Cardiology
Rotation Director:
Name: Michael Silberbach, MD
Email: silberbm@ohsu.edu
Phone: 503-494-3189
Overview:
Residents spend 2 weeks in outpatient and 1 week in in-patient cardiology (usually the last week of the rotation). Expect to see cardiac patients over a variety of settings including ICU, ward, outpatient, ECHO, cath lab.
Rotation goals and objectives:
Become familiar with pre-operative, post-operative, and longterm care of infants, children, and adolescents with acquired and congenital heart disease
The resident will be able to evaluate, describe, and initially manage common cardiac murmurs
Entrustable Professional Activities (EPAs) used to be core competencies (from the ABP website (Go to person for “teachable moments”):
EPA 1 (Madriago, Grosse-Wortmann)
Acquire the imaging skills required for all aspects of pediatric and cardiology care
EPA 2 (Burch/Armsby)
Care for patients who require catheter-based interventions
EPA 3 (Balaji
Diagnosis and management of patients with arrhythmias and conduction abnormalities
EPA 4 (Armsby)
Diagnose, initially manage, and refer children with advanced or end stage heart failure and/or pulmonary hypertension to experts for medical therapy, ECMO, ventricular assist devices, and/or cardiac transplantation
EPA 5 (All)
Diagnosis and management of patients with congenital or acquired cardiac problems
EPA 6 Miller-Smith/Kelly
Diagnosis and management of patients with acute congenital or acquired cardiac problems requiring intensive care
Prior to the start of the rotation:
Please email Liz Schultz (schulliz@ohsu.edu) and Dr Silberbach (silberbm@ohsu.edu) prior to starting your rotation to begin receiving the Division’s conference schedules (from Liz Schultz) and to determine where to meet with Dr. Silberbach for a brief orientation.
You will be receiving conference schedules starting on the Friday afternoon before you starting the cardiology rotation.
First day of the rotation:
If Outpatient…
Cardiology clinic: 7th floor DCH in the Specialty Clinic area (by the Salmon sign).
Log into EPIC and review patients from the following lists “Ped Cardiology DCH” and Ped Kaiser Cardio DCH”
Clinic starts at 0900. Arrive on time/early (after attending morning report)
If Inpatient...
Rounds start in the 8th floor PICU at 0730
The attending and fellow will then round with you on patients in the NICU, ward, and active consults
Resident Expectations:
Be an active and contributing member of the inpatient/outpatient team. This could include pre-rounding and/or pre-clinic review of patient charts, asking pertinent questions during rounds, and taking thorough histories.
Timely assessment and workup of new consults in coordination with fellow
Timely arrival to all activities, conferences. Attendance is required at the weekly Friday AM CT surgery conference (takes precedent over the resident morning report)
Selected review of a difficult case with the fellow and/or attending during inpatient week
General Schedule:
A. Inpatient Experience
Rounds start at 0730 in the PICU on the 8th floor
Accompany fellow/attending to DNCC and wards to complete rounds
Accompany fellow to ECHO lab, teaching, or to see new consults as they come up
May leave in afternoon after all new and active consults seen, assessed, and discussed
B. Outpatient experience
Clinic starts at 0900 in the 7th floor Pediatric Subspecialty clinic. Arrive on time. May leave at conclusion of clinic
Satellite clinics: please make an effort to attend at least a few of these clinics as they are unique experiences. Please contact the appropriate attending at least 2 days in advance to coordinate meeting place and time.
Other Clinics:
Single ventricle clinic (Dr Bohun)
Lipid clinic (Dr Armsby)
Turner Syndrome clinic (Dr Silberbach)
Aortopathy clinic (Dr Holmes)
Rehab/stress testing (Dr Huang)
Pulmonary hypertension (Drs Evers, Kelly)
C. Conferences (refer to schedules that will be emailed to you on Friday
afternoon.
Sign-in rounds: Monday 8:30am, DCH 8411 (during both inpatient and outpatient weeks)
Pediatric Cardiology/Cardiothoracic Surgery Conference: Friday, 7:00-9:00 am in DCH 11600 Collins/Goudy (during both inpatient and outpatient weeks)
Monthly Journal Club. M&M occurs monthly.
You are expected to attend all typical resident conferences including Grand Rounds, Friday Forum, and Academic Enrichment
Exceptions: Monday and Friday Morning Reports ( on Monday morning you should attend cardiology sign-in and on Friday morning you should the CT surgery/Cardiology conferences instead)
If you are going to be absent for all or part of a day:
Please email Liz Schultz and the attending of record (if on service), and chief on-call if you are unable to make it to work. Please also contact chief on call after 0700 and, if on inpatient, appropriate fellow by pager after 0800 to inform them of your absence. A verbal exchange must happen with the chief on call. You will need to make up days if you miss more than 2 days of this rotation (per ACGME graduation requirements).
Resident Resources, Helpful Tips, and Further Readings:
1. Box Folder with Readings
2. ABP Content Outline
Clinical presentation (eg, abnormal blood pressure, chest pain, syncope)
Diseases, disorders, and conditions
Congenital heart disease
Cyanotic
Acyanotic
Dysrhythmias (recognizing common PALS rhythms only)
Cardiomyopathies
Infection/vasculitis
Connective tissue disease
Dyslipidemias
3. Other Resources
a. Moss and Adams Heart Disease in Infants Children and Adolescents
b. Park: Pediatric Cardiology for Practitioners (out-of-print, but if you can find a copy it is good).
c. Harriet Lane: ECG section is excellent
d. Park, Gunteroth: How to Read Pediatric ECG's, second edition.
e. AHA Scientific Statements URL: http://www.heart.org/HEARTORG/