cardiology fellowship – The Early Career Voice

#AHA21: Matching Into Cardiology Fellowship: The Inside Scoop from Program Directors

November 14, 2021November 14, 2021 Bhavya Varma, MD

We were lucky enough to hear from some exceptional PDs and APDs during #AHA21. The process of applying to cardiology fellowship can be daunting. These discussions provide amazing tips and insight on the process so we can best prepare.

What catches your eye on CVs?

Although this will vary by program and individual, a few themes were consistent amongst the panelists. Most programs and directors will be looking for continuation of a story and a common thread between your research, personal statement, and letters. You want to convey who you are and why you have an interest in cardiology. “It’s a two-way street” meaning fellowships also function as a part of a larger clinical and research program. They look for applicants who will fit into their culture and further the values of their program.

Additionally, PDs and APDs will look at the residency training programs, whether you are local and want to stay local, and your research. For your research projects, multiple panelists mentioned quality was more important than quality. The emphasis was showing you could follow a project to completion. “More than case reports or review articles, I look for a substantive experience in research.”

How much weight do you put on the personal statement? Should anything be avoided?

This should be used as a place to tell your story. “What attributes does this person have that will put their trajectory where we want our fellows to go? Does this person have resilience, are they able to turn disadvantages into advantages?”

The main themes that came across in the panelists answers to this question were humility, resilience, and a willingness to learn. Additionally, multiple people highlighted that this is a good place to address anything unusual that could cause confusion in your application – do you have an unusual timeline? Are there gaps in your career? Did you take breaks to do other things? They also mentioned that this would be a great place to highlight how your background prior to medicine/hobbies lend to your interest in cardiology. With this in mind, it’s important to remember this is different than a medical school application and you should be cautious with how provocative or creative you are in your writing. It was also mentioned that you can emphasize your love of a subspecialty but should also remain open-minded to the field as a whole. “The point of fellowship is to introduce you to the field so you can navigate the next steps in your career” and multiple panelists mentioned numerous fellows change their focus throughout fellowship and exploring is encouraged.

Tips for the virtual interview?

“It can be challenging to convey your narrative when you’re not in person. Find a way to project your narrative to someone who may have nothing in common with you.” Make sure you practice this with a loved one or your colleagues. Recognize your ticks, be careful when you’re reading from your screen when answering questions because interviewers notice. Applicants should also be aware that they will be asked behavioral questions (Ex. Tell me about a mistake you made when caring for a patient. Tell me about a challenging patient interaction). Practice these beforehand and think ahead about the kinds of answers you might give.

Be aware of how you look on your camera. Record a mock interview on zoom and watch it. Even small details like lighting and not have distracting objects placed in your screen can have a big impact in the age of virtual interviews. Attend the program orientation session the evening before. Do not turn off your camera, dress professionally, and don’t be late to zoom sessions. Research the program and ask the faculty about it! Show them you are invested and know about the program. It is still not clear whether interviews will be virtual or in-person for the next interview cycle.

Post-Interview Communication?

The main advice here was similar to what we heard during residency interviews: do not lie. Do not tell multiple programs they are your number one choice. Keep in mind, many people change their mind throughout the interview season and ultimately you do not want to make decisions early in the process. With this in mind, telling a program you are enthusiastic and interested can be very helpful. This is especially true during virtual interviews, where it can be difficult for programs to gauge interest and investment. If you genuinely feel you found your top choice, most programs encourage hearing from you. If you are trying to match to a different geographical location, this can also be a good opportunity to reiterate the reasons you want to move. Notably, you need to be mindful about over-communication.

Hearing from those on the other end of the interview process was an excellent opportunity to focus on what is important. Ultimately, its about your love for cardiology and passion for furthering the field! Find you network and enjoy this time as you explore and determine what you want to do in your career.

This program is part of the FIT Program at #AHA21. The panelists include Drs. Eric Yang, Salim Virani, Carlos Alfonso, Naomi Botkin, Melvin Echols and was moderated by Drs. Aubrey J Grant and Agens Koczo. All FIT program at AHA Scientific Sessions were produced and moderated by FITs for FITs.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

Goodbye Self-Inflicted Intimidation and Hello Learning: A fellow’s experience working with Dr. Rick Nishimura

July 23, 2021July 15, 2021 Kyla Lara-Breitinger, MD

“Don’t speak out, you may answer incorrectly and embarrass yourself.” This thought was not uncommon during my first two years of fellowship. Yes, I evolved out of this which is why I am sharing my experience. At the same time, I am here to tell you to not make this mistake early in fellowship.

