-invasive imaging, cardiaccatheterization and interventionalcardiology, arrhythmia manage-ment, exercise physiology andpost-operative care. In addition,progress and growth in asubspecialty is dependentupon active work in basic andapplied research.

The clinical cardiology serviceat Riley Hospital is a busy one.However, strong participation inclinical care by the faculty andpediatric house staff is traditional.This permits us to tailor fellowassignments according to theindividual training needs of thefellow and not according toservice needs.

GOALS

The goal of our program is to pro-vide a personalized environmentwhich will permit and encouragethe fellow to become a well-rounded pediatric cardiologistwith excellent clinical and labo-ratory skills and have a basis onwhich to build a career in patientcare, research and teaching. Weaccomplish this through a three-to four-year program, balancingextensive clinical exposure to abroad spectrum of congenital andacquired heart defects and cardiac

arrhythmias, and time spentin active clinical or basicresearch. Interested fellowsmay take a fourth year oftraining in order to extend theirresearch experience or developexpertise in areas such asinterventional catheterization,electrophysiology, noninvasiveimaging or basic research.

We hope the following infor-mation will provide you witha sense of the clinical andresearch opportunities availableat Indiana University and RileyHospital for Children.

FELLOWSHIP TRAINING PROGRAMIN PEDIATRIC CARDIOLOGYIndiana University School of MedicineJames Whitcomb Riley Hospital for Children

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Medical Inpatient ServiceResponsibilities include roundswith the pediatric cardiologyteam, management of inpatientswith an attending's supervision,admitting new cardiology patientsto various units and teaching basiccardiology topics to residents andmedical students. In addition,fellows receive calls from referringhospitals and physicians, andprovide referring physicianswith follow-up and dischargeinformation. Night call is sharedamong all fellows. By the end ofthe first year, fellows will havelearned acute medical manage-ment of infants and childrenwho suffer from congenital andacquired heart disease, howto interpret various imagingmodalities for the diagnosis andmanagement of heart diseaseand when to refer patients forcardiac surgery. During the secondand third year of the fellowship,these skills are refined and fellows

will acquire the experiencenecessary to manage patientsindependently after completionof training.

Outpatient ClinicsThroughout the 3 years of trainingfellows manage a biweeklyPediatric Cardiology clinicaffiliated with the county hospital

on the medical center campus.This clinic serves as a consultationclinic for pediatric outpatientswith murmurs, chest pain andother common symptoms andcomplaints, as well as for continuitycare of patients with congenital oracquired heart defects. A PediatricCardiology faculty member is avail-able as consultant to help fellowswith diagnostic or treatmentstrategies. In addition, fellowsaccompany staff at satellite clinicsin the community to gain outpa-tient clinical assessment skills andexperience. Early in the first yearand at the end of their third year,fellows spend at least a 1-monthrotation in the Riley PediatricCardiology outpatient clinics.By the end of their training,fellows should be skilled in theperformance of a complete cardiovascular examination, theinterpretation of common out-patient diagnostic modalities, andunderstand appropriate outpatientmanagement of common pediatriccardiac problems.

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Cardiac CatheterizationFellows spend six monthson the Catheterization Laboratoryrotation over three years.Approximately 400 procedures(not including Electrophysiology/Ablation procedures) areperformed each year. Theseinclude the full spectrum ofdiagnostic and interventionalprocedures. Currently usedoccluder devices includeCardioSeal and AmplatzerOcclusion devices. Trainees areassigned to assist and performprocedures under the guidanceof a staff physician. With eachsuccessive rotation throughthe lab, fellows assume moreresponsibility for performingprocedures. All fellows attendangiography review sessionsand participate in cardiaccatheterization and pre-surgeryconferences.

Fellows participate in approximately150 catheterization proceduresduring their training. By thecompletion of the fellowship,trainees are able to plan, performand interpret a complete diagnosticstudy. Interested fellows mayextend interventional catheteriza-tion training during a 4th year.

