Pathways for Continued Training After Interventional Fellowship

“A wise man will make more opportunities than he finds.”–Francis Bacon

While coronary interventions are the focus of most interventional cardiology programs, many trainees would prefer to participate in the full spectrum of procedures that their institutions offer. Due to busy curriculums, emphasis on achieving certain procedural volumes, and especially time, fellows aren’t always able to take part in enough rare or advanced cases to reach competency before they seek full-time jobs. Furthermore, a survey of interventional cardiology program directors conducted by the Society for Cardiovascular Angiography and Interventions highlighted that the volume of structural heart interventions fellows partake in might not be enough for them to become fully proficient at the end of training.

But just because fellowship ends does not mean that we should stop learning and training, especially as we transition into clinical practice. If you persevere, you should be able to master any procedure. Here are my suggestions for those who aim to continue exploring new areas after landing your first job. 

1. Read, read, read!

Even though you’ve signed that contract and moved across the country, don’t box up your textbooks with mothballs. If anything, stack your favorites on an easy-to-access shelf so that you can conveniently review them when needed. Also, seek out journals and online forums that focus on topics in which you are interested. Interact and exchange opinions with others who have similar interests, and even use social media to find relevant content. 

2. Seek out videotaped procedures

Watching live cases will enable you to better understand experienced operators’ rapid thought processes when facing complications under time constraints. Additionally, viewing them will help you to get even more familiar with terminology and techniques. In particular, pay attention to the operator’s hands in order to learn how to maneuver equipment that you are not familiar with. These videos are usually produced during conferences, and they are often free to view after the fact. For starters, check out the archives of TCTMD, EuroPCR, and Congenital and Structural Interventions. 

3. Find new mentors

While we have all been fortunate to develop relationships with amazing mentors throughout our training, after we graduate it is a good idea to find new mentors to help us specifically with our career goals. To do so, contact experts in your topic(s) of interest and be willing to travel to their labs and observe or scrub-in cases with them. The American College of Cardiology offers a mentorship program to connect expert interventionalists with early career physicians, but be open-minded and search farther afield as well. Additionally, if you are in a private practice setting, reach out to interventionalists with more experience at your institution and discuss your strategies before you jump into cases. Not only will this give you a second opinion, but it will also create a more friendly networking opportunity.  

4. Perform cases with the assistance of a proctor

By the time you go into practice, you should be confident and competent enough to perform basic procedures alone. But using the aid of a proctor every so often can only help you improve. If you are new to using a device, some companies send representatives to assist you before or during the procedure, thus ensuring that their product is being used appropriately. These people can also provide device models, and with enough notice they can connect you with a high-volume proceduralist during your case to best manage unforeseen complications.  

5. Search for medical simulators

Medical simulation is improving every day, and the experience it provides is paramount for a burgeoning interventionalist. Some good examples to seek out are Compass, ANGIO Mentor, CardioSkills, and Mentice. Some companies provide simulation services along with the products they sell. However, if you decide to implement one of these software programs at your institution independently, keep in mind that they can be expensive and you might need to justify it to your administration.  

6. Take advantage of industry supported education

Drug and device manufacturers especially want to make sure that early career interventionalists know the ins and outs of their offerings. As such, most of these programs are targeted to specific products, but they can also focus on broader topics like peripheral arterial disease or coronary interventions. These types of offerings can also give you the opportunity to exchange experiences with high-volume operators that the company invites to lecture in their area of expertise. 

7. Go international

It’s no secret that devices are introduced into clinical practice faster outside of the United States. So if you are able, travel internationally for a chance to see how others practice. Several centers of excellence throughout Europe offer opportunities for international trainees to come visit, observe, and learn for anywhere from a week to much longer. Institutions and companies can offer assistance with travel and documentation to ensure you get train at a high-volume center at reasonable cost to you.  

Quevedo served as a Fellow Talk blogger from 2015 to 2016. He is now working as a full-time interventional cardiologist for Louisiana Heart Center in Slidell, LA.