December 2nd, 2011

Follow the Fellows: Which Program Is Right for Me?

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For our new series at CardioExchange, “Follow the Fellows,” we have invited physicians from various cardiology fellowship programs to document their course through their training. In this post, the fellows describe how they chose their fellowship programs. You can read their earlier posts here and here.


A Long and Winding Road

by Erica Spatz, MD, MHS

For a long time I struggled with the decision of whether to pursue a cardiology fellowship. I did not have reservations about the science or clinical demands — these I welcomed. Rather, I was uncertain how I would integrate my interests in public health, disease prevention, and health-system reform to reduce health disparities. Many of my mentors were internists, and while they were supportive of my pursuit of a cardiology fellowship, they also emphasized the importance of finding a cardiology program that was supportive of my goals, and vested in developing my skills as a clinician and as a health services researcher.

As a third-year resident, I applied to several cardiology fellowship programs in the Northeast. However, by the end of interview season, my concerns became more pronounced. I had not found the perfect “fit,” and I decided to drop out of the match. This decision did not come easily, but ultimately it forced me to reevaluate my priorities and the kind of impact I wanted to make as a physician and to reconsider how best to pursue my interests.

In my following year, now a chief-resident, I applied and was accepted to the Robert Wood Johnson Clinical Scholars Program, where I received training in clinical research, gained new mentors, and was exposed to incredible opportunities to learn from and collaborate with leaders in health care research and delivery. Additionally, I connected with a cadre of cardiologists who shared similar values and who emulated the kind of work I had always hoped to do. They introduced me to a world of outcomes research and, perhaps more importantly, made me feel welcomed and supported.

And so once again I found myself interviewing for a cardiology fellowship. It was different this time, however, purposeful. I had a clearer focus of how clinical training in cardiology could help advance my research and career and my overall satisfaction as a physician taking care of patients. I was also supported by a committed husband who was willing to relocate and to change a few more diapers than he had previously.  I am fortunate for this opportunity and consider it a gift to be back in clinical training.


Marrying the Professional and the Personal

by Kathryn Lindley, MD

In deciding on the “right” cardiology fellowship program for me, I had to take into account both what my future career goals were — I hope to become a clinician-educator — and what my life had already become — I am the mother of a two-year-old. I considered three aspects of possible fellowship programs in determining the one that best fit both my present and future.

Aspect #1: The Program. To become an excellent clinician-educator, I needed to see patients. Lots of patients. Lots of sick patients. So, I needed a program that would have high volume and excellent teaching. I also needed a program with a schedule that would allow me to work very hard, but still allow adequate time to spend with my family. At Barnes-Jewish Hospital, my calls are busy and my days full. Yet the call schedule is manageable, and on most days I get home in time to eat dinner with my family and put the little one to bed.

Aspect #2: The People. Most programs have busy patient loads, interesting conferences, and multiple research opportunities. But I also wanted to be happy. I figured that if I was going to be spending 80 hours a week with a group of people, I might as well spend it with people I enjoy. So I really tried to see whether I “clicked” with the fellows and attendings at the various institutions I visited. Were people collegial? Did they seem happy? Would they choose the same place again?

Aspect #3: The Location. I have a toddler…and a husband who travels to California and Germany for work. My parents live in the middle of nowhere. How could I reconcile my demanding career with these factors? I chose a city where we could afford a house with a yard and that has great daycare. My parents are several hours away, but this is significantly closer than many other programs I was considering. And still it is clutch when my husband is away on a business trip, and I need to take call!

In the end, I found a program with high patient volume, excellent teaching, and research opportunities, in an affordable city that is close to home — and filled with people that I really enjoy. I think I made a great decision!


Moving Beyond One’s Comfort Zone

by Bill Cornwell, MD

Developing a rank order list for fellowship programs was difficult.  My ultimate goal was a program allowing me to fulfill all my career goals while satisfying personal and family interests.  I spent a great deal of time communicating with faculty and fellows at various programs throughout the country, sought advice from mentors at my home program, and spent countless hours researching fellowship programs online.

My personal statement in my fellowship applications clearly outlined my career goals: to become an academic cardiologist, with a focus on heart failure and pulmonary hypertension, and to be involved in outcomes research and medical education.  So, I sought out programs that would prepare me for such a career.

Along the interview trail, answers from the program leadership to my questions were vital in helping me rank my list. Have previous fellows gone on to pursue similar interests?  Are there strong mentors to help me along the way?  Is it possible to obtain an MPH or MSc? Other impressions from the interview days helped seal the fate of several programs – whether they were at the top or the bottom of my list.  Would I enjoy working for the program director? Were the current fellows happy? Was the program vibrant and healthy?

Also, my wife and two children would be accompanying me on this venture, and incorporating their interests was of the upmost importance.  My wife and I deliberated on the negatives of moving far away from our home and our families.  However, we also envisioned this as a great opportunity for us to become immersed in a new culture and meet new people, and at the same time, for me to practice medicine in a different region with a vastly different patient population.  As the deadline for the rank list grew near, we welcomed the thought of moving beyond our comfort zone, recognizing the personal and professional opportunities that would result.


My Personal Checklist for Choosing a Fellowship

by Aaron Earles, DO, MS

Looking for the cardiology fellowship to best fit your personal and professional needs can be exhausting.  I developed my own system to help me evaluate the pros and cons of each fellowship to which I applied.

Exposure to pathology. This was the most important determinant for me. I am a “hands on” learner. The more I am exposed to something, the better the chance I will remember.  An emphasis on academics was also paramount. In my program, we have a weekly journal club, catheterization and critical care conferences, and weekly board review sessions.