Electrophysiology There is an active electrophysiologyand arrhythmia service withapproximately 175 tilt tests, 200twenty-four hour ECG tests, 6,000ECG’s, and 60 radio frequencycatheter ablations done annually.There is early implementationof new ablation techniquesperformed in collaboration withadult cardiology researchers

at the Krannert Institute ofCardiology/Indiana UniversitySchool of Medicine. These haveincluded the use of an “atrialbasket” catheter for ablation ofatrial flutter in Fontan patients.Currently 175-200 patients withvarious types of pacemakers/AICD’s are followed through ourprogram. During the EP rotation,trainees participate in outpatientarrhythmia visits, pacemakerclinics, intracardiac electrophysiol-ogy studies and radio-frequency

ablation procedures. Fellowsalso gain experience with theelectrocardiographic interpretationof complex arrhythmias onstandard electrocardiograms, 24-hour ambulatory monitors,transtelephonic monitors and theacute and chronic managementof patients with arrhythmias. Overthe course of the 3 year fellowship,3 months are spent on this rotation.

In addition, fellows may initiatearrhythmia-related research projects.A position is available for fourth-year fellows to obtain intensiveelectrophysiology training.

Exercise PhysiologyExperience through the cardiovas-cular exercise physiology laboratoryis part of the electrophysiologyand arrhythmia rotation. Theexercise stress laboratory performsapproximately 150 tests annually.Metabolic measurement of oxygen

uptake and carbon dioxide outputis performed in the majority ofpatients. Fellows will attend and besupervised in the interpretation ofexercise testing for a wide range ofchildren with both cardiovascularand non-cardiovascular diagnoses.In addition, fellows will attendlectures/discussions on basic exer-cise physiology and the principles ofexercise testing and interpretation.

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By the end of the fellowship,trainees should know theindications and contraindicationsto exercise testing in children,and be able to interpret basiccardiopulmonary exercisedata. The exercise physiologylaboratory also offers fellows theopportunity to design and carryout research projects.

EchocardiographyAbout 7,000 transthoracic, 700fetal and 250 transesophagealechocardiograms are performedannually. Fellows spend sixmonths during the fellowship onthis rotation. Fellows learn basicfundamentals of Echo-Dopplerstudies, necessary skills toperform complete 2-dimensionaland Doppler echocardiograms,and attend daily reading sessions.During the second and third yearsthere is introduction to principles,

indications and interpretationof transesophageal and fetalechocardiography. Fellowsalso present echo derivedanatomical and physiologicdata at pre-surgical conferences.By the fellowship's end, trainees

should be familiar with theinstrumentation and physicsof echocardiography, proficientin the performance andinterpretation of 2D, pulsed,continuous wave and colorDoppler examinations.

Fellows can spend an additionalfocused year developing furtherechocardiography skills andknowledge in transesophagealand fetal echocardiography.Opportunities to pursue relatedclinical research projects areavailable, employing variousechocardiographic modalities.

ResearchThe trainee will spend theequivalent of at least one yearduring the 3 year fellowshipin activities related to a clinicalor laboratory research project.Exploration of a “topic” for researchendeavors begins during the firstyear. Fellows should acquire adepth of understanding in an areaof research, learn specific research

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techniques and generate questionsabout their study. Additional goalsinclude the submission andacceptance of at least one first-author, peer-reviewed manuscript.Preparation of a research grantand presentation of findings at anational meeting are encouraged.A clinical project can be done incooperation with and under theguidance of a pediatric cardiologyfaculty or a faculty person of anallied specialty. A basic scienceproject can be arranged in oneof the research laboratories ofthe Indiana University MedicalCenter including: adult electro-physiology; radiologic imaging;myocardial metabolism andcardiac cell physiology; moleculargenetics; and developmentalmolecular biology. The fellowwill be supported by the pediatriccardiology division duringthis research.

FACULTYThe section of pediatric cardiologyincludes 10 faculty members.All are full-time members of thePediatric Department of IndianaUniversity. Though each facultymember has general cardiologyskills, personal interest andacademic pursuits include cardiaccatheterization and interventionalcardiology, nuclear cardiology,echo-Doppler, fetal echo, exercisestress testing, arrhythmia diagnosisand management, transplant care,and physiologic/hemodynamicresearch. There is close liaison withcardiovascular surgery, radiology,pathology, and cardiovascularanesthesia. There are also goodworking arrangements withneonatology, intensive care andall pediatric subspecialties, generalpediatrics, adult cardiology, andbasic sciences.

