On behalf of the Fellows-in-Training Leadership Council, welcome to the American College of Cardiology (ACC)! We have created a number of resources for those with an interest in cardiology training; whether you are a medical student, resident, current applicant, or elsewhere on the path to a career in cardiology.

As Fellows-in-Training, we know this is an exciting time of your career. The process for entering a fellowship position requires skill, time, and most importantly, preparation. In this section, you will find information created by Fellows-in-Training who have successfully made the transition to fellow. While each path will be different, hopefully we can provide information that will help you along the way to becoming cardiologists.

Did we miss something? Please let us know! Send a message to Stefan Lefebvre at slefebvre@acc.org and tell us what you’d like the ACC to do for you.

  How to Join
  How to Join

Medical residents in accredited training programs in the U.S. and Canada can join the ACC for free! Click here to join. Medical residents who join the ACC will automatically be made a part of the Medical Resident e-mail list-serv group.

  Leadership and Initiatives
  Leadership and Initiatives

Our medical resident initiative is spearheaded by the Medical Resident Working Group, which includes both FITs and residents. The 2018-19 Working Group is comprised of:

Co-chair Amir Kazerouninia, MD PhD
akazerouninia@gmail.com
Baylor College of Medicine / Texas Children's Hospital Part-time hospitalist / emergency medicine
Co-chair Arnav Kumar, MD MS
arnav.kumar@emory.edu
Emory University Cardiology Fellow (Academic Clinical Investigator Pathway)

ACC support is provided by Stefan Lefebvre (slefebvre@acc.org) and Kristin West (kwest@acc.org).

Our primary aims are to increase membership in, and participation by, current medical residents with an interest in cardiology. To this end, we continually work on improving digital content relevant to medical residents, such as advice on fellowship applications and profiles of current fellows at various stages of training. We are also working on improving content relevant to IMGs, medical students, and others on the path to cardiology fellowship. As part of these efforts, we are committed to seeking opportunities for residents and other future FITs to actively participate in and contribute to the ACC.

  Applicant Resources
  Applicant Resources

With 200 general training programs across the country, Cardiology draws more trainees than any other specialty. It is also highly competitive. In the 2016-17 application cycle (i.e., applying for 2017 appointments), 1147 applicants applied for 866 positions. In other words, there were about 1.3 applicants for each position. Many large academic programs will receive 300-500 applications and only interview 50-100 applicants for 5-10 positions.

Who is applying?
In the 2016-17 cycle, NRMP reported 56% of cardiology fellowship applicants were U.S. allopathic graduates. About 26% were non-U.S. international medical graduates (IMGs), and the remainder were primarily U.S. IMGs (11%) and osteopathic graduates (7%).

Who is successful?
The overall match rate for all cardiology applicants in the 2016-17 cycle was 75%. While U.S. allopathic medical graduates have a relatively high match rate (~90%), the match rate was only 61% for all other categories of applicant.

What makes for a successful match?
According to data published in the NRMP Program Director Survey, some of the most important factors to being selected for an interview and ultimately matching, as cited by fellowship program directors, included letters of recommendation, residency program reputation, demonstrated involvement and perceived interest in research, and interactions with faculty/interpersonal skills during interviews. Data on the attributes of successful candidates, including mean USMLE Step scores, is available in Charting Outcomes in the Match.

For more in-depth advice on the fellowship application process, check out our "Path to Fellowship" series, in which the ACC's resident members interview cardiology fellowship program directors and others involved in the selection process. The first article in the series focuses on the application (e.g., personal statement, letters of recommendation) and is available here: Path to Fellowship: The Application


Sources/Resources

  • National Resident Matching Program, Charting Outcomes in the Match, Specialties Matching Service®, Appointment Year 2011, Characteristics of Applicants Who Matched to Their Preferred Specialty (May 2013), LINK TO DOCUMENT .
  • National Resident Matching Program, Results and Data: Specialties Matching Service, 2017 Appointment Year (Feb. 2017), LINK TO DOCUMENT .
  • National Resident Matching Program, Results of the 2016 NRMP Program Director Survey Specialties Matching Service (Oct. 2016), LINK TO DOCUMENT .
   Frequently Asked Questions
   Frequently Asked Questions

The following are common questions asked about fellowship and the application process. Have one of your own? Send a message to Stefan Lefebvre slefebvre@acc.org.

