March 30, 2017 | Peter Flueckiger, MD
Education

Advanced cardiovascular imaging fellowships are a relatively recent development in cardiovascular medicine training. The need for imaging training programs has arisen due to advances in multiple cardiovascular imaging modalities, specifically computed tomography (CT), cardiac MR (CMR), echocardiography, and nuclear cardiology. CT and echocardiography are key modalities used in advanced transcatheter therapies (transcatheter aortic valve replacement [TAVR], MitraClip, etc.) and complex electrophysiology procedures (atrial fibrillation ablations, left atrial appendage closure devices, etc). Cardiac MRI has developed as an important modality in the evaluating cardiac viability, infiltrative cardiomyopathies and cardiac masses. Finally, newer radiotracers and PET/MRI require further understanding of nuclear cardiology protocols and interpretation.

To be sufficiently trained in multiple imaging modalities often requires additional training beyond a general cardiology fellowship. The clinical cardiologist trained in advanced imaging has the distinct advantage of being able to adeptly integrate imaging modalities with clinical care to provide more efficient and affective care to the patient. Furthermore, based on the most recent COCATS 4  requirements (with additional specific documents pertaining to cardiac MRI, cardiac CT, echocardiography, nuclear cardiology), expertise in more than one imaging modality likely requires an additional year beyond general cardiology fellowship. This being the case, how do FITs apply for an advanced imaging fellowship and what should you look for in an advanced training program? Below are challenges and issues I considered during my application process.

Defining objectives for additional cardiovascular imaging training:

An initial step is to define your objectives in pursuing an advanced imaging fellowship and to identify future career goals. Is your objective to obtain additional expertise in an imaging modality you’re currently proficient in? Or is it to achieve training and experience in an imaging modality that you weren’t sufficiently exposed to in a general cardiology fellowship? Additional objectives may include pursuing further clinical or basic science research in a particular imaging modality. Identifying career goals will also help you find the training program best suited to achieve these objectives. Defining your goals will help narrow down the imaging fellowships that meet your objectives. COCATS IV requirements help define goals regarding duration of training and number of cases, etc. Finally, it is important to ask yourself what you plan to achieve with the additional cardiovascular imaging training. It is important to identify this upfront before dedicating more time and energy to further training.

Finding programs that match your goals:

After identifying what your objectives are for an additional advanced cardiovascular imaging fellowship, it is time to find a program that matches your goals. The ACC has compiled a database of advanced cardiovascular imaging fellowships. It is important to note the diversity in what is offered by these training programs. Imaging fellowships range in duration (most are one to two years), training modalities (range from 100 percent flexible to strictly one modality), and in required research responsibilities (from incorporating research within the clinical fellowship to dedicated T32 research grants/years). The structure of the fellowship is also important as it relates to COCATS requirements and achieving specific levels in each imaging modality. It is important to clarify the expectations, requirements and goals of each imaging fellowship, as certain institutions may expect a level of training prior to starting an imaging fellowship. By previously refining your own aims for additional training, you are able to narrow down the imaging programs that will enable you to obtain you objectives.

Advanced cardiovascular imaging fellowship application process:

Currently, advanced cardiovascular imaging fellowships are non-ACGME accredited fellowships, and are offered outside of the typical match period. It may be the first time that cardiology fellows have applied outside of the match system. This means that the application process, interviews and offering of positions may vary greatly between programs. Applications and interviews may range between 6 – 18 months prior to the start of the respective fellowship.  Additionally, the timing of offers for fellowship positions vary significantly. Unlike residency and cardiology fellowship match, applying to fellowships outside of the match takes on a process more similar to applying for jobs.  While more choice and flexibility is offered to the applicant regarding accepting a position, some of the pitfalls the match is designed to prevent may occur: short time periods in which to accept a fellowship offer, receiving offers prior to completing all interviews, receiving non-guaranteed commitments, etc.  Applicants should be aware of these potential issues prior to applying.

An advanced cardiovascular imaging fellowship can help fellows become adept at multimodality cardiovascular imaging, become experts in their field and provide a key role in the clinical care of cardiovascular patients. Identifying your training and career goals, finding a program that will allow you to achieve these objectives, and being aware of the varied application cycle will ensure that fellows make the best choice for both themselves and the training program they pursue.

This article was authored by Peter Flueckiger, MD, a Fellow in Training (FIT) at Wake Forest University School of Medicine.