interventional cards and "fast track"

[blakey]

Anyone know of programs that have "fast tracking" for cardiology?

I heard some programs will allow you to do 2 years of IM, and then move onto fellowship...Also, some programs allow you to combine the cardiology and interventional fellowships into something more manageable.

So therefore it would concievably be possible to be an interventional cardiologist after 5-6 years...so I've heard (rumors). Anyone know this as fact, or is this just not true?

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[njbmd]

•••quote:•••Originally posted by blakey:
•Anyone know of programs that have "fast tracking" for cardiology?

I heard some programs will allow you to do 2 years of IM, and then move onto fellowship...Also, some programs allow you to combine the cardiology and interventional fellowships into something more manageable.

So therefore it would concievably be possible to be an interventional cardiologist after 5-6 years...so I've heard (rumors). Anyone know this as fact, or is this just not true?•••••Hi there,
I know that many surgical programs are considering "fast tracking" residents for Cardiovascular and Thoracic Surgery. These programs enable a senior resident to do more cases in their specialty and a little less in General Surgery. The reason cited for "fast track" is that the General Surgery residency is already 5 years at most places and 6 to 7 at others. If you combine this with a Cardiovascular Surgery fellowship, you have committed a huge block of time to post-graduate training. I have not heard that this has been bantered for Internal Medicine Specialties.

 

[task]

Fast-tracking in IM is typically done by those who plan a research/academic career and can justify leaving an IM residency after two years by planning to go a lab for a few years in as part of or as a prelude to a fellowship. Where I train, one of my residents this year is fast tracking into ID at Baylor in Houston -- so he'll finish his second year of IM this year and then "fast-track" into fellowship -- however, he is spending two years in research work before doing the clinical portion of his training, what would have been 3 years IM and 2 years fellowship is now 2 years IM and 4 years fellowship. 6 years either way.

Another guy in my program is fast-tracking into an Endocrine fellowship at the Brigham. He has funding to set up his own lab there, so who knows how long he'll be in the research portion of his fellowship before he does the clinical part.

One of my co-interns plans to do Cards, and has a lab waiting for him at the end of next year. He plans 2-3 years of research and will apply to Cards fellowship during one of those years. The lab he's going to is indirectly related (maybe) to Cardiology, but he loves basic science.

So bottom line, fast-tracking is allowed to so that you can move on to the next phase of training a year early because you're gonna be spending more time in post residency (fellowship with significant research time) then if you did the traditional route.

Also, if you notice above, the people fast tracking are going in to research heavy non-competitive fellowships. My friend going into Cards does not have his fellowship yet, but will be applying for it during his research tenure.

As a general rule, because of the competitive nature of Cards and GI, people fast-tracking into them is pretty rare. There are always the people who have 3 PhDs in cardiovascular physiology or in liver metabolism that can say with credibility that they will be pursuing an academic/research career who may be able to justify and make such an arrangement, but that's obviously pretty rare.

Hope this helps.

 

[task]

Oh, and with regards to combining general Cards fellowship with intervention (or EP) or whatever.....

About half the Cardiology fellowships out there are three years. About half are 4 (12 months of dedicated research). Many Interventional programs are 1 year, but most are turning into 2 years because peripheral vascular interventional techniques are being taught as well. EP is 2 years. Duke is one place I know of that has their fellows "declare" so to speak what their interest is -- intervention, EP, ECHO, preventive, whatever, and focus on that during the latter part of their fellowship -- whether this translates into saving any time or allowing you to count cases toward getting a CAQ in intervention or whatever, I don't know. And I don't know how common Duke's philosophy is amongst other fellowships.

For EP, I've heard it's much more common to turn your final year of "general" Cards fellowship into a first year of EP so that you'd only have to do one more year to be trained in this field.

 

[droliver]

Don't you have to be at least board-eligible in Medicine to do a fellowship?

 

[task]

You can sit for the ABIM exam after 2 years of residency. While most competitive fellowships require board certification (and most give you the first year of fellowship to take the test) others just stipulate board eligible. But with the trends in credentialing, etc., I'm sure that will all change and everyone will have to sit for the ABIM.

 

[droliver]

Task,

are you sure? This is from the ABIM site:

"To be admitted to the Certification Examination in Internal Medicine physicians must have completed, by August 31 of the year of examination, 36 months of graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec. Residency or research experience occurring before the completion of the requirements for the M.D. or D.O. degree cannot be credited toward the Board?s requirements.

The 36 months of residency training must include (1) a minimum of 12 months of internal medicine training at the R-1 level, and (2) a minimum of 24 months of training in an accredited internal medicine program, 12 months at the R-2 level and 12 months at the R-3 level."

"Physicians who are awarded a certificate in a subspecialty or area of added qualifications must have been previously certified in Internal Medicine by the ABIM, completed the requisite training, demonstrated clinical competence in the care of patients, and passed the subspecialty or area of added qualifications examination. Diplomates must maintain a valid underlying ABIM certificate to maintain certification in an added qualification"

This seems pretty unequivocal that you must do 3 clinical years to sit for IM boards & you must be IM boarded to to recieve certification in your subsequent subspecialty, no?

 

[task]

droliver,

Here's details about the exception from the ABIM website, which I probably should have conveyed more clearly before:

"RESEARCH PATHWAY

The research pathway is intended for trainees who anticipate academic careers as investigators in basic science or clinical research. It integrates training in clinical medicine with three years of training in basic or clinical research. Although prospective planning of this pathway by trainees and program directors is necessary, prospective approval by the Board is no longer a requirement. Program directors must document the clinical and research training experience through the Board?s tracking program.

At least 36 months of research training in which the trainee devotes 80% of time to research and 20% to clinical work as described in the following chart are required. The Board defines research as scholarly activities intended to develop new scientific knowledge. The research experience of trainees should be mentored and reviewed; training should include completion of work leading to a graduate degree (if not already acquired) or its equivalent. The last year of research training may be undertaken in a full-time faculty position if the level of commitment to mentored research is maintained at 80%.

During internal medicine research training, 20% of each year must be spent in clinical experiences including a half-day per week in a continuity clinic. During subspecialty research training, at least one half-day per week must be spent in an ambulatory clinic. Ratings of satisfactory clinical performance must be maintained annually for each trainee in the ABIM Research Pathway.

The specific requirements for the Research Pathway are set forth in the chart below.



Internal Medicine Research Pathway

Internal medicine training 24 months
Direct patient responsibility 20 months
Research training (80%) 36 months
Clinical training during research (20%) ~ 1 day per week
Total training 5 years
Internal Medicine examination August, PGY-5

Subspecialty Research Pathway
Internal medicine training 24 months
Direct patient responsibility 20 months
Subspecialty clinical training (80%) 12-24 months*
Research training (80%) 36 months
Ambulatory clinic during research training (10%) ~ 1/2 day per week
Total training 6 or 7 years*
Internal Medicine examination August, PGY-4
Subspecialty/AQ examination November, PGY-6 or 7"

 

[task]

So let me clarify --

You can sit for the ABIM after two years of acutal IM residency in the context of one of these research pathways. Doesn't seem like otherwise.