CLINICAL PROGRAMSRiley Children's Hospital (www.rileyhospital.org) is the pediatrictertiary care hospital for the stateof Indiana. Riley Hospital hascatheterization and non-invasivefacilities dedicated exclusively topediatric use. All pediatric cardiacsurgery is done at Riley Hospital.We have a busy pediatric cardio-logy service with approximately500 cardiac catheterizations(diagnostic, interventional, biopsy,and electrophysiologic), 7,000echo-Doppler studies, 6,000 EKGtracings, 400 open heart surgeriesand 200 closed heart surgeriesperformed annually. Outpatientvisits total 100-120 weekly. Another20-30 patients are seen weekly atsatellite clinics throughout thestate. Daily in-patient census andconsults average 20-30. This ampleexperience will allow the traineeto become competent in theclinical management of a widevariety of both common anduncommon cardiac conditions.

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EDUCATIONALPROGRAMS

In addition to the regular inpatientrounds and continuum of inpatientand outpatient teaching, severaladditional cardiac/cardiovascularconferences are held regularly.These include a weekly topicsconference, a monthly mortality/pathology conference and aweekly surgery conference. A CoreCurriculum series is presentedweekly by fellows, covering basiccardiology principles and conceptsin depth. There is a weekly

interactive teaching session withalternating focus on echo reading,ECG and arrhythmia interpretation,and angiography or nuclearinterpretation attended by allfellows and directed by a facultymember. There are also weeklypediatric grand rounds andpediatric patient managementconferences. The traineeparticipates fully in these andoccasionally presents materialof his/her own. Pediatriccardiology fellows attend oneor two national meetings ormajor national courses.

SCHEDULE ANDRESPONSIBILITIES

The pediatric cardiology fellowshipprogram is a three year program.Two years will be devoted tolearning and practicing the skillsof clinical care and one year toresearch. During the first year, thefellow develops skills in historytaking, physical examination andclinical management in both in-patient and outpatient settingsand becomes knowledgeable inelectrocardiography, echo-Doppler,nuclear cardiology, exercise stress

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testing, and cardiac catheterization.Principles of cardiac catheterizationare learned, and the fellow per-forms diagnostic catheterizations.In the second year the fellowperfects catheterization skills,including those of interventionalcatheterization and electrophysio-logy. During electives in the firstand beginning of the second year,the fellow explores possibleavenues of research and formalizeshis/her major research activity. Theend of the second and first half ofthe third year is devoted primarilyto performance and completion ofa research project, with enhance-ment of clinical skills. This latter isfinalized during the last 3-6 monthsof fellowship, which are spent"electively" in clinical cardiology,catheterization laboratory, andecho-Doppler. The pediatriccardiology fellow has an excellentopportunity to develop teachingskills. Pediatric residents and thirdand fourth year medical studentsregularly rotate through thepediatric cardiology service. Theyare fully integrated into all patientcare and teaching programs. Thefellow is expected to participate inthe informal teaching. From timeto time, fellows will also conductformal teaching sessions.

SUPERVISIONEach fellow will meet with theprogram director and/or divisionchief at least quarterly for a critiqueof performance and progress.During the first year, the fellowshould choose a "mentor" andpersonal training director. He/shewill serve with the program director

as a "dissertation committee".This committee will help decide ifa fellow has satisfied clinical andresearch requirements to qualify forsub-board certification. In additionto the major research efforts, eachfellow is expected to perform,present, and submit for publicationclinical projects, with a facultyadvisor/collaborator.

BENEFITSSalary and standard benefits aredetermined by University policy.Expenses related to presentationof teaching conferences andpresentation of scientific papersat regional and national meetingswill be reimbursed by the Sectionof Pediatric Cardiology. The fellowwill be afforded the opportunity

to attend at least two coursesor conferences during thetraining period.

LIVING IN INDIANAPOLISIndianapolis, the nation's twelfthlargest city, is known as theCrossroads of America. With ametropolitan population of overone million people, Indianapolisoffers the advantages of a citywith a diverse, thriving economycombined with small-townfriendliness known as "HoosierHospitality".

The downtown area has becomea focal point of the city with theopening of Circle Centre in 1996.This is a major downtown shoppingmall and entertainment complex.

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Downtown landmarks include theSoldiers and Sailors Monument,Union Station, the IndianaRepertory Theater, the IndianapolisZoo in White River State Park andthe Eiteljorg Museum of AmericanIndian and Western Art.

