The best preparation for a successful fellowship is a strong clinical foundation built during residency. While it may be tempting to begin focusing on fellowship early in your career, there is no substitute for the internal medicine training you will receive during residency. A strong letter of recommendation will go a long way, so you certainly want to spend some elective time in cardiology; however, most of your time should be spent learning other specialties in medicine.

How else can you prepare for fellowship during residency? Develop good relationships with a few mentors. These mentors will not only provide invaluable advice (not only for your fellowship application, but potentially throughout your career), but will likely also write your highly important letters of recommendation. You should also get to know current cardiology fellows at your program and other programs (involvement in the ACC and attendance at ACC events is a great way to go about that!), as they will be able to provide insight that only a recent applicant would know.

Publications on cardiology topics in peer-reviewed journals are the most highly valued. Among them, original research articles are more heavily weighed than narrative reviews. Oral presentations of research in national/international conferences are also valued highly. Poster presentations are lower on the hierarchy, but still very much worthwhile. However, remember that at this stage of your career any type of scholarly activity product before or during residency is very valuable in your effort to match to a fellowship program. If you are involved in projects that have not yet resulted in publication, you should list them on your ERAS application under “Experience,” and note if you are pursuing publication (e.g., you are working on a manuscript that you will be submitting for consideration).

This may be difficult to do. However, consider approaching potential mentors from outside institutions. There are many examples of mentoring relationships done successfully from a distance.

Away rotations can be very helpful if you are interested in a specific program as it could give you a chance to work with faculty from cardiology and potentially obtain a letter of recommendation that you can use in your application specifically for that program. Meeting with the fellowship program leadership during your away rotation could also be very helpful as it shows your genuine interest in the program. The best time to do that is shortly before the application season starts so that their memory of your visit is fresh.

A good cardiologist is a good internist, with a strong foundation in the basics of internal medicine. You need to be able to consider the multiple interactions between the cardiovascular system and the rest of your patient's physiology, and be able to see the big picture. Additionally, cardiologists develop meaningful relationships with patients. The best cardiologists have great communication with patients and other care providers. Being well versed in the critical appraisal of medical literature and the basics of biostatistics is important for you to gauge if any of new cardiovascular trials would apply to your patient.

A standard cardiology elective is a great place to start learning about cardiology. Cardiac subspecialty electives can help you learn about various opportunities within the field. Rotations in intensive care units or a dedicated procedural service will serve as useful settings to get procedural numbers. If a research month(s) is available, reviewing how to appraise literature and delving into basic biostatistics or performing some analysis yourself can also be useful to understand the nuances.

There are a few ways you can get connected! The ACC Member Hub is ag great platform to network. There is a new mentorship program for students and residents looking to learn more about cardiology. In addition, social media, especially Twitter, is a great place to start to network with other cardiologists from URM groups.

With ACC membership you'll get all of the latest and greatest research right to your email with complementary access to the JACC family of journals and updates from major meetings. There are also may great resources available on the web including a variety of podcasts.

If a medical resident is interested in research there are many funding sources available. It would be important to first discuss with your research mentor to see if there are any local funds available. You can also apply for funding through various organizations. Travel stipends and monetary prizes can be obtained by applying when these come available.

The field of cardiology is diverse with a variety of sub-specialities, including interventional cardiology, electrophysiology, preventative cardiology, imaging, advanced heart failure/transplant, sports cardiology, cardio-oncology, and more. There is something for everyone.

Find a place where you feel you are going to be at "home." Take the opportunity to talk to the fellows and trying to gauge how they got along and how they felt about their training environment. Finding out what kind of formal and informal mentoring happens at the program is also important to consider. It is important to reflect about what is important to you and try to identify programs that meet those needs.

At least 3-4 months before you apply, start by reviewing the ERAS directory of cardiology programs and formulating a list of programs you will apply to. Review each program for application requirements. The majority require some or all of the following:

• ERAS application (which includes a CV)
• Personal statement
• Three (less commonly, four) letters of recommendation (many programs require one letter to be from your Program Director)
• Medical school transcripts and/or Medical School Performance Evaluation (MSPE) (also known as Dean’s Letter)
• USMLE score report
• Photograph
• There may be additional requirements for IMG applicants

There is, however, some variation that you don’t want to discover at the last minute. Some schools, for example, require a letter from your Chief.