Regarding the application process:

Residency / pre-application:

  How should we allocate our time during residency in order to be the best fellowship candidate?
  How should we allocate our time during residency in order to be the best fellowship candidate?

The best preparation for a successful fellowship is a strong clinical foundation built during residency. While it may be tempting to begin focusing on fellowship early in your career, there is no substitute for the internal medicine training you will receive during residency. A strong letter of recommendation will go a long way, so you certainly want to spend some elective time in cardiology; however, most of your time should be spent learning other specialties in medicine.

How else can you prepare for fellowship during residency? Develop good relationships with a few mentors. These mentors will not only provide invaluable advice (not only for your fellowship application, but potentially throughout your career), but will likely also write your highly important letters of recommendation. You should also get to know current cardiology fellows at your program and other programs (involvement in the ACC and attendance at ACC events is a great way to go about that!), as they will be able to provide insight that only a recent applicant would know.

  What research is most worthwhile? How should we weigh abstracts versus posters or papers?
  What research is most worthwhile? How should we weigh abstracts versus posters or papers?

Publications on cardiology topics in peer-reviewed journals are the most highly valued. Among them, original research articles are more heavily weighed than narrative reviews. Oral presentations of research in national/international conferences are also valued highly. Poster presentations are lower on the hierarchy, but still very much worthwhile. However, remember that at this stage of your career any type of scholarly activity product before or during residency is very valuable in your effort to match to a fellowship program. If you are involved in projects that have not yet resulted in publication, you should list them on your ERAS application under “Experience,” and note if you are pursuing publication (e.g., you are working on a manuscript that you will be submitting for consideration).

  How should we obtain a research mentor when doing residency training at a program without strong research capabilities?
  How should we obtain a research mentor when doing residency training at a program without strong research capabilities?
This may be difficult to do. However, consider approaching potential mentors from outside institutions. There are many examples of mentoring relationships done successfully from a distance.
  How important is it to do outside rotations at a particular program of interest? When is the best time to do these rotations?
  How important is it to do outside rotations at a particular program of interest? When is the best time to do these rotations?
Away rotations can be very helpful if you are interested in a specific program as it could give you a chance to work with faculty from cardiology and potentially obtain a letter of recommendation that you can use in your application specifically for that program. Meeting with the fellowship program leadership during your away rotation could also be very helpful as it shows your genuine interest in the program. The best time to do that is shortly before the application season starts so that their memory of your visit is fresh.

The application process:

  What’s the general timeline for applicants putting together their application?
  What’s the general timeline for applicants putting together their application?

At least 3-4 months before you apply, start by reviewing the ERAS directory of cardiology programs and formulating a list of programs you will apply to. Review each program for application requirements. The majority require some or all of the following:

  • ERAS application (which includes a CV)
  • Personal statement
  • Three (less commonly, four) letters of recommendation (many programs require one letter to be from your Program Director)
  • Medical school transcripts and/or Medical School Performance Evaluation (MSPE) (also known as Dean’s Letter)
  • USMLE score report
  • Photograph
  • There may be additional requirements for IMG applicants

There is, however, some variation that you don’t want to discover at the last minute. Some schools, for example, require a letter from your Chief.

Also at least 3-4 months before you apply, think about:

  • Beginning to draft your personal statement
  • Scheduling meetings with your mentor(s), cardiologists you have worked with, and/or current fellows to discuss the strength of your application and the programs you plan to apply to

You should have your Letter of Recommendation (LOR) writers lined up well in advance (ideally, talk to an attending you worked well with about their willingness to write you a letter during or right after you finish working with them). Remind them of your request early in the year, and by May or June you should provide them with a finished or nearly-finished CV and personal statement so they can write your letter. Giving your LOR writer at least a month to write your letter is courteous. Importantly, note that after your LOR writer uploads your letter to EFDO, it can take up to five business days for the letter to be released and available to programs. Therefore, give your LOR writers a deadline of about a week before the date programs can start receiving applications (which is usually mid-July).

  What makes a good personal statement?
  What makes a good personal statement?

