The fellowship program in pediatric cardiology is structured to ensure participants develop excellent clinical and research skills and to provide fellows with the skills needed for a successful career in academic medicine.

The structure of a residency program is very different from that of an academic faculty group:

• A residency program is hierarchical; the year of training defines the rotations available to the resident
• It is relatively consistent; similar rotations are offered to each resident with limited time for elective rotations
• it is externally controlled; the clinical rotations generally are developed by a program director with the assistance of a chief resident.

A faculty group is non-hierarchical:

• A first-year assistant professor performs the same tasks as a full professor when he/she is the attending on the ward, on call at night, in the catheterization laboratory, etc.
• The program or activities of a faculty member are unique: there are rarely two faculty members in an academic pediatric cardiology group who have similar work lives
• Thee activities are internally defined. The faculty together create a schedule to meet the clinical needs of their patients and individually develop an academic agenda that does not conflict with those needs.

We have structured our fellowship program to mirror a faculty group, so that, with faculty guidance, the fellows develop the skills necessary to succeed in a group of academic cardiologists. The rotations are non-hierarchical; when a fellow is on clinical service, in the catheterization laboratory, in the echo laboratory, etc., he/she performs the same activities irrespective of the year of training, and the rotations are not year-based. The fellows together create their schedule to meet the clinical needs of the program and their own academic interests. Each fellow, by defining individual academic interests and goals and by being able to do any of the requirements of clinical training listed below in any year, develops a unique program different from any other fellow's program.

We understand that it is very difficult to achieve these goals, given that the fellow has little prior training in pediatric cardiology and in career development. It can also be overwhelming to a new fellow to be given such responsibility. To maximize the likelihood of a successful fellowship, we have put several mechanisms in place, the most important of which are the advisor and summer programs.

A faculty advisor from the Division of Pediatric Cardiology is assigned to each fellow upon acceptance into the program. With the assistance of the advisor and the fellowship director, the fellow designs an individualized training program on a yearly basis, with quarterly review. Once the program is developed, it is the responsibility of the director to ensure that the first three years of the program fulfill the requirements of the sub-board of Pediatric Cardiology. It is our hope that the advisor functions in many ways: as a resource to the fellow for discovering the range of academic possibilities within UCSF during training and in the broader academic world when the fellow is ready to apply for a faculty position, as a mentor in the development of a career as an academic cardiologist, and as a support to review ongoing evaluations and career planning throughout the fellowship and to assist in job searches at the end of the fellowship.

The summer program during the first eight weeks of the fellowship ensures that the fellow is capable of undertaking any clinical rotation, particularly on call service, during the first year. It is an intensive period of training in both the basic technical skills of pediatric cardiology and in developing the critical foundation upon which to built a knowledge base. Over that eight-week period, the fellow does intensive four-week rotations in the echo laboratory and the cardiac catheterization laboratory, often alternating in a weekly or biweekly schedule with the other first year fellow. After a brief period of observation, the fellow acts as the echo and cath fellow, performing studies under the direction of a faculty member. In the late afternoons of each day for the first 6-7 weeks, a 2-3 hour lecture is given to present the core information necessary to develop a comprehensive understanding of pediatric cardiology. For example, talks on echocardiography begin with the physics of ultrasound and Doppler and progress to discuss techniques necessary to perform and interpret studies. Likewise, talks on catheterization present radiation physics and cardiovascular physiology prior to discussing the catheter manipulation and angiographic techniques, and talks on neonatal cardiology present fetal physiology and the transition at birth prior to considering the pathophysiologic presentation of heart disease in the newborn. With this early intensive training in the critically important skills and by developing a core knowledge of pediatric cardiology, the fellow is prepared to function along with a faculty member as a pair of cardiologists caring for children with heart disease from the first day of clinical service in the fall.

This fellowship program is clearly different than many others. It requires that the fellow to be prepared to make a major change in his/her life, to be prepared to be responsible both for the clinical needs of patients and of his/her own career development, albeit under the watchful eye of a faculty member. There are two ways to view a fellowship program: the last day can be considered to be the last day of residency training, or the first can be considered to be the first day of an academic career in pediatric cardiology. Our program is developed according to the latter view.