Fellowship
Adult Congenital Heart Disease Program Curriculum
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Curriculum Details
Overview
The Adult Congenital Heart Disease (ACHD) fellowship program is two years in duration and complies with the Accreditation Council for Graduate Medical Education (ACGME) requirements, in addition to following the guidelines and recommendations of the American College of Cardiology’s (ACC) COCATS. All applicants entering ACHD must have completed an ACGME-accredited Internal Medicine-based cardiovascular disease fellowship or Pediatric Cardiology fellowship, or its equivalent.
A subspecialty educational program in ACHD must function as an integral component of an accredited subspeciality in cardiovascular disease. Therefore, the guidelines put forth are complementary to both Internal Medicine and Pediatric-based cardiology fellowships.
Training Goals and Objectives
The ACHD subspecialty fellowship is designed to provide the fellow with COCATS Level III competency in ACHD. Specific curricular milestones for training in ACHD, as they relate to the Core Competencies put forth by ACGME, are adopted as outlined in the COCATS 4 Task Force 10 document, and the forthcoming 2026 ACC/AHA Advanced Training Statement on ACHD. They are included in this curriculum with appropriate associated Evaluation Methods for fellows. Specific curricular milestones for Ambulatory and Longitudinal Care, as well as Research, are also included.
General Structure
The care of ACHD patients requires seamless integration between inpatient and outpatient services. In both settings, understanding of advanced imaging, electrocardiographic monitoring, percutaneous and surgical procedures, application to adolescent/pediatric groups (i.e. transition of care), and cardio-obstetrics remain important. The ACHD fellow will gain experience in both settings, which will facilitate knowledge acquisition and clinical experience.
The clinical experience will focus on gaps of Pediatric or Internal Medicine-based Cardiovascular Medicine (CVM) that were not covered in the general cardiovascular medicine fellowship pathway of training (i.e. adult trainees will require more pediatric exposure and pediatric trainees will require more adult medicine exposure).
Further exposure to Adult Congenital Heart Disease content may occur across settings to include:
ACHD Inpatient/Consultative Care
ACHD Outpatient Care/Ambulatory Clinic
ACHD Cardiac Imaging
ACHD Cardiac Catheterization
Pediatric/Adolescent Medicine vs. Adult Cardiology, where applicable
Intensive Care/Cardiothoracic Surgery
Cardio-obstetrics; High-risk ACHD Pregnancy Care
ACHD Elective/Research
ACHD Inpatient/Consultative Care
The ACHD fellow will participate in inpatient rounding and consultative care of those with ACHD admitted to pediatric medicine, internal medicine, cardiology, intensive care, and cardiothoracic surgical services. Through this experience, it is expected that the fellow will become proficient in managing both chronic and acute exacerbation of ACHD. Exposure to this service is expected to result in competency in the management of, or integration of:
Decompensated ACHD heart failure
ACHD arrhythmia (both atrial and ventricular)
Pulmonary hypertension in ACHD
Extra-cardiac disease in the ACHD patient, and non-cardiac surgery
Cardiac surgery, pre-/peri-/post-operative
Cardiac intervention, pre-/peri-/post-procedural
Application of, assessment, and integration of imaging-based findings
Application of, assessment, and integration of hemodynamic findings
Pediatric/Adolescent or Adult Cardiology inpatient admissions (as they relate to the primary pathway of general cardiology training, i.e. provide exposure to opposite training pathway)
High-risk pregnancy in ACHD, inpatient management
ACHD Outpatient Care/Ambulatory Clinic
The ACHD fellow will participate in ongoing ambulatory ACHD clinics. Through this experience it is expected that the fellow becomes proficient in managing chronic and expectant management of cardiac and extracardiac disease associated with ACHD. Exposure is expected to deliver knowledge and skill-based experience to provide competency in the management, or integration of:
Chronic ACHD heart failure
ACHD arrhythmia
Extra-cardiac disease in the ACHD patient, and perioperative assessment of risk
Acquired cardiovascular disease in the ACHD patient
Pulmonary hypertension in ACHD
Decisions regarding cardiac surgery
Decisions regarding cardiac interventions
Application of, assessment, and integration of imaging-based findings
Application of, assessment, and integration of hemodynamic findings
High-risk pregnancy in ACHD, antepartum and postpartum management
ACHD Elective/Research
During the ACHD fellowship, it is expected that the ACHD fellow participates in research to foster their experience and understanding of evidence-based medicine and application to this specialized population. Scholarly activity will take place under the guidance of ACHD and cardiovascular disease faculty within the Penn State Heart and Vascular Institute and will be supported by institutional biostatistics, IRB, and research mentorship resources. Each fellow should identify a project within the first six months of training. Scholarly work may include clinical research, case reports, or quality-improvement projects related to ACHD care, with expected presentation at regional or national meetings and/or submission for publication by program completion. Progress is reviewed semi-annually by the program director and the Clinical Competency Committee. Fellows may also use some of this time to further broaden their experience in a specific area of interest as it relates to ACHD (i.e. pregnancy care, advanced imaging, etc.).