You may or may not have heard of Dr. Rick Nishimura, a master clinician, and educator of cardiovascular hemodynamics. You may have seen his name authored in many of the national guidelines or his face at national and international conferences. Now, imagine him (or your own respective master clinician-educator at your own program) leading weekly hemodynamic sessions and asking escalating difficult questions to the audience. Would you answer? How confident would you need to be to articulate this out loud?

I am about a month away from completing my general cardiology fellowship (my 3 years were slightly extended from two maternity leaves) and I have had time to reflect on my clinical experience. I remember my first year sitting in our auditorium and can vividly recall answering a question about x and y descents incorrectly in front of everyone. I rarely spoke out again for the rest of that year.

As a third-year at the Mayo Clinic, I had the opportunity to work in “Nish” clinic amongst a handful of other fellows and participate in his hemodynamic sessions. Every fellow before me, alongside me, and after me all feel the same way: to work with him requires a great deal of preparation and meticulous chart review of patients, repetitive review of all the guidelines, and an attempt at reading published research relevant to each case. The more I thought about it, it became clear that I had a unique opportunity to challenge myself before graduating. I’m glad I did.

I’d like to share reflections, learning pearls, and takeaways from my experience working with and learning from Dr. Nishimura:

Find passionate clinician educators early in training and don’t be timid about learning from them.

The way he lectures to hundreds of people in a room is the exact way he teaches you and it is incredibly motivating. By explaining complicated pathophysiology with such simplicity, I became deeply entrenched in the learning process. I cannot overemphasize the hours I spent preparing for the potential questions he might ask yet I still left clinic with at least 4+ things to look up, feeling inspired and motivated to be a better learner and educator. This is the art of teaching.

Do a good physical exam and use it to determine whether the rest of the workup is concordant or discordant.

One example I learned was the location of the P2 component of S2 on the chest can tell you the degree of elevated pulmonary pressure.

Look at the data (i.e. echocardiograms) yourself.

Avoid only reading reports as they can sometimes mislead you into making life-altering management decisions for patients. For example, do not accept pulmonary artery systolic pressures without looking at the tricuspid valve regurgitant Doppler profile yourself. Confirm if this was measured correctly because it can change management.

Know the guidelines but understand that not all patients fit perfectly in them.

An elderly woman with severe aortic stenosis may be eligible for both SAVR and TAVI, which stresses the importance of individualization and shared decision-making with the patient and heart valve team.

Communication with the referring provider and follow up with the patient cannot be overstated.

Reaching out to referring providers via letter and phone will develop your communication skills, professionalism, and collaborations. Following up with the patient is not only the right thing to do but also allows you to learn whether your management decision resulted in the best outcome for your patient or if there is a learning opportunity for the next patient who presents similarly.

Teach one another.

Create an environment where you are sharing cases with your co-fellows and colleagues and practice teaching to one another with the hope that one day with dedication you will also inspire trainees.

Lastly, do not be afraid to ask questions and answer questions. Even when you are intimidated.

I eventually told Dr. Nishimura how intimidated I initially felt. If you haven’t had the privilege of meeting him, he is one of the most down-to-earth and welcoming teachers you will ever come across. He laughed and said there was nothing to be intimidated about. Many of the questions you have in your head are also questions others have. In that light, more learning, engaging, and teaching can occur if you allow yourself to.

I May Have Finished My Training but the Learning Will Never End

June 30, 2021June 24, 2021 Barinder Hansra, MD

Today, as I write this, it’s my last month in the formal term of being a ‘trainee.’ And not just any old trainee but a critical care fellow who’s had 6 years of training under his belt. I started my internal medicine residency in Worcester, Massachusetts – roughly 3000 miles from where I grew up. The population was diverse, the hospital life seemed incredibly exciting (and nerve-racking)

Day of 1 of the intern year with Dr. Deeqo Mohamud who become of my best friends.

and I was far from my family. But, I quickly had a new family – those that I would spend the next 3 years together with.

There is a general feeling and oftentimes unspoken trauma with training. We have endless shifts spanning weekends/holidays, fear of failing, fear of harming our patients, and at times knowing our best efforts may not help save a life. These feelings are often not discussed in residency but I was fortunate to have trained in a place that helped provide me with the support I needed to become the best doctor I could. In fact, I stayed at the University of Massachusetts for an additional 3 years for cardiology training.

