-
Practice your interview with the new SDN AI Interview Coach. Choose a school, answer by voice or typing, and receive a personalized feedback report. Available now to all SDN members. Try the AI Interview Coach.
Delete
Started by earlk15
- Status
You will likely end up practicing near where you completed fellowship, so take this into account when selecting a program.
People will have different opinions on this, but I recommend a "supervisory" fellowship. This will give you time to bounce between rooms during the day and exponentially increase you echo numbers. Even in a supervisory role, you will have plenty of time to practice procedures as you will be salvaging many of the residents attempts. You will also be there for the most important parts of the procedure...you don't want to be stuck in the OR while the PA takes a vein graft. Most programs are happy to put you solo in a room if you request.
I loved my experience at UCSD. The editors of Kaplan's Cardiac Anesthesia are UCSD staff, you can't get much better than that if you are looking to learn from the best!
Finally, most of us only have experience with 2 programs, so objectively comparing fellowships is incredibly difficult. Sometimes you gotta go with your gut when it comes to your interactions with the staff and current fellows and your interview day experience.
Advertisement - Members don't see this ad
True to an extent.
Getting taught by truly exceptional faculty has value. Assuming it's a place where they actually teach, of course.
It's also not true that all programs have equivalent case load and complexity. Fellowship is the time to do the sickest craziest cases you can. I'm happy to never do another BOLT again as long as I live, but they were good learning cases.
Point taken but choosing lung transplant of all things as your example is weird. Exposure to BOLT and OHT only matters if you’ll be doing those once you leave fellowship. You can safely forget everything about them if you pick up a job after fellowship that does not do them.
I think about the details of those procedures exactly zero times per year since leaving fellowship and I’m at a high volume center that does LVADs
I think about the details of those procedures exactly zero times per year since leaving fellowship and I’m at a high volume center that does LVADs
Sure but what I was getting at is that even though I don't do lung transplants any more, doing those cases as a fellow made me a better doctor. And if I'd trained somewhere without them, I'd have missed an opportunity to learn something.
Fellowship is a year. People should flog themselves to do the most cases in the sickest people with maximal time physically present in an OR.
Opinions differ, see the age-old debate about fellowships that are supervisory vs mostly/all do-your-own-cases. But that's mine.
Go to the best place with the toughest cases and excellent faculty you can find. Doesn't matter that you'll never do a BOLT or OHT after you're done - the principles stay with you and you'll be that much more legit in the eyes of the surgeons and staff. However your partners might try to screw you over with sicker cases that the wimpy generalists wouldn't touch.
I'll disagree and advocate for own case fellowships.
You'll never feel as challenged as you do when doing it yourself, especially as those programs with own cases tend to have the higher acuity and higher volume. That's how they can afford a fellow to be in their own room. They farm out the easy stuff to residents primarily, and fellows do the circ arrest, lung transplants, thoracos/spinal drains, and other mega sick non-cardiac cases for cardiac patients.
A good amount of NORA for cardiac patients is important too. That's a primary function of cardiac anesthesia in many hospitals.
Where do u see yourself working and what do they do there?
I learned the most from some unassuming guys, not big names but workhorses that slammed out cases and had a knack for knowing when **** was gonna hit the fan. Stayed calm under pressure and skills never wavered whether it was 8am starting a shift or 6am end of shift.
Some of these big researcher guys cant even do their own lines
I learned the most from some unassuming guys, not big names but workhorses that slammed out cases and had a knack for knowing when **** was gonna hit the fan. Stayed calm under pressure and skills never wavered whether it was 8am starting a shift or 6am end of shift.
Some of these big researcher guys cant even do their own lines
Also extremely biased because I did a "sit your own case" fellowship but if you're willing to sacrifice a year to do more training, do it right. If you're already thinking about trying to find a fellowship where you can "chill" for a year, then just forget fellowship and go find a job. Fellowship is the time to see nasty, complex cases and learn as much as you can while managing them.
This! Don't train to just be a bread & butter cardiac anesthesiologist. Know how to do cardiac transplants, LVAD and other VAD devices, minimally invasive robotic procedures, aorta surgeries, etc. It makes you a better cardiac guy overall. It qualifies you for more advanced jobs out there. An example of this was when Corewell Health in Grand Rapids was looking to hire cardiac locums to temporarily staff their program last year. The problem was that the Corewell heart program does heart lung transplants, peds hearts etc. The only cardiac locums guys they could attract only had experience with CABGs, heart valves and TAVR's.
I have some familiarity with the Penn program as they let you manage cases like an attending after a while. Stanford does the same and I expect Mass General as well since they expect even their CA-1's to act autonomously even on their 1st day of residency. There is no hand holding at these top programs. You are all hands on and learn via trial by fire.
I'd be interested to see evidence that higher acuity/volume is linked to sit your own case fellowships. It is more of a function of the ratio between residency class size (or number of residents on the cardiac rotation) vs. daily cardiac volume.
The anesthesia skills required for cardiac cases are picked up quickly in fellowship (or even residency, depending on your training program). Exposure to TEE is exponentially increased when a fellow is able to check out the other rooms while their resident sits in the room during rewarming, waiting for the donor heart to arrive, etc. This prepares fellows for some of the most challenging questions we are asked as cardiac anesthesiologists , "Can this valve be repaired?" "Do we need to go back on pump to fix this?" "Does this echo finding need to be addressed as well?"
I agree that NORA is an important part of training, but would be incredibly skeptical about any program that is asking CTA fellows (or residents on cardiac rotations) to cover non-cardiac cases. That would be a huge red flag and probably the best indicator that the cardiac volume is not adequate to support the training program.
Look at the rankings of the own case fellowships. They're the top cardiac volume and acuity programs in the country almost perfectly.
Most own case fellowships have a TEE rotation as well. At good volume programs, a person can do both TEE and sit ones cases in the same year.
You would be wrong about this. NORA days in our program had a huge value to each of us.
I think you misread my post. I agree, it is great to be exposed to NORA during fellowship.
Covering non cardiac cases for "cardiac" patients is a not a valuable use of time, though.
I'm always interested to see these fellowship "rankings." As far as I'm aware, there's no official list, and the top programs just happen to be the programs with huge fellowship cohorts, at hospitals with saavy marketing departments. There's nothing objective about these rankings.
Advertisement - Members don't see this ad
- Status
