Cardiac Critical Care Fellowship: Insights From a Fellow Who Recently Completed Her Training

I am pleased to have the opportunity to share the experiences of Dr. Alejandra Gutierrez-Bernal who was one of my general cardiology chief fellows and she recently completed her cardiac critical care fellowship!

Please describe yourself and your prior training.
I am a Latin American woman who loves cardiology, spending time outside, running, swimming, painting, and reading novels. I am the youngest of three and have a baby niece who brightens my days. I was born in Colombia and was fortunate enough to live in different places growing up including Mexico, here in the US and my native Colombia. I did my medical school training in Colombia and then spent some time doing research with my great mentor, Dr. Mina Chung, and Dr. Van Wagoner at the Cleveland Clinic. We studied the molecular mechanisms leading to atrial fibrillation which increased my interest in cardiology as a field. I then did my internal medicine residency at CCF and moved on for my cardiology fellowship at the University of Minnesota. I am currently finishing my critical care fellowship here too.

When and why did you decide to pursue cardiac critical care training?
As a medical student, I was fascinated by cardiology, specifically electrophysiology. I loved to look at ECG’s and try to figure out the exact origin of different PVC’s or arrhythmias. By the end of the residency, I was sure I was going to do electrophysiology. However, during my first year of fellowship, I spent a lot of time in the intensive care unit and everything it involved including VA ECMO, cardiogenic shock, and acute heart failure, and was given enormous autonomy. I found that at the end of the day, I was very tired but felt extremely accomplished and happy. I have had great mentors during my training and one of the people that has influenced me as a person and as a doctor, the most is Dr. Bartos. He is an interventional cardiologist and an intensivist. One day he told me I should think about this as a career and the thought had not occurred to me. The idea stuck with me and now after completing my training I wouldn’t have it any other way.  I have the opportunity to make a difference, establish connections with families and help them when they are most vulnerable. I couldn’t be happier with the choice I have made.

What unique experiences does a cardiac critical care physician who completed a cardiology fellowship have compared to those who pursue cardiac critical care training after completing an anesthesiology residency?
Critical care training is interesting because you work with various specialties. We all have very different perspectives which has made this past year of training so much more enjoyable.  When I approach a patient, I can’t stop myself from looking through the ECG, echocardiogram and think through their hemodynamics imagining what their numbers would be if I had a swan. I manage shock, assess volume responsiveness and fluid status, and use inotropes a little differently given my general cardiology training. My pulmonary critical care colleagues taught me to look at the chest CT and make a mental picture of their pulmonary status and my anesthesia colleagues play with the medications differently. As a cardiologist, the critical care field is very exciting. Our older cardiac patients often have multiple organ systems involved and patients in the other units have more cardiac disease.  This year has been an amazing journey as I go around the other units and look at them from different perspectives, critical care cardiologists fill a gap that was missing.

Why did you choose to stay at the University of Minnesota for cardiac critical care training?
There are three main reasons I wanted to stay here. First and foremost is mentorship. The field of critical care cardiology is newer and having someone to guide me and to aspire to was very important to me. Here I had the opportunity to train with great people who since the early stages of my training pushed me to think out of the box and practice independently, transforming me into a better person and doctor.  The second was the patient population. The University of Minnesota has a great resuscitation team, and we see a multitude of cardiac arrest patients many of whom are treated with VA ECMO. I wanted to have the first-hand experience treating these patients since I believe this is the future of cardiology. And lastly, the research experience. I had protected research time last year which was important to me as I wanted to stay at an academic center and wanted to start building my portfolio in critical care given that my prior research experience had been focused on electrophysiology. Overall, it has been a great experience and I wouldn’t do it any other way.

What are some of the unique aspects of cardiac critical care and general cardiology training at the University of Minnesota?We are lucky enough to have a lot of exposure to mechanical circulatory support. During our general cardiology training, we have several rotations in our intensive care units with our cardiac structural and interventional team which includes our post-arrest patients and the heart failure service with LVAD and transplant patients. We are given a lot of independence with these very sick patients, and I believe that this is what taught me the most and reinforced my decision to pursue critical care. Our cardiothoracic surgeons are very approachable and wonderful team players which makes work so enjoyable and patient care seamless.

What is the balance of your time during your first faculty position (e.g. how many weeks are you on service, do you get protected academic time, etc.)?
I am very excited about starting my first job. I think the balance is perfect for me to start my career. My appointment is 80% clinical and 20% academic. I will have around 13 weeks of service and will be only in the intensive care unit while on service. On my time off service, I will be in the echocardiography lab and will have some clinic. With this, I hope to have a great balance between the sick patients in the ICU and the more relaxing setting  of imaging and general cardiology.

What were you looking for when you were searching for your first attending position?
It was very important for me to be in an academic institution. I like clinical research and the idea of furthering the field is fascinating to me. I was looking for a place that would push me in terms of clinical experience to continue learning and had challenging patients yet provided support and mentorship. The University of Minnesota seemed like the perfect fit. I truly think that what I will be part of, will change the field of resuscitation and save lives, that is why we all signed up for medicine.

What advice do you have for other early career cardiologists?
I think the most important thing is to find and do what makes you happy. If the days are long and tiring but you feel fulfilled at the end of the day, then that is what you should be working for.

Thanks so much for the great advice, Dr. Gutierrez-Bernal!


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