Interventional fellowship

[docscoobie]

I am scheduled to start my Interventional year in 2014. I just received a call from my PD, asking if I would be interested in postponing my ACGME PGY 7 to 2015 and instead start 2014 as structural fellow, training in TAVR, mitraclip, etc. The center is a high volume TAVR center, so I'd have to ensure (if I take on the offer) that I actually get to do several of them as primary operator, especially towards the later part of my structural year. I am currently doing some PCIs including non type A & shd have ~150 by end of my PGY 6, so hopefully I can get onboard with being 'structural' fellow soon after.
I plan to have an academic career in the future.
I need your input, if this is a good idea & what pitfalls should I be looking for.

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[docscoobie]

I am scheduled to start my Interventional year in 2014. I just received a call from my PD, asking if I would be interested in postponing my ACGME PGY 7 to 2015 and instead start 2014 as structural fellow, training in TAVR, mitraclip, etc. The center is a high volume TAVR center, so I'd have to ensure (if I take on the offer) that I actually get to do several of them as primary operator, especially towards the later part of my structural year. I am currently doing some PCIs including non type A & shd have ~150 by end of my PGY 6, so hopefully I can get onboard with being 'structural' fellow soon after.
I plan to have an academic career in the future.
I need your input, if this is a good idea & what pitfalls should I be looking for.

Any help please?

 

[Keg]

I'd do it.

 

[IMDoc607]

I am scheduled to start my Interventional year in 2014. I just received a call from my PD, asking if I would be interested in postponing my ACGME PGY 7 to 2015 and instead start 2014 as structural fellow, training in TAVR, mitraclip, etc. The center is a high volume TAVR center, so I'd have to ensure (if I take on the offer) that I actually get to do several of them as primary operator, especially towards the later part of my structural year. I am currently doing some PCIs including non type A & shd have ~150 by end of my PGY 6, so hopefully I can get onboard with being 'structural' fellow soon after.
I plan to have an academic career in the future.
I need your input, if this is a good idea & what pitfalls should I be looking for.

I would do that in a heart beat. That sounds like a home run.

 

[sanj238]

error

 

[sacrament]

I think the key question is: do you actually have any interest in structural heart disease?

 

[docscoobie]

Thank you for your comments. Like many others I had been sitting on the fence about formal structural heart training versus learning on the job under preceptor. I finally decided that being a newly trained interventionalist I'd be better off having formal hands on training, since in most labs veteran interventionalists are cross training in structural, so I may not have much of a standing being fresh out of PGY 7. So I have decided to go ahead with 2 year training. Hopefully I don't have extremely difficulty finding interventional job with some structural options in 2016, when PARTNERS 2 results expand TAVR indications & smaller profile valves would not require too many transapical approach. We will see.
Thanks again for your help.

 

[CanIMakeIt]

I discussed your situation with one of the attendings and they said that you need to be good with wires etc before you will be better with structural manipulations. Also, he said if you do structural first and then do your interventional then you will be rusty with your structural training. At least he thought it would be better to do interventional and then structural training FWIW.

 

[Trifling Jester]

If you want academics then I guess I'd do it. Many people will get grandfathered in for structural stuff without needing a dedicated fellowship for it.

 

[hipopanonymous]

Trifling Jester is wise, as you'd expect from somebody in New Orleans with the cover for Confederacy of Dunces as their avatar.

I find it odd that all these structural fellowships are popping up when you consider how no leading structuralist today had any sort of structural fellowship training. Go back 30-35 years and there was no such thing as interventional fellowship. Go back 20 years and hardly anybody was using stents excepts as bailout for failed ballooning. Balloon aortic valvuloplasty, peripheral, PFO closure etc etc are within that time frame as well. With all of these innovations, formal training was never an entry requirement for those who didn't have the technology in training. I find it hard to believe that in 10 years, if all of a sudden we're doing lots of TAVRs on medium risk patients that people who finished interventional fellowship 5 years ago are going to be shut out. What I think is more likely is that they'll just continuously relax the requirements on who can do them until it shakes out that every group or center will have 3-4 guys doing TAVR via 10-12 french.

Good luck with the fellowship