Indianapolis is considered the"Automobile Racing Capitol ofthe World". In addition to theIndianapolis 500 race held eachMay, the National Hot RodAssociation's U.S. Nationals, theBrickyard 400 Nascar and theFormula 1 U.S. Grand Prix races

are held here yearly. Professionalsports teams include the IndianaPacers of the NBA and theIndianapolis Colts of the NFL.The Triple-A Indianapolis Indiansplay baseball in Victory Field, anew downtown stadium. TheIHL Indianapolis Ice games arereadily available to hockey fans.Professional soccer is representedby the Indiana Blast. Sometimestermed the "Amateur SportsCapital of the World", the city hashosted the Pan American Games,the National Swimming andDiving championships, the RCA

Hardcourt tennis championships,the World GymnasticsChampionship and the NCAAMen's Basketball Final FourChampionship along with manyother sporting events.

The Indiana UniversityNatatorium, site of the 1996Olympic swimming and divingtrials, is conveniently locatednear the IUSOM campus. BigTen Conference athletics atIndiana University and PurdueUniversity are within an hour'sdrive. Recreational possibilities

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abound at Eagle Creek Park whichoffers biking, sailing, swimming,fishing and cross-country skiing.Major tennis complexes and over30 public golf courses are conve-niently located throughout the city.

The Children’s Museum andIndianapolis Museum of Art areworld renowned. The world'slargest Children's Museum featuresnumerous exhibits for children ofall ages. Cultural events are offeredat Clowes Hall on the ButlerUniversity campus, at VerizonWireless Music Center, at therestored Murat Theater and atthe Circle Theater, home of theIndianapolis Symphony Orchestra.The Indianapolis Museum of Artis the seventh largest in the U.S.Other cultural activities includedance and opera companies,professional and amateur theater,jazz clubs, comedy clubs and artleagues and galleries.

Indiana University-Purdue Universityat Indianapolis (IUPUI; www.iupui.edu) offers 170 degree programs.Part-time or graduate studentscan complete studies here or atother local universities such asButler University (www.butler.edu),the University of Indianapolis(www.uindy.edu) or Marian College(www.marian.edu). The city alsohas a variety of public, private andparochial schools to meet the edu-cational needs of family members.

There are affordable new andrenovated apartment complexesdowntown and in neighborhoodsnear Eagle Creek Park as well asother locations within 20 minutesof the hospitals. House rentals arealso available. Housing costs are

reasonable and many fellows findthey can purchase a home.

These are only some of the attrac-tions which make Indianapolis anideal place to live. The facilities andresources are typical of those of alarge city, but without the crowding,congestion and other problemsthat have troubled many largecities. The people of Indianapolisare proud of their community andtreasure it as a great city in which tolive, work, play and raise a family.

APPLICATIONS ORINFORMATION

Physicians who will have completedresidency training in a programapproved by the American Boardof Pediatrics or will be eligible for

Board certification may apply.A completed application form,including 2 letters of recommen-dation from physicians familiarwith the applicant's graduatetraining, medical school transcript,and curriculum vitae should besent before consideration of theapplicant for interview will beundertaken. Foreign medicalgraduates should also submitECFMG certificate number andvisa information. For furtherinformation, application form,etc., please communicate withRoger A. Hurwitz, M.D., Directorof Fellowship Training, 126 RileyResearch, 702 Barnhill Drive,Indianapolis, IN 46202-5225, (ph: 317-274-8906; FAX: 317-274-4022;e-mail: rhurwitz@iupui.edu).www.rileyhospital.org

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PEDIATRIC CARDIOVASCULAR SURGERY FACULTY

John W. Brown, MD

Specialty: PediatricCardiovascular Surgery

Degree From:Indiana UniversitySchool of Medicine

Residency:University of Michigan

Fellowship:National Institutes of Health

Faculty Rank:Professor of Surgery,Chief of the CardiothoracicSurgery Section

PEDIATRIC CARDIOLOGY FACULTY

Randall Caldwell, MD

Specialty: Pediatric Cardiology

Special Interests:Echocardiography, cardiactransplantation, diagnosticcardiac catheterization

Degree From:Indiana University School of Medicine

Residency: Indiana UniversitySchool of Medicine

Fellowship: Indiana UniversitySchool of Medicine

Faculty Rank:Peter Lawrence PhillipsProfessor of Pediatrics

Timothy Cordes, MD

Specialty: Pediatric Cardiology

Special Interests: Transthoracicechocardiography;transesophagealechocardiography;fetal echocardiography

