There has been an increase in the number of patients with cardiac conditions both in inpatient and outpatient settings. Imaging is the "corner stone" in the diagnosis of cardiac conditions. This field requires various levels of training, including one or two years for a level three certification such as echocardiography, MRI and CT after three years of general cardiology fellowship.

Imaging fellowships introduce the trainee to advanced levels of imaging skills and various pathologies, with the anticipation of pursuing a future imaging lab directorship. Perfection as an imaging cardiologist is not governed by the number of cases exposed to as a trainee, but is usually achieved over many years of working and collaboration with senior experienced and wise colleagues. Real learning happens during the first five years after the graduation and lifelong thereafter.

What should the new cardiac imager do during their first job? The incumbent imaging cardiologist should research the new lab and respectfully learn the existing imaging protocols. They should also learn to collaborate with their senior colleagues and study the nuances of the imaging laboratory, as it takes years to set up a well-functioning imaging lab with time tested protocols. Furthermore, new cardiac imagers should not hesitate to ask for help when faced with a difficult or a challenging situation. It is always wise and helpful to get insight from their senior and experienced colleagues. It is also beneficial to be mentored by a senior imaging colleague who will help the fresh imaging graduate learn and grow in their respective imaging field.

What should the new cardiac imager not do at their first job? New cardiac imagers should not have a notion that the places where they trained are perfect, look down on the personnel in their new imaging laboratory, have an attitude that their training laboratories were superior, or look down upon their new colleagues. Often, cardiac imaging faculty have been well-published and the new imaging faculty have completely ignored it. It is important that they get well-versed with active research that is happening in the laboratories and respectfully approach the existing faculty for participation. Most importantly, the younger team players should discuss with their senior colleagues about the pros and cons of bringing changes to the existing laboratory protocols rather than quickly implementing the changes to match the places of their training. Sudden changes to the existing culture at a lab may not be easily accepted by the senior colleagues or ancillary staff.

Take home points: Most imaging trainees do not realize that training is just exposure to acquire perfection over the years. It takes many years of collaboration and mentoring to walk towards a path of perfection. If the young imaging faculty comes in with an attitude of respect, humility and collaboration, they can achieve long-lasting success in shaping into excellent cardiac imagers. This success holds true for all disciplines, regardless of academic or private setting.

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Padmini Varadarajan, MD, FACC

This article was authored by Vinutha Rajesh, MD, and Padmini Varadarajan, MD, FACC, from the Division of Cardiology at Loma Linda University Medical Center in Loma Linda, CA.