The division is part of the Department of Pediatrics, also based at CHEO. The program will consider candidates who have completed three to four years of core training in pediatrics. At the end of the program, trainees will be qualified to write the Royal College subspecialty fellowship examinations in Pediatric Cardiology and will be qualified to function as an independent pediatric cardiologist or apply for an academic position at university-based pediatric cardiology programs.

Related links

• CaRMS
• Royal College of Physicians and Surgeons of Canada

Subspecialty trainees will have a rotational program as outlined in the course description below. The program has been configured to fulfill the requirements of the Royal College of Physicians and Surgeons of Canada. The program provides graduated responsibility for patient care and a well-coordinated balance of time for learning the clinical and technical skills necessary to practice as a pediatric cardiologist.

Conference funding is available for subspecialty residents to attend relevant conferences or to present research papers. Residents will be encouraged to participate and/or develop an area of focus so that they may have a specific research interest.

The first two years of the program will be focused on the development of clinical and technical skills while the last year will be directed towards specific research interests and/or the enhancement of special skills such as advanced expertise in interventional cardiac catheterization, echocardiography, cardiac MRI or electrophysiology.

Remuneration and benefits applicable for this position will be stipulated by the guidelines and agreements already in place between the Professional Association of Interns and Residents of Ontario (PARO), the University of Ottawa (uOttawa) and the Children's Hospital of Eastern Ontario (CHEO).

The program curriculum is based on the subspecialty training requirements in pediatric cardiology as outlined by the Royal College of Physicians and Surgeons of Canada.

The three-year mandatory content of training includes the following with one block equal to four weeks:

• Outpatient Cardiology (ambulatory) - 4 blocks (May be done longitudinally)
• Electrophysiology - 3 blocks
• Pathology - 1 block
• Clinical Cardiology (inpatients / consultations) - 7 blocks
• Pediatric Intensive Care Unit - 2 blocks
• Cardiac Catheterization - 5 blocks
• Echocardiography - 6 blocks
• Adult Congenital Heart Disease - 1 block
• Research - 3 blocks
• Elective - 3 blocks
• Cardiac Diagnostic Imaging - 1 block  (May be taken longitudinally).
• Magnetic Resonance Imaging - 5 blocks (concurrently done with cardiac catheterization) is not mandatory by Royal College of Physicians and Surgeons of Canada, but standard in our program
• CVS - Pediatric Cardiovascular Surgery - 1 block - not mandatory by Royal College of Physicians and Surgeons of Canada but standard in our program
• Heart Failure/Transplantation – 1 block - not mandatory by Royal College of Physicians and Surgeons of Canada but standard in our program and usually done at a quaternary centre such as the Hospital for Sick Children in Toronto or the Stollery Children’s Hospital in Edmonton

Subspecialty residents are relieved of their clinical duties during academic sessions. The academic time covers the core topics in pediatric cardiology. The curriculum is varied according to the level of the resident and his or her particular needs. In addition, teaching occurs during weekly rounds on Monday (cardiovascular surgical conference and pre-catheterization review) and Friday (cardiology patient conference).

There are also formal teaching sessions with the staff cardiologists on various topics that are scheduled throughout the year. As well, there are monthly national pediatric cardiology rounds (by teleconference) and a monthly journal club with mandatory resident attendance and participation. The residents are present at monthly cardiovascular surgery mortality and morbidity rounds. The residents are also expected to attend the monthly adult congenital cardiology conference.

Year 2013 to 2014 – Average patients per week

Number of inpatient consults: 394 per year – eight per week

All outpatient consults are seen in clinic as new patients as reflected below.