ACHD Focused Didactics
ACHD Weekly Case Presentation Conference: Tuesdays, 3-5 p.m., Hamilton Conference Room
Pediatric Surgical & Cath Case Conference: Thursdays, 7-9 a.m., Microsoft Teams
Monthly ACHD Educational Conference: 2nd Tuesday of the month, 3:30-5 p.m., Hamilton Conference Room
Monthly Cardio-Obstetrics Conference: 3rd Wednesday of the month, 7-9 a.m., Microsoft Teams
HVI Grand Rounds: Monthly, Friday at noon
Educational Content
Throughout the ACHD Fellowship, the fellow will rotate between inpatient and outpatient services, gaining exposure to a variety of compensated and decompensated cardiovascular conditions in ACHD. They will interact with various services in co-managing multiple medication conditions, particularly in those with complex ACHD. Exposure to imaging, hemodynamic testing, complex decision-making, and collaboration between programs in the Congenital Heart Center will be required to effectively care for these patients. Responsibilities will start with observation, and gradually over the duration of the fellowship the trainee will partake in progressive responsibility including: functioning as the direct contact for inpatient consultative services or outpatient communication with partnering healthcare practitioners, discussing care at conference, coming up with reasonable differential and therapeutic plan options, analyze and interpreting specialized testing, and performing non-invasive and invasive testing with appropriate oversight by expert mentors in the Congenital Heart Center. Direct supervision will be employed initially (1:1) with faculty and planned advancement to semi-independent work with communications, clinic note writing, discussions with patients/families, as skills and competencies are refined and mastered. Direct supervision of the fellow’s performance will be provided daily, and there will be quarterly evaluations and semi-annual performance reviews every 6 months.
The schedule will be designed to provide experience in areas of pediatric and/or adult cardiology that the ACHD fellow may not have received in their primary cardiovascular medicine training pathway according to the ABIM sample ACHD curriculum as outlined below.
Internal Medicine Pathway
Outpatient Clinic: 18 Months | Total: 24 months
ACHD Inpatient/Consult Service
9-12 months
Patients Procedures:
≥ 200 Inpatient admissions
≥ 10 ACHD pregnancies
≥ 10 Noncardiac surgeries
≥ 30 ACHD PH
≥ 30 ACHD heart failure
≥ 30 ACHD atrial arrhythmias
≥ 15 ACHD vent arrhythmias
ACHD Cardiac Imaging
3 months
Patients Procedures:
≥ 150 TTE
≥ 25 TEE (10 intraoperative)
≥ 50 CMR
ACHD Cardiac Catheterization
2 months
Patients Procedures:
≥ 10 diagnostic and 20 interventional performed or interpreted
≥ 10 diagnostic and 20 interventional participate
Pediatric Cardiology/Adolescent Medicine
2 months
ICU/CT Surgery
1 month
Patients Procedures:
See inpatient requirements
ACHD Elective/Research
6 months
Pediatrics Pathway
Outpatient Clinic 18 Month | Total: 24 months
ACHD Inpatient/Consult Service
9-12 months
Patients Procedures:
≥ 200 Inpatient admissions
≥ 10 ACHD pregnancies
≥ 10 Noncardiac surgeries
≥ 30 ACHD PH
≥ 30 ACHD heart failure
≥ 30 ACHD atrial arrhythmias
≥ 15 ACHD vent arrhythmias
ACHD Cardiac Imaging
3 months
Patients Procedures:
≥ 150 TTE
≥ 25 TEE (10 intraoperative)
≥ 50 CMR
ACHD Cardiac Catheterization
2 months
Patients Procedures:
≥ 10 diagnostic and 20 interventional performed or interpreted
≥ 10 diagnostic and 20 interventional participate
Internal Medicine Cardiology
2 months
ICU/CT Surgery
1 month
Patients Procedures:
See inpatient requirements
ACHD Elective/Research
6 months
Principle Teaching Methods
The principle teaching methods used by the faculty follows the recommendations set forth by the American College of Cardiology and the American Heart Association and covers medical knowledge and procedural skill requirements on the following topic areas specific to ACHD:
ACHD classification system and anatomic risk
Understand initial and post-surgical ACHD anatomy and physiology
Pathophysiology, epidemiology, clinical presentation, and diagnostic work up to make a therapeutic plan for Simple, Moderate, and Complex ACHD
Transitions of care and understanding delivery care models
Neurocognitive and mental health associations with ACHD