Degree From:Michigan State University

Residency:Michigan State University

Fellowship: Mayo GraduateSchool of Medicine

Faculty Rank:Clinical AssociateProfessor of Pediatrics

Donald Girod, MD

Specialty: Pediatric Cardiology

Special Interests: Cardiac cath-eterization; interventionalcardiac procedures

Degree From:Indiana UniversitySchool of Medicine

Residency: Ohio StateUniversity Schoolof Medicine

Fellowship:Ohio State UniversitySchool of Medicine;University of Minnesota

Faculty Rank:Carleton Buehl McCullochProfessor of Pediatrics;Director, PediatricCardiology Division

Mark Hoyer, MD

Specialty: Pediatric Cardiology

Special Interests:Interventional cardiaccatheterization

Degree From:Ohio State UniversityCollege of Medicine

Residency:Wright-Patterson USAFMedical Center/Wright State

Fellowship:Children's Hospital andUniversity of PittsburghSchool of Medicine

Faculty Rank:Clinical AssociateProfessor of Pediatrics

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Robert Darragh, MD

Specialty: Pediatric Cardiology

Special Interests: Fetal cardiology,interventional cardiaccatheterization, cardiactransplantation

Degree From:University of Pittsburgh

Residency: Children's Hospital of Buffalo

Fellowship: Children's Hospitalof Buffalo, Children's Hospitalof Pittsburgh

Faculty Rank: Clinical AssociateProfessor of Pediatrics

Eric Ebenroth, MD

Specialty: Pediatric Cardiology

Special Interests:Echocardiography,fetal echocardiography,transesophagealechocardiography

Degree From:Indiana University School of Medicine

Residency: Children's MedicalCenter, Dayton, OH

Fellowship: Indiana UniversitySchool of Medicine

Faculty Rank: ClinicalAssistant Professorof Pediatrics

Anne Farrell, MD

Specialty: Pediatric Cardiology

Special Interests: Prenatalfetal echocardiography,transesophagealechocardiography

Degree From:Loyola University, Chicago

Residency: IU Medical Center

Fellowship: Indiana UniversitySchool of Medicine

Faculty Rank:Clinical AssistantProfessor of Pediatrics

Joyce Hubbard, MD

Specialty: Pediatric Cardiology

Special Interests:Electrophysiology;arrhythmias, pacemakers,radio frequency ablation

Degree From: Indiana UniversitySchool of Medicine

Residency: Indiana UniversitySchool of Medicine

Fellowship: Indiana UniversitySchool of Medicine

Faculty Rank: Clinical AssistantProfessor of Pediatrics

Roger Hurwitz, MD

Specialty: Pediatric Cardiology,Nuclear Medicine

Special Interests:Pediatric cardiovascularnuclear medicine

Degree From:Northwestern UniversitySchool of Medicine

Residency: Children'sMemorial Hospital, Chicago

Fellowship: University ofCalifornia, Los Angeles

Faculty Rank:Philip Murray Professor ofPediatrics and of Radiology

Marcus Schamberger, MD

Specialty: Pediatric Cardiology

Special Interests: Prenatalfetal echocardiography,transesophagealechocardiography,exercise physiology andexercise stress testing

Degree From:University of Erlangen-Nuremberg, Germany

Residency:University of Missouri

Fellowship: Indiana UniversitySchool of Medicine

Faculty Rank:Clinical AssistantProfessor of Pediatrics

Mark W. Turrentine, MD

Specialty: PediatricCardiovascular Surgery

Degree From: University ofKansas School of Medicine

Residency: University ofKansas - Wichita

Fellowship: Indiana UniversitySchool of Medicine

Faculty Rank: AssociateProfessor of Surgery

Mark Rodefeld, MD

Specialty: PediatricCardiovascular Surgery

Degree From: Indiana UniversitySchool of Medicine

Residency: WashingtonUniversity, St. Louis

Fellowship: University ofCalifornia, San Francisco

Faculty Rank: AssistantProfessor of Surgery

Section of Pediatric CardiologyRiley Research 126702 Barnhill Drive

Indianapolis, IN 46202-5225

www.rileyhospital.org