Adopting a hybrid attending-fellow-in-training (AFIT) training model may offer a solution to funding an additional year of training for structural heart disease (SHD) trainees, while also allowing them to act as part-time interventional cardiology attendings, according to a Fellows in Training/Early Career column published Feb. 12 in the Journal of the American College of Cardiology.

Abdul Moiz Hafiz, MD, FACC, and Marie-France Poulin, MD, FACC, discuss the lack of standardized curriculum for SHD fellowship programs and the difficulties to attain secure funding as programs are not accredited by the Accreditation Council for Graduate Medical Education. To resolve this issue, the authors suggest using an AFIT model, allowing clinical time to be divided into two major categories: SHD fellowship training and interventional cardiology attending responsibilities.

Through the AFIT model, trainees are advised to allocate at least 80 percent or more of non-vacation time from the academic year to SHD fellowship training, as this time will maximize SHD training and allow for sufficient maintenance of non-SHD skills. The authors explain that since the fellows’ most important role is to gain new SHD skills, SHD procedures should be a priority.

For the remaining 20 percent of the time, the AFIT model recommends that trainees dedicate it to interventional cardiology attending responsibilities. The attending clinical time should then be divided into three categories: interventional cardiology attending in the catheterization laboratory (about one day a week), clinical service time (about three weeks per year) and an optional outpatient clinic.

Through both categories of the AFIT model, SHD fellows gain independence as attendings in general cardiology and interventional cardiology, while also having protected time to learn SHD interventions. This model aims to prepare fellows for both academic and private practices, and allow trainees to maintain and improve their other cardiovascular medicine skills.

The authors point out that while the AFIT model is promising, further studies are still necessary to determine if graduates of AFIT model programs gain sufficient SHD skills compared with graduates of traditional non-AFIT model SHD fellowships. In the meantime, the authors conclude that "careful planning, flexibility, and continuous self-assessment are integral to successfully make this training experience a professionally rewarding one for both the trainee and the program."

In a response, Rani K. Hasan, MD, MHS, and Jon R. Resar, MD, FACC, note that although the AFIT model is attractive in that it allows for both the continued development of coronary skills and SHD training, there are still major disadvantages, such as the proposed mechanism for self-funding and unavoidable schedule conflicts. “Ultimately, we must develop a sustainable training model that allows for rigorous SHD training while balancing the maintenance of non-SHD interventional skills,” Hasan and Resar conclude. "In the meantime, the AFIT may be a fit."

Keywords: Fellowships and Scholarships, Self-Assessment, Education, Medical, Graduate, Accreditation, Curriculum, Private Practice, Ambulatory Care Facilities, Catheterization

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