What should I do?

[lubdublin1985]

I am currently an interventional cardiology fellow at a semi-private hospital where I am concerned that my job as a trainee is mainly reduced to secretarial work without much emphasis on building the actual procedural skills.

Currently I am required to do all the paper works for each patient (diagnostic LHC, RHC, etc) as there aren't enough general cardiology fellows.

I am also responsible for prepping the patient/table as well as helping with clean up after and rarely patient transport.

When it comes to actual hands-on training, I am doing negligible amount, especially when it comes to PCIs. Even in stable patients, I am doing minimal amount of actual procedural work. I am frustrated that at the first sign of struggle or hesitation, the procedure is taken out of my hand. By the way, I have been a safe operator so far and have not given my current attendings any reason to doubt my skills or medical decision making.

I have tried to bring it up to the PD in a polite manner but to no avail.

I am concerned that I will not graduate as a competent operator and that my time here is not being spent the way it is meant to be.

Does anyone have any suggestion on how to provide the program with constructive feedback (so far does not seem open to it). What about alternative ways I can look to improve my skills independent of my current fellowship? Finally, is this something I should report to ACGME?

Thanks.

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[Egghead34]

Can you explain how your talks with PD have been unhelpful? Are they uncaring towards your plight, or do they not know how to help you? Makes a big difference in how to tackle the issue.

Regarding procedures being taken away, that is a limitation of the attending. You can talk to them directly and ask that they not jump in so suddenly. Otherwise try to identify the attendings who aren’t so prone to jumping in.

Tough situation, but you present it in a thoughtful and mature way

 

[Phospholipid]

I am currently an interventional cardiology fellow at a semi-private hospital where I am concerned that my job as a trainee is mainly reduced to secretarial work without much emphasis on building the actual procedural skills.

Currently I am required to do all the paper works for each patient (diagnostic LHC, RHC, etc) as there aren't enough general cardiology fellows.

I am also responsible for prepping the patient/table as well as helping with clean up after and rarely patient transport.

When it comes to actual hands-on training, I am doing negligible amount, especially when it comes to PCIs. Even in stable patients, I am doing minimal amount of actual procedural work. I am frustrated that at the first sign of struggle or hesitation, the procedure is taken out of my hand. By the way, I have been a safe operator so far and have not given my current attendings any reason to doubt my skills or medical decision making.

I have tried to bring it up to the PD in a polite manner but to no avail.

I am concerned that I will not graduate as a competent operator and that my time here is not being spent the way it is meant to be.

Does anyone have any suggestion on how to provide the program with constructive feedback (so far does not seem open to it). What about alternative ways I can look to improve my skills independent of my current fellowship? Finally, is this something I should report to ACGME?

Thanks.

I am also an Interventional Fellow, so keep my advice with a grain of salt.

I feel that the most you learn is maybe the first month of practice, when you are completely independent. I know you may not feel like you are learning much, but being a 2nd operator, and watching the decision making, wire selection, balloon, stent sizing, watching the mistakes they make and how they bail themselves out...you do gain a lot of experience in that way. Although ideally you should be doing the wiring, balloon placement and stuff, I wouldn't discount your experience as a 2nd operator.

I am in a program that fortunately at least lets us do the diagnostic portion alone in the room, and we have a mix batch of attendings who lets you do all the intervention, and some who does it all and you just watch. But like I said, in the end of the day, you learn the most when you are completely independent, and that will come in yr first month of practice. Just make sure you have a good mentor in your first job.

I would also not report it to ACGME. Ironically, it may screw you over in the end. Just suck it up, graduate, and learn on the job. If you pay attention enough as a second operator, you can still learn on the job, and be safe. Gluck!

 

[cardsguy2017]

I'm not surprised of your experience and anecdotally it doesn't seem uncommon. Seemingly, there are even some big name (mostly academic places) where fellows have similar experiences. It's partly the reason why many say it takes a few years to get proficient at the skills. Just keep at it and absorb as much as you can. Have a serious talk to the PD but I wouldn't necessarily report to acgme.

 

[lubdublin1985]

@Onion01 I had a discussion with my PD regarding the concerns I have and though he did not seem uncaring, he was not perturbed and nor did have a solution. H mentioned that it is a frustrating situation but apparently it is normal for the attendings to be that hands on especially so early in the year. The attendings who give us more autonomy are unfortunately not the core faculty we work with.

@Phospholipid and @cardsguy2017 Though there is always something to take away from a case, IMHO it is minimal compared to the experience gained as the 1st operator. I can tell you what my plan would be for most of the basic PCI cases now that I am two months in, however it's another thing to implement the plan into action. To safely and effectively carry out the plan requires a consistent hands-on exposure that an additional year in training interventional cardiology is meant for. This is my opinion based on seeing fellows in the cath lab in residency and then in general cardiology fellowship. Your points are well taken, however, regarding paying extra attention as the 2nd operator to learn from the attending's mistake. My fear is making a big mistakes as a new attending not because I did not know the potential complications of a procedure but because of a lack of adequate training in dealing with the complications.