Heterotaxy syndrome characteristics
Collaboration with congenital heart surgeons, adult cardiothoracic surgeons, and medical specialists with expertise in the non-cardiac disease management of patients with ACHD
Evaluative and risk stratification tools for: non-cardiac surgery, cardiac surgery, pregnancy, pulmonary arterial hypertension
Indications and methods for rhythm assessment, electrophysiology study, and pacing/ICD placement
Anticoagulation use in ACHD
Exercise and functional testing
Transthoracic Echocardiographic imaging performance and interpretation
Transesophageal Echocardiographic imaging performance and interpretation
Advanced 3-dimensional imaging assessment and incorporation of findings into care plans
Management of pregnancy and reproductive health
Management of chronic heart failure in ACHD
Management of decompensated heart failure in ACHD
Collaboration with advanced heart failure and transplant teams for escalation of care to include device and transplant for patients with ACHD
Collaboration with electrophysiologists to manage arrhythmia in ACHD patients
Recognition and screening for comorbid extra-cardiac disease in ACHD
Pathogenesis, characteristics, diagnostic approach for assessment and management of pulmonary arterial hypertension, in concert with pulmonary hypertension experts
Chronic and longitudinal management of single ventricle palliation/Fontan physiology
Chronic and longitudinal management of Eisenmenger Syndrome
Chronic and longitudinal management of cyanotic ACHD
Critical care management of moderate and complex ACHD
Vascular access and surgical/procedural planning in ACHD
Discuss risks/benefits and alternatives for ACHD interventions and surgery, in concert with the congenital heart team
Evaluate and incorporate hemodynamic findings into the care plan for ACHD patients
Understand and be able to apply shunt hemodynamic findings to design specific ACHD patient care plans
Additionally, fellows participate in mentored scholarly activity under the guidance of ACHD and cardiovascular disease faculty within the Penn State Heart and Vascular Institute. Each fellow identifies a project within the first six months of training, supported by institutional biostatistics, IRB, and research mentorship resources. Scholarly work may include clinical research, case reports, or quality-improvement projects related to ACHD care, with expected presentation at regional or national meetings and submission for publication by program completion. Progress is reviewed semi-annually by the program director and the Clinical Competency Committee.
Mandatory Expectations
Attend ACHD conferences and weekly case conference for ACHD and pediatric cardiology throughout the year, and when assigned, prepare a topic or case review as required.
Attend the monthly cardio-obstetrics conference and when assigned, prepare a topic or case review, as required.
Attend HVI grand rounds monthly.
Participate in weekly (up to 4 days a week) outpatient ACHD clinic.
Round on ACHD inpatients and/or consultative cases. Act as the point person for inpatient services when assigned on these months.
For experiences in the opposite training pathway (i.e. pediatric cardiology rotation for adult fellows), participate in the rotation as a rotating fellow/resident, fulfilling rotator duties as outlined in service structure model for that particular rotation.
Communicate plan of care to other services who are also following ACHD patients either in the inpatient or outpatient setting.
Didactic teaching for general fellows on ACHD rotation (can be done at the bedside, or more formally at the ACHD conference)
Participate in on-going ACHD quality improvement projects such as Coarctation imaging.
Participate in echocardiography interpretation and reading (in clinic, on wards, and dedicated in the lab)
Participate in transesophageal echo and 3D imaging on dedicated time blocks when ACHD patients may be presenting for procedures.
Participate in hemodynamic and procedural catheterization procedures if desired, when ACHD patients be presenting for procedures.
Overnight call will be rotated with faculty in ACHD, such that the ACHD fellow will provide first (home) call in the rotation during the assigned weeks (one week per month) with faculty back-up.
