With little to no prior experience in a pediatric cardiology setting, first-year fellows at BCH traditionally started clinical rotations right away. One’s first day could be spent interpreting echocardiograms, programming a pacemaker, or scrubbing in the Catheterization Lab at 2 a.m.
"It was really a ‘sink-or-swim’ approach,” explains Fellowship Program Director Dr. David Brown. While nearly everyone eventually swam, it became clear that the first few rotations were the most challenging across disciplines, particularly the intense rotations such as Cardiac ICU and the Catheterization Lab. Struggles seemed to stem from a dearth of skills and an inadequate understanding of basic cardiac anatomy and physiology.
Enter the Cardiology Fellowship Boot Camp. Launched in the summer of 2013 by Dr. Brown and Associate Fellowship Program Director Dr. Catherine Allan, the month-long program engages new fellows in hands-on training and skill development. Fellows complete a checklist "passport" of activities in the areas of: Cardiac ICU, Electrophysiology, Exercise Physiology, Catheterization, and Echocardiography. Tasks vary from using a state-of-the art vascular access simulator, to obtaining consent for a procedure from a patient's family, to simulating a code situation with a responsive human mannequin simulator (and later debriefing around team performance). A core group of committed teaching staff oversee the program and supplement the clinical experiences with lectures, including an in-depth series on congenital cardiovascular pathology complete with heart specimens from the Cardiac Registry.
“Boot Camp allows fellows to be truly immersed in and learn from the clinical arena while free from the responsibility of primary care-giver. We help them develop a tool box of skills and knowledge to make the transition easier and faster,” says Dr. Brown.
“This is the first block of dedicated learning time I’ve had since my second year of medical school,” says Dr. Sarah Pickard, new first-year fellow.
“For pediatric cardiology in particular, this is crucial, given the lack of exposure to this subspecialty in medical and even general pediatric training,” adds her classmate Dr. Robert Whitehill.
The Cardiology Fellowship Boot Camp has been incredibly popular among both participating fellows and senior attending physicians. Fellows report feeling more prepared once they start rotations, and attendings have noticed a higher level of competence earlier in training. Bootcamp finished its second successful run this past June—and the good news is spreading fast. In October, the Boston Children’s Clinical Learning Environment Committee will propose that this become a paradigm for residencies and fellowships throughout the hospital.