September 13th, 2011

Follow the Fellows: A Series from the Front Lines

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John RyanFellowship is such a unique experience that we at CardioExchange have wished for it to be documented from the front lines. And so we are introducing a new series, “Follow the Fellows.” We have invited fellows from various fellowship programs around the U.S. to document their course through their training over the next three years.

Our fellows include:

They will be providing periodic updates and commentary on how their training has progressed and how it has influenced them, starting from the earliest days and extending into their final year. We anticipate that this will be a great forum to document modern cardiology training and all the emotions that accompany the various stages — the anxiety on the first night on call, the satisfaction of grasping the minutia of ECG interpretation, the excitement as training finally comes to an end. We encourage our readers to contact us if you would like particular features of training, whether the practical or the emotive aspects, to be addressed.

In this first series of posts, we asked the fellows to share their thoughts regarding their experiences in these first few weeks of fellowship. — John Ryan, Co-moderator, Fellowship Training blog


Bill CornwellBill Cornwell — Fellowship has been everything that I anticipated — but all the while something I could only partly prepare for. Dissecting it further is difficult, but anyone who has been there likely knows what I mean. A steep learning curve was expected; after all, on some level I have been through this before. As a student, I marveled at the knowledge my supervising residents had accrued, and as a resident myself, I questioned whether I would ever measure up to the attending physicians who were so accomplished and well versed. Now as a fellow, I am in the shadows of giants in the world of cardiology and again, bewildered by their mastery of the subject, wonder whether I will ever be where they are.


Aaron EarlesAaron Earles — I will never forget how anxious I was the night before I began my fellowship. The facility where I completed my internal medicine residency did not have an associated cardiology fellowship, so I did not have access to a fellow to ask advice for what to expect. Another added stressor for me was moving from a rural community to Chicago, where I knew no one. Doubt began to dominate my every thought, to the point where I questioned whether or not I made the appropriate decision to continue training.


Kate LindleyKate Lindley — As with each major transition point in my life, I found the first few days of my cardiology fellowship to be full of anxiety, uncertainty, and, well, even fear. As excited as I was to finally begin my career as a cardiologist, I had been out of “the trenches” for a year while serving as an Internal Medicine Chief Resident. As a resident, I was proud of my ability to be extremely efficient without losing an eye for detail. My first day of fellowship, I forgot to check the I/Os on the heart failure patient. I missed a Wenckebach on another patient’s telemetry. The wheel needed some grease.

Day # 2: Saturday call. The echo requests came rolling in. The CT Surgery attending is asking me to evaluate whether an effusion would be better approached percutaneously or surgically. Are you kidding me?! My subcostal echo windows revealed a surgically absent gallbladder. Could I evaluate a patient in the ER for a cardiac etiology of her 50/30 blood pressure? Also, she weighs 350 pounds and has altered mental status. This last case led to a stat “I’m going to need you” consult to the senior fellow.


Erica SpatzErica Spatz — Somehow mothers have the uncanny ability to expose the central conflicts that lie within us. I was reminded of this when my own mother, in her struggle to grasp the world of medical training, asked, ‘How are you, a new cardiology fellow, an expert consultant to others?’ How dare she ask this question!

Ummm…. but wait. Does she have a point? During the day we are a team; the fellow is an extension of an expert attending. But at night, when on call, we are on our own. Unfortunately, the night does not respect the inexperience of a first year cardiology fellow — an equivocal STEMI in the ED, a post-ablation with dropping blood pressures, persistent V-tach in a man with prolonged QT…sound familiar?

On call, we are forced to meet our insecurities of being first-year fellows…warriors of the night, if you will. Yet strangely, often the only hints of battle are cries of …

  • outrage!@#, as in this was the most bogus consult; they didn’t even have a clinical question or an electrocardiogram
  • bravado, as in I did a stat echo, gave adenosine, or activated the cath lab
  • relief, as in handing over the call pager.

3 Responses to “Follow the Fellows: A Series from the Front Lines”

  1. What a great series! I totally empathize with the authors. My first night on call was full of looking up things in books and online before even giving confident answers. But like residency, I feel (or hope) that fellowship will bring the comfort level soon as time passes.

    Competing interests pertaining specifically to this post, comment, or both:
    Biased towards the practice of cardiology and the excitement of what life has to offer!

  2. Umar Shakur, D.O. says:

    Love the quote “how are you, a new cardiology fellow, an expert consultant to others?”

    …because we have to be? First 3 months, it’s amazing what we’ve learned, from engaging the pesky RCA to the humility of echo windows that are just not quite like the techs.

    My brain hurts from acute reperfusion of old learning centers…

    Aaron – say hello to Alo for me, nice to see Olympia Fields represented in this series! Many good memories of Oly!

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

    • aaronearles986 says:

      Umar, I will tell Malo you said hello. I agree with you on the learning curve. I spent most of my first week on call looking information up. I called the attending several times that week. We have great attendings here and they were very understanding. I find they actually want you to call them before making decisions until we have experience under our belts.

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