Vacation/CME Time
Time off for vacation may be requested through the Program Coordinator by completing the Time Off Request form in Microsoft Teams. It is the fellow’s responsibility to make sure the Program Director and any necessary faculty are notified of the impending time off.
One or more faculty members will be assigned to the ACHD outpatient clinic. Outpatient management of the ACHD patient will be supervised in-person by the clinic ACHD attending(s) of the day.
Inpatient management will be supervised either in person (during the daytime) or over the phone (nights and weekends) with the appropriate ACHD attending.
Any additional rotations through adult cardiology or pediatric cardiology (to gain experience in each setting) will be supervised by the attending adult or pediatric cardiologist, as appropriate.
Echocardiograms will be reviewed by the ACHD attending, with efforts to provide direct teaching experience with dedicated time reviewing the images either in clinic or the laboratory.
All faculty will attend the ACHD case conferences and educational sessions to improve the depth of discussion on ACHD educational topics and to provide board-style question practice. Faculty will facilitate all educational sessions on a pre-assigned basis/rotation.
The fellow may choose a research mentor of their choice to oversee scholarly projects in ACHD that align with the fellow’s area of interest.
Evaluation of the Fellow
The fellow is evaluated quarterly by the faculty on the six core competencies and the ACHD curricular milestones. These evaluations are available to the fellow in New Innovations immediately after faculty completion. The expectation of the faculty is to have these completed within 14 days of receipt for the fellow to be provided with timely feedback.
The fellow is evaluated semi-annually by peers (cardiovascular disease fellows on the ACHD rotation) and staff. The fellow is also required to complete a self-evaluation semi-annually. The fellow is evaluated on an ongoing basis by patients in his/her continuity clinic.
The responses of the faculty, peers, staff, patients, and self-evaluations are presented at the Clinical Competency Committee (CCC) meeting semi-annually. The committee discusses fellow progress and assigns milestones. A summary of these evaluations and milestones is communicated to the fellow during his/her semi-annual mid-year and end-of-year evaluation with the Program Director. Upon completion of their training, the fellow is provided with a Final Summative Evaluation by the Program Director.
Evaluation of the Teaching Faculty
The faculty are evaluated on an ongoing basis by both the cardiovascular disease and ACHD fellows. A summary of the information is communicated to the faculty member annually during their AC-40 evaluation conducted by the Heart & Vascular Institute. De-identified evaluations are sent to the faculty by the Program Coordinator at the end of each academic year.
Evaluation of the Program
The faculty and ACHD fellow conduct an evaluation of the program annually.
For anonymity, the evaluation of the program by ACHD fellow is managed by the central GME office and results are provided every 5 years. All faculty and fellows are required to participate in the annual ACGME Faculty and Resident Survey.
Graduates are surveyed by the program, also in concert with the cardiovascular disease fellowship for anonymity, the first two years following completion of fellowship, as well as at five years post-graduation, to assess their academic and clinical growth and satisfaction with their training.
The Program Evaluation Committee (PEC) consists of the Program Director, Associate Program Director, and core adult congenital heart disease faculty, as well as the current fellow. The committee reviews and discusses the responses of all of these surveys to assess the experience of the fellow in an effort to enhance and strengthen the training.
COCATS 4 Task Force 14 : Training in Care of Adult Patients with Congenital Heart Disease
2018 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease
2011 ESC Guidelines on the management of cardiovascular disease during pregnancy
Recommended Journal Articles by Faculty/Fellows:
Cabanes, L., J. Coste, et al. (2002). "Interobserver and intraobserver variability in detection of patent foramen ovale and atrial septal aneurysm with transesophageal echocardiography." J Am Soc Echocardiogr 15(5): 441-6.
Gatzoulis, M. A., J. A. Till, et al. (1995). "Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death." Circulation 92(2): 231-7.
Diagnosis and Management of Adult Congenital Heart Disease, 3rd edition
Cases in Adult Congenital Heart Disease
Heart Disease in Pregnancy, second edition
The Natural and Modified History of Congenital Heart Disease
Moss and Adams' Heart Disease in Infants, Children and Adolescents: Including the Fetus and Young Adult, 2 Volume Set
IM/Peds or IM, IM Cards
All blocks at Penn State Health Milton S. Hershey Medical Center and Penn State Health clinics. Consults included throughout.
IM/Peds, Peds Cards
All blocks at Penn State Health Milton S. Hershey Medical Center and Penn State Health clinics. Consults included throughout.
