Fellows Can Take on Major Meetings via Careful Planning, Networking

As any physician or clinical researcher can attest, attending large national and international medical conferences comes with the job. For a first-timer, however, making the most out of the myriad sessions, exhibits, and social events can seem like finding a way through a maze—running head first into several dead ends before stumbling upon the prize.

“It is easy for [fellows] to feel overwhelmed at meetings. There's so much going on,” said Jason H. Rogers, MD, the interventional cardiology fellowship program director for the UC Davis Health System (Sacramento, CA). “Fellows have much smaller worlds and fewer connections, so it's especially easy for them to feel lonely and swamped.”

As a matter of reference, the 2014 Transcatheter Cardiovascular Therapeutics (TCT) symposium that took place in Washington, DC, included 32 late-breaking trials and featured clinical research presentations, 851 peer-reviewed abstracts, 48 live-case transmissions, 10,318 attendees, 1,199 faculty members, and 145 exhibitors spread out over 5 days and 2.3 million square feet. Even in a field where quick decision making is key, navigating through large meetings is challenging even for the most established of physicians.

Choosing to Follow a Track—or Not

Over the years, several cardiology meetings have established specific tracks for fellows to help make the most of their experience. In a telephone interview with TCTMD, the chair of the 2015 American College of Cardiology (ACC) Scientific Session, Athena Poppas, MD, of Brown University (Providence, RI), said the professional society has gone so far as to include fellows in the planning of the meeting.

“We've not only thought about what we think they need to know, we've actually asked them what they think and what they would want,” she said, referring to the ACC’s Fellows in Training (FIT) council. Planned FIT sessions for the 2015 meeting touch on topics such as women in cardiology and options for career paths. On the more casual side, she said, the FIT council is also planning a “stump the professor” game session to foster learning through participation.

But not all fellows choose to follow tracks meant specifically for them when they attend meetings.

Interventional fellow Ramin Hastings, MD, of Columbia University Medical Center (New York, NY), told TCTMD in a telephone interview that he often prefers to focus on clinically oriented sessions in fields he finds interesting or in which he lacks knowledge. “I try to go to sessions that focus on clinical conundrums that I have… like how to treat bifurcation lesions,” he said. “This is something that we run into very frequently, and my faculty all have different takes on how to approach it. So it's great to go to a session where you hear from the leaders of interventional cardiology.”

Many fellows tend to sit in on the larger late-breaking trials as opposed to smaller, niche presentations, added general cardiology fellow Ateet Patel, MD, of Northwestern University (Chicago, IL). He told TCTMD in a telephone interview that fellows often are “not as heavily differentiated at this point in our careers.” As such, he continued, they usually select sessions by scanning the meeting’s app and “either picking the subspecialty of cardiology that [they are] interested in or finding people [they] know from the literature who do interesting things.”

Another way for fellows to add structure to their schedule is for them to play a designated role during the meeting. For example, all of Columbia University’s interventional fellows serve on the “factoid team” during live case sessions at TCT, pulling up relevant PowerPoint slides when an operator cites different research studies and techniques.

“That's a unique opportunity not available to every fellow,” Dr. Rogers said. But Dr. Hastings, who served in this role during TCT 2014, said the experience was partly why he chose Columbia for fellowship.

Irrespective of whether they participate in the meeting, simply attending live case sessions can be a “thrill” for fellows, according to Dr. Rogers. “They really get to see operators thinking and talking through cases, and [it can help them] develop their own ways of thinking about a case,” he noted.

Sharing Research, Networking With Colleagues

Presenting research can also be an optimal way for fellows to make the most of a conference. “Even at my level, meetings have the most importance if you're participating…, so you're not purely a spectator,” Dr. Rogers said.

In his experience, Dr. Hastings observed, presenting research requires true expertise. “You can't just know a little bit. You have to know [the topic] extremely well and keep up to date,” he said, acknowledging that it can be intimidating to talk in front of leading experts. “Overall, people provide good feedback on your research projects and give you ideas for new ways to interpret data. So, in that sense I find it very useful.”

Dr. Patel, who will be starting an interventional fellowship at Emory University (Atlanta, GA) in July, said the greatest benefits to attending a meeting are the social and networking opportunities.

Many conferences curate an intimate, invite-only session for fellows to informally network with some of the aforementioned leading experts. “Those [sessions] tend to be really good in terms of the quality of the people who come and their availability,” he said. “Oftentimes interacting with people of that caliber within the context of the meeting itself is difficult because they have so many major obligations.”

