November 30, 2016 | Daniel Addison, MD
Career Development

As we head into the holiday season with thanks-giving for the completion the start of another academic year, we recognize our achievements as we cast an eye on the next horizon. Many of us are faced with important decisions over this holiday season. These decisions range from how to prepare for a successful finish to the first year of cardiology fellowship, to the decision on jobs for the upcoming year. In this article I will focus on the decision to pursue additional sub-specialty training and a potential framework to aide in making a good transition.

As a current FIT, I still remember the initial daunting task of taking on the responsibilities of title: “Cardiology Fellow”. My initial impression following medical residency was that this would be straightforward. But as many of us can attest, I quickly realized this was the biggest challenge of my early medical career. Day after day, I faced the burning question of how I would  perform on a new service and assimilate new procedures. Thankfully, I passed these tests and the pressure eased. Shortly after, I realized that I had to prepare for a new challenge – what subspecialty area to focus on:  interventional, electrophysiology, heart failure, imaging, academics, or general cardiovascular medicine in a private practice setting. These were a few of the thoughts that passed through my mind. I soon realized that I needed to develop a framework to guide me in these important choices. Practically speaking I did what I have always done – ask, observe and plan.

I sought the opinions of faculty and senior FIT colleagues as to why they elected to purse their chosen pathways. I identified people who had similar thoughts on how they envisioned their careers. I soon realized that nearly all of these individuals had a plan that got them to where they were and most had plans on how to go where they wanted to be in the future. I observed those whose career interests and pathways, closely mirrored my desires, even down to studying their times of departure to and from work, and reviewing their journal citations. I realized that if I wanted a particular course (imaging fellowship in my case), I would have to be strategic to see it through. I generated lists of persons, places and friends I could reach out to for advice and began building toward my destination. After several months, I appreciated that I had developed a framework from which to proceed. Here is a summary of my strategy:  

• Ask for advice: I asked senior fellows and faculty the reasons behind their specialty choices.
• Experience and explore: In each of my clinical [subspecialty] rotations, I immersed myself in learning as much as possible about that aspect of cardiology. Information facilitates good decisions.
• Observe: I identified the roads of success and training routes/institutions selected by those in positions of interest.
• Plan: I reached out to the chief fellows and adjusted my rotational schedule(s). I also calculated the time I would need to develop my skills. Clinical and research mentors were identified and I began to build my curriculum vitae using similar roadmaps.  
• Lists - Create lists: I came up with lists of institutions and programs that could prepare me for my desired career pathway. The opinions, advice and assistance of co-fellows, friends, and faculty were sought.
• Patience: I waited until five months into my final general fellowship year to pick the program I eventually went to. Applications and decisions are made at various times with many considerations (program needs, personal factors of the applicant, etc). Start early, but don’t be afraid to wait for the program you need to open up – doors open suddenly.

After over a year of planning, networking and interviews, I committed to my destination. These were some of the experiences I and others found to be helpful through this process. As an FIT nearing the end of training, I hope these points will make your journey along this road a little smoother. With gratitude, I acknowledge the mentorship of Henry Okafor, MD, FACC, (Vanderbilt University) and my BCM and MGH faculty, as well as the assistance of my FIT colleagues along the way. Happy Holidays everyone!

This article was authored by Daniel Addison, MD, T32 Advanced Cardiac Imaging Fellow at Massachusetts General Hospital in Boston, MA.