At the completion of the program, fellows will demonstrate proficiency in all clinical aspects of congenital cardiac surgery and will have extensive experience and training in education and clinical research.
The two-year accredited fellowship program provides for progressive responsibility and a balanced exposure to neonatal, infant, child and adult congenital heart surgery. The philosophy of the training program is predicated on mentorship in all aspects of patient care, including clinical consultations, operative instruction and postoperative patient management.
One of the most important features of the training program is the opportunity for exposure to a wide variety of complex congenital heart surgery and truly innovative techniques developed by our faculty. The goal of the training program is the development of the complete academic congenital cardiac surgeon, competitive for all professional opportunities at the Assistant Professor level, with no requirement for additional training.
Clinical Experience
St. Louis Children’s Hospital is the primary training site for Congenital Cardiac Surgery Fellowship Program. The hospital is a large tertiary-care referral facility with a robust congenital service staffed with three congenital surgeons, a fully staffed, dedicated pediatric cardiac intensive care unit, and specialists encompassing all aspects of pediatric cardiology.
Washington University/Barnes-Jewish Hospital is the primary training site for the Division of Cardiothoracic Surgery fellowship programs. All of the necessary subspecialty support services are also integral to the multidisciplinary team- including general pediatrics, pediatric anesthesia, adult cardiothoracic surgery, radiology, and interventional cardiology. The majority of congenital cardiac operations are performed at St. Louis Children’s Hospital.
Our program performs the entire breadth of congenital cardiac operations which will allow the trainee exposure to the pre-operative care, operation and intraoperative decision making, and post-operative care of any patient the trainee will subsequently care for after training. Additionally, we are a busy transplant institution, providing the trainee the opportunity to become proficient in both procuring and implanting hearts and lungs when either simple or complex reconstructions are involved. While the overall surgical volume is not the highest overall, index cases can be anticipated daily, and the fellow is expected to actively participate in all aspects of each patient’s care. While training programs performing a larger overall number of operations exist, as the fellow can only perform one operation at a time, the breadth and volume offered by our program create an excellent operative experience.
This ensures the trainee will obtain sufficient exposure to transition to practice after 2 years of training.
Surgical Experience
Trainees will complete a minimum 150 major cases, with a minimum of 50 major cases in their first year of training. The additional Board’s requirements include performance of a minimum of 75 major pediatric Congential cardiac open operative procedures as primary surgeon during each 12-month period of training.
Operative experience must include at least the following minimum numbers of index cases:
| 5 | Ventricular Septal Defect |
| 5 | Atrioventricular Septal Defect repairs, of which at least 2 must be complete |
| 4 | Tetralogy of Fallot repair |
| 4 | Aortic arch reconstruction, including coarctation procedures |
| 5 | Arterial Switch, Norwood, Damus-Kaye-Stansel, truncus arteriosus repair [any combination to a total of at least 5] |
| 5 | Reoperative procedures (includes adult congenital disease reoperation) |
| 5 | Glenn/hemi-Fontan and/or Fontan procedures |
| 3 | Systemic-to-pulmonary artery shunt procedures |
In order to ensure an appropriately diverse distribution of cases, the trainee’s cannot exceed a maximum of the specified number for the following cases for credit among the 75 major congenital cases:
| 5 | Secundum Atrial Septal Defect/Patent Foramen Ovale closure |
| 5 | Patent Ductus Arteriosus ligation or division |
| 5 | Pulmonary Artery banding |
| 5 | Pulmonary valve replacement procedures |
| 5 | Right Ventricle-to-Pulmonary Artery Conduit insertion/replacement |
| 5 | Other valve repair or replacement (patients 18 years of age or under only) |
Heart Transplant
The fellow will be included in the transplant evaluation process. When the attending surgeon is called to discuss a potential donor/recipient match, the fellow will be involved in this call. This will allow the fellow to better understand the decision to accept or reject an organ, as well as timing the OR. The fellow is expected to be involved in every transplant, either procuring or with the recipient. If a transplant occurs during a scheduled day off, the fellow may assist with the transplant and alter the schedule later in the month to comply with ACGME requirements.
Educational Curriculum
The Congenital Cardiac Surgery Program follows the TSDA Weekly Advanced Congenital Curricula Schedule. The curriculum is housed in the STS Learning Center.
The fellow is required to attend conference every Wednesday morning for the Heart Center Disposition Case. Here, preoperative judgement will be learned. Understanding the nuance of when a patient should undergo surgery and when a patient can safely be monitored and allowed to grow is important.
Every Friday, timing depending on cases, a sign out is done for the week. All inpatients are discussed. This also provides a great forum for discussion on surgical, as well as pre- and postoperative, decision making.
Power rounds: This was designed primarily for the pediatric cardiology fellows, however, it presents an excellent learning opportunity for the CT fellow as well. This occurs the first Friday of each month after the huddle. The CT fellow should have prepared by reading about the topic.
| Didactic Curriculum | Day |
| Cardiothoracic Surgery Grand Rounds | Monday |
| Cardiology Lecture | Monday |
| Clinical Research Meeting | Tuesday |
| Heart Center Disposition Case | Wednesday |
| Lung Transplant Listing Meeting | Thursday |
| Heart Transplant Listing Meeting | Thursday |
| Pathology Lecture | Thursday |
| Power Rounds | Friday |
| Adult Congenital Case Conference | Friday |
| Heart Center Team Huddle | Friday |
| Heart Center M&M | Friday |
| Radiology Rounds | Friday |
| Case Review & Preparation | Weekly |
| Congenital Heart Talks (visiting Professor) | Quarterly |
In order to further reinforce the educational opportunities provided by each patient, there is a review performed each week involving the fellow and all faculty members. Operations from the preceding week are evaluated, including any opportunities for potential improvement. All scheduled cases for the following week are discussed to hone the preoperative decision making and discuss tips to optimize the operation for the best possible outcomes.
Evaluation
Formative Assessment
Fellow performance is assessed during each rotation or similar educational assignment in a timely manner. Formative assessments include both informal verbal feedback and written assessments through direct observation, global assessment, simulations/models, record/chart review, standardized patient examination, multisource assessment, project assessment, patient survey, in-training examination, objective structured clinical examination, practice/billing audit, review of case or procedure log, review of patient outcomes, review of drug prescribing, and additional applicable assessment methods.
Written and electronic formative assessments are used to provide a mechanism through which the program can document progressive resident performance improvement. Self-assessments of the resident is an important component of formative assessment, both to compare with data from other evaluators, and to also help the leaner develop important lifelong skills. The purpose of the formative assessment is to capture the process of developing abilities. It permits the resident to recognize learning gaps in knowledge, skills, and behaviors, to guide planning for further leaning and to possibly identify and need for remediation.
Semi-Annual Evaluation
The Program Director will provide the fellow a written a semi-annual evaluation document that captures metrics to properly access the progression of the fellow.
Faculty Evaluation
Regular evaluation of faculty is critical to maintaining and improving the quality and effectiveness of a program. The program will evaluate faculty performance as it relates to the educational program annually. Faculty will be evaluated on their clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities.