General Information
Location: McGill University Health Centre
Type of Fellowship: 2-year Fellowship in Pediatric and Adult Congenital Heart Surgery
Number of fellowship positions: 1 with a 2-year minimum
Academic affiliation: McGill University
Name of hospitals involved in training & % time spent by the fellow in each institution:75% of the trainee’s time will be at the Montreal Children’s Hospital and 25% will be at the Royal Victoria Hospital.
Fellowship Program Director: Dr. Christo Tchervenkov
Background
McGill University and the McGill University Health Centre have been privileged to develop an international recognized expertise in pediatric cardiac surgery as well as the treatment of adult congenital heart disease [Maude Unit] over the last 5 years. There has been a particular growth in the population of adults with previously operated on congenital heart disease who now are being followed into early and late adulthood and require not only medical therapy but also ongoing surgical treatment and care. In the United States, pediatric cardiac surgery has become a recognized fellowship and a mandatory training requirement for those residents interested in a career in pediatric cardiac surgery. As such, there is a growing demand for qualified pediatric cardiac centres with the recognized reputation and ability to deliver care from neonate to the adult such as present at McGill University and the McGill University Health Centre.
Research Activity
Fellowship candidates will be encouraged in clinical research during their 2-year fellowship. This could be part of epidemiological reviews at the Congenital Heart Surgery Society or as part of reviews performed in conjunction with the Maude Unit of the MUHC.
Publications
Publications and presentations at international and national meetings are a requirement of the fellowship.
Mission
The mission of the fellowship training is to provide the necessary experience in neonatal, pediatric and adult congenital heart disease to allow the candidate to practice at a consultant level upon completion of the fellowship.
Outline How Intended Fellowship Will Enhance Residency Training
The fellowship in pediatric and adult congenital heart surgery will provide support to the residency training program in terms of workload, call and in terms of knowledge transfer and technical skills training.
Teaching Faculty
Dr. Christo Tchervenkov (Head, Pediatric Cardiac Surgery)
Neonatal, pediatric, and adult congenital heart disease
Dr. Susan Vobecky (Pediatric Cardiac Surgeon)
Noenatal and pediatric heart Surgery
Dr. Benoit deVarennes (Cardiac Surgeon, McGill University)
Complex adult cardiac surgery with emphasis on mitral valve repair both at the acquired and congenital levels.
Dr. Renzo Cecere (Head, Mechanical Heart and Transplantation)
Adult and pediatric mechanical heart support and transplantation.
Dr. Kevin Lachapelle (Program Director, Cardiac Surgery, McGill University)
Adult cardiac surgery with emphasis on complex aortic surgical repair both in the acquired and congenital spheres.
Dr. Marie Beland (Head, Pediatric Cardiology)
Neonatal and pediatric heart disease
Dr. Ariane Marelli (Head, MAUDE Unit)
Adult congential heart disease
Academic Facilities
The fellow will have access to the same facilities for clinical and academic pursuits as do the residents. This includes web access to on-line journals via McGill, access to video library via CTSnet, pediatric training curriculum through the Thoracic Surgery Directors Association and the Program Director, access to both the adult and pediatric as well as the adult congenital database at the McGill University Health Centre, access and training at the McGill Medical Simulation Centre.
Fellow Duties and Responsibilities
The fellow will share responsibilities with the senior and/or chief resident of the service with regards to on-call. As instituted in the training program, this call will be no more than 1 in 3 from home. The fellow will be directly supervised by the attending surgeon and will not be the senior supervisor of the senior or chief residents. The fellow will have complete support of the Program Director as well as the Program Coordinator in the same fashion as the residents. As with the residents, the fellow will be subsidized to attend one North American meeting per year up to $1,000. It is also expected that the fellow will have one research project per year to be determined by the Fellowship Program Director, Dr. Christo Tchervenkov.
The fellow will have a 6-month rotation at the Royal Victoria Hospital in adult cardiac surgery with emphasis on adult congenital heart surgery. The operative responsibilities will be focused on adult congenital surgery which usually occurs once a week with Dr. Tchervenkov. The fellow will also have 1.5 additional operating days to learn techniques of adult heart surgery necessary to treat adult congenital heart patients. The total operative experience therefore at the Royal Victoria Hospital will be 2.5 operating days per week. This will not affect the senior or chief resident exposure to adult cardiac surgical cases. While at the Royal Victoria Hospital, the fellow will be responsible for attending on a weekly basis the Pediatric Cath Conference on Monday afternoons as well as the Adult Congenital Conference at noon on Mondays.
While at the Royal Victoria Hospital, the fellow will participate in all of the Cardiac Surgery teaching activities including Monday 5:00 p.m. Teaching Rounds, Thursday morning Service Rounds, Technical Skills training 4 times a year and Combined Cardiac Surgery/Cardiology Rounds 6 times a year at noon on Fridays. The fellow will be responsible for presentation at Morbidity and Mortality Rounds, all cases for which he was involved and responsible. While at the Royal Victoria Hospital, the fellow will take call in concert with the other senior and chief residents, and will not have operative priority apart from the O.R. for which the fellow is assigned. As with the senior and chief residents, the fellow will be expected to teach on regular ward rounds to both the junior residents and students.
While at the Montreal Children’s Hospital, the fellow will work with the chief resident in pediatric cardiac surgery. The chief resident and fellow will share on-call duties and responsibilities on the service and will share rotating through first and second assistant in the operating room at the Montreal Children’s. Since neonatal and pediatric surgery is usually performed by an attending surgeon, both the chief resident and fellow will be able to assist and observe surgery at the first and second assistant level. Ward duties at the Montreal Children’s Hospital will be on a rotational basis between the Intensive Care Unit, the Cardiology Ward and the Emergency Room. Responsibilities will be to attend to all patients with the senior resident, attend all rounds (Monday noon MAUDE unit, Monday 1600 Pediatric Cath Rounds, Outpatient weekly Clinic). The fellow will also participate in all adult congenital cases performed at the Royal Victoria Hospital.
Curriculum
The curriculum is extended over 2 years. The first 6 months is dedicated towards adult cardiac surgery at the Royal Victoria Hospital. As previously described, the fellow will become part of the ward team with dedicated operating time assigned to the fellow. This will include 1 day of adult congenital cardiac surgery as well as 1.5 days of general adult cardiac surgery. The goal of these 6 months is to familiarize the fellow with adult cardiac surgical techniques in the treatment of adult congenital heart disease. It is also understood that the fellow will gain significant knowledge into the specific adult congenital lesions and their treatment. The following 18 months will be spent primarily at the Montreal Children’s Hospital where the fellow will become an integral part of the ward and operative team. During this time, the fellow will acquire knowledge in skills of neonatal and pediatric cardiac surgery for use at the consultant level. During the fellow’s time at the Montreal Children’s Hospital, the fellow will also be responsible for adult congenital heart surgery that is performed at the Royal Victoria Hospital. The estimated caseload and variety during the 2 years is described below:
- 90 general adult cardiac surgical cases
- 40 adult congenital heart surgical cases
- 150 neonatal repairs [75 performed as first assistant and 75 performed as second assistant]
- 90 pediatric repairs with ½ performed as first assistant and ½ performed as second assistant
The fellow will receive regular reading materials provided through the Thoracic Surgery Directors Association and through the Program Director in Cardiac Surgery, Dr. Kevin Lachapelle. The fellow will also be responsible for all of the weekly conferences previously described and reiterated below:
Monday noon.............Adult Congenital Conference at the Maude Unit
Monday 4:00 p.m.......Pediatric Cath Conference at the Montreal Children’s Hospital
Monday 5:30 p.m.......Cardiac Surgery Teaching at the Royal Victoria Hospital
Thursday 7:30 a.m.....Cardiac Surgery Service Rounds, Royal Victoria Hospital
Friday noon................Combined Cardiology/Cardiac Surgery Rounds [6 times per year]
Presentations and attendance at the annual Cardiac Surgery Congenital Heart Day named after Dr. A.R.C. Dobell as well as presentation attendance at the annual Stikeman Visiting Professorship in Cardiac Surgery. The fellow will be responsible in rotation with the chief resident in pediatric cardiac surgery for the presentation at the Maude Unit, the Pediatric Cath Conference as well as Morbidity and Mortality Rounds. The fellow will take an active role in the presentation of pediatric and adult congenital heart disease topics at teaching rounds for the residents.