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Navigating postfellowship burdens with the help of mentors
The ultimate goal of any cardiology fellowship program is to train the future leaders in CV medicine by offering an indispensable curriculum. Every program is designed to provide exposure to different areas of cardiology and training in subspecialties such as interventional cardiology or cardiac electrophysiology. Throughout each program, a special emphasis is often placed on ensuring that each fellow establishes a strong relationship with a faculty mentor.
The completion of a fellowship program not only signifies that an individual is exceptionally well qualified and prepared to become a leading physician, but it also means the end of the mentor relationship. This leaves the fellow without a mentor as they transition to becoming a practicing physician in this challenging field, creating a significant burden on the recent fellow graduate.
It is becoming increasingly recognized in our field that continuing a formal mentor relationship after training is beneficial. It is recommended that new practicing physicians receive 2 to 5 years of mentoring before they are truly 100% independent. They can achieve this through continued communication with past mentors to maintain an open and still familiar line of communication; taking an active role in the formation and development of new mentoring relationships with senior colleagues within their new workplace, such as a new hospital or private practice; and joining a community group, such as the Heart Rhythm Society, that can help establish means by which new graduates can connect with potential mentors.
More specifically, mentors can fulfill three purposes: help new faculty navigate advancement in the academic environment; help new physicians choose an area of specialty; and help new physicians enter medical communities.
Transitioning from academia to real-world practice
Although it is great that every fellowship program offers a unique experience that sets them apart from other programs, varied academic experiences can create challenges for fellows as they become practicing physicians. For example, some training programs may be more apt to focus on device implantation, whereas others might be more focused on ablation procedures. Very few programs are comprehensive in all techniques and procedures. In particular, procedures considered even more specialized, such as lead extraction, can be underrepresented in training programs. Because trainees are not exposed to all the different facets that represent cardiology, some fellows are more advanced in certain areas of expertise than others.
Regardless of academic background, all cardiologists are expected to deliver the same results. This increased pressure to perform challenging procedures quickly means a demanding, stressful road ahead for these new practicing physicians.
Besides increased pressures to perform from the very beginning, new practicing physicians have to navigate the rapidly changing field of cardiology as it relates to new guidelines, technologies, diagnostic tests and therapies. New medical information, treatments and technologies continue to evolve at an astounding rate. Procedures have become increasingly more complex and advanced in the past decade. Specifically, we have seen a paradigm shift in catheter ablation during the past several years in which research and innovation have emerged, especially with mapping systems, that allow us to pinpoint the location of atrial fibrillation.
With these constant changes, mentors will provide support and reassurance as new practicing physicians enter their career.
Choosing an area of specialty
For physicians wishing to obtain employment in a competitive field, there is tremendous pressure to subspecialize. We are seeing many more general cardiologists choosing to receive specialty training as the rate of scientific advancement is accelerating and the field is becoming increasingly more technologically sophisticated. Fellow graduates wishing to attain employment in a competitive field face tremendous pressure in today’s society to subspecialize in electrophysiology, interventional cardiology, echocardiography, HF/transplantation or noninvasive imaging.
Experienced physicians serving as mentors can point new-career physicians to accredited programs and organizations that are dedicated to helping cardiologists acquire subspecialty training in a certain field.
It is important to have contact with more than one mentor before choosing a subspecialty to make informed, strategic career choices. Each mentor may have a different perspective, