Best CT Fellowships?

[NiemannPick]

What are the best CT fellowships in terms of quality of training and reasonability of responsibilities?

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[abolt18]

What are the best CT fellowships in terms of quality of training and reasonability of responsibilities?

I anticipate that most answers here will say "depends on what you want" and I think that's true. Do you want to supervise all year and do tons of echos? Do you want to do all your own cases? Or do you want something in between? You kind of have to start there.

 

[AdmiralChz]

What part of the country do you want to work in afterwards? Want to do academics/research? Pair with CCM Fellowship? Interested in a supervision or own cases year?

Asking which is the best is totally in the eye of the beholder. Your year is what you put in to it.

 

[NiemannPick]

I anticipate that most answers here will say "depends on what you want" and I think that's true. Do you want to supervise all year and do tons of echos? Do you want to do all your own cases? Or do you want something in between? You kind of have to start there.

Good point. I would like to be doing my own cases most of the time with solid echo experience, but not the focal point. More all-around.

 

[NiemannPick]

What part of the country do you want to work in afterwards? Want to do academics/research? Pair with CCM Fellowship? Interested in a supervision or own cases year?

Asking which is the best is totally in the eye of the beholder. Your year is what you put in to it.

West Coast living, academics/mentoring/teaching is more important to me than research, dual CCM fellowship is not likely, and I'd like to do my own cases.

 

[JiPo]

I applied this year mostly to the east coast programs. I've wrestled with this idea for some time, and I DMed a bunch of CT trained SDN members, who were extremely helpful.

Just to throw in some names of programs that many people (from SDN and from mentors at my institution) considered to provide great training, in no particular order, are Duke, CCF, THI, BWH, MGH, BI, Penn, Hopkins, Columbia, Michigan, Stanford, WashU, Vanderbilt, Emory. I am sure there are a few more, and I didn't ask about west cost programs. I won't get into which programs are "THE BEST" programs since people had more differing opinions on this.

The general consensus from what I gathered is that you can't go wrong with any of these programs and you will get phenomenal training at all of them. It is more about your fit and what you are looking for in the fellowship. If you come from a residency program with strong cardiac experience and you want an echo dominant fellowship, BWH, BI, Penn, Michigan, Hopkins would fit you well.

If you want more hands on experience because your cardiac exposure wasn't great, or if you just want to take care of sicker patients and do more complex cases at the expense of being treated like a CA-4, which also comes with doing non-fellow level BS cases at times, Duke, CCF, THI, MGH, Columbia will give you that.

I realized that there is no right or wrong answer. There is no perfect fellowship and every fellowship will have flaws. You are giving up a lot for the fellowship, and you should go to the fellowship that best fits your needs and goals.

 

[CoxMD]

The general consensus from what I gathered is that you can't go wrong with any of these programs and you will get phenomenal training at all of them. It is more about your fit and what you are looking for in the fellowship. If you come from a residency program with strong cardiac experience and you want an echo dominant fellowship, BWH, BI, Penn, Michigan, Hopkins would fit you well.

If you want more hands on experience because your cardiac exposure wasn't great, or if you just want to take care of sicker patients and do more complex cases at the expense of being treated like a CA-4, which also comes with doing non-fellow level BS cases at times, Duke, CCF, THI, MGH, Columbia will give you that.

With the caveat that I'm also an applicant from this current cycle who predominantly applied East Coast, I like/agree with your division of echo dominant vs sicker/complex case fellowships.

 

[deleted171991]

With the caveat that I'm also an applicant from this current cycle who predominantly applied East Coast, I like/agree with your division of echo dominant vs sicker/complex case fellowships.

In my amateur understanding, the future of cardiac anesthesia is the echo part, because procedures are moving into the realm of interventional cardiology. TAVR is just the beginning.

The complex cases sound nice, but, unless one works in a big academic center, I don't know how important they'll be. In the end, most community places do bread and butter cases, and care mostly about basic stuff and echo skills. There is a reason there isn't a cardiac anesthesia board certification, just an echo one.

 

[AdmiralChz]

West Coast living, academics/mentoring/teaching is more important to me than research, dual CCM fellowship is not likely, and I'd like to do my own cases.

Stanford is a good target for you. Especially for west coast, it is important to train fairly nearby - my friends who trained in the northeast had difficulty moving home to California afterwards, even at big name institutions. CCF and THI are somewhat far away but reasonably options. I am less familiar with other programs out west to be completely honest.

 

[Nivens]

You're going to do "sick, complex cases" at any of the major academic centers JiPo mentioned. The suggestion that it's an either/or thing doesn't hold water, though I can see why a place that cracks the whip and treats you like a super-resident while expecting you to learn echo on your own would want to suggest such a thing. Go to the place that's going to make you the best echocardiographer. Period. That means structured learning, faculty who are leaders in the field, interventional/cath lab cases where ANESTHESIA does the echo, etc.

 

[JiPo]

You're going to do "sick, complex cases" at any of the major academic centers JiPo mentioned. The suggestion that it's an either/or thing doesn't hold water, though I can see why a place that cracks the whip and treats you like a super-resident while expecting you to learn echo on your own would want to suggest such a thing. Go to the place that's going to make you the best echocardiographer. Period. That means structured learning, faculty who are leaders in the field, interventional/cath lab cases where ANESTHESIA does the echo, etc.

I agree with this for the most part, but on interview days at least, Duke and CCF made it sound like they see Pulmonary pressures bordering systemic pressures fairly often. That is what I meant by "sick, complex case."

 

[AdmiralChz]

I agree with this for the most part, but on interview days at least, Duke and CCF made it sound like they see Pulmonary pressures bordering systemic pressures fairly often. That is what I meant by "sick, complex case."

Eh, I see crap like that in my non-academic level 1 center and that’s just on the OB ward.

Different strokes for different folks. I wrote a mega long diatribe on cardiac fellowships in the other active thread by JiPo.

A quick note on echo: At least 90% of the esoteric crap is just that - crap. You can be a whiz at 3D full volume loops and building your kidney bean, advanced strain analysis and what not but at the end of the day it’s about getting the pictures in real time. Especially out here in PP - you can give an advanced report in diastology, RV strain and the surgeon will blink a few times and ask “so... the aortic valve?” Every program out there, I would suspect, would set you up for that.

I sought out extra opportunities but to be honest I was comfortable enough in echo to be able to do many cardiac cases coming out of residency. But it’s the moment-to-moment decisions and variations that distinguish pre and post-residency skills. YMMV.

 

[Ronin786]

Eh, I see crap like that in my non-academic level 1 center and that’s just on the OB ward.

Different strokes for different folks. I wrote a mega long diatribe on cardiac fellowships in the other active thread by JiPo.

A quick note on echo: At least 90% of the esoteric crap is just that - crap. You can be a whiz at 3D full volume loops and building your kidney bean, advanced strain analysis and what not but at the end of the day it’s about getting the pictures in real time. Especially out here in PP - you can give an advanced report in diastology, RV strain and the surgeon will blink a few times and ask “so... the aortic valve?” Every program out there, I would suspect, would set you up for that.

I sought out extra opportunities but to be honest I was comfortable enough in echo to be able to do many cardiac cases coming out of residency. But it’s the moment-to-moment decisions and variations that distinguish pre and post-residency skills. YMMV.

I don't know. I was in the same mindset as you, until I saw the inner machinations of an academic powerhouse in TEE and echocardiography. The standing it gave their department among the rest of the hospital was worth the effort it takes. Cardiac surgery couldn't walk around strutting their **** or talking down to the anesthesiologists in the OR. Especially when said group used live 3D volume loops to identify an annular perforation that would have led to AV dissociation if it hadn't been fixed (just for example).

Maybe my residency was just a spineless division, but seeing the difference gave me an appreciation for a department that actually knows what they're doing with next level TEE, their ability to apply it in the cardiac OR and their mastery of outside of OR TEE (I.e. interventional cardiology). But I know we've disagreed about this in the past and it likely depends on your practice setting after fellowship.

 

[AdmiralChz]

But I know we've disagreed about this in the past and it likely depends on your practice setting after fellowship

For sure. I’m in true PP quite removed from academics. Furthermore, I am less than 40% cardiac... a decision I am very happy with right now given the shutdowns.

 

[Nivens]

I agree with this for the most part, but on interview days at least, Duke and CCF made it sound like they see Pulmonary pressures bordering systemic pressures fairly often. That is what I meant by "sick, complex case."

I’m telling you man, you’re being suckered. There’s nothing magical about taking care of those patients. You need to see a few to be comfortable, but after that it’s just annoying.

 

[bubbleboy123]

.

 

[JiPo]

Consensus on Cornell, NYU, Yale?

All were solid mid-tiers from what I gathered. Definitely not on the same level as ones I mentioned above. Cornell was quite underwhelming tbh.

 

[CoxMD]

All were solid mid-tiers from what I gathered. Definitely not on the same level as ones I mentioned above. Cornell was quite underwhelming tbh.

Yale's department overall and their former division chief specifically have been in the news lately. Was warned by a former Yale trainee that this might be just the beginning of things to come out of the department.

6 women accused a doctor of harassment. Yale excused his behavior and promoted him, lawsuit says

A Yale administrator brushed off a report that an award-winning professor and doctor had sexually harassed a female colleague as “boys will be boys,” a new lawsuit filed by six women alleges.

www.nbcnews.com

 

[pgg]

All were solid mid-tiers from what I gathered. Definitely not on the same level as ones I mentioned above. Cornell was quite underwhelming tbh.

I got a weird vibe from Yale when I interviewed there a few years back.

They had a word for people would-be fellows who simply wanted to be better anesthesiologists - "toppers". Mildly derogatory, a bit disdainful. Like they were topping off their residency but weren't aiming to remain in academia to become distinguished academic leaders and prolific publishers. Almost like I should feel bad about wanting to spend a year with them to learn echo, how to better manage patients during cardiac surgery, etc.

I'd say I was a proud topper, but that sounds a little kinky, but what the hell, I was a topper. Yale was also more supervisory than my other choices. It wouldn't have been a good fit for me. For someone aiming for that kind of academic career I'm sure they'd have opened doors.

 

[deleted162650]

I'd say I was a proud topper

Is that like the opposite of a power bottom?

 

[ProRealDoc]

I agree with this for the most part, but on interview days at least, Duke and CCF made it sound like they see Pulmonary pressures bordering systemic pressures fairly often. That is what I meant by "sick, complex case."

I see that in my community hospital practice.

 

[Arch Guillotti]

Eh, I see crap like that in my non-academic level 1 center and that’s just on the OB ward.

Why are these patients getting echos to begin with?

 

[dchz]

I agree with this for the most part, but on interview days at least, Duke and CCF made it sound like they see Pulmonary pressures bordering systemic pressures fairly often. That is what I meant by "sick, complex case."

I’m telling you man, you’re being suckered. There’s nothing magical about taking care of those patients. You need to see a few to be comfortable, but after that it’s just annoying.

+1. it's just a number bro, if the RV is beating away, what's the big deal? I'd rather not get burned out before i start my job.

 

[deleted171991]

I'd rather not get burned out before i start my job.

I had the same optics (but I was also older when I did my CCM fellowship). I think it was a mistake.

Though I had excellent training (when coupled with my personality and interests), people are not that impressed when they hear where I did my fellowship (as in your case). And that can be the difference that gets one's foot in the door, especially in academia.

For example, I know from my PD (who's a straight shooter) that a certain big name fellowship was much weaker than ours (back then). Still, I have seen more than one physician get wet with emotion from that name on the fellowship diploma, while I just roll my eyes.

Brands do matter. Even/especially the malignant ones, if one can survive.

 

[Lidolover]

I had the same optics (but I was also older when I did my CCM fellowship). I think it was a mistake.

Though I had excellent training (when coupled with my personality and interests), people are not that impressed when they hear where I did my fellowship (as in your case). And that can be difference that gets one's foot in the door, especially in academia.

For example, I know from my PD (who's a straight shooter) that a certain big name fellowship was much weaker than ours (back then). Still, I have seen more than one physician get wet with emotion from that name on the fellowship diploma, while I just roll my eyes.

Brands do matter. Even/especially the malignant ones, if one can survive.

So true.
btw which programs in critical care have been considered malignant traditionally? I know Hopkins is one of them.

 

[deleted171991]

So true.
btw which programs in critical care have been considered malignant traditionally? I know Hopkins is one of them.

Columbia may be another.

Also, I expect tough residencies to have tough CT and CCM fellowships, too. If they work you as a resident, they will work you as a fellow, too. It's usually not about education, it's about money.

 

[abolt18]

Whoops

 

[deleted171991]

Whoops

No reason to delete your post, too, but thanks.

I just didn't want to come across as boastful. I'm wiseguy enough as it is.

 

[JiPo]

No reason to delete your post, too, but thanks.

I just didn't want to come across as boastful. I'm wiseguy enough as it is.

Now i am curious what was said

 

[deleted171991]

Now i am curious what was said

Me too, because the boastful one is still up, in a different thread. What did I delete and from which thread? I don't think abolt18's post had actually quoted me.

Oops, early Alzheimer? Probably just doing too many things too fast.

So, if you want to clean up, we could just delete all 3 extra posts.

 

[abolt18]

Me too, because the boastful one is still up, in a different thread. What did I delete and from which thread? I don't think abolt18's post had actually quoted me.

Oops, early Alzheimer? Probably just doing too many things too fast.

So, if you want to clean up, we could just delete all 3 extra posts.

I just responded to the comment thinking we were in a different thread. As soon as I realized my error, I changed it because it didn't make sense.