Also at least 3-4 months before you apply, think about:

• Beginning to draft your personal statement
• Scheduling meetings with your mentor(s), cardiologists you have worked with, and/or current fellows to discuss the strength of your application and the programs you plan to apply to

You should have your Letter of Recommendation (LOR) writers lined up well in advance (ideally, talk to an attending you worked well with about their willingness to write you a letter during or right after you finish working with them). Remind them of your request early in the year, and by May or June you should provide them with a finished or nearly-finished CV and personal statement so they can write your letter. Giving your LOR writer at least a month to write your letter is courteous. Importantly, note that after your LOR writer uploads your letter to EFDO, it can take up to five business days for the letter to be released and available to programs. Therefore, give your LOR writers a deadline of about a week before the date programs can start receiving applications (which is usually mid-July).

A good personal statement is concise, well-written, clearly highlights your experience with cardiology and identifies an intended career focus. Don’t try to make your personal statement too original or artistic; this isn't a college application. You can upload multiple personal statements to ERAS, allowing you to assign different personal statements to different programs. While it is generally not necessary to customize your personal statement to a particular program, some programs may have requirements regarding length and content, so check the program’s webpage well in advance.

One organizational method is to think of your personal statement as having past, present and future sections. The past section should include clinical experiences that were meaningful to you. The present section should include ongoing academic research and leadership projects. The future section should identify how you envision your career (subspecialty training, academic medicine, basic science research, etc.).

Ideally, start thinking about your personal statement at least several months before you apply. Get as many people as you can find to read it and offer feedback, including those with no cardiology experience at all.

Typically undergraduate activities are not included unless they are particularly notable or directly relate to medicine. Medical school awards and honors can be included, but medical school activities you are not still participating in should not be included.

Yes, all scholarly work, including prior abstracts, posters, and manuscripts, should be included.

This is highly variable between programs. According to self-reported data from the 2016-17 cycle, the majority of interview offers come in August and September.

Typically between early September and early November. The majority occur in September and early October.

Fellowship interviews are generally more personal. When applying for residency, you may have felt like a number: There are usually multiple interview dates per program, and many days you’ll be interviewing with 20-30 other medical students. Fellowship interviews, on the other hand, are much smaller groups. Most programs will be accepting 5-7 applicants, at most, so they may only offer 3-4 interview dates. Additionally, interviews for fellowship will be more about you liking the fellowship than them liking you. Most fellowship programs will tell you that if you’re offered an interview, you’re already qualified for the program. Now it’s up to you to decide what’s best for your interests.

This can be highly variable between programs. You should expect at least a half day of interviews, although sometimes this can be stretched across the entire day.

You will only sometimes know the names of your interviewers prior to the interview day itself. Usually you are given the names of the interviewers at the start of the interview day. In general, you should expect at least one interview with the program director or one of the associate program directors, two additional interviews with faculty members, and an additional interview with the Chief of Cardiology or other senior leader. Programs will occasionally conduct panel interviews, where you meet with multiple people at once. Typically current fellows do not interview directly but are available for discussion at applicant dinners.

Panel interviews have become more popular as a way to conduct more interviews in less time. In general, these are no different than individual interviews except that you’re asked questions from multiple people on a panel. The types of questions and your answers should not change. In some ways, these types of interviews are better as you can give the same answer without repeating yourself to 2-3 different people.

For some programs, it will be listed on their fellowship website. For others, you will obtain the information during the interview day. If neither of these options work, you can discuss this with the program director either during your interview day or following the interview with an email request.

The most important people you can talk to during your interview day are the fellows. They will be able to tell you the strengths and weaknesses of the program, as well as the responsiveness to change. If you don’t like a particular answer, ask a different fellow. If you get inconsistent answers, this should be a red flag about the program.