How well the current fellows interacted with each other.  While interviewing last year, I paid very close attention to camaraderie, which I think is crucial for the overall development of the individual and the program. I wanted to be sure that I could get along with these individuals on a daily basis for 3 to 4 years! Every now and then, everyone needs to trade a call or shift with another fellow and it makes it much easier if the other fellows are team players.

Availability of an interventional cardiology fellowship.  I want to pursue a fellowship in interventional cardiology after finishing my general cardiology fellowship. I was hoping to find one program for both fellowships, which would increase my exposure to that field as well as to the attending cardiologists who make the decisions. However, not all of the programs I reviewed had interventional fellowships associated with the general cardiology program. I also was looking for a program with strengths in electrophysiology.

Location.  This was the least important factor for me. I would have moved to the North Pole if necessary to get a cardiology fellowship. Still, most fellowships are located in or near cities, but I come from a small town in West Virginia and completed my Internal Medicine residency in a rural setting. My solution: a program outside Chicago. The price of living in Chicago is quite high, and I live in one of the suburbs.

Family obligations.  If you have a family, this is one of the most important factors in selecting a fellowship. Because I am not currently married, this was not really a factor.  If you have an understanding spouse, then you should do fine.  I will tell you, however, fellowship can be difficult for any relationship!





3 Responses to “Follow the Fellows: Which Program Is Right for Me?”

  1. These are great posts. Erica, how long was the Robert Wood Johnson fellowship and did you feel “rusty” when you returned to clinical activities in your cardiology fellowship? This is often a concern for residents who are thinking about taking a similar path to you.

  2. The Robert Wood Johnson fellowship is 2-years. I received funding for an additional third year, however I don’t think the 3rd year is available any longer.
    Transitioning back to clinical training was difficult for multiple reasons. Dare I say, ‘yes,’ I was/am rusty. But, it comes back quick. The basics are there. And UpToDate/Wikipedia/Pubmed are an i-phone touch away. I’ve also been lucky to have support from lots of senior fellows. After getting over the shock of being a trainee again, it’s been loads of fun. I think I come at it with a new lens, and a certain maturity, so as not to sweat the small stuff – and focus on what matters…the patient.

  3. Dina Sparano, BS. MD. says:

    These are great posts, hopefully some of our junior colleagues aboard the interview trail will find their way to these for some guidance.
    I did apply, or at least tried to apply, some formula to my personal evaluation of cardiology fellowship programs. There are a few that I firmly stand by:

    #1: The Program Director. Leaving the interview day with a good feeling from this person is fundamental in my opinion. He or she must have fellow advocacy as their top priority, and if this is true of a program’s director, it will be very obvious right off the bat. This is the person who will be your liaison and advocate with faculty, serve as a career and (if you’re lucky) a life mentor. and help you navigate any challenges that come your way – personal or professional. Feeling comfortable and unguarded with the program director is one very important key to a successful fellowship.
    #2: The Fellows – obviously. Just as in searching for a residency “fit”, getting a sense of the fellows as a group and how you do or do not “fit in” to this group should be fairly easy to ascertain upon visiting the program. Observe how they interact with each other – do they seem like friends? How many of them are coming to the social parts of the interview process (breakfast meet-and-greet, lunch, evening-before dinner, etc). This not only clues you into their relationship with each other but also how invested they are in the program. A great showing suggests the fellows tend to have a vested interest in the incoming fellows, the integrity of the program, and want to represent the program with pride. Pay attention to these “volunteer” portions of the interview process – they are very telling regarding the fellows personalities.
    #3: The Career-Boosting aspects. These are likely obvious as well and include research opportunities, where and in what types of settings do the fellows tend to get jobs after they graduate, community outreach opportunities, and so forth. This includes all of those “unique” questions we all bring to the interview that concern how the program molds its rising cardiologists. While these are important, I would say that with any of these “career-boosting aspects”, there are 2 key things to remember: 1) you will always get the answer you ‘want” to hear on the interview day – they are trying to sell the program, after all and 2) to take advantage of any of these, it relies less on how much it is sold to you at the interview and more on your own interest in the pursuit. If you want to do research that badly, you will figure out how to make it happen.
    #4: The Faculty – to whatever extent this matters to you, pay attention to faculty – are you looking for “big names” in the field? A large vs a small, more intimate department? How do they seem to interact with the fellows? Do they treat fellows more like colleagues or is the hierarchy very well delineated?

    Things I would say to pay less attention to:
    The call schedule, the rotation schedule, the “perks” (annual stipends for educational use, laptops, etc). These are fairly insignificant as they are relatively stable from program to program and any differences balance each other out eventually. Don’t get caught up in the details, is what I’m trying to say…which brings me to my next, final and most important point…

    It’s all about the X-factor. Call it what you will – gut feeling, instinct, a sign. It all refers to the same thing. You will walk away with a feeling and “just know”, as they say, when it feels right. Do not ignore or underestimate the X factor, it is quite powerful. Perhaps it is a combination of some of the things I mentioned above. I’ve tried to conceptualize this and really dissect what goes into this, but I always come up short. Like most things in life, if you get a good feeling about something (or a bad feeling for that matter), you are typically right.
    I had this feeling when I left the interview at my fellowship institution (The University of Chicago), but I didn’t know what it was. I kind of let it go at first, mainly because I couldn’t make sense of it. Yes, on paper, my program looked terrific, but what made it jump off the page? I couldn’t tell you other than that I just got this feeling. I was right, I am happier than I could have ever imaged being with my fellowship experience. For one of the few times in my life, I know with 1000% certainty, I am exactly where I am supposed to be. That is a priceless feeling, I think it’s actually the opposite of regret – the absolute worst feeling.

    That’s how powerful the X-factor is.