This post was authored by Akhil Narang, MD, a fellow-in-training at the University of Chicago.

Most cardiology fellows spend the majority of their rotations in the inpatient or laboratory setting. Whether it’s the catheterization lab, electrophysiology lab, stress lab, imaging lab, consult services, or the coronary care unit, fellows-in-training become well versed in these key domains. The Accreditation Council for Graduate Medical Education mandates fellows also spend one half-day per week caring for patients in the ambulatory cardiology setting. In addition to weekly continuity clinic, fellows often get varying degrees of outpatient training in preventative cardiology, lipidology, hypertension clinic and vascular clinic. Are these outpatient experiences sufficient to enable fellows to confidently care for patients in the ambulatory setting?

After completing fellowship, regardless if one pursues subspecialty training, much of the practice of cardiology takes place in the ambulatory domain. There is no doubt that the busy inpatient services and laboratory experiences better equip fellows to take care of the most complex patients. While it’s likely that many of the inpatient skills translate into the outpatient realm, outpatient cardiology is fundamentally distinct from inpatient cardiology. What are your strategies for ensuring you’re well equipped to efficiently see patients while providing high quality care?

Beyond acquiring the knowledge base of outpatient cardiology, I first needed a system to approach clinic. At present, I use the inbox function in the electronic medical record to keep track of studies or tests I’ve ordered on patients I see in clinic. Whenever a new result is available, it is automatically forwarded to my inbox for review. I also keep a clinic notebook with a list of all patients with a brief note on whether I need to follow-up on an electrophysiology referral or to touch base with a patient after a recent hospitalization. While busy attending cardiologists will typically rely on their ancillary staff to complete these tasks, as a trainee, there is value in following up on your own patients. This system works for me at present but once I start seeing dozen(s) of patients in a half day (compared to the five or six currently), the paperwork, whether electronic or physical, will accumulate substantially.

With respect to developing an adequate knowledge base of outpatient cardiology, a busy cardiologist is challenged by keeping up-to-date. Practice guidelines are essential for this reason. Familiarity with ACC/American Heart Association guidelines on valvular disease, perioperative care, treatment of stable ischemic heart disease, atrial fibrillation, cholesterol, among many others is imperative. While the guidelines are readily available online through ACC.org, I keep snapshots of key figures on my phone. I also use a variety of smartphone apps for referencing guidelines and using risk stratification calculators.

The cornerstone of cardiology fellowship will always be the inpatient experiences. Successfully navigating the divide between the inpatient and outpatient worlds poses a challenge to many. Proactively cultivating the tools during fellowship to ease this transition to ambulatory cardiology is paramount. My mentors stressed from day one of fellowship that it’s important to develop a clinic “system.” One size certainly does not fit; all advice on maximizing the ambulatory training environment is welcomed.

To stay connected as an FIT, check out the FITs on the GO video blog featuring interviews from leaders in cardiovascular disease, follow the ACC’s Facebook page, and use the hashtag #ACCFIT on Twitter. Also check out the FIT Section hub on ACC.org. To get involved email fellowsintraining[at]acc.org.

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