I could feel myself growing as a provider during my cardiology training. The responsibilities grew, the fear of mistreating a patient having a heart attack was always on the forefront of my mind, and the expectation that I would be a master of all things related to the heart was

Dr. Noami Botkin (PD) plus my amazing co-fellows, 2 couldn’t make it for the picture.

overwhelming – and still is to this day. I was fortunate to have mentors who helped me grow clinically, academically, and personally. I saw the type of doctor I wanted to become, the changes in medicine that inspired me, and the continued inequalities that broke my heart. The end of my fellowship was marked with a more somber mood due to the COVID-19 pandemic. The ceremonious feeling of finishing residency wasn’t there for any of the trainees who were graduating but true to form, UMass continued to make us feel like family. With the resolve to not let a global pandemic dampen my spirits, I headed back to California after nearly a decade of not living in my home state.

I started yet another fellowship – more training, more weekends, more holidays, and more rewards. I was growing and gaining new skills that were making me a better physician. I was working in various intensive care units across the Stanford Hospital system and all the while, meeting colleagues who become family. COVID was unrelenting and we were all feeling the fatigue of it. The reduced social interactions, the hostile political environment, and our own uncertainty of when things would be back to “normal.” We banded together to provide the support and encouragement needed to get through our shifts.

Stanford Critical Care Fellows posing for the camera

The cumulation of my training has led me to become a critical care cardiologist – a doctor who works in ICUs to take care of any and all aspects of a patient’s heart. As I reflect on my years as a trainee, I’ve realized that the learning will never stop. Not only the science of medicine but the humanity, humility, and courage to do our best daily.

As Dr. Louis Weinstein stated: “At the initiation of your residency, after having received a medical degree, you were legally a medical doctor. Now that you have finished your formal training, you have the potential to become a true Healer.” Having completed my short-term goals of finishing my training, I am now looking to how I can harness Dr. Weinstein’s teachings, to combine elegance into the art and science of medicine. As I start my new position as an attending at the University of Pittsburgh Medical Center, I may no longer be a trainee but I will be a life-long learner.

Top 10 Tips for Incoming Cardiology Fellows

April 30, 2021April 30, 2021 Baljash Cheema, MD, MSCI

Cardiology fellowship comes at you fast. Within the first day, you realize how much nuance exists within the field that you hadn’t been exposed to in internal medicine, and there are lots of patients whose care depends on those details. At the same time, you quickly come to appreciate how much of an impact you can make on a patient’s health and just how rewarding the field is. it’s a beautiful journey! In thinking back on the last two years, I wanted to share my top 10 tips and insights on fellowship aimed at incoming fellows.

Learn from everyone. Nurses, techs, the cath lab team, sonographers, any staff with any clinical experience. There is often a sense you get when things aren’t right, and it takes a while to learn. These folks have developed it.
It will take you at least 6 months to start to feel somewhat comfortable, a year before you think you got a hang of things, and that’s normal.
Ask for help often. Key resources: senior fellows. They know everything, or they know who does.
When you are on call, you are never alone. Get in the habit of communicating with your attending, even in the middle of the night. It’s the best thing for patient safety and your learning, and the attendings want it too.
“Don’t guess when you can know.” The credit for the quote goes to Dr. Neil Stone, but the point is to get all the information you need (safely) and double-check the basics. The stakes are high in cardiology, so do the little things that prevent errors.
Stay well outside of work. Family, friends, exercise, sleep, hobbies, whatever makes you you. These things are never more important than now. Burnout is real, prevalent, and painful.
Meaningful learning happens through rote repetition in cardiology. Whether it’s in the cath lab or on echo, you will make insights through monotonous reps of seemingly routine studies/cases that you can’t make through any other means. Show up and dive in.
It may take you a while to have the bandwidth to delve into academic pursuits outside of “just being a fellow” – that’s okay. Fellowship is hard.
Recognize sick from not sick, and if someone is sick, move fast.
When you consent a patient for a procedure, know the facts, and tell them. There is no such thing as a no-risk procedure. I will never forget this, after being involved in a case of a PA rupture during a straightforward right heart cath leading to a cardiac arrest. Make sure they know what they are signing up and consent is truly informed.