COCATS stands for “Core Cardiology Training Statement” and refers to the ACC’s curriculum recommendations for Cardiovascular fellowship training. The original statement and its revisions were put forth by the ACC in an effort to standardize the minimum training requirements in adult cardiology. The most recent iteration of the COCATS that was released in 2015 (COCATS 4) encompasses 15 different training areas and details specific competency based milestones for each area. Three levels of competency are defined (as described in the COCATS 4 Introduction by Halperin et al, J Am Coll Cardiol. 2015;65(17):1724-1733):

Level I training, the basic training required of trainees to become competent consultant cardiologists, is required of all cardiovascular fellows and can be accomplished as part of a standard 3-year training program in cardiology. In the case of cardiac catheterization, Level I represents training for those who will practice noninvasive cardiology and whose invasive activities will be confined to critical care unit procedures. This level will also provide training in the indications for the procedure and in the accurate interpretation of data obtained in the catheterization laboratory.

Level II training refers to the additional training in 1 or more areas that enables some cardiologists to perform or interpret specific diagnostic tests and procedures or render more specialized care for specific patients and conditions. This level of training is recognized only for those areas in which a nationally accepted instrument or benchmark, such as a qualifying examination, is available to measure specific knowledge, skills, or competence. Level II training may be achieved by some trainees in selected areas during the standard 3 year general cardiology fellowship, depending on the trainee’s career goals and use of elective periods.

Level III training requires additional experience beyond the general cardiology fellowship to acquire specialized knowledge and competencies in performing, interpreting, and training others to perform specific procedures or for the trainee to render advanced, specialized care at a high level of skill. Level III training cannot generally be obtained during the standard 3-year general cardiology fellowship and requires additional exposure in a program that meets requirements delineated in Advanced Training Statements (formerly in Clinical Competence Statements) and developed for each specialized field of endeavor. Advanced (Level III) trained faculty should be available to participate in training Level I fellows in cardiac catheterization, interventional cardiology, and cardiac electrophysiology, but are not required for Level I training in other fields.

Depending on your professional goals, obtaining Level II training in certain areas may be important (for example, Level II training in echocardiography or cardiac catheterization is highly valued in some private practice models for general cardiologists). While Level I training is the standard for all training programs, Level II training in an area of interest may or may not be feasible to obtain during the three years of General Cardiology fellowship as this will depend on the specific fellowship program’s structure and flexibility with individualizing the curriculum to a trainee’s professional goals. Information on the attainability of different levels of training during fellowship should be readily available during your application/interview process. Current and former trainees may be the best sources of information in this regard.

You will generally always interact with the program director. Even if you don’t interview with them (e.g., you met them but didn’t formally interview with them, or they were absent due to an emergency), you should still thank them for the opportunity to interview at their program. You can do so via a handwritten card or an e-mail. If you’re particularly interested in a program, thanking each interviewer may also improve your standing, although you certainly don’t need to do this for every program.

Any time after your interview but make sure that it doesn’t happen too late. Some programs (especially those doing interviews early) formulate their rank lists quite in advance, after which time it may be difficult to change their ranking significantly.

Post-interview communication is generally expected and well perceived. Programs will value a communication stating your honest interest in them. This should typically happen as soon as you have formulated the rank order of your top programs. You may also update the programs with additions to your CV that they need to consider (such as a new abstract or publication). Another way to be kept in a program’s radar is to ask your closest mentor and biggest advocate to call your top ranked program on your behalf.

Programs may be classified into the following depending on their focus: (a) primarily clinical with limited research opportunities, (b) academically oriented with expectation that fellows will be heavily involved in scholarly activities, and (c) programs with balance between the clinical and research focus and flexibility regarding their research requirements. Thus, it mostly depends on whether one is considering a career in academic cardiology or not. For those yet undecided (and it is totally fine to be undecided at this stage), the latter type of program may be a better fit. Of course, several other factors should be considered: interview day experience, potential research mentors, particular area of interest, work-life balance, experiences of current and past fellows, program leadership, family, geographic preference, etc.

Most programs may be strong in one or more areas but not in all areas. If you are certain that you want to focus on a specific area in cardiology, then it is reasonable to try to match in an institution that is strong in that area. As most subspecialty programs prioritize fellows from their general programs, this will potentially save you another round of applications and interviews (for the subspecialty). It will also mean that you can have clinical and research exposure in that particular area and establish mentorship relationships early on. However, bear in mind that many fellows change career pathways during fellowship. Therefore, unless absolutely certain about a specific area in cardiology, choosing a generally well-rounded program may be the way to go. Remember, you can always apply to different institutions for subspecialty training if your general fellowship institution is not as strong in that area.