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Adult Congenital Heart Service

 Adult Congenital Heart Service
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Flower Fellowship Information
General Fellowship Information
The rapidly growing population of adults with congenital heart disease has heightened the need for specifically trained individuals who can provide comprehensive outpatient and in-patient care to these patients. In addition, such individuals should have the educational background necessary for successful academic careers in order to advance knowledge and educate other providers. As of 2001, the physician workforce caring for ACHD patients in the United States consisted of fewer than 20 adult cardiologists with the advanced training described and with an ongoing career focus in ACHD, and a much larger number of adult and pediatric cardiologists with on-the-job experience, but little or no formal training in the care of ACHD patients.

The Adult Congenital Heart Disease fellowship program at Children's Hospital aims to produce a highly trained cohort of ACHD specialists who are capable of assuming a leadership role in the creation of an integrated network of specialized centers that would improve clinical care, advance knowledge, and help provide ongoing professional education for the larger population of adult and pediatric cardiologists who care for the majority of these patients.

The Boston Adult Congenital Heart Disease (BACH) and Pulmonary Hypertension service is an internationally recognized multi-departmental, multi-institutional clinical service which functions as a center of excellence for both adult congenital heart disease and pulmonary hypertensive disorders. Our program involves Brigham and Women's Hospital and Children's Hospital Boston as the two primary institutions, and has strong ties with the Massachusetts General Hospital and Beth Israel Deaconess Medical Center, as well as developing affiliations with Boston Medical Center and the New England Medical Center.

The BACH service at Harvard Medical School actively follows over 6,000 adult patients with both inpatient (approximately 35-45 patients per month) and outpatient (approximately 120 visits per month) services, accepting approximately 5-10 new referrals per week. The patient base at Children's Hospital and Brigham & Women's Hospital represents one of the greatest strengths of the fellowship training program. It reflects the hospitals' long histories of leadership in caring for congenital and acquired heart disease, and includes large local, regional, national and international referral sources. Our patients include many living here in New England as well as some who travel from as far away as Norway. In this way, our ACHD fellowship program provides world-class hands-on training in clinical skills, diagnosis, and management of the most complex of patients. To date, the BACH service has graduated over 20 full-time fellows.

Training Expectations
The Boston Adult Congenital Heart Disease and Pulmonary Hypertension service at Children's Hospital accepts up to 3 new fellows a year into our 1- to 2-year training program. We welcome applicants who have completed at least 2 years of fellowship training in adult and/or pediatric cardiology. While many of our fellows have benefited from previous training in combined internal medicine-pediatrics residency programs, this is not seen as a requirement. However, depending on the individual applicant's long-term goals, those with limited internal medicine or pediatrics exposure may be strongly urged to complete a 2-year ACHD fellowship.

The BACH ACHD fellowship curriculum is based largely upon recommendations set forth by the American College of Cardiology in the 1995 Recommendations for Training in Adult Cardiovascular Medicine Core Cardiology Training (COCATS) Task Force 9, the COCATS II revision in 2002, and in the 32nd Bethesda Conference Task Force 31-3. To date, there have been no formal recommendations for ACHD training in pediatric cardiology. Our fellows attend general ACHD clinic one day a week, medical/surgical conference one day a week, and present at least 4 times a year at the weekly Brigham and Women's cardiology conference. Full-time BACH senior fellows are expected to provide at least 6 months of direct inpatient on-service time during the course of training including inpatient responsibilities 18 weekends per year. For individuals with specific interests, there is potential for tailoring the curriculum to include emphasis on non-invasive imaging (echocardiography and/or MRI), interventional procedures, or electrophysiology. For trainees with limited or no background in internal medicine, additional exposure to primary prevention, coronary artery disease, and heart failure will be ensured. Similarly, those with limited background in pediatric cardiology will be presented with additional opportunities for acquiring familiarity with embryology and post-operative management.

BACH ARCHES is a data management and registry program with goals to accurately and efficiently catalogue and assess BACH clinical, research and financial activity, and to assay productivity and outcomes. Potentials roles for ARCHES include 1) audit or peer review monitor of care/quality assurance, 2) outcomes assessment and risk stratification, when disease is sufficiently common with high levels of resource use, and, 3) generation of evidence to support care standards when disease occurrence is less common or rare, and accompanied by mostly observational outcomes data. Clinical research within the ARCHES program of BACH is an expected and necessary part of the BACH training program. Fellows are expected to bring a desire to further understand basic or clinical mechanisms of normalcy, disease and health recovery in ACHD patients, and will be mentored to continue this pursuit of knowledge within their fellowship and future academic careers.

Interested individuals are invited to contact:

Anne Marie Valente, MD
Department of Cardiology
Children's Hospital Boston
300 Longwood Avenue
Boston, MA 02115
617-355-6508

Application Process
To apply to our fellowship program for July 1, 2009, you will need to submit the following documents by October 1, 2008:
  • A completed online Training Application Form
Training Application
  • Official medical school transcript (copy accepted)
  • Official record of USMLE board scores
  • 3 letters of recommendation, including 1 from current fellowship program director
  • Curriculum Vitae
  • Personal Statement describing your experience, research interests and career goals.
  • A valid ECFMG certificate (if you graduated from medical school outside of the United States or Canada). Graduates who are not United States citizens or permanent residents must obtain a J-1 visa from the Education Commission of Foreign Medical Graduates (ECFMG).
Please mail your application materials to:

Peter Lang, M.D
Director, Clinical Training Program
Department of Cardiology
Children's Hospital Boston
300 Longwood Avenue
Boston, MA 02115

References:
  1. Skorton DJ, Cheitlin MD, Freed MD, et al. Guidelines for training in adult cardiovascular medicine. Core Cardiology Training Symposium (COCATS). Task force 9: training in the care of adult patients with congenital heart disease. J Am Coll Cardiol 1995;25:31-33
  2. Beller GA, Bonow RO, Fuster V. Core Cardiology Training Symposium (COCATS). ACC revised recommendations for training in adult cardiovascular medicine. Core Cardiology Training II (COCATS 2). J Am Coll Cardiol 2002;39:1242-1246
  3. Child JS, Collins-Nakai RL, Alpert JS, et al. Task force 3: workforce description and educational requirements for the care of adults with congenital heart disease. J Am Coll Cardiol 2001;37:1183-1187
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