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ACC/AHA/AAP RECOMMENDATIONS FOR TRAINING IN PEDIATRIC CARDIOLOGY

	INTRODUCTION

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence (ACC/AHA/AAP Writing Committee to Develop Training Recommendations for Pediatric Cardiology)
Steering Committee: Thomas P. Graham, JR, MD, FACC, FAHA, FAAP, Chair; Robert H. Beekman III, MD, FACC, FAHA, FAAP, Co-Chair; Michael D. Freed, MD, FACC, FAHA, FAAP; John W. Hirshfeld, JR, MD, FACC, FAHA; Thomas Kulik, MD; John D. Kugler, MD, FACC, FAAP^*; Tim C. McQuinn, MD, FAAP; David J. Sahn, MD, MACC, FAAP; Victoria L. Vetter, MD, FACC, FAHA; and William B. Moskowitz, MD, FACC, FAAP

Task Force Members: Mark A. Creager, MD, FACC, FAHA, Chair; John W. Hirshfeld, JR, MD, FACC, FAHA; Beverly H. Lorell, MD, FACC, FAHA; Geno Merli, MD, FACP; George P. Rodgers, MD, FACC; John D. Rutherford, MB, CHB, FACC, FAHA; Cynthia M. Tracy, MD, FACC, FAHA; and Howard H. Weitz, MD, FACC, FACP

Training Guidelines for Pediatric Cardiology Fellowship Programs

Thomas P. Graham, Jr, MD, FACC, FAHA, FAAP, Chair; and Robert H. Beekman, III, MD, FACC, FAHA, FAAP, Co-Chair

Pediatric cardiology is a complex, multifaceted specialty composed of diverse clinical and academic subspecialty areas. It is characterized by rapid growth of subspecialty areas and swift incorporation of new information from the clinical and laboratory sciences. It is important, therefore, to define the fellowship training required to launch a successful career in pediatric cardiology. The following document represents the first broad-based effort to do so.

In 2000, the Society of Pediatric Cardiology Training Program Directors (SPCTPD) embarked on the process of defining fellowship training guidelines. The process itself was broad-based and inclusive. All pediatric cardiology training program directors were invited to nominate members to participate in the training guidelines task forces; in turn, each task force was comprised of all nominated members who agreed to participate. Therefore, all training programs were provided an opportunity to actively participate.

In 2002, the American College of Cardiology (ACC) approved and published the Revised Recommendations in Adult Cardiovascular Medicine Core Cardiology Training.¹ As the SPCTPD was concluding its training guideline development, plans were formalized to use a similar process through the ACC Pediatric Cardiology/Congenital Heart Disease Committee and the ACC Training Program Directors Committee. Accordingly, a steering committee was developed with original authors of the Pediatric Cardiology Training Guidelines to form a liaison with the ACC, the American Heart Association (AHA), and the Section on Pediatric Cardiology and Cardiac Surgery of the American Academy of Pediatrics (AAP) to agree on the final guidelines and to publish them widely.

These guidelines are written with the planned goal of serving as a practical resource for directors of pediatric cardiology training programs. We also hope that this document will prove useful to the Residency Review Committee (RRC) for pediatric training programs in the revision of requirements for the accreditation of pediatric cardiology programs. The general requirements, clinical competencies, and oversight for fellows in pediatric cardiology would remain the same as outlined by the Accreditation Council for Graduate Medical Education (ACGME).

	GENERAL CONSIDERATIONS

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
The guidelines proposed in this document address overall recommendations for training in pediatric cardiology and important subspecialties within the field of pediatric cardiology. Although we understand that the pediatric RRC sets minimum standards for accreditation of fellowship programs, this document endeavors to define a more comprehensive set of guidelines for pediatric cardiology fellowship training. Fellowship training guidelines are presented for: 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. Each section other than general pediatric cardiology specifies "core" and "advanced" training experiences. 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. All guidelines are recommended experiences, and not absolute mandates, as it is recognized that each training program has unique strengths and that clinical and academic variation across training programs provides important diversity for the specialty.

Table 1 summarizes the approximate time commitment (in months) recommended for core training in the task force reports that follow. Variations in these time commitments should be allowed, as pediatric cardiology programs vary widely in size, organization, and emphasis. For example, in some programs, fellows may get considerable cardiac intensive care unit training during their general inpatient experiences and not require a two- to four-month stand-alone rotation. Thus, the training guidelines must provide programs with flexibility to address individual trainee clinical and/or research training needs during a core fellowship of 36 months’ duration.