I would recommend going into cardiology to those who are interested 10 times out of 10. Congrats to those just starting out! I hope this list gives some pointers that help as you embark on your own journey in the field.

Listen to Your Heart: How to Prepare Yourself for A Career in Cardiology

April 19, 2021April 16, 2021 Andi Shahu, MD, MHS

The road to Cardiology fellowship can be a confusing one. Residency, with its breakneck pace and punishingly long hours, is already a Herculean challenge in and of itself. Simply completing residency is its own feat. Attempting to set yourself up for the next stage in your career in a hyper-competitive specialty adds an entirely new layer of complexity. Trainees on this path towards post-residency training in Cardiology often find themselves asking critical questions: How can I figure out if Cardiology is truly the right field for me? How can I prepare myself for fellowship? What can I do to make myself a competitive applicant?

As you can imagine, the real answer here is that there is no one right way to approach the journey of becoming a cardiologist. Everyone must forge their own path. Still, I would like to share some lessons I have learned from my experiences as a Cardiology-bound resident.

Trade into Cardiology rotations

The only way to find out if you like Cardiology is to ensure that you actually have exposure to it. Sometimes, this means trading into additional Cardiology rotations and increasing your exposure to both cardiologists and potential Cardiology mentors who can talk to you about this career. Only by rotating in Cardiology rotations can you decide if this is a field that you would like to pursue further!

Seek out outpatient Cardiology experiences

Much of the exposure that Internal Medicine residents have to Cardiology during residency comes in the form of inpatient Cardiology rotations (Cardiology wards, Cardiac ICUs). While these are wonderful entry points into the field, they represent only a fraction of the breadth and depth of Cardiology. They may even erroneously lead you to think that most Cardiology happens inside of the hospital (surprise: much of it happens in the outpatient setting). I did not realize this myself until I participated in an ambulatory Cardiology elective. I strongly encourage you to explore the world beyond the CCU or Cardiology wards, so that you can develop a more realistic view of how you will spend the majority of your clinical time later in your career.

But don’t do too much Cardiology!

A common misconception among residents, regardless of their intended career, is that they should only pursue experiences in their field of interest. While this is admirable and might make you feel more prepared for fellowship, you must remember that nothing can truly prepare you for a career in a subspecialty except for fellowship itself. You will have entire years of your academic life set aside to learn how to be a cardiologist. However, after residency, you will no longer have the opportunity to improve upon your weaknesses in other areas of Internal Medicine. One of my mentors once told me that I should use my spare elective time to learn about other subspecialties so that I can become a better and more well-rounded internist. You will have plenty of time to learn about Cardiology during the fellowship. Use this precious extra time to learn about other things that will make you a better doctor, and ultimately, a better cardiologist.

Seek mentors out early

One common mistake that I see people make is that they wait too long connect with potential mentors. Applying to Cardiology fellowship applications is an extremely competitive process. Thus, it can only help to have mentors in your corner who help you think about your career goals, give you feedback about your fellowship application, help you plan research projects, connect you with other mentors, write letters of recommendation on your behalf, and go to bat for you when the time comes. However, mentor-mentee relationships are not born overnight. You need to dedicate time to building a relationship with mentors that understand you and advocate for you. Allow time to see if you and a mentor hit it off and give your mentor a chance to get to know the real you. The only way to accomplish this is to start early.

Find projects that excite you

It can be really tempting to fall into the trap of taking on as many research projects as possible with the sole purpose of “fluffing” your resume, without regard to a project’s value or quality. Remember that everything you put out into the world is a reflection on you; you should be willing to stand proudly by any work that you produce. Be judicious. Select only those projects in which you are genuinely invested. Don’t just pad your resume with countless meaningless abstracts or manuscripts. Quality will always triumph over quantity.

Set realistic research goals

At the end of the day, your primary job in residency is to be a resident. Sometimes you will be too busy to do research. Sometimes you will be too drained to do research. Sometimes you need to recharge instead of doing yet more work. That’s OK. You cannot do it all. During my first meeting with one of my mentors, we talked about pursuing smaller projects that I could realistically complete during residency rather than trying to take on huge untenable projects. In retrospect, it was incredibly thoughtful and kind of my mentor to be so deliberate. It helped me set more realistic goals about what I could accomplish during residency and it made my research experience more fulfilling. You are a very busy resident. You should accordingly select realistic, sustainable and completable projects.

Join the online Cardiology community!