A good personal statement is concise, well-written, clearly highlights your experience with cardiology and identifies an intended career focus. Don’t try to make your personal statement too original or artistic; this isn't a college application. You can upload multiple personal statements to ERAS, allowing you to assign different personal statements to different programs. While it is generally not necessary to customize your personal statement to a particular program, some programs may have requirements regarding length and content, so check the program’s webpage well in advance.

One organizational method is to think of your personal statement as having past, present and future sections. The past section should include clinical experiences that were meaningful to you. The present section should include ongoing academic research and leadership projects. The future section should identify how you envision your career (subspecialty training, academic medicine, basic science research, etc.).

Ideally, start thinking about your personal statement at least several months before you apply. Get as many people as you can find to read it and offer feedback, including those with no cardiology experience at all.

  On the ERAS application, should we include activities from undergraduate/medical school?
  On the ERAS application, should we include activities from undergraduate/medical school?

Typically undergraduate activities are not included unless they are particularly notable or directly relate to medicine. Medical school awards and honors can be included, but medical school activities you are not still participating in should not be included.

  When should we expect to hear back from programs after we apply?
  When should we expect to hear back from programs after we apply?

This is highly variable between programs. According to self-reported data from the 2016-17 cycle, the majority of interview offers come in August and September.

Interviewing:

  When do most interviews take place?
  When do most interviews take place?

Typically between early September and early November. The majority occur in September and early October.

  What are the differences between fellowship interviews and residency interviews?
  What are the differences between fellowship interviews and residency interviews?

Fellowship interviews are generally more personal. When applying for residency, you may have felt like a number: There are usually multiple interview dates per program, and many days you’ll be interviewing with 20-30 other medical students. Fellowship interviews, on the other hand, are much smaller groups. Most programs will be accepting 5-7 applicants, at most, so they may only offer 3-4 interview dates. Additionally, interviews for fellowship will be more about you liking the fellowship than them liking you. Most fellowship programs will tell you that if you’re offered an interview, you’re already qualified for the program. Now it’s up to you to decide what’s best for your interests.

  How many interviews are on an interview day?
  How many interviews are on an interview day?

This can be highly variable between programs. You should expect at least a half day of interviews, although sometimes this can be stretched across the entire day.

  Will we know who we are interviewing with before the interview? Will we be interviewed by current fellows?
  Will we know who we are interviewing with before the interview? Will we be interviewed by current fellows?

You will only sometimes know the names of your interviewers prior to the interview day itself. Usually you are given the names of the interviewers at the start of the interview day. In general, you should expect at least one interview with the program director or one of the associate program directors, two additional interviews with faculty members, and an additional interview with the Chief of Cardiology or other senior leader. Programs will occasionally conduct panel interviews, where you meet with multiple people at once. Typically current fellows do not interview directly but are available for discussion at applicant dinners.

  Will we have panel interviews? What is the best way to handle a panel interview?
  Will we have panel interviews? What is the best way to handle a panel interview?

Panel interviews have become more popular as a way to conduct more interviews in less time. In general, these are no different than individual interviews except that you’re asked questions from multiple people on a panel. The types of questions and your answers should not change. In some ways, these types of interviews are better as you can give the same answer without repeating yourself to 2-3 different people.

  How can we best find out where prior fellows have gone to practice?
  How can we best find out where prior fellows have gone to practice?

For some programs, it will be listed on their fellowship website. For others, you will obtain the information during the interview day. If neither of these options work, you can discuss this with the program director either during your interview day or following the interview with an email request.

  What is the best way to gauge how “fellow-driven” a program is?
  What is the best way to gauge how “fellow-driven” a program is?

The most important people you can talk to during your interview day are the fellows. They will be able to tell you the strengths and weaknesses of the program, as well as the responsiveness to change. If you don’t like a particular answer, ask a different fellow. If you get inconsistent answers, this should be a red flag about the program.

  What are COCATs levels? What levels should we be aiming for in a fellowship program?
  What are COCATs levels? What levels should we be aiming for in a fellowship program?