A comment about trainee research participation is appropriate. The field of pediatric cardiology is absolutely dependent upon research (basic and clinical) for meaningful progress. There is a critical need for the development of physician-scientists in our specialty to assure such future progress. Therefore, it is key that training programs begin to prepare trainees for a successful investigative career. Such preliminary research training will in most instances require 18 months or more. The balancing of clinical and research training will continue to be a major issue for training programs. It is highly probable that trainees who want to pursue a physician-scientist career will require at least four years of fellowship to begin the academic process and to finish training in the clinical areas. The authors are in complete agreement with the newly published American Board of Pediatrics (ABP) Training Requirements for subspecialty certification concerning scholarly activity, meaningful accomplishments in research, scholarship oversight, and differing pathways to train physician-scientists.

	APPENDIX

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
The authors of this section declare they have no relationships with industry pertinent to this topic.

	REFERENCE

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 

1. Beller GA, Bonow RO, Fuster V. ACC revised recommendations for training in adult cardiovascular medicine Core Cardiology Training II (COCATS 2) (revision of the 1995 COCATS training statement). J Am Coll Cardiol 2002;39 :1242 –1246.[Free Full Text]

Task Force 1: General Experiences and Training

	INTRODUCTION

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
The goals of pediatric cardiology training include acquiring the cognitive and procedural expertise required to provide high-quality care to children with cardiovascular disease, acquiring the academic skills to make meaningful scholarly contributions to the specialty, and, importantly, to develop the capacity for ongoing self-education beyond the years of formal training.

The general training of pediatric cardiology fellows builds on the general clinical and academic skills acquired during residency training. The pediatric cardiology fellow should be given broad exposure to clinical activities in pediatric cardiology inpatient and outpatient care, pediatric cardiology inpatient and outpatient consultations, and in preventive cardiology. The academic skills of formal presentation, small-group teaching, literature review, data analysis, and study design are also components of the general training guidelines.

	CLINICAL TRAINING

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
A fundamental goal of clinical training is to acquire bedside diagnostic skill and the ability to provide high-qualilty consultative inpatient and outpatient pediatric cardiology care. The core skills of history-taking and physical examination are the only means for correctly initiating diagnostic and management options appropriate to the individual patient, and these must be heavily stressed at all points of patient contact. Pediatric cardiology fellows should be observed by faculty while performing key portions of the history and physical examination, and to also have the opportunity to observe faculty perform history-taking and physical examination, so that meaningful discussion of useful strategies and techniques may develop. Consultation services, general inpatient wards, and outpatient clinics all provide excellent opportunities for such interaction.

The pediatric cardiology fellow must have the opportunity to provide not only inpatient and outpatient consultation services but also direct patient care in both inpatient and outpatient settings. There must be a continuity of care in the outpatient clinic so that fellows can begin to appreciate the course of pediatric cardiac disease over time and its cumulative impact on individual patients and their families. The combined time commitment of the general inpatient and inpatient consultation services should be no less than three months. The continuity outpatient clinic should begin early in fellowship and continue throughout training, preferably on a biweekly basis. Both inpatient and outpatient experiences should include exposure to the management of the adult patient with congenital heart disease.

There are many ways for general inpatient and outpatient practices to be organized. In the delivery of high-level inpatient and outpatient care the pediatric cardiologist must demonstrate effective team leadership, accurate and efficient medical record keeping, sensitivity to medical ethical issues, an ability to communicate with and support patients and their families through stressful decisions and experiences, and show strict compliance with federal regulatory statutes. The general inpatient and outpatient training environment for pediatric cardiology fellows must provide full opportunity for observation, acquisition, and application of these skills by the trainee.

During the course of inpatient and outpatient activities the pediatric cardiology fellow will become familiar with a core knowledge base, as outlined in Table 1, at a minimum.

	DIDACTIC CONTENT

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

Additional Conferences
Preoperative conferences with the cardiovascular surgical service are essential. Journal clubs are a recommended element of an academic environment and provide an excellent venue for participatory evaluation of study design and data analysis. Quality assurance evaluation and morbidity/mortality conferences should be held periodically. Multidisciplinary clinical and research conferences are highly desirable; according to the strengths of the institution, contributors might include neonatology, cardiothoracic surgery, adult cardiology, cardiac pathology, physiology, pharmacology, pulmonology, intensive care, cardiac anesthesiology, cardiovascular radiology, clinical genetics, molecular genetics, tissue engineering, stem cell biology, or developmental biology. In all of these conferences, pediatric cardiology fellows should be provided with active roles appropriate to their level of knowledge and training.