Peds, Peds Cards
All blocks at Penn State Health Milton S. Hershey Medical Center and Penn State Health clinics. Consults included throughout.
Additional Notes
Electives include rotations in ACHD inpatient, ACHD outpatient, imaging, cardiac cath, electrophysiology, pediatric cardiology, CTICU and research. With approval from the program director and GME office, electives can be completed at another institution. However, most are done at Penn State Health Milton S. Hershey Medical Center and Penn State Health clinics.
Outpatient clinics include Penn State Health IO Silver Clinic, Nyes Road Clinic, and Penn State Health outreach clinics in Lancaster, York and State College.
Core Competency Components and Curricular Milestones
Goal – Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.
General
First Year:
Skill to apply evidence-based ACHD specific recommendations appropriately in the clinical setting
Skill to effectively and efficiently perform an initial outpatient cardiovascular consultation in an ACHD patient or a patient suspected of having a new CHD diagnosis
Skills to lead and engage appropriate consultative services in palliative care and end of life discussions with ACHD patients and their families
Skill to risk stratify ACHD patients undergoing noncardiac surgery or procedures and to optimize perioperative management
Second Year:
Skill to provide longitudinal ACHD-specific care, inclusive of consideration of current anatomy and physiology, to improve long-term outcomes and quality of life
Diagnostic
First Year:
Skill to interpret electrocardiographic monitoring in ACHD patients and recognize common abnormalities and disease-specific arrhythmias associated with ACHD
Skill to determine which ambulatory electrophysiologic monitoring is indicated in the ACHD patient that presents with findings concerning for arrhythmia
Second Year:
Skill to select the most appropriate type of stress testing in ACHD
Skill to interpret CPET testing results in ACHD
Skill to perform and interpret a transthoracic echocardiogram in ACHD
Skill to perform and interpret a transesophageal echocardiogram in ACHD
Skill to assess and include cardiac computed tomographic imaging and MRI information to guide clinical management in ACHD
Pregnancy
First Year:
Skill to perform a detailed sexual and reproductive health history in ACHD
Skill to collaborate with reproductive specialists to weigh risks and benefits of contraception and/or hormone replacement therapy in ACHD
Skill to assess maternal cardiac risk in those with ACHD pursuing assisted reproductive technology or pregnancy
Second Year:
Skill to formulate an individualized labor and delivery plans to reduce maternal morbidity and mortality in ACHD
Skill to manage thromboembolic and bleeding risk with anticoagulation during pregnancy in ACHD
Heart Failure/Transplant
First Year:
Skill to work effectively with heart failure and transplant teams to manage ACHD with heart failure
Skills to recognize advanced HF in ACHD and refer to heart failure/transplant teams for consideration of advanced therapies
Skills to initiate and titrate GDMT heart failure medications in ACHD patients with: 2-ventricle systemic morphologic LV, 2-ventricle systemic morphologic RV, and single ventricle/Fontan palliation
Skill to collaborate with heart failure, congenital, and adult cardiothoracic transplant surgical teams to assess for mechanical circulatory support candidacy in ACHD patients
Second Year:
Skill to recognize reversible causes of heart failure in ACHD
Skills to recognize decompensated HF and partner with HF teams to apply inotrope and/or vasopressor support in ACHD
Comorbid Extracardiac Disease
Second Year:
Skill to longitudinally care for extra-cardiac disease (i.e. hepatic, renal, pulmonary dysfunction) in ACHD
Pulmonary Arterial Hypertension
First Year:
Skills to refer and work collaboratively with PAH specialists for the care of PAH in ACHD
Skill to refer and work collaboratively with PAH specialists to recommend medical (PAH directed therapy), device and surgical therapies for shunt-associated PAH in ACHD
Second Year:
Skill to recognize and evaluate ACHD patients who have new onset or worsening features of PAH
Skill to use various risk stratification models to risk stratify ACHD patients who have new or progressive PAH
Skills to manage or co-manage (with PAH specialists) cardiac and extra-cardiac disease in adult patients with Eisenmenger’s Syndrome
Skill to initiate monotherapy for ACHD patients with PAH, considering indications, contraindications, risks, benefits, and side effects
Skill to recognize when to refer adults with Eisenmenger Syndrome for consideration of lung transplant and defect repair or heart-lung transplant when end-stage disease is present
Critical Care
First Year:
Skill to work with critical care teams to provide congenital heart specific input for critically ill ACHD patients
Skill to assess volume status and guide critical care teams in this assessment, in critically ill patients with single ventricle / Fontan palliation