There is a very active Cardiology community on social networks such as Twitter, talking about the latest high-profile articles, debating new guidelines, and sharing amazing tweetorials or interesting clinical experiences. Social media offers a great opportunity to get to know and make connections with people in the field. I “met” some people on Twitter before I formally met them on the interview trail. It was nice to already have that connection with others in Cardiology. It made me feel from the very beginning that I belonged to a larger Cardiology community. Moreover, it has enhanced both my learning and my excitement about becoming a cardiologist!

Integrity is everything

No matter what you do, put your best foot forward every time. Your reputation really does matter. Though it seems large, Cardiology is also a tightly knit community and people do talk. You will want to develop a reputation as a hardworking, honest, conscientious and reliable person. Actions always speak louder than words. Remember that everything you do will be a reflection on you and your character. When in doubt, ask yourself, can I proudly stand by this decision a month or a year from now? Do the right thing every time. Don’t cut corners. Work hard and be kind. Whether you do good or bad things, people will take notice, and they won’t forget.

So You Want To Apply To Cardiology Fellowship: Tips From the 2020 Application Cycle

February 22, 2021February 19, 2021 Andi Shahu, MD, MHS

The fellowship match process for Cardiology, an increasingly saturated subspecialty with an ever-expanding applicant pool, is extremely competitive. However, the 2020 application cycle proved to be an entirely different beast, with the COVID-19 pandemic and the inability to interview in-person adding layers of complexity to an already confusing process.

Applicants and fellowship program directors alike wrung their hands over the impersonal nature of Zoom interviews (how could you really feel the “vibe” of a place from a Zoom?). Sure, costs decreased because programs were not “wining and dining” applicants and applicants did not have to travel while working full-time. But this democratization of the application process had the adverse effect of leading many applicants to apply to many more programs. Cardiology program directors were overwhelmed by record numbers of applications. Concurrently, applicants were distressed about not receiving interview invitations. It was tough.

As someone that just matched into Cardiology, I would like to offer some unsolicited advice for future fellowship applicants:

DO be judicious in how you build your Cardiology resume

Fellowship applicants are told that they need to join projects or produce manuscripts to “show interest” in Cardiology. While it is important that you explore Cardiology outside of your clinical rotations, it is also important to choose quality over quantity and not over-commit to projects for the sole purpose of buffing your resume. For each possible project or extracurricular activity, be a little bit selfish and ask yourself, what will I get out of this experience? Will you acquire new skills? Will you gain valuable new insight or knowledge? Will you build relationships with great mentors? How will that project fit into your personal narrative or your career interests within Cardiology? Your time is precious. Spend it developing meaningful, in-depth experiences that help you grow as a future cardiologist, not just checking off boxes.

DO give yourself time to make your personal statement about YOU

Writing is hard. I love writing, but I find it uniquely painful and time-consuming. My first drafts are awful; I go through countless edits before landing on a final product that I can tolerate. Writing personal statements is EXTRA hard because we are bad at writing about ourselves and framing our lives and career goals into a short, neat narrative. Instead, we resort to narratives about patients (nice, but says nothing about who YOU are) or generic maxims (ditto). Your personal statement needs to be PERSONAL. It should be about YOU, the journey you took to get to where you are today, and the journey you hope to embark on next. What MUST the reader absolutely know about you by the time they get to the end of the essay? Does a sentence or paragraph reveal anything about you or does it serve a purpose in telling your story? If the answer to either of these questions is “No,” cut that sentence/paragraph out. Be brutal. Lastly, find out who in your life is a good editor and ask them for lots of feedback.

DO be realistic / DON’T take away opportunities from other people

Some applicants are overly confident and do not apply to enough programs. Some apply to way too many, ultimately interviewing at programs in which they are not truly interested, thus shutting out other applicants who would have loved to interview at those programs. How do I know if I am a competitive applicant? How many applications is too many?, you might ask. The only way to know is to make a list of programs to which you’d like to apply and show it to trusted advisors (e.g. your program director). Solicit their honest feedback so that you can make an informed decision about what you need to do to be able to match.

DO research the institutions to which you apply and interview

There are many great Cardiology fellowship programs. There are no “best” programs. The best program for you is one that aligns with your career goals. Different programs have different flavors, strengths, and weaknesses. While interviewing, I realized that some programs were a great fit for me and my specific interests, while other, equally amazing programs were not. The only way to figure out whether a program might be well-tailored to your interests is to research programs before you apply (search online, talk to people that know the program), research them again before your interview, and ask lots of questions during your interview day. If you know before you even apply that a program would not be a good fit for you, why apply there?