COCATS stands for “Core Cardiology Training Statement” and refers to the ACC’s curriculum recommendations for Cardiovascular fellowship training. The original statement and its revisions were put forth by the ACC in an effort to standardize the minimum training requirements in adult cardiology. The most recent iteration of the COCATS that was released in 2015 (COCATS 4) encompasses 15 different training areas and details specific competency based milestones for each area. Three levels of competency are defined (as described in the COCATS 4 Introduction by Halperin et al, J Am Coll Cardiol. 2015;65(17):1724-1733):

    Level I training, the basic training required of trainees to become competent consultant cardiologists, is required of all cardiovascular fellows and can be accomplished as part of a standard 3-year training program in cardiology. In the case of cardiac catheterization, Level I represents training for those who will practice noninvasive cardiology and whose invasive activities will be confined to critical care unit procedures. This level will also provide training in the indications for the procedure and in the accurate interpretation of data obtained in the catheterization laboratory.

    Level II training refers to the additional training in 1 or more areas that enables some cardiologists to perform or interpret specific diagnostic tests and procedures or render more specialized care for specific patients and conditions. This level of training is recognized only for those areas in which a nationally accepted instrument or benchmark, such as a qualifying examination, is available to measure specific knowledge, skills, or competence. Level II training may be achieved by some trainees in selected areas during the standard 3 year general cardiology fellowship, depending on the trainee’s career goals and use of elective periods.

    Level III training requires additional experience beyond the general cardiology fellowship to acquire specialized knowledge and competencies in performing, interpreting, and training others to perform specific procedures or for the trainee to render advanced, specialized care at a high level of skill. Level III training cannot generally be obtained during the standard 3-year general cardiology fellowship and requires additional exposure in a program that meets requirements delineated in Advanced Training Statements (formerly in Clinical Competence Statements) and developed for each specialized field of endeavor. Advanced (Level III) trained faculty should be available to participate in training Level I fellows in cardiac catheterization, interventional cardiology, and cardiac electrophysiology, but are not required for Level I training in other fields.

Depending on your professional goals, obtaining Level II training in certain areas may be important (for example, Level II training in echocardiography or cardiac catheterization is highly valued in some private practice models for general cardiologists). While Level I training is the standard for all training programs, Level II training in an area of interest may or may not be feasible to obtain during the three years of General Cardiology fellowship as this will depend on the specific fellowship program’s structure and flexibility with individualizing the curriculum to a trainee’s professional goals. Information on the attainability of different levels of training during fellowship should be readily available during your application/interview process. Current and former trainees may be the best sources of information in this regard.

Post-interview:

  To whom should we send thank you notes after the interview? Should we thank the program director even if we do not interview with them?
  To whom should we send thank you notes after the interview? Should we thank the program director even if we do not interview with them?

You will generally always interact with the program director. Even if you don’t interview with them (e.g., you met them but didn’t formally interview with them, or they were absent due to an emergency), you should still thank them for the opportunity to interview at their program. You can do so via a handwritten card or an e-mail. If you’re particularly interested in a program, thanking each interviewer may also improve your standing, although you certainly don’t need to do this for every program.

  When is the best time to ask your residency faculty to make calls in support of your application?
  When is the best time to ask your residency faculty to make calls in support of your application?

Any time after your interview but make sure that it doesn’t happen too late. Some programs (especially those doing interviews early) formulate their rank lists quite in advance, after which time it may be difficult to change their ranking significantly.

  What is the best way to stay “on the radar” of programs after the interview?
  What is the best way to stay “on the radar” of programs after the interview?

Post-interview communication is generally expected and well perceived. Programs will value a communication stating your honest interest in them. This should typically happen as soon as you have formulated the rank order of your top programs. You may also update the programs with additions to your CV that they need to consider (such as a new abstract or publication). Another way to be kept in a program’s radar is to ask your closest mentor and biggest advocate to call your top ranked program on your behalf.

  What factors should we consider when making our rank list?
  What factors should we consider when making our rank list?

Programs may be classified into the following depending on their focus: (a) primarily clinical with limited research opportunities, (b) academically oriented with expectation that fellows will be heavily involved in scholarly activities, and (c) programs with balance between the clinical and research focus and flexibility regarding their research requirements. Thus, it mostly depends on whether one is considering a career in academic cardiology or not. For those yet undecided (and it is totally fine to be undecided at this stage), the latter type of program may be a better fit. Of course, several other factors should be considered: interview day experience, potential research mentors, particular area of interest, work-life balance, experiences of current and past fellows, program leadership, family, geographic preference, etc.

