Mentoring From FIT to Early Career
During the transition from training to practice and beyond, there is no step-by-step plan for success or formula for the perfect career. It is an exciting yet confusing time and it is important to have someone to lean on for support and give advice when needed. Scott Lilly, MD, PhD, FACC, a member of the College’s Early Career Section and an interventional cardiologist, and Arun Kamanthareddy, MD, a first-year fellow in training (FIT), are a good example of such a relationship. Through their mentorship, formed using the ACC’s Mentoring Program, they work together to navigate the challenges of cardiovascular practice. Below is an interaction between Lilly and Kamanthareddy, which showcases the importance and benefits of mentorship.
Kamanthareddy: What made you interested in becoming an interventional cardiologist?
Lilly: It was a procedural specialty and you get immediate feedback on what works and what doesn’t. You meet people at a pivotal crossroads in their life and often you can help them.
Kamanthareddy: At what point in your training did you realize procedural cardiology was what you wanted to work towards?
Lilly: I’m not sure procedures appealed to me in the beginning, but once I went to the cath lab I realized they were a lot of fun! I was exposed to the breadth of what procedural cardiology has to offer. I loved that hemodynamics were emphasized, I felt the patient could leave the lab with a well-rounded diagnosis and treatment plan.
Kamanthareddy: How did you work towards becoming an interventionalist once you got into cardiology?
Lilly: I was very fortunate that I didn’t have to leave one institution to train at another. I trained at the University of Pennsylvania and during clinical rotations I had cath lab rotations with Howard Hermann, MD. I asked him if he would have me as an interventional fellow and that was that.
Kamanthareddy: What do you know now that you wish you knew during training?
Lilly: As a fellow, everything is incredible. You show up in the morning and look at the board and see several cases – three or four of which are outside the norm and incredibly interesting – and you have this perspective that you’re going to leave training, start your job and have these exciting and odd cases every day. Well, that’s not reality when you first start out. It takes a while to earn the big cases and to establish your sub-specialty in relation to the patient mix.
Kamanthareddy: As a fellow, a lot of my peers are scared to enter into a procedural specialty due to the inherent high risk of the field. How do you overcome the fear of failed procedures as an interventionalist?
Lilly: Complications happen. You go into a procedure and advise the patient of the complication rate, and do your best to perform a safe procedure. However, mistakes happen, and things happen in the lab that are out of your control; that’s just the nature of procedures. As a new guy right out of training, you want to get a number of straight-forward cases under your belt, establish yourself and polish your technical skills. That being said, things happen. We all care for critically ill patients, and you need to go into the next case resolving to help.
Kamanthareddy: What is your biggest success or “ah-ha” moment to date?
Lilly: I don’t think it’s any one accomplishment, but the pivotal point in my career was getting into the interventional program at the University of Pennsylvania. The faculty there has a cognitive approach to interventions, and the opportunity to learn from them was special. I feel that it set me up to succeed in my career and I gained a wonderful group of mentors.
Kamanthareddy: So how do you maintain your mentee relationship with those mentors from your institution?
Lilly: Generally when you work for someone for a few years and you click, they have an interest in seeing you succeed. When a clinical trial comes up I can ask them how to engage the sponsor, or I may ask advice on getting funding or writing a paper. If they know of openings or information that can help me in my career they reach out. I also find the time to send them an email now and again just to say “hi” and let them know how I’m doing to maintain the connection.
Kamanthareddy: Being an interventionalist is very stressful. How do you unwind?
Lilly: I think cardiology and certainly interventional cardiology defines you as a person. To be in this field, you have to derive pleasure from your interactions with patients and love what you do. When I’m not in the cath lab, I play with my two boys, who are now 10 months and three years old. We go to the garden center and the zoo and do fun stuff like that. I also used to do a lot of camping and canoeing. My boys are too small for that now, but one day!
Kamanthareddy: With this ever-changing field, it is so important to stay up-to-date. How did you keep up with the literature during fellowship and how do you keep up with it now?
Lilly: Well, fellowship was a little different because I was focused on the basics of cardiology, and kept up with the literature through journal clubs and such. When I started out as an interventionalist, I resolved to read the Journal of the American College of Cardiology (JACC) and the New England Journal of Medicine (NEJM) a half-hour every morning, but it’s hard for me to keep that schedule. Now, I get things from ACC.org, scroll through the contents of JACC, NEJM, etc., and I review papers in my field. It is also helpful to be around residents, fellows and other interventional cardiologists. Our discussions keep me on my toes.
Kamanthareddy: What do you love most about your job?
Lilly: It’s fulfilling. I get to interact with patients at an important time in their life. I also get to interact with fellows and house staff. Often times what more established physicians have forgotten, the fellows remember and it’s a great exchange of knowledge. I love the feeling of community. It keeps you on your toes and I love being part of something bigger.
Kamanthareddy: I am in my first, almost second year of fellowship and know I also want to be an interventionalist. What can I do to ensure I get there?
Lilly: You’re ahead of the game just by knowing you want to go into invention your first year. I would start by making it very clear to your training program that you want to specialize in intervention. And when you interact with physicians in practice and at meetings you say: “I’m working to become an interventionalist and here are some of the things I’ve done. I’m not ready for practice yet but I will be soon and wanted to introduce myself.” You can’t be shy, just go up, shake hands at meetings, introduce yourself and hand out your card. You have already achieved so much and have an impressive resume – you’ll be great! And lean on your mentor!
Kamanthareddy: Thank you Dr. Lilly. Once I spoke to you, it was clearer in my mind that I wanted to be in the interventional field. What should I do to polish my skills during my training?
Lilly: There’s two parts to this. Most people can be taught to be proficient with procedure. I encourage you to try and look at the cognitive part of interventional cardiology. Look at what you are doing and understand why it’s right. You need to focus on the technical part because it’s new, but if you go slow and ask questions the technical skills will come. The mental part is lifelong, and a behavior you need to establish early.
Learn more about the ACC’s Mentoring Program at ACC.org/Mentoring.
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