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For the new cardiovascular fellows about to begin, congrats on the new adventure! My ten tips to follow:
1. Get comfortable with echo scanning and interpretation quickly, even if you are not on echo rotation. Read your go to echo text book front to back in the first month. To be trusted as a CVD consultant you must speak echo.
2. For the sickest of patients, echo helps the least. Learn to stand at the bedside, labor over the clinical trends, discern with thorough examination, and get invasive hemodynamics when you feel like you are flying blind.
3. When starting a medication for heart failure therapy or ACS or picking an intervention for vascular disease, etc., once you identify the RCT applicable to your therapy, read it, file it, and read it again when the question arises again, until you can accurately quote it.
4. Be judicious about your electives. Don’t try to get boarded or COCATS level two in everything if you are committing to a subspecialty in which you won’t routine read nuclear studies or do cardiac cath, for instance.
5. A special suggestion for HF specialty bound general fellows, focus your rotations on critical care, ambulatory HF clinic, and cardiac cath. Especially cath lab your hands and understanding of hemodynamics will be important in your career.
6. Identify a mentor and perhaps several mentors early. Some can identify projects and hold you accountable to present at a meeting and ultimately publish. Find others who help your career development. Keep them forever. Mine are @HFpEF @NMHheartdoc @CountryPumpDoc @Ed_McGee1967
7. Learn to write shorter notes but master oral presentations. You will be giving talks all the time and the best ones are off the cuff and at the bedside with your team. To know is to teach.
8. Know when you are beyond your knowledge or experience limit. Know when to call for help. And then do it. Even at 2 AM. I have never yelled at a fellow for calling me at 2 AM. I have absolutely rebuked fellows for calling me at 8 AM when the patient was dying at 2AM. Wake us!
9. Help your co-fellows out. They will become lifelong friends and colleagues. Don’t burn bridges. It’s a small small world. You will someday serve on steering committees together, review each other’s papers, call each other for referrals.
10. Give a shit. The most important of all. Nothing is more disturbing than the fellow who cares less about the patient than others on the team. Patient dying? Be present at the bedside? Diagnostic dilemma? Be Present. Interesting pathology? Be Present. Crazy procedure? Present.
