September 13th, 2010

Fellowship Training Around the World

In the last of a series of posts from the ESC meetings, Susan Cheng offered some interesting insights into differences between the ESC and the large U.S. meetings such as AHA and ACC, including major differences in how research is funded and performed in countries outside the U.S. Comoderator Andy Kates and I started thinking about how the training of cardiologists also varies across countries. In the U.S., the “format” of clinical training for cardiovascular specialists is highly regulated (even over-regulated!) by the ACGME and ABIM and so is fairly similar across institutions. However, it differs vastly from the training formats in many other countries. For example, in my interactions with a number of cardiovascular fellows from Brazil, I’ve observed the following differences:

  • Students complete medical school at a younger age than in the U.S.
  • Internal medicine training is brief.
  • “General cardiology” training does not include developing expertise in basic procedures such as diagnostic catheterization and echo interpretation.
  • Fellows may elect or apply for additional training in catheterization, echo, EP, etc., but do not have broad-based training in all of these core skills.

We’d love to hear from you about your insights into differences in training across countries, and in particular, whether there are features that we should consider adopting in the U.S.

9 Responses to “Fellowship Training Around the World”

  1. Andre Paixao, MD says:

    Dr de Lemos has very accurately pointed out some of the major differences between cardiology training in Brazil and the US. I would however like to make a few comments.
    Programs vary widely and, although some institutions require 2 years of formal training in internal medicine and provide comprehensive teaching in the different areas of cardiology, others accept candidates straight from medical school and, within 2 to 3 years, certify physicians with questionable skills. Overall more regulation and oversight would go a long way.
    As far as features to be adopted in the US, I believe that 2 years of training in internal medicine is a reasonable requirement for those who are interested in subspecialty training.

  2. Saurav Chatterjee, MD says:

    How about doing a survey on differences in training across different countries as compared to the US?

    Competing interests pertaining specifically to this post, comment, or both:

  3. I would be interested in this and could recruit Irish cardiology trainees (Specialised Registrars) to contribute.
    So far we would be able to have (1) US (2) Brazil (3) India (4) Ireland.
    This would be a neat survey and produce nice publishable findings.
    I am in.
    Anyone else?

  4. Saurav Chatterjee, MD says:

    let’s do this-sounds promising…….

    Competing interests pertaining specifically to this post, comment, or both:

  5. Saurav Chatterjee, MD says:

    I can try to get inputs of ppl from Germany………

  6. Leon Hyman, Ms M.D. says:

    Unless there are well designed studies comparing lengths of IM training followed by sub specialty training that can accurately measure the quality of the final result,ie how good is the sub specialist; all this is just speculation. Ability to pass the boards could be one measure. One problem with the boards is that they have become self perpetuating empires within themselves. I am re certified once in IM and 3 times in Allergy, all no time limit. Do I really need to take a time limit exam, when there is no proof that that makes me a better Doctor.ecent debate in the New England journal covered this.

    Competing interests pertaining specifically to this post, comment, or both:

  7. Saurav Chatterjee, MD says:

    its difficult undoubtedly to assess the subjective parameters of different programs-however we can try to assess how broadbased programs are in their scope objectively….

  8. We’re thrilled by the interest this topic has generated, and the suggestion to pursue a survey is an excellent one. Our plan is to revisit this (with your help) after the AHA meeting. One idea is to create a survey monkey that would go out by email to cardioexchange members.

  9. Shaumik Adhya, MBBS BSc MRCP CCDS says:

    Certianly it would be interesting to compare different training schemes across the world. I work in London and am a UK trainee, but we have a number of fellows coming through the Cardiology unit, mostly from Europe, but also we have a fellow from Kuwait, and it is fascinating to see the difference in what is regarded as essential training before certifiacation across Europe.

    I’m sure a well designed survey would be very publishable to define the different expectations and competencies that trainnes have from their training around the world.