CardioExchange Archive

With July just around the corner and a new generation of cardiologists about to start their training, the CardioExchange editors have asked the fellowship moderators to share their advice about how to face this exciting new challenge. We bring you that advice in a three-part series through the end of June. Part 2 focuses on Reading and Research.

What should fellows be reading?

John Ryan (current fellow): I find Braunwald to be the best resource. I don’t think you can read it from cover to cover. Instead, make a note of the questions or clinical scenarios that you have been presented during the day and then read up about them in the evening after work.

Andy Kates (fellow from 1997 to 2001): There is no substitute for self-motivated reading. This is as true for an attending as it is for fellows. Didactic instruction cannot replace the reinforcement that comes from reading about the basics of, say, aortic stenosis after you see a patient with AS. Texts like Braunwald offer those basics, which the core lectures that most programs provide to fellows then reinforce. It helps to do focused reading on a topic the day before the lecture (e.g., reviewing a chapter from the echo text on MR before an echo MR lecture). I also remind fellows that it takes reading material several times before one “gets it.” Lastly, point-of-care learning (e.g., PubMed) is essential, so never hesitate to look up rare entities or even the basics as you see a patient, in either the inpatient or the outpatient setting.

James de Lemos (fellow from 1996 to 1999): A disciplined reading plan is crucial. I agree with John that Braunwald (or an equivalent such as Topol or Hurst) should be your core reading material.  I would suggest case-directed reading to learn the basics about the patients you have seen. This should be done in “real time,” even when you’re tired, because it won’t stick if you wait a few days.  You also need a regular reading schedule that is not case-based to fill in gaps and to learn the core concepts for each rotation. For example, you must read Feigenbam or another echo book while on echo, a core cath book on cath, etc. For interesting cases, focused literature searches and reviews are very important, and learning to do this quickly and efficiently is an important skill you should work to develop. Remember that as useful as they are, the textbooks are always out of date for rapidly changing areas.

When should fellows get involved in research?

Ryan: The first clinical year is so overwhelming that I think it is very tough to get involved in research, and I also don’t think it is necessary. The priority is to develop the skills of a clinical cardiologist. However, once fellows do get settled in, some take the opportunity to write review articles or case reports, but again only to complement clinical training, not at the expense of it.

Kates: Our fellows are encouraged to explore research options during their first year of training, although the demands of the first clinical year make this difficult for many.  Some of our fellows (such as those who are part of the Physician Scientist Training Program) have already developed research interests. For others, though, it is primarily during the first six months of second year that they begin to form a research proposal, which is then formalized (e.g., IRB approval, statistical powering) by the beginning of third year.  All of our fellows are expected to engage in scholarly activity, and I believe it helps them regardless of their ultimate career pathway.

de Lemos: This decision differs greatly from fellow to fellow.  I do think that fellows should work to learn principles of cardiovascular research during the first year, including critical interpretation of the literature, basic study design and analysis, etc.  I also think that toward the latter half of the first year, the fellows should try to have an idea of whom they would like to select as a research mentor, and set up meetings to talk about research with a number of potential mentors. If you wait until the end of the second year to pick a mentor, it is often too late.

What reading resources would you recommend to fellows? And what are your thoughts about getting involved in research as a fellow?