November 22, 2017 | Konstantinos Stathogiannis, MD, PhD
International

Cardiology fellowship in Greece is a vigorous four-year program in which intense training takes place under the constant vigilance of attending cardiologists. These four years involve lengthy day shifts and night calls, preparation for multidisciplinary meetings, dealing with frustrated patients and relatives, and long study hours. Apart from these challenging aspects, it is important to stay focused on the main goal, which is becoming a proficient and independent physician.

One of the most interesting aspects of cardiology training is the opportunity to rotate in different subspecialties and be involved in the treatment of patients with a wide range of heart conditions. This opportunity is also a crucial part of the training period because exposure to different subspecialties will ultimately lead to the choice of specialization field after cardiology fellowship has ended.

The typical training structure in Greece involves almost two and a half years of general cardiology training, including CCU/ICU rotations. The rest of the time is divided into subspecialty training, which is mainly in the echocardiography department, cath lab, electrophysiology lab and nuclear medicine. FITs are given ample time and possibility to perform basic imaging and invasive studies (such as transthoracic echocardiograms and coronary angiograms), and should be able to perform them independently by the end of training.

Preparation and planning for the echo exam (TTE/TEE) at early stages of training, regardless of the future career path one might choose, is important because it is easier to appreciate the heart conditions by acquiring essential non-invasive imaging skills. FITs may wish to further enhance their skills and knowledge by participating in more advanced workshops or seminars for other modalities (both invasive and non-invasive), and training faculty should endorse such initiatives. During my training, keeping a logbook with details of the patient and the procedure performed was fundamental and of great assistance during studying, since it could add a more practical note during preparation for exams and boards. Having logbooks also makes it easier to track progression and be on par with training curricula.

These FITs are fortunate to be in a specialty that is evidence-based, and a big part of training focuses on learning and implementing recommendations and guidelines that serve as an aid in daily practice. Hence, research has become an integral part of training and many academic centers urge FITs to participate in at least one research project during their training. Although it is not an official requirement to undertake research during training, FITs in academic medical centers can choose a research project, which ultimately leads to a master's degree or a doctorate. Since this task can be difficult to complete, there are an increasing number of graduates who decide to go into research and complete a higher degree before training starts, which was the case for me.

After graduating from medical school and deciding that cardiology was the best choice for me, I joined a research team that had me involved in various scientific projects, both clinical and experimental. I was taught how to interpret literature, prepare abstracts and manuscripts, and perform statistics. Above all, the most significant aspect of joining a team was the mentoring that I received, which has been guiding me ever since. Many years later, as a young trainee, I found myself puzzled by the vast amount of knowledge I had to accumulate, the number of procedures I would need to excel and the constant notion of what the next step after fellowship would be. My mentors provided me with support, guidance and invaluable insight into the difficulties that lie ahead, and pearls of wisdom on dealing with those difficulties.

Visiting an international medical center as a fellow or an observer should be a priority for all FITs before, during or after cardiology fellowship. Fostering strong international associations benefits FITs and the cardiology community in general, as such collaborations can lead to joint research projects and ultimately improved patient outcomes. Even though it is not a part of the Greek training program, FITs are usually supported by academic staff in finding the right centers that meet their needs and allow them to visit for a few months. Before training in my current position, I was a junior fellow in a busy cardiothoracic center in the United Kingdom, where I had the chance to work in a vibrant environment and collaborate with physicians that shared the same excitement for cardiology as I did. It was then that I realized cardiology has become a global specialty, and true cooperation and collaboration can have significant impact to a patient's life.

Cardiology is a constantly evolving specialty that requires intense training and continuous refinement of both clinical and practical skills. It is highly rewarding and provides an extensive research field for possible endeavors to those who are willing to step into the academic world. "Guidelines" on decision-making regarding training and "recommendations" on how to achieve personal goals can be reassuring. However, it is hard work and passion towards advancing patient care that will ultimately help us overcome any obstacle and become cardiologists.

This article was authored by Konstantinos Stathogiannis, MD, PhD, Fellow in Training (FIT) at Hippokration General Hospital in Athens, Greece.