Question for Fellows: How to prepare for July 1st - first day of fellowship

[ucladukes]

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This question is mainly for the current fellows out there. I am starting fellowship this July 1st and I am a little nervous. I was wondering, based on your experience, what did you do to prepare / what do you wish you did differently to prepare for your first month or first call of fellowship.

Thanks in advance for any advice or input.

 

[cardsfellow2007]

This question is mainly for the current fellows out there. I am starting fellowship this July 1st and I am a little nervous. I was wondering, based on your experience, what did you do to prepare / what do you wish you did differently to prepare for your first month or first call of fellowship.

Thanks in advance for any advice or input.

At my fellowship we don't take call until Sept 1st. You need to prepare for call depending on what your responsibilities are going to be. If you have to perform echo's in the middle of the night then spend a couple of hours with an echo tech to get the basics down. The same goes for interrogating devices, placing transvenous pacemakers, and swan's. For me it was never an issue with medical knowledge as I was coming from a resident run program where the fellow took “home call.” Putting your first TV pacer in someone with a HR of 20 at 2am by yourself is scary, but really not that difficult. If you have any problem interrogating a pacemaker then you can always call the rep for help. In all likelihood you will have some kind of backup. The three year fellowship will develop you into a cardiologist; you aren't supposed to come in as one.

 

[tibor75]

At my fellowship we don't take call until Sept 1st. You need to prepare for call depending on what your responsibilities are going to be. If you have to perform echo's in the middle of the night then spend a couple of hours with an echo tech to get the basics down. The same goes for interrogating devices, placing transvenous pacemakers, and swan's. For me it was never an issue with medical knowledge as I was coming from a resident run program where the fellow took "home call." Putting your first TV pacer in someone with a HR of 20 at 2am by yourself is scary, but really not that difficult. If you have any problem interrogating a pacemaker then you can always call the rep for help. In all likelihood you will have some kind of backup. The three year fellowship will develop you into a cardiologist; you aren't supposed to come in as one.

Don't waste your timing doing any of this. fellowships assume that on day 1, you have no idea on how to read an echo or interrogate a device. That's what fellowship is for. Besides, spending a few hours with an echo tech won't teach you anything. You need to spend a month with echo techs and attendings before you are even close to being competent to do an echo. Being an expert on placing Swans is a plus, but every IM program is different - some programs don't place as high of a priority on procedures than others.

If you want to do anything useful, read up on clinical trials.

 

[cardsfellow2007]

Don't waste your timing doing any of this. fellowships assume that on day 1, you have no idea on how to read an echo or interrogate a device. That's what fellowship is for. Besides, spending a few hours with an echo tech won't teach you anything. You need to spend a month with echo techs and attendings before you are even close to being competent to do an echo. Being an expert on placing Swans is a plus, but every IM program is different - some programs don't place as high of a priority on procedures than others.

If you want to do anything useful, read up on clinical trials.

Again, it depends on your fellowship...obviously were tibor is coming from they start you from the ground up. The first week of my fellowship we had a brief intro on how to do an echo and interrogate a pacemaker then, two months later, it was off to the races. We did have a backup fellow to call with questions for the first six months.

Cardiosource.com has great excerpts on trial data with respect to treatment strategy, landmark trials, and guidelines.

 

[gerald78]

Don't waste your timing doing any of this. fellowships assume that on day 1, you have no idea on how to read an echo or interrogate a device. That's what fellowship is for. Besides, spending a few hours with an echo tech won't teach you anything. You need to spend a month with echo techs and attendings before you are even close to being competent to do an echo. Being an expert on placing Swans is a plus, but every IM program is different - some programs don't place as high of a priority on procedures than others.

If you want to do anything useful, read up on clinical trials.

hi tibor,
do you know of any listings on the web of important clinical trials? with links to full text would be great, but just a list is a good start. thx,

gerald78

 

[drdavemd]

gerald78: Definitely check out Cardiosource, best clearinghouse of Cards trials on the web.

Regarding what to know on day 1, if you knew it all you wouldn't need a fellowship. In a couple of hours with a tech, you can at least turn a machine on and estimate EF or see that someone's anterior wall is acutely down.

The more you know about the current state of practice, the better you will be, but I know it takes me several times hearing the acronym of a well-known trial before I have it in my head.

The other source I would consider is the ACC practice guidelines. They can be a little dry and dense, but some have great graphics illustrating how to systematically approach common Cardiology problems like tachycardias or ACS.