The following are common questions asked about fellowship and the application process. Have one of your own? Send a message to Stefan Lefebvre slefebvre@acc.org.

Regarding the application process:

1. What makes a good personal statement?

What makes a good personal statement?

A good personal statement 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. Organizationally you can 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). – Ben Kenigsberg, MD

2. On the ERAS application, should we include activities from undergraduate/medical school?

2. On the ERAS application, should we include activities from undergraduate/medical school?

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. – Tyson Turner, MD, MPH

3. On the ERAS application, should we include abstracts/papers that we’ve done previously that are not relevant to cardiology?

On the ERAS application, should we include abstracts/papers that we’ve done previously that are not relevant to cardiology?

Yes, all scholarly work, including prior abstracts, posters, and manuscripts, should be included. – Tyson Turner, MD, MPH

4. When should we expect to hear back from programs after we apply?

4. When should we expect to hear back from programs after we apply?

This is highly variable between programs but some programs may contact you with an invitation for interview or a rejection within a week from submission of applications. – Konstantinos Siontis, MD

5. When do most interviews take place?

5. When do most interviews take place?

Typically early September to early November. – Konstantinos Siontis, MD

Regarding the interview day:

1. What are the differences between fellowship interviews and medicine residency interviews?

1. What are the differences between fellowship interviews and medicine residency interviews?

Fellowship interviews are generally more personal. Applying for internal medicine, 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. – Aaron Kithcart, MD, PhD

2. How many interviews are on an interview day?

2. How many interviews are on an interview day?

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. In general, you should expect at least one interview with the program director or one of the associates, two additional interviews with faculty members, one interview with a fellow, 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 (described more in another question). – Aaron Kithcart, MD, PhD

3. Will we know who we are interviewing with before the interview? Will we be interviewed by current fellows?

3. Will we know who we are interviewing with before the interview? Will we be interviewed by current fellows?

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 though. Typically current fellows do not interview directly but are available for discussion at applicant dinners. – Ben Kenigsberg, MD

4. Will we have panel interviews? What is the best way to handle a panel interview?

4. Will we have panel interviews? What is the best way to handle a panel interview?

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. – Aaron Kithcart, MD, PhD

5. How can we best find out where prior fellows have gone to practice?

5. How can we best find out where prior fellows have gone to practice?

In general, there are many different ways to obtain this information. 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. – Tyson Turner, MD, MPH

Post-interview communication and other general questions:

1. To whom should we send thank you notes after my interview? Should we thank the program director even if we do not interview with them?

1. To whom should we send thank you notes after my interview? Should we thank the program director even if we do not interview with them?

Your interview day should always include a personal communication with the program director. Even if you don’t personally interview with him or her, you should still reach out to the director thanking them for the opportunity to interview. Follow up each interview with a handwritten card or email to the program director. If you’re particularly interested in a program, then thanking each interviewer may also improve your standing, although you certainly don’t need to do this for every program. – Aaron Kithcart, MD, PhD

2. What is the best way to gauge how “fellow-driven” a program is?

2. What is the best way to gauge how “fellow-driven” a program is?

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. – Aaron Kithcart, MD, PhD

3. What are COCATs levels? What levels should we be aiming for in a fellowship program?

3. What are COCATs levels? What levels should we be aiming for in a fellowship 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 competencybased 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. – Konstantinos Siontis, MD

4. What factors should we consider when making our rank list?

4. What factors should we consider when making our rank list?

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, worklife balance, experiences of current and past fellows, program leadership, family, geographic preference, etc. – Konstantinos Siontis, MD

5. What do we do if we want to go into a particular program but it is not strong in our expected area of interest? Should they be ranked lower because of that?

5. What do we do if we want to go into a particular program but it is not strong in our expected area of interest? Should they be ranked lower because of that?

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. – Konstantinos Siontis, MD

6. How important is it to do outside rotations at a particular program of interest? When is the best time to do these rotations?

6. How important is it to do outside rotations at a particular program of interest? When is the best time to do these rotations?

This 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. – Konstantinos Siontis, MD

7. How should we obtain a mentor when doing residency training at a program without strong research capabilities?

7. How should we obtain a mentor when doing residency training at a program without strong research capabilities?

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. Such opportunities may also be explored via ACC’s Mentoring Program (ACC.org/Mentoring). – Konstantinos Siontis, MD

8. When is the best time to ask your residency faculty to make calls in support of your application?

8. When is the best time to ask your residency faculty to make calls in support of your application?

Anytime 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. – Konstantinos Siontis, MD

9. How much does post-interview communication from the fellowship program matter?

9. How much does post-interview communication from the fellowship program matter?

In the vast majority of programs this matters a lot, certainly quite more than in residency recruitment. When a program director calls you in an unsolicited fashion (especially when this is shortly before the rank list submission deadline), they do it because they are interested in recruiting you. Keep in mind that programs may vary with regards to their approach to post-interview communication. Some programs never call or email even if you are their number one rank so do not be discouraged if you haven’t heard from them. – Konstantinos Siontis, MD

10. What is the best way to stay “on the radar” of programs after the interview?

10. What is the best way to stay “on the radar” of programs after the interview?

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. – Konstantinos Siontis, MD

11. How should we allocate our time during residency in order to be the best fellowship candidate? Should we devote more time to being the best clinical resident or should we ensure we have time for fellowship?

11. How should we allocate our time during residency in order to be the best fellowship candidate? Should we devote more time to being the best clinical resident or should we ensure we have time for fellowship?

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. – Aaron Kithcart, MD, PhD

12. What research is most worthwhile? How should we weigh abstracts versus posters or papers?

12. What research is most worthwhile? How should we weigh abstracts versus posters or papers?

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 and then follow poster presentations. 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. – Konstantinos Siontis, MD