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.

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:

5Ventricular Septal Defect
5Atrioventricular Septal Defect repairs, of which at least 2 must be complete
4Tetralogy of Fallot repair
4Aortic arch reconstruction, including coarctation procedures
5Arterial Switch, Norwood, Damus-Kaye-Stansel, truncus arteriosus repair [any combination to a total of at least 5]
5Reoperative procedures (includes adult congenital disease reoperation)
5Glenn/hemi-Fontan and/or Fontan procedures
3Systemic-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:

5Secundum Atrial Septal Defect/Patent Foramen Ovale closure
5Patent Ductus Arteriosus ligation or division
5Pulmonary Artery banding
5Pulmonary valve replacement procedures
5Right Ventricle-to-Pulmonary Artery Conduit insertion/replacement
5Other 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 CurriculumDay
Cardiothoracic Surgery Grand RoundsMonday
Cardiology LectureMonday
Clinical Research MeetingTuesday
Heart Center Disposition Case Wednesday
Lung Transplant Listing MeetingThursday
Heart Transplant Listing MeetingThursday
Pathology LectureThursday
Power RoundsFriday
Adult Congenital Case ConferenceFriday
Heart Center Team HuddleFriday
Heart Center M&MFriday
Radiology RoundsFriday
Case Review & PreparationWeekly
Congenital Heart Talks (visiting Professor)Quarterly


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.