	TEACHING AND EVALUATION SKILLS

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
It is a fundamental responsibility in academic medicine that those with the most experience must teach. The pediatric cardiology fellow will often be the most clinically experienced house officer on a team of residents, interns, and/or medical students. The fellow in that setting should be expected to provide lectures/seminars to the team of house officers. The pediatric cardiology fellow should also be allowed the opportunity to practice clinical leadership, organizational skills, and impromptu educational activities as appropriate to his/her demonstrated level of knowledge and training. There should be occasion for observation and critique of these skills by the attending physician as well as demonstration of these skills to the fellow by the attending.

Pediatric cardiology fellows should develop formal evaluation of trainees and training skills during their fellowship. To do so, they should participate in feedback to residents, students, and cardiology attendings throughout their rotations regarding their own educational and technical progress and the progress of other team members. Accurate self-evaluation is the most valuable skill of all and should be nurtured in all phases of pediatric cardiology training.

	APPENDIX

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
The authors of this section declare they have no relationships with industry pertinent to this topic.

Task Force 2: Pediatric Training Guidelines for Noninvasive Cardiac Imaging

Endorsed by the American Society of Echocardiography and the Society of Pediatric Echocardiography

	INTRODUCTION

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
Noninvasive imaging, including echocardiography and magnetic resonance imaging (MRI), is a primary means for elucidating the anatomy and physiology of childhood heart disease. Competence in performance and interpretation of echocardiography and MRI is now essential to the practice of pediatric cardiology. Depending upon one’s individual career goals, varying levels of expertise may be expected to be achieved during fellowship training. This document defines the levels of knowledge and expertise that pediatric cardiology trainees should acquire in echocardiography and MRI during training, and it offers guidelines for achieving these levels of competence.

Training guidelines have been previously published for pediatric echocardiography,¹ fetal echocardiography,² and pediatric transesophageal echocardiography.³ Those documents were reviewed and considered during preparation of these guidelines. The guidelines presented here differ in some instances from previous recommendations because this task force recognizes that training programs have changed significantly over the decade since the last guidelines were promulgated.

	PEDIATRIC ECHOCARDIOGRAPHY

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION APPENDIX REFERENCES  INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE REFERENCES   INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE EVALUATION AND DOCUMENTATION OF... REFERENCES    INTRODUCTION FACILITIES AND ENVIRONMENT LEVELS OF EXPERTISE CORE TRAINING: GOALS AND... SPECIFIC AREAS OF KNOWLEDGE... REQUIRED TRAINING PERIOD FOR... ADVANCED TRAINING: GOALS AND... GENERAL REQUIREMENTS SPECIFIC AREAS OF KNOWLEDGE... APPENDIX INTRODUCTION LEVELS OF TRAINING APPENDIX REFERENCES     GENERAL STANDARDS DURATION OF RESEARCH TRAINING CONTENT OF TRAINING PROGRAM EVALUATION FLEXIBILITY SUMMARY APPENDIX REFERENCES

 
Echocardiography, as used in this document, includes two-dimensional imaging of the heart and related structures, M-mode echocardiography for assessment of chamber size and function, color M-mode and Doppler tissue and flow mapping, pulsed and continuous-wave spectral Doppler flow analysis, and other variations of these basic modalities used to assess the structure and function of the heart and related organs, including new technologies such as three-dimensional echocardiography as they become available.

Facilities and Environment
The pediatric echocardiography laboratory should serve a hospital with inpatient and outpatient facilities, neonatal and pediatric intensive care units, a pediatric cardiac catheterization/interventional laboratory, and an active pediatric cardiac surgical program. The pediatric echocardiography laboratory should be under the supervision of a full-time pediatric cardiologist-echocardiographer qualified to direct a laboratory, and whose primary responsibility is supervision of the laboratory. The laboratory must perform a sufficient number of pediatric transthoracic, pediatric transesophageal, and fetal echocardiograms^1,4 each year to allow trainees sufficient exposure to both normal and abnormal examinations.

	LEVELS OF EXPERTISE

TOP INTRODUCTION GENERAL CONSIDERATIONS APPENDIX REFERENCE INTRODUCTION CLINICAL TRAINING DIDACTIC CONTENT TEACHING AND EVALUATION SKILLS APPENDIX INTRODUCTION PEDIATRIC ECHOCARDIOGRAPHY LEVELS OF EXPERTISE TRAINING GUIDELINES TRAINING GOALS TRAINING METHODS EVALUATION LEVELS OF EXPERTISE TRAINING GUIDELINES