DO pre-plan your Zoom interview space

Are you the kind of person that goes with the flow? Or do you get anxious and feel the need to exert control over your surroundings? If you are the former, then great! If you are more high-strung, however, plan your Zoom space out in advance so that there are no unpleasant surprises on Game Day. Where are you going to place the camera? Does your laptop need to be propped up so that the camera is in line with your eyesight? Do you need additional lighting so that others can see you well? Is there too much noise from your surrounding milieu? Does your location have a reliable internet connection? Do you wish to display anything behind you while you are on Zoom? Note that anything you display on screen [e.g. books, artwork] is an open invitation for the interviewer to ask you questions about said item.

DO talk to acquaintances at fellowship programs

Now that interviews are on Zoom, it is as important as ever to talk to current Cardiology fellows and solicit their honest opinions about programs. I found talking one-on-one with people I knew at various fellowship programs to be more helpful in giving me a sense of that program’s “vibe” than just about anything else I heard on interview day. Ask to talk one-on-one with a fellow at every program with which you interview (i.e. someone who attended your medical school or residency, who is from a similar area or who has something in common with you). After these conversations, I felt more confident that I knew what I needed to know in order to make informed decisions about where to place programs on my rank list.

DO think about your “5-10 year plan” and career goals

We all dread the interview question about our “5-10 year plan.” However, rest assured that you will be asked about it at virtually every interview. The fellowship is the final training ground before you launch into your career. Because many people often stay at their institution after fellowship, your fellowship interview in some ways doubles as a faculty interview. The program will view you as a long-term investment and they want to know what you would bring to the department. With that in mind, think about your narrative. How will you “package” yourself? Sure, everyone knows that things might change in the future, but as things stand right now, what niche will you carve out for yourself if you become faculty in the department after fellowship? You should be ready to answer these questions.

DON’T be afraid to preserve your spirit

Interviewing can be fun, but it can also be stressful when paired with an 80-hour-per-week job. Find ways to decompress before, after, or during your interview day. Exercise as needed, spend time with family, debrief with friends, take breaks. For self-care, on Zoom interview days, I would select a 30-60 minute window when I was not on camera and leave my apartment to grab a coffee (yes, I went to the coffee shop in a suit!). It broke up my day, reenergized me, and made me feel like I was at a real in-person interview.

DO be yourself
You should always be professional and courteous to others. However, that does not mean that you need to be a robot! Do not be afraid to let your personality shine. You will have more interesting interactions with others and you will come across as more relatable. More importantly, depending on how the people on the other side of the screen respond, it may help you decide if a program is the right fit for you. Never be anyone other than yourself. You deserve to be at a program that will welcome you for who you are.

Building an academic portfolio during medical training: Part 1 – research outside the box

January 21, 2020January 21, 2020 Amr Barakat, MD

As a medical trainee in the US, whether you are pursuing an academic career or applying for a fellowship or advanced fellowship, your academic profile is one of the most important currencies you rely on for this endeavor. Academia as a general term refers to 2 main areas: research and education. Many trainees, like myself, start their residency with no or very minimal research experience. It then becomes essential to create a reasonable research portfolio during medical training, which is often not an easy task, especially in clinically demanding specialties. In this series of blogs, I will try to share some ideas and tips that can help you build a competitive research résumé during residency and fellowship. These ideas also apply to medical students, inside or outside the US, who are trying to match their dream US residency program.

The first idea that I would like to talk about is one that I thought was particularly a game changer for me when it comes to research. I like to call this one “research outside the box”, and by the box here, in addition to the abstract meaning of doing things in unorthodox ways, I’m also referring to the literal box that is the walls of your training institution. Residents and fellows are rarely involved in multicenter clinical trials or prospective studies. In fact, the vast majority of research done during medical training is retrospective observational studies. One of the main reasons trainees rely on retrospective studies is the time factor. Prospective studies often take longer to execute, and it becomes difficult to get a tangible product, a conference abstract, or a published manuscript on time for your next fellowship or job application. Therefore, retrospective studies become the more realistic option, and traditionally, these are carried out using institutional databases (i.e. clinical data from patients treated at your own training hospital), which is and will remain one of the most valuable research resources. Then comes the fundamental question – why should I consider doing research in a non-traditional way, or “outside the box”? – For many reasons:

Many training hospitals do not have large clinical databases that can produce impactful research projects.
You may not find a good research mentor in your training institution.
Even with available databases and good research mentors, some retrospective studies may still take long to come to fruition, sometimes longer than you can afford without a back-up plan.
Diversifying the ways you do research by pursuing both traditional and non-traditional means, can lead to a marked increase in productivity.
Most importantly, collaborating with motivated medical students, residents, and fellows around the country (and sometimes even around the globe), not only enhances your research output but is in itself a great learning and networking opportunity.