Skills to recognize and collaborate with critical care teams to manage extra-cardiac disease in Eisenmenger syndrome
Second Year:
Skill to collaborate with critical care and advanced heart failure teams for application of temporary percutaneous mechanical circulatory support in ACHD
Skill to collaborate with critical care, anesthesia, and surgical teams to manage ACHD-specific anatomic and physiologic factors as it relates to impact by anesthetic agents
Subspecialties
First Year:
Skill to refer and work collaboratively with electrophysiology experts to assess and manage ACHD
Skill to interpret invasive hemodynamic and angiographic findings in ACHD
Skill to evaluate and interpret coronary angiograms in ACHD
Second Year:
Skill to diagnose cardiac arrhythmia in ACHD by 12-lead electrocardiography or implantable electronic device interrogation
Skill to refer ACHD patients for permanent pacemaker, implantable cardioverter-defibrillator, and/or cardiac resynchronization therapy
Evaluation Methods: assessment of case-based discussion, case log, direct observation, multisource feedback, end-of-rotation evaluation, evaluation of conference participation
Goal – Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Competently perform all medical, diagnostic, and surgical procedures essential for the practice of cardiac catheterization.
General
First Year:
Skill to apply evidence-based ACHD specific recommendations appropriately in the clinical setting
Skill to effectively and efficiently perform an initial outpatient cardiovascular consultation in an ACHD patient or a patient suspected of having a new CHD diagnosis
Skills to lead and engage appropriate consultative services in palliative care and end of life discussions with ACHD patients and their families
Skill to risk stratify ACHD patients undergoing noncardiac surgery or procedures and to optimize perioperative management
Second Year:
Skill to provide longitudinal ACHD-specific care, inclusive of consideration of current anatomy and physiology, to improve long-term outcomes and quality of life
Diagnostic
First Year:
Skill to interpret electrocardiographic monitoring in ACHD patients and recognize common abnormalities and disease-specific arrhythmias associated with ACHD
Skill to determine which ambulatory electrophysiologic monitoring is indicated in the ACHD patient that presents with findings concerning for arrhythmia
Second Year:
Skill to select the most appropriate type of stress testing in ACHD
Skill to interpret CPET testing results in ACHD
Skill to perform and interpret a transthoracic echocardiogram in ACHD
Skill to perform and interpret a transesophageal echocardiogram in ACHD
Skill to assess and include cardiac computed tomographic imaging and MRI information to guide clinical management in ACHD
Pregnancy
First Year:
Skill to perform a detailed sexual and reproductive health history in ACHD
Skill to collaborate with reproductive specialists to weigh risks and benefits of contraception and/or hormone replacement therapy in ACHD
Skill to assess maternal cardiac risk in those with ACHD pursuing assisted reproductive technology or pregnancy
Second Year:
Skill to formulate an individualized labor and delivery plans to reduce maternal morbidity and mortality in ACHD
Skill to manage thromboembolic and bleeding risk with anticoagulation during pregnancy in ACHD
Heart Failure/Transplant
First Year:
Skill to work effectively with heart failure and transplant teams to manage ACHD with heart failure
Skills to recognize advanced HF in ACHD and refer to heart failure/transplant teams for consideration of advanced therapies
Skills to initiate and titrate GDMT heart failure medications in ACHD patients with: 2-ventricle systemic morphologic LV, 2-ventricle systemic morphologic RV, and single ventricle/Fontan palliation
Skill to collaborate with heart failure, congenital, and adult cardiothoracic transplant surgical teams to assess for mechanical circulatory support candidacy in ACHD patients
Second Year:
Skill to recognize reversible causes of heart failure in ACHD
Skills to recognize decompensated HF and partner with HF teams to apply inotrope and/or vasopressor support in ACHD
Comorbid Extracardiac Disease
Second Year:
Skill to longitudinally care for extra-cardiac disease (i.e. hepatic, renal, pulmonary dysfunction) in ACHD
Pulmonary Arterial Hypertension
First Year:
Skills to refer and work collaboratively with PAH specialists for the care of PAH in ACHD
Skill to refer and work collaboratively with PAH specialists to recommend medical (PAH directed therapy), device and surgical therapies for shunt-associated PAH in ACHD
Second Year:
Skill to recognize and evaluate ACHD patients who have new onset or worsening features of PAH
Skill to use various risk stratification models to risk stratify ACHD patients who have new or progressive PAH
Skills to manage or co-manage (with PAH specialists) cardiac and extra-cardiac disease in adult patients with Eisenmenger’s Syndrome
Skill to initiate monotherapy for ACHD patients with PAH, considering indications, contraindications, risks, benefits, and side effects
