Congenital Heart Surgery (CHS) is now a subspecialty of cardiovascular and thoracic surgery (CVTS) encompassing congenital heart corrections from neonatal age groups to adults.

With more and more lesions of increasing complexity being addressed surgically in the neonatal and infant age groups, an extended and focused apprenticeship in managing these patients by acquiring the necessary special surgical skills and concepts, cardiological aspects of their evaluation, and management of these babies and children in the intensive care unit has become mandatory to achieve even reasonable outcomes.

Candidates after their MCh/DNB in CVT Surgery and desirous of pursuing this subspecialty, are at sea where to go and get the necessary training. Even if they do find a unit, the training is not structured and generally the candidates have to “hang on” for years and develop on their own.

To help our aspiring graduates get the necessary exposure, skills, and a mindset in handling neonates, infants and other patients with congenital heart lesions, a peer reviewed fellowship program under the aegis of a respected professional body such as IACTS is being proposed to be commenced from 2016.

In the light of new knowledge and advancing technologies, IACTS through its academic council and the respective subcommittees, desires to conduct and oversee specialized courses of study in CVT subspecialties, having a peer reviewed and a structured training program with uniformity, with an emphasis on providing one on one mentoring needed to build up the confidence and develop the practical skills of the candidate to go and practice the subspecialty, certified primarily by the mentor and then by the IACTS.

Also, we have various universities conducting fellowship programs adding to the many “qualifications” that could be secured by a candidate, the thrust being on securing another qualification rather than a structured training under a specified mentor, with finite end points. It is earnestly hoped that this is one point that will differentiate the IACTS fellowship from other programs.

There are many peer respected and skilled surgeons of good standing achieving excellent outcomes and conducting many outstanding programs in this subspecialty in many private hospitals across India who could be great mentors. However, these individual’s talents are not harnessed in our training schedules.

Hence, IACTS as a peer body could help to bridge this gap.

Many professional associations have adopted this practice. It is in vogue in many countries such as America (AATS) and Europe (EACTS) and closer home in India, the Indian Academy of Pediatrics (IAP) and Indian Association of Cardiac and Thoracic Anesthesiologists (IACTA).

1. SUBSPECIALTY TRAINING IS ESSENTIAL:

• 1. Given the skills to be acquired.
• 2. The paucity of exposure to complex subspecialty cases in their training institutions.
• 3. Giving the candidate an opportunity to work under the tutelage of senior and skilled surgeons in the teaching and non-teaching sector in a structured training program.
• 4. Providing a platform of training encompassing all aspects of the subspecialty in an accredited centre of excellence of the respective subspecialty.
• 5. Recognizing that peer certificate by an accredited mentor is perhaps the most balanced assessment and certification of a surgeon’s training and skills in the concerned subspecialty after a recognized post doctoral qualification.

It also gives an opportunity for the senior surgeons interested in mentoring to provide this platform for our junior colleagues in helping them become well trained surgeons in future in their chosen subspecialty.

It is hoped that the Fellowship in CHS will be a “Fellowship” in the true sense of the word—more emphasis on transmission of concepts, thoughts and surgical skills needed for practice of the subspecialty and creating a platform and environment for the candidate to acquire and develop the same. Unlike the training programs prevalent in India, where acquisition of theory plays a dominant role, it is hoped that a “Fellowship” after a post doctoral degree is more for getting exposed to the practice and nuances of the subspecialty, and learn the practical ways to handle problems working shoulder to shoulder with a peer recognized expert, The Mentor. More emphasis and opportunity is to be given for the mentee to acquire the fine surgical skills needed in a supervised environment and build the confidence of the young surgeon.

• 1. At the completion of the “Fellowship” tenure of two years, the candidate would be required to appear for an exit examination.
• 2. An “exit” examination (written and oral) is more of a formality than a true test of knowledge in the traditional sense.
• 3. Once certified by the mentor, it is assumed that the candidate is well trained to go forth and practice the subspecialty. Hence it places great onus on the mentor in the selection, training and certification of the candidate or mentee.
• 4. On successful completion of the fellowship training of two calendar years at the accredited centre, a pass at the exit examination, fulfillment of all the norms of the fellowship, and a certificate of competence signed by the accredited mentor under whom the candidate has worked, he/she would be eligible for the Fellowship in Congenital Heart Surgery Certificate given under the seal of the IACTS.
   

• a. President
• b. Senior Vice President
• c. Junior Vice President
• d. Secretary
• e. Treasurer
• f. Editor

2. Program Coordinator, CHS Fellowship Program

The Steering Committee will meet twice a year at the annual conference and another midterm EC meeting of IACTS.

• 4. The Program Coordinator of the CHS Fellowship program of IACTS is a peer respected senior IACTS member practicing CHS. He/she is appointed by the Executive Committee to coordinate this Fellowship Program for a tenure of three years.
• 5. He/she would select three committee members from IACTS members/Academic Council members—who are senior practitioners of the subspecialty and are at least 15 years in practice after completing MCh/DNB.
• 6. Tenure of the subcommittee would be three Years.
• 7. Subcommittee proceedings would be reported twice a year to the Steering Committee by the Program Coordinator with regard to the functioning of the fellowship program, and update the latter about all aspects of the program, including funding needs, budgets etc.
• a. THE COMMITTEE WILL:
  
  • 1. Decide on the course curriculum
  • 2. Conduct examinations, identify centres, schedules, etc.
  • 3. Monitor the fellowship program through site visits to the accredited centres by one member at least once a year, interviewing the candidate and the mentor and submitting a report to the CHS E & A Subcommittee.
  • 4. Accredit centres and mentors meeting the norms of accreditation through site visits and inspection of the centre and facilities. One E & A committee member would be deputed by the Program Coordinator.
  • 5. The E & A committee members would communicate with each other and meet at least twice a year at the national meeting before the Executive and Steering Committee meeting during the annual conference and IACTS Midterm CME and at the Examinations.
  • 6. The Program Coordinator and the committee members would prepare the annual budget for the expenses of that year as regards travel, and other anticipated expenses and secure the approval for the same from the steering committee.
     

• 1. List of accredited mentors and accredited centres will be displayed on the IACTS website by 15th, June each Year.
• 2. Candidates who wish to apply for the IACTS Congenital Heart Surgery Fellowship Program should have passed the examination and undergone training leading to MCh (CVTS)/DNB (CTS) or equivalent overseas qualifications with MCI registration, and should have worked for a year in a CVTS unit after their qualification.
• 3. Candidates who wish to apply must be a Life Member (or Overseas Life Member) of the IACTS.
• 4. Those candidates who have been working in an accredited congenital heart centre after their qualifying examinations under an accredited mentor, are also eligible to apply for the fellowship. The E & A subcommittee would scrutinize their credentials and inform them of their eligibility, and decide on credits to be given for periods of training already undergone, provided other norms of the fellowship requirements are met and fulfilled.
• 5. Interested candidates should write to the mentor with all details mentioned in the application process.
• 6. Mentor will scrutinize the applicants and their credentials and inform the Secretary, IACTS and Program Coordinator of the CHS Fellowship program about his/her choice by email with all submitted attachments.
• 7. Secretary IACTS and CHS E & A subcommittee will register the candidate for fellowship.
• 8. All fellowships commence on 1st August each year for a duration of TWO calendar years.
• 9. A candidate is permitted 15 days leave for each year of the fellowship tenure. This includes attendance of conferences, teaching sessions. Any leave granted more than this specified period will need to be compensated by working in the parent unit for the excess leave period, before the fellowship certificate and mentor’s competence certificate is awarded.
• 10. If a candidate leaves the course after one or more month of commencing the fellowship, then the succeeding candidate could be registered only from January 1st of the subsequent year. The latest a candidate can commence the fellowship is February 1st of the year of commencement.
• 11. If the candidate who is selected leaves the fellowship course midway, then he/she forfeits their right to apply for any of the IACTS Fellowships in other subspecialties currently in force or proposed in future.

• 1. An exit examination (written (MCQ & short answers) & oral) needs to be taken and passed by all candidates at the completion of the fellowship tenure to obtain their Fellowship Certificate at a centre announced by 30th June every year. 
• 2. Examination Centre: (an accredited training centre) would be decided by the E & A Subcommittee.
• 3. Examination fee will be included in the admission fees.
• 4. Submission of attested logbook of training, signed certificate of competence from the mentor, and copies of the mandatory publications/research project conducted to be submitted to the CHS Program Coordinator by 15th June each year.
• 5. Examination would be held in the last weekend of July each year. All formalities regarding the examination and fellowship needs to be completed by July 15th of each year.
• 6. Program Coordinator and the Mentor whose centre the examination is being conducted would oversee the examination conduct and ensure that all facilities are provided for conduct of the examination.
• 7. Two Pediatric and CHS Subcommittee Members, Mentor who is hosting the Examination and Program Coordinator would constitute the Examiner Team who would examine the candidates.
• 8. The marking and results declared by the Examiners would be final and will be forwarded by the Program Coordinator to the members of the Fellowship Steering Committee for information and action by the Secretary, IACTS. As this examination is a peer certified test of competency to pursue a very skilled surgical subspecialty, any canvassing would be frowned upon, and may go against the concerned candidate.
• 9. Fellowship certificates would be given to the successful candidates by the President of IACTS after their presentation about the CHS Fellowship Program at the GB meeting at the next annual conference of IACTS.
   

• a. The stipend to be paid and the accommodation to be provided will be as per the norms of the accredited institution where the candidate applies for the fellowship.
   

• a. The annual fee of INR 24000/- should be paid by the candidate to the IACTS, after the selection procedure. It includes the examination fee as well.
• b. Payment can be made online only. The candidate who is selected under IACTS guidelines, the link will be shared through the e-mail.
   
• 10. TIMELINES:

a. Admissions

b. Fellowship Exit Examination:

The latest dates for admissions & examinations will be announced accordingly.

11. ACCREDITATION:

a. Centre: Teaching hospital or a major private hospital with all supportive super specialties, pathology, blood banking and imaging facilities.
b. Facilities For Congenital Heart Surgery:
1. Staffing:

• a. Should have dedicated congenital heart surgeon(s), pediatric cardiologists, pediatric cardiac anesthesiologists, intensivists, and perfusionists. A dedicated pediatric cardiac ICU and operating room and cath labs with all current facilities for performing congenital heart surgery and cardiological interventions.
• b. The principal mentor should be a qualified (MCh (CVTS)/DNB (CTS)) and a trained congenital heart surgeon with at least 15 years of experience exclusively in congenital heart surgery and a peer recognized expert in this field.
• c. Centre should be performing at least 500 simple and complex congenital heart surgeries on a regular basis, in neonates and infants per year with good outcomes complimented with a robust pediatric cardiology interventional program.
• d. Preference for accreditation would be given to a centre with an exclusive congenital heart team for delivery of care.
   

• 1. Combined cath meetings between cardiologists, surgeons and other members of the team, case planning, discussion etc.
• 2. Journal clubs, topic presentations, seminars and teaching rounds.
• 3. Monthly mortality and morbidity audit meetings.
• 4. Attendance of at least one national (IACTS, PCSI)/international meeting during the tenure by the mentee with a paper presentation.
• 5. At least one original study or two case reports in a peer-reviewed cardiology or CVTS journal should be done by the Mentee. Extra credits could be accrued for publishing these in the Indian Journal of Thoracic and Cardiovascular Surgery (IJTCVS).
• 6. Presentation of the final report of the Fellowship (for five minutes) at the IACTS annual conference in the year the fellowship is being awarded or subsequent year.
• 7. IACTS will bear the mentee’s travel, registration and lodging expenses to participate in the conference when he/she presents the fellowship report.
• 8. Minimum mandatory cases to be performed by the Trainee as a primary surgeon and supervised by the Mentor: 50
  Index cases as the operating surgeon assisted by the Mentor:
  1. Closed Cases:
  • a. PA Bandings – 5
  • b. PDA – 3
  • c. BT shunts – 3
  • d. Pacemaker implantation – 2

  2. Open Cases:

  • a. ASD – 10
  • b. VSD – 10
  • c. TOF – 10
  • d. RV-PA conduits – 3
  • e. ASO – 2
  • f. Arch repair – 2