The next logical question would be – as a student or a trainee, what type of research can I do outside my institution?

For the same practical reasons that I previously mentioned, I am still referring to retrospective observational research rather than multicenter trials or prospective studies. In that case, to be able to easily collaborate with researchers across different institutions the data has to be publicly available and not protected by privacy laws. There are different types of publicly available data, some are mostly free, such as already published literature, some can be purchased for a fee, such as national and state administrative databases, and others require a research proposal that goes through a grant-like process, such as societal databases. The latter typically requires a higher degree of research expertise and are restricted by application cycles, so I would not recommend them as the first go-to option if you are still taking your very first steps in medical research. Here are some examples of observational research work that can be done collaboratively using these publicly available data sources, without being limited by institutional boundaries:

Published medical literature can be used for meta-analyses and systematic reviews. These types of studies commonly address hot topics in medicine or topics with controversy or equipoise. A common scenario where topics are considered “hot” is immediately after the publication of a large clinical trial, particularly if the results are not in line with prior trials on the topic. Meta-analyses are also ideal for examining uncommon side effects or complications of medications or medical procedures.
National administrative databases can be used to perform retrospective observational studies, e.g. the National Inpatient Sample (NIS) and the Nationwide Readmissions Database (NRD), which are commonly used in cardiovascular research. They are particularly helpful in researching rare conditions or special populations where getting a large sample size using single-center data is challenging, or to examine trends in diseases or therapies over time. Most of these databases are available for purchase per calendar year (e.g. 2010, 2011, 2012 etc.), meaning that you can buy one or more year worth of data, depending on your budget and your research question.
Societal databases can also be used for original outcomes and quality improvement research, e.g. the American Heart Association (AHA) Get With The Guidelines and the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) Although these do not cost money, yet, they mostly require more work including submission of a proposal during an annual or bi-annual application cycle, which is a very competitive process.

These are just examples of what can be done and some common resources that can be used to start with, but in reality, the possibilities and the available resources are endless. Now that we talked about “why” and “what”, the next question is “how” – how to reach potential collaborators? how to build a successful multi-institutional team of young researchers? And what are the challenges to this approach? This will be the topic of my next monthly AHA Early Career Voice blog. So stay tuned..

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.

Happy July 1: Cardiology Fellowship Begins

July 15, 2019July 15, 2019 John Chen, MD

Anyone in the medical field knows the significance of July 1. Don’t get sick in July, they say, because the hospital is full of brand-new residents and fellows. For me, cardiology fellowship begins right where internal medicine residency left off—at Emory. At least I know where to park and how to find the bathrooms.

This year we have a tight-knit group of six clinical fellows. At orientation, we practiced performing echocardiograms on each other, taking turns squinting at gray speckles on a dark screen. That night, we raised our drinks to say a toast—and to wash away our nerves. And soon enough, I’m strolling into the hospital sporting my new white coat, which drapes over my shoulders like an oversized tent. The coat fits awkwardly, in both a physical and figurative sense.

I’m told you don’t even feel like a real cardiologist until you’ve learned to perform heart catheterizations and read echocardiograms. Ask me again in six months. For now, I start with general consults, where I’m the cardiology consultant for other physicians in the hospital. The hardest part about inexperience is the decision-making fatigue—even trivial decisions require excessive mental effort. To overcome this, the goal is to see as many bread-and-butter cases as possible, to build a sort of muscle memory.

It’s been a wonderful year on this blog, reminiscing the end of residency, chronicling the start of fellowship, and pondering the milestones yet to come. What gives me comfort at this moment is the supportive culture of my program, where I can always lean on co-fellows and attendings. I’ll keep this mind as I tackle the next major hurdle—my first overnight call. Just thinking about it gives me palpitations.