  What do we do if we want to go into a particular program but it is not strong in our expected area of interest? Should they be ranked lower because of that?
  What do we do if we want to go into a particular program but it is not strong in our expected area of interest? Should they be ranked lower because of that?

Most programs may be strong in one or more areas but not in all areas. If you are certain that you want to focus on a specific area in cardiology, then it is reasonable to try to match in an institution that is strong in that area. As most subspecialty programs prioritize fellows from their general programs, this will potentially save you another round of applications and interviews (for the subspecialty). It will also mean that you can have clinical and research exposure in that particular area and establish mentorship relationships early on. However, bear in mind that many fellows change career pathways during fellowship. Therefore, unless absolutely certain about a specific area in cardiology, choosing a generally well-rounded program may be the way to go. Remember, you can always apply to different institutions for subspecialty training if your general fellowship institution is not as strong in that area.

Authors

Catherine P. Benziger, MD, Cardiology Fellow, University of Washington
Amir Kazerouninia, MD PhD, Medicine/Pediatrics Resident, Baylor College of Medicine
Benjamin B. Kenigsberg, MD, Cardiology Fellow, Georgetown University Hospital - Washington Hospital Center
Aaron Kithcart, MD, PhD, Cardiology Fellow, Brigham and Women’s Hospital
Konstantinos Siontis, MD, Cardiology Fellow, University of Michigan
Tyson Turner, MD, MPH, Cardiology Fellow, Washington University

  Profiles
  Profiles

Profiles

General cardiology training consists of an adult cardiology fellowship or a pediatric cardiology fellowship. Some training programs offer research tracks which add an additional year(s) of training and provide dedicated time for research endeavors. After general cardiology training, there is the option of pursing advanced training. Some of the primary advanced training specialties include:

Curious about what path current fellows took to get to where they are today? Or about what a day in the life of a general cardiology or advanced training fellow looks like? Check out our fellow profiles.

  Women in Cardiology
  Women in Cardiology

There are more women in cardiology now than in the past but women are only 18% of cardiology fellows, 10-15% of practicing cardiologist and 4% of interventional cardiologists.

For female applicants, it is important to consider the following factors when deciding which programs you want to rank:

  • How many women are on faculty and do they serve in leading roles?
  • Are there other women trainees? What is the call schedule like?
  • Is the call in-house?
  • Is it front-loaded or dispersed equally throughout the three to four years?
  • What are the maternity leave policies?

In general, time off policies vary by program but are usually less flexible than residency programs.

  • Will your total fellowship time get extended?
  • If so, will this affect pursuing further sub-specialty training?
  • Will time off conflict with other important rotations?

For more information on these issues, visit the ACC’s Women in Cardiology section by clicking here.


Sources/Resources:

  • Hauguel-Moreau, Adjedj J. Managing Pregnancy as an Interventional Cardiologist Fellow-in-Training: My Experience With a Simulator. J Am Coll Cardiol. 2016 Oct 25;68(17):1916-1919.
  • Hlatky MA, Shaw LJ. Women in Cardiology: Very Few, Different Work, Different Pay. J Am Coll Cardiol. 2016 Feb 9;67(5):542-4.
  • Kohli P. Where Are the Women in Cardiology? ACC in Touch Blog. American College of Cardiology. May 20, 2013. Link . Accessed July 23, 2017.
  • Poppas A, Cummings J, Dorbala S, Douglas PS, Foster E, Limacher MC. Survey results: a decade of change in professional life in cardiology: a 2008 report of the ACC women in cardiology council. J Am Coll Cardiol. 2008 Dec 16;52(25):2215-26.
  • Sobolev M. What Should Women Look For When Choosing a Cardiology Fellowship? ACC in Touch Blog. American College of Cardiology. November 13, 2014. Link . Accessed July 23, 2017.
  • Wang TY, Grines C, Ortega R, et al. Women in interventional cardiology: Update in percutaneous coronary intervention practice patterns and outcomes of female operators from the National Cardiovascular Data Registry®. Catheter Cardiovasc Interv. 2016 Mar;87(4):663-8.