• Number of new patients: 1,123 per year – 22 per week
• Number of repeat patients: 3,001 per year – 58 per week

Inpatient care

Cardiac catheterization laboratory

Diagnostic catheterization – 11 per year for 2013 to 2014;
Interventional catheterization – 34 per year for 2013 to 2014

Cardiac catheterization is a non-surgical procedure in which specialized catheters are introduced into an artery or vein and directed into the heart for the purposes of diagnostic testing or intervention. Information not readily available via other testing can be obtained in this way, aiding in the diagnosis and treatment of congenital heart disease. Interventions can also be performed in this manner, including the closing of holes in the heart, expanding narrowed vessels and valves and opening new passages within the heart, which once would have required surgery.

Outpatient care

Clinical services provided by the division on site at CHEO include:

• Consulting Pediatric Cardiology Clinic – provides full cardiology consultation and ongoing care for a wide range of pediatric cardiac conditions, including congenital and acquired heart disease. Clinical visits include cardiology testing such as ECG and echocardiography as required. Children requiring cardiac surgery are evaluated and followed pre- and post-operatively in this clinic as well. 
• Arrhythmia Clinic – is a specialized clinic for children who have, or are at risk for, an abnormal heart rhythm. The clinic is directed by an electrophysiologist, a cardiologist with special expertise in this area. Specific cardiology testing including ECG, signal-averaged ECG, stress testing, Holter monitoring and telemetry may occur during these clinics. Since some cardiac rhythm disorders are inherited, there is also a cardiac genetic counsellor affiliated with the clinic.
• Pacemaker Clinic – provides assessment and ongoing care of children with an implantable pacemaker, defibrillator or other monitoring device. The clinic is staffed by an electrophysiologist cardiologist and specialized nurses.
• Neuromuscular Cardiac and Heart Function Clinic – provides specialized cardiac care for children at higher risk of heart muscle disease, including neuromuscular diseases such as muscular dystrophy, some chemotherapy recipients and children with a family or personal history of dilated cardiomyopathy.
• Hypertrophic Cardiomyopathy Clinic – provides specialized care to children with a diagnosis of hypertrophic cardiomyopathy and/or a family history of this. A genetic counselor is affiliated with this clinic to provide assessment and counseling regarding available genetic testing. 
• Fetal Cardiology Clinic – provides prenatal evaluation by echocardiography of fetuses with known cardiac conditions and screening of fetuses at risk of cardiac disease. A cardiologist, specialized echosonographers, a registered nurse and a social worker are affiliated with this clinic. 

As well as the above clinics within CHEO, the division conducts cardiology outreach clinics to Iqaluit, Nunavut twice a year. Children with suspected and known heart disease from the communities of Nunavut can receive full cardiac evaluations during these clinics, often saving them a trip to Ottawa. 

Clinical problems and diseases evaluated and followed

• Congenital Heart Disease
• Acquired Heart Disease
• Arrhythmias
• Fetal Heart Disease

Related links

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

The University of Ottawa’s program in pediatric cardiology uses the Children’s Hospital of Eastern Ontario (CHEO) as its primary training site. CHEO is a tertiary hospital with a high acuity of critically ill medical-surgical patients. The hospital has a Pediatric Cardiac Surgery program and is also a trauma centre. In addition, the hospital provides a community-based experience in the Pediatric Cardiology Outpatient Clinic.

Pediatric cardiology residents have the advantage of working closely with a dedicated group of pediatric cardiologists. There are links with the University of Ottawa Heart Institute for adult cardiology rotation. Elective rotations may be taken at outside institutions upon the approval of the program director.

Cardiology fellows are encouraged to participate in research opportunities within the Division of Cardiology. We have a dedicated cardiologist with a specific focus in developing and implementing research projects. In addition, the division has a close link with the CHEO Research Institute.

Application forms will be made available through the Canadian Residency Matching Services.

Applicants must have completed at least three years of core training in a pediatric residency in order to be eligible for consideration into the cardiology subspecialty fellowship program. Selection of candidates will be made on an annual basis by the selection committee of the Division of Cardiology.

Applicants are evaluated on their record during pediatric residency, recommendations from former program directors and mentors as well as their apparent commitment to achieving excellence in training towards a career in academic cardiology.