Skill to recognize when to refer adults with Eisenmenger Syndrome for consideration of lung transplant and defect repair or heart-lung transplant when end-stage disease is present
Critical Care
First Year:
Skill to work with critical care teams to provide congenital heart specific input for critically ill ACHD patients
Skill to assess volume status and guide critical care teams in this assessment, in critically ill patients with single ventricle / Fontan palliation
Skills to recognize and collaborate with critical care teams to manage extra-cardiac disease in Eisenmenger syndrome
Second Year:
Skill to collaborate with critical care and advanced heart failure teams for application of temporary percutaneous mechanical circulatory support in ACHD
Skill to collaborate with critical care, anesthesia, and surgical teams to manage ACHD-specific anatomic and physiologic factors as it relates to impact by anesthetic agents
Subspecialties
First Year:
Skill to refer and work collaboratively with electrophysiology experts to assess and manage ACHD
Skill to interpret invasive hemodynamic and angiographic findings in ACHD
Skill to evaluate and interpret coronary angiograms in ACHD
Second Year:
Skill to diagnose cardiac arrhythmia in ACHD by 12-lead electrocardiography or implantable electronic device interrogation
Skill to refer ACHD patients for permanent pacemaker, implantable cardioverter-defibrillator, and/or cardiac resynchronization therapy
Evaluation Methods: assessment of case-based discussion, case log, direct observation, multisource feedback, end-of-rotation evaluation, evaluation of conference participation
Goal – Demonstrate an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare.
First Year:
Patient Safety and Quality Improvement: Engages in the analysis and management of patient safety events, including relevant communication with patients, families, and health care professionals; to conduct a QI project
Second Year:
System Navigation for Patient-Centered Care: Effectively navigates the health care system, including the interdisciplinary team and other care providers; to adapt care to a specific patient population to ensure high-quality patient outcomes
Physician Role in Health Care Systems: Understands the physician’s role in the complex health care system and how to optimize the system to improve patient care and the health system’s performance
Evaluation Methods: direct observation, multisource feedback, medical record (chart) review, QI project, case management quality metrics and goals, evaluation of interdisciplinary rounds, lectures and workshops, QI or M & M conference evaluation, simulation
Goal – Demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
First Year:
Evidence-Based and Informed Practice: Incorporates evidence and patient values into clinical practice
Second Year:
Reflective Practice and Commitment to Personal Growth: Seeks performance information with the intent to improve care; to reflect on all domains of practice and develop goals for improvement
Evaluation Methods: Direct observation, QI meetings, review of presentations/publications, end-of-rotation evaluations, review of learning plan
Goal – Demonstrate a commitment to carrying out professional responsibilities and adherence to ethical principles.
First Year:
Professional Behavior and Ethical Principles: Recognizes and addresses lapses as well as opportunities to improve ethical and professional behavior
Accountability: Takes responsibility for one’s own actions and the impact on patients and other members of the health care team, as well as recognizes and manages potential conflicts of interest
Self-Awareness and Well-Being: Identifies, uses, manages, improves, and seeks help for personal and professional well-being for self and others
Evaluation Methods: direct observation, multisource evaluation, self-reflection/evaluation, compliance with deadlines and timelines, individual interview, participation in institutional well-being programs
Goal – Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
First Year:
Patient- and Family-Centered Communication: Uses language and behaviors to form constructive relationships with patients, identifies communication barriers including self-reflection on personal biases, and minimizes them in the doctor-patient relationships; to organize and lead communication around shared decision making
Communication within Health Care Systems: Effectively communicates using a variety of methods (First Year)
Second Year:
Interprofessional and Team Communication: Effectively communicates with the health care team, including consultants, in both routine and complex situations
Complex Communication Around Serious Illness: Sensitively and effectively communicates about serious illness with patients and their families/caregivers, promoting shared decision making and assessing the evolving impact on all involved
Evaluation Methods: direct observation, multisource evaluation, self-assessment, standardized patients or structured case discussions, medical record (chart) review.