Hi all
I thought about posting this in the cardiology interviews thread but I then wanted faculty and fellows to see this rather than applicants, and I am sure it will be helpful to all cards applicants.
I am interviewing for cardiology soon, I come from an average university peds program with an average cardiology service, mainly outpatient clinics, echos and PICU/NICU consultations along with few post-op cardiac patients sometimes in the PICU. No cath lab. I am interested in a academic job after my training, and maybe interventional. I am looking for a solid general cardiology training and not necessary big name centers. What kind of things I should look for in a program when I interview to make sure I will be getting solid training regardless of the name? For example, does a program with dedicated CICU is going to be superior to a program with no CICU? some programs don't have in house cardiac MRI, is this something I should be worried about? Does number of yearly caths and open heart make a big difference? what exactly I should be looking for?
Also, everyone knows that big names programs will provide solid training, does any one knows about smaller programs that don't necessarily have the name but still train their fellows very well?
I am currently a 3rd year peds card fellow in the midwest. Personally i think the best way to get 'solid' training is by seeing as much as possible. So, surgical volume is important. Ask them how many surgeons they have, and how many cases they have per year. Or more generally can ask them if they consider themselves a low volume, medium volume, or high volume center. Obviously the higher the volume the busier you will be. You can get a sense of not only surgical volume but echo volume, cath volume, EP volume, etc. Also, in regards to surgeons, a lot of the senior ones are getting older and close to retirement. Make sure that if that is the case that the program has a reasonable plan in place if they lose a surgeon and that their surgical volume won't plummet without any 1 surgeon.
i think a 'small' program is fine as long as their volume is adequate and they have all of the major departments. I cant imagine having a fellowship without being able to staff and take care of the entire spectrum of disease, but if you are looking at the smaller programs then may be worth asking. Your program should not have to refer any patients to other centers (unless it is some crazy rare thing where the 1 specialist in the world is in Philadelphia then thats where they go...)
Not sure a dedicated CICU vs no CICU is important. Obviously there will be some sort of CICU as your post op patients have to go somewhere, so whethere its a separate unit or not i dont think is important. One big question and difference between progarms is who runs in the CVICU and also how much time do the fellows spend in the ICU and what is their role. This varies widely. Are the ICU docs PICU trained with an extra year of cardiology? Are they cardiology trained with an extra year of CVICU? Are they just PICU trained and working in the CVICU because that is what they are told to do but don't really have any true cardiac training other than whatever they did in fellowship? That will change the dynamic between the departments for sure. If you are dead set on CVICU, i would go to a program where the cardiologists control the ICU and the fellows spend a lot of time there. If you aren't going to be a CVICU doc, then you may tolerate going to a program with less ICU experience. Michigan is an extreme example where their 2nd years spend a LOT of time in the CVICU as the primary care giver. they spend severeal months on ICU service and take q6day ICU call. That is pretty extreme, and arguably not necessary, but thats how they do it. On the flip side, my program is not ICU heavy at all. We have two months of ICU in teh whole 3 years. One month acting more as an ICU fellow and the other as a cards consultant. Either way, we never are the primary overnight person taking care of post op ICU patients. One could argue that that is not enough and probably there is a happy medium in between.
I wouldnt put much weight on in house cardiac MRI specifically. if you want to do MRI training, you'll do a 4th year in advanced imaging anyway. What that may suggest tho, is that the program is small and the resources are limited, which is a red flag potentially. Again, you wont to be at a center that can do everything it needs to do to take care of its patients (cath, EP, fetal, heart failure/transplant, adult congenital, MRI, etc)
One thing I ended up liking and is the main reason I am in the midwest is that I preferred the progarms where they were the only program in the state or the only program for a considerable distance, which limits the competition between other programs. You go to a mjor city like LA or NY...there are 3, 4, 5 different programs within miles of each other. They are all competiting for the same pateints. What will happen in that instance is that you'll have one program which attracts all of the carzy complex, rare cardiac lesions and all of the other more general peds cards stuff go elsewhere. Neither is good training. In contarst, if you are at a place like Michigan, for example, or Utah, or Indiana, etc these are programs where competition is limited so every congenital heart kid who is born comes to that program bc there is no other option - so you see super rare stuff to the super general pediatric cardiology stuff. it makes for all around good training.
another big difference as the other poster mentioned is research. you have to be active in research, like it or not. To graduate fellowship you have to have submitted an original manuscript. There is a big difference in programs in how well supported the fellows are in terms of getting stuff done. I remember Utah being veeeery organized in their research support, but at the same time because of that the expectations for projects is probably higher. On the extrem will be progarms that are like "you have to do research, here is a list of things people are doing" and then the rest is kind of on you to figure out how to get stuff done and finding a mentor who can help you.
i really dotn think there are many major differences between programs, you just need to know what you like and most importantly pick a place where you fit in with the peopel. Even the 'big' programs are relatively small. CHOP has 6 fellows per year (i think). Thats a big program, but still not a large number of people. My program, which is still high voluime, has 2 fellows a year. So, you better hope that you like the people you work with because there is nowhere to hide. And if you are miserable with the people you work with, your training will suffer, it doesnt matter where you are.
another thing to consider is if the program has 4th year fellows or not. I wouldnt say its a deal breaker, but theres a difference for sure. Sometimes 4th year fellows can be great if they are good teachers and can help you learn the ropes. But at the same time, if you are on cath and there is a 4th year fellow, who do you think is getting access and manipulating the catheters and doing the cath? Not the 1st year general fellow thats for sure. In contrast, if you are a categorical fellow where there is no 4th years and you are on a research month, you can do whatever you want to do. Want more cath time? Go for it. Want to focus on learning fetals? Great. Spend more time in the EP lab? No one is stopping you. So, i think it gives you some more flexibility in that regard. Again, wouldn't make that a deal breaker and certainly others will argue taht having a 4th year is better for whateve reason, but thats my thoughts.
Similar to med school, simialr to residency, similar to life in general...you will get in what you put out. There is no hand holding in fellowship. If you are proactive and want to learn and do your best to see as much as possible then you will learn and see and ton. If you approach your fellowship that way and you go to a program that is at least medium volume, you will come out well trained.
