December 13, 2017 | Ahmad Masri, MD
Career Development

Cardiovascular Medicine Fellowship is the largest ACGME-accredited fellowship participating in the National Residency Matching Program, with 866 FIT positions offered in 2017. Training in cardiovascular medicine is an intense yet utterly rewarding journey with many trials and tribulations. Cardiology is a distinct subspecialty of medicine which combines aspects of clinical medicine, critical care, invasive procedures and a multitude of imaging modalities. With such complex training, opportunities arise for innovation in educating future generations.

The procedural aspects of cardiology training can be daunting at times for incoming fellows and may serve as a source of trepidation and uncertainty. The three most common procedures that most FITs are exposed to are (1) left heart catheterizations, (2) right heart catheterizations and (3) transesophageal echocardiography. FITs have varying degrees of exposure to these procedures during their residency training. The majority learn these procedures through trial and error, with a direct focus on the procedures during their respective rotations. The current models of learning involve self-directed learning (i.e., reading articles or book chapters prior to starting the rotation and applying the principles learned); step-by-step active learning from either a senior FIT or an attending; and learning through observation. While these models have worked well for decades, it is time to reflect and potentially learn from others. There are three main questions that need to be addressed:

1) Should a procedural boot camp exist for common procedures for incoming FITs? Can't FITs learn these procedures during their clinical training?

The counter argument to establishing a resource-intense boot camp is the fact that clinical fellowship is the time to learn these procedures and techniques. However, boot camps for medical students and residents have been evaluated in multiple studies and shown to be associated with better performance or confidence. A structured boot camp accelerates learning, improves confidence in real-world scenarios and establishes a scientific foundation to the skills learned. It emphasizes evidence-based medicine and de-emphasizes anecdotes and "that is how we do it" type of practice.

2) Have other disciplines in medicine done society-sponsored boot camps at the national level?

Within cardiology, there are boot camps designed for interventional fellows, such as the Society for Cardiovascular Angiography and Interventions Fellows Course and the Cardiovascular Research Foundation Interventional Fellows Course. In all other cardiology disciplines, there are many courses and boot camps sponsored by industry or individual institutions. However, there are no society-sponsored national boot camps for first-year FITs. Outside of cardiology, the American Society for Gastrointestinal (GI) Endoscopy First Year Fellows Endoscopy Course is a boot camp for all first year GI FITs that combines lectures with hands-on training, and FITs are responsible for transportation and lodging. Another example is the American Thoracic Society Resident Boot Camp, a two-day hands-on boot camp offered to internal medicine and pediatric residents or physicians who have matched into pulmonary or critical care fellowships, and participants are chosen via a randomized lottery system.

3) How can such a boot camp be executed?

Given the large number of cardiology FITs, organizing such a boot camp is not an easy process. For example, in 2017, there were 866 FITs who matched into cardiology, compared to 504 FITs who matched into GI. However, bigger programs and societies translate into more resources and volunteer educators who can establish these programs. From a practical standpoint, incorporating boot camps into national meetings will help foster greater interest from first-year FITs coming to grips with the rigors of fellowship training. Another approach in the case of heart catheterization is adding a beginner's track to one of the national interventional cardiology boot camps.

The principles of teachings the basics, and teaching them early, broadly and uniformly, are the basis for boot camps. It is true that the clinical cardiology fellowship is designed to teach these principles and procedures; however, upfront knowledge in some procedures will allow FITs to be ready to apply those principles in the procedural room and focus on perfecting their skills.

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This article was authored by Ahmad Masri, MD, Fellow in Training (FIT) at the University of Pittsburgh Medical Center in PA.

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