I Made It! 10 Ways to Make the Most of Your Interventional Cardiology Fellowship

I’m finally done. I am an interventional cardiologist! Yes, it was a long road—7 years since medical school—but who’s counting? I’ve been through my first bifurcation stenting procedure, performed a high-risk PCI with mechanical support, worked through the COVID-19 pandemic, and even completed a few intravascular lithotripsies, but that only touches the surface of the lessons I learned in my interventional cardiology fellowship.

After training for this long, you can start to really think you know the lay of the land. Upon starting my interventional cardiology training, I felt my confidence build, I felt good, but then my first STEMI came rolling through those cath lab doors and that confidence escaped me. However, I was in command of the room and everyone was looking to me for answers.

Yes, those first few weeks will be rough, but if you take the time to learn the details and follow the tips I’ve outlined here, I’m confident you will find interventional training to be the best year of your life.

1. Scrub in for every case: One of the things I noticed during my interventional year was the lack of enthusiasm among other trainees for diagnostic cases. Yes, we are here to “treat,” but great interventionalists are excellent diagnostic cardiologists. Master these concepts early in your fellowship as they will come in handy during those complex interventions when you need to know catheter shapes, hemodynamics, and angiographic views to navigate rough waters. That said, don’t be a procedure stealer! Giving someone a complex case here and there will go a long way to forming lasting relationships with your fellow trainees, which may come in handy down the road when you need advice on your own tough case.
    
2. Teach as you learn: As an interventional cardiology fellow, you are recently removed from general fellowship and as such are more relatable and approachable to the staff and junior fellows. Be open to teaching them concepts and techniques, and learn to be an attending. After all, teaching will really help fortify concepts within your own mind. And don’t forget about teaching your attendings! The field is constantly evolving and as a fellow you have the benefit of learning from many different operators. Humbly teach your attendings, staff, and fellows the concepts you have learned. People never forget a good teacher.
    
3. Be a team player: It’s possible for the confidence we gain with more training to come off as arrogance. Remember that most of the staff has been in the same position for years—they know the ins and outs of the system and often were there when your attendings were fellows. That deserves your respect. Don’t hesitate to ask them for help when you start off—they will teach you so much about the daily workings of the lab, which will make your life easier. Make yourself available to help them when needed. Additionally, be open to teaching them new things. Remember, the leader is only as good as the team.
    
4. Befriend the device reps: In academic medicine, there’s this notion that having relationships with industry is unethical and unprofessional. For the most part within interventional cardiology, I’ve found that untrue. The medical device industry provides some of the best free learning tools and opportunities for fellows, so take advantage. Go to training courses and use their free online medical education to progress in your fellowship. Just remember to be fair and balanced and keep an open mind.
    
5. Know the equipment: We live in a world of many technological choices. The field of interventional cardiology has exploded with new equipment available to use every day. Veterans of the field often tell us we have it easy since the days of crimping our own stents are over. However, with all of today’s choices comes greater complexity in decision-making. Take the first few months of your fellowship to learn the specifications of your equipment—the wires, atherectomy devices, and stents—since each have their own nuances that can sometimes make the difference between procedural success or failure. Also, by knowing your equipment, you become a vital and respected source of troubleshooting during a procedure, on which attendings will depend.
    
6. Don’t be a procedure robot: Many times, interventional fellows get tunnel vision on technique and lose sight of the entire procedure. When you are handed a stent, you need to be a master of deployment, but also know how and why it was selected. Don’t finish your fellowship afraid of choosing between a 3.0-mm and 4.0-mm stent because you were so used to the attending making the decision for you. Take charge during the procedure and call out for equipment on your own. After all, you only have 1 year to learn to make these decisions.
    
7. Complete research you love: By the time you reach your interventional cardiology fellowship, you might wish that research was in your rearview mirror. I find it sad that research has such a negative connotation to many trainees today, since it is often looked at solely as a resume builder. But now that you have no more applications to submit or other training programs to impress (unless you decide to do a structural year), I’d advise you to find projects that you truly enjoy. You’ve chosen a niche field that is perhaps also one of the most evidence-based, so your experiences and procedures can make a real difference. 
    
8. Study, study, study: While most of your learning will happen in the lab, you won’t master techniques unless you take the time outside of work to study. Some of the online resources that I found extremely useful include ACC CathSAP, Manos Brilakis’ Manual of PCI videos on YouTube, free webinars from industry, on-demand videos from SCAI and TCTMD, and #Cardiotwitter. Also, I found it very helpful to study other similar cases immediately after completing a complex case. Learn about complications and troubleshooting. The awesome yet sometimes complex aspect of interventional cardiology is that there is rarely one specific way to do things. You should be familiar with as many options as possible because I guarantee you will need them during your career. An attending once told me that it’s easy to do procedures, but it takes time to learn the complications and how to deal with them. Learn from other people’s mistakes.
    
9. Network to succeed: You likely haven’t gotten this far in your career without being open and meeting people. As you become more subspecialized, the pool of people like you shrinks significantly and these colleagues will become your close network throughout your career. With the explosion of social media, make sure to create an online presence in order to share knowledge and connect with like-minded individuals that will help you advance and stay up to date in our constantly evolving field.
    
10. Enjoy your life: Life isn’t all about your career and frankly if you make it that way, it will be hard to find real happiness. Exercise, take time for self-care, spend time with your family, and relax as much as you can. One of the difficult aspects of a career in interventional cardiology is finding that work-life balance, and it’s never too early to learn. Trust me, with prioritization and planning ahead, it’s possible to have both.

Overall, relish your time during training. You only have 1 year to learn an ever-changing field. Go in early, stay late, scrub everything, and always be available. You’re in for some fun, so embrace it!