Cardiology fellow getting dual certification

Program includes training in adult and pediatric cardiology with the goal of treating adult congenital heart disease.

A fellow in combined pediatric and adult cardiovascular medicine, Stephen Cook, MD, says one of his most interesting patients was a 63-year-old woman with unrepaired double outlet right ventricle, a complex form of congenital heart disease.

“Her prior surgical pallation included only a left Blalock-Taussig shunt, and she presented to our Adolescent and Young Adult Congenital Clinic looking for somebody who would undertake her case to undergo complete repair,” Cook told Cardiology Today.

“That’s probably one of the most fascinating cases I’ve had. Most survivors with DORV would have been operated on during their childhood. She’s coming to us in spectacular condition, the best we would expect her to be in.”

Five-year fellowship

Cook is completing a five-year fellowship at The Heart Center, Columbus Children’s Hospital and Ohio State University and is one of the few fellows undergoing a dual certification program in the country. “Columbus Children’s and Ohio State University, both separate institutions, allowed me to do a combined cardiology fellowship, so I spend half my fellowship at Columbus training in pediatric cardiology and half at Ohio State training in adult cardiovascular medicine.

“My goal is to take care of young adults with congenital heart disease, which is a growing population that’s underserved in the United States,” Cook said.

Stephen Cook

Cook will complete his fellowship in 2006 after five years of training, rather than the three years typical of most cardiology fellowships. “Potential candidates may be overwhelmed by the length of this training, but this type of training is necessary to be clinically competent and to contribute academically,” he said.

Training with both populations

Still, he does advocate for this kind of dual certification. “Training in pediatric cardiology is necessary to understand the different types of anatomy and surgical procedures that these patients need to undergo,” Cook said. “But as a pediatric cardiologist, there is little time spent training in issues surrounding adult cardiovascular medicine.”

Cook said most patients with congenital heart disease remain with their pediatric cardiologists, so adult cardiologists tend to not see many congenital cases during their career. One of his goals is to create structural plans to transition these patients. The relationship between Columbus Children’s Hospital and Ohio State University will hopefully facilitate this process.

“Organization of care is important, not only to optimize care but to reduce errors in their care,” Cook said.

Cook has published several journal articles, including two recently in the American Journal of Cardiology, and he wants to continue research when he completes his fellowship.

“I would definitely want to pursue a career in academic medicine with a high priority in research because this is such a young field with so many research opportunities.” Currently, he is researching the role of multi-detector CT to evaluate the coronaries of patients with coarctation of the aorta.

“The long-term survival of patients who have undergone surgical repair is less than the general population,” Cook said. “Typically, the mean age of death is 38 years and the most comon cause of death is coronary artery disease. We are using this technique to assess the coronaries in an otherwise asymptomatic population for preventive purposes.” – by Jeremy Moore