Calming the Nerves and Hitting Your Stride: Seven Tips for New Interventional Fellows

2016-2017 Fellow Talk Bloggers       
 

A new academic year is upon us, and that means changed roles for nearly every level of trainee in residency and fellowship programs. This can be incredibly daunting, particularly for interventional cardiology fellows, many of whom are coming off an extended period of research time and may not have spent many hours in the lab recently. While dusting off your skills as an operator is usually quick after a few days back, a structured approach to the early part of your interventional training can lead you to a more successful and fulfilling year. 

Undoubtedly, fellows are focused on procedural volumes—initial skills are for better or worse gained through pure experience—but very likely this will not be an issue in the long run. It is easy to be focused on a desire for more and more PCI cases. However, other aspects of the interventional fellowship should also be prioritized in the beginning of your interventional year.

Here are my seven tips for how new interventional fellows can be successful in the early weeks of fellowship:

1. People matter—be friendly and network

Nearly every interventionalist will agree that having a positive working relationship with all cath lab personnel—nurses, technologists, IT specialists, patient transport workers, emergency department physicians and staff, housekeeping staff, and countless others—will make life as an interventional fellow significantly easier. Consider introducing yourself to everyone you encounter in your first few weeks to start off on the right foot. Additionally, make a concerted effort to introduce yourself to visitors such as grand rounds guests at your hospital and key opinion leaders at conferences. Lastly, industry representatives not only can teach you invaluable tips and tricks about the equipment available in your lab, but also may be able to help with your search for a full-time position after fellowship. 

2. Don’t be afraid to dive right into cases as primary operator

Interventional fellowship is not a time to be an observer, as there are limits to what you can learn in books and even with multimedia. Being the first operator during a case is an entirely different experience, and you are 100% responsible for the patient both during and after the procedure. Be aggressive, but also be aware of when you are in over your head and learn to ask for help. The times when you do not know something are key opportunities to hone your skills, of which clinical decision-making is arguably the most important. It is also useful to spend extra time in the lab before or after cases are done for a chance to really learn your equipment and all of its capabilities. 

3. Identify key resources for learning

You can never be too prepared, especially if you have never performed a specific procedure before. There are many excellent reference textbooks are available (I recommend Grossman & Baim and Topol & Teirstein). Additionally, take advantage of online resources such as the SCAI FIT portal, TCTMD Fellows Forum, and the ACC Fellows in Training Section, all of which offer a wide variety of materials free of charge to fellows. Lastly, identify a handful of journals most relevant to your practice and read them regularly. 

4. Attend the meetings most relevant to your interests

Conferences serve as a great place to learn basic skills and stay up to date with current research, equipment, and guidelines. You might even be able to present some of your own work or interesting cases you have done. Of course, these meetings also are excellent places to network. The ACC and AHA annual sessions both contain interventional tracks, while TCT, SCAI, and CRT all are interventional-focused and offer more opportunities to connect with others in the field. Make an effort to attend at least one meeting each year, and check with your program director or national organizations to see if funding assistance is available. However, keep in mind that hands-on learning typically is much higher yield than didactic sessions; while conferences are often valuable, prioritize your time in the lab and only attend the highest-yield meetings. 

5. Start thinking about next steps

It is never too early to start thinking about what comes after fellowship. It may be a bit premature to start a job search in July of your interventional year, but knowing what type of position you will eventually be seeking will allow you to tailor your learning. Consider spending some time in the echocardiography lab, nuclear imaging lab, and/or CT imaging lab if these modalities will play a major role in your future career. It may also be worthwhile to seek formal certification in one or multiple of these areas—often this requires you to read certain numbers of cases or enroll in formalized coursework. 

6. Don’t forget about your patients and their families

It is very easy to get caught up in the fast-paced nature of the cath lab, particularly if you are training at a high-volume program. However, keep in mind that one of the major reasons for pursuing advanced training is ultimately to help patients. Make an effort to meet each patient (and their family, if possible) before they are placed onto the table in the lab. Postprocedure, updating the family is incredibly important as the patient’s loved ones are often quite concerned during cases. It’s easy to rely on your faculty to do this, but avoid this trap if possible. Following up later in the day with your patient, and the next day if they stay overnight, not only strengthens the bond you have established with them, but also serves as a learning opportunity for you to see their improvement in symptoms or deal with any complications.

7. Make time for yourself and stay healthy

It is quite obvious that interventional fellowship is grueling. You will be challenged physically, emotionally, and mentally, and making an effort to prioritize yourself is a key part of maximizing your training experience. Protect yourself from radiation exposure, stay fit with a regular exercise routine, find ways to manage stress, attempt to keep a normal sleep schedule, and balance out-of-work relationships so that you do not lose touch with people who are important to you in life. Lastly, make time for your hobbies and interests, and you will likely find your mood and productivity both will stay consistently higher than they would otherwise. 

Adjusting to your new role as an interventional fellow is quite challenging at times, but the transition can be smooth, exciting, and fulfilling. Before you know it, you will be a seasoned fellow with a rapidly increasing repertoire and on your way to achieving the skills of the operator you have worked so hard to become.