Dr. Poppas said planned FIT gatherings at previous ACC meetings have received positive feedback. “In addition to approaching somebody [in the halls], [fellows] know that [experts] are a captive audience in the fellows lounge and… are able to ask questions about career choices or their science,” she said.

Additionally, social receptions for fellows can discourage the trap of blindly attending a slate of didactic sessions without stopping to smell the roses, Dr. Rogers noted. Otherwise, fellows “might go through the whole [meeting] and not talk to another fellow. You walk into a room, there's a lecture going on, you sit down, and then you go to your next lecture.”

Not to be forgotten, he continued, is that “part of going to a meeting is also to have a little down time—to have a beer and talk about things and to not just be in a lecture all day.”

Still Some Missing Pieces

One way that meetings can improve is by incorporating more simulation and hands-on training specifically geared toward fellows, Dr. Hastings said.

Also, he suggested incorporating more practical guidance into fellows’ tracks. Topics like how to negotiate a contract, what to look for when considering joining a practice, and the rules of job searching “would be very helpful, and I haven't gotten much of that to be honest,” he said. “It's just word of mouth from people who have done it before.”

Dr. Patel proposed a meet and greet that brings together advanced fellows from other institutions and junior faculty 1 or 2 years out of fellowship. This “might be a helpful thing for first- and second-year [general] fellows who are beginning to apply for advanced fellowships and jobs,” he said.

A more structured feedback system after oral and poster presentations might also benefit those just starting out, said Dr. Patel, who presented a poster at the American Heart Association (AHA) Scientific Sessions in 2014. “All the posters were judged and awards were given out for the best poster. But unless you happen to get some feedback when you are standing around your poster, it's just left out in the open without any sort of feedback.”

Time, Cost the Biggest Obstacles

Many general cardiology fellowships allot funds for fellows to attend at least 1 conference per year. Dr. Patel said half of Northwestern’s fellows tend to go to ACC and half to AHA because coverage is provided for those meetings.

Smaller meetings, Dr. Patel added, “are generally not part of our department's coverage.” For the few he plans to attend in 2015, he will use vacation time and either pay his own way or apply for grant money.

He cited cost and time as the biggest factors keeping him away from more conferences. So even though AHA was held in his hometown of Chicago last year and he presented research, Dr. Patel did not have time to go to any sessions or exhibits. Instead, he will fly to San Diego for ACC in March.

Meetings that let fellows in free are high on his list because admission fees can often eat up as much as one-third of his annual stipend. “I'm going to be short $300 or so for ACC because I had to use that [money] to register for AHA just to present a poster,” he said, adding that it is “sort of unfortunate that fellows have to pay to ‘attend the meeting’ to present.”

In his fellowship, meetings are “considered part of our time away from the lab,” Dr. Hastings related. “There's nothing written in stone in terms of our vacation time and nonvacation time, but we're not supposed to be away from the lab that much so we kind of take it as vacation time.”

Also, “if I have a choice of taking a week and going to a conference or taking a week and spending it with my family—who I don't get to see very often because I'm always in the hospital—I'm more inclined to spend it with my family,” he said. “That's the big tradeoff.”

Dr. Hastings has dedicated this year to learning clinical skills and has put research on the backburner, not actively submitting abstracts for presentation. Yet the fellows courses led by CRF and SCAI are still appealing, he added, “because they are purely clinical-based and on our level of learning. To hear from the experts about the technical aspects of cath and how to manage our patients, as opposed to interpreting the new trials that are coming out, is very useful for us at this stage.”

As for funding, Dr. Hastings supports free admission for fellows. “Living in a place like New York and trying to raise a kid, there's not a lot of money left for going to conferences,” he said. “So, it's pretty important that they keep providing that for us.”

Enforcing a ‘Career of Learning’

Conferences follow so many different formats that it would be hard to mandate fellows to attend one over another, Dr. Rogers said, but they should be required to attend at least 1 meeting during their tenure. “It could be whatever they want, but it establishes the precedent that interventional cardiology is a whole career of learning and knowledge, and it should be expected that when they go on in their careers that they will attend these regularly and stay up to date,” he said.

Dr. Poppas agreed. “Until you go, you don't realize the benefit of a live meeting,” she said. “You really get to see people thinking differently than you do in your institution. That's important to your intellectual growth.”

According to Dr. Hastings, conferences are a “great learning experience and it's nice to see how other people do things, but in the end I don't think it's critical for our training—our interventional fellowship is designed to provide the skills that we need and instruct us how to manage patients. I think it's absolutely worthwhile and I think everyone should do it, but I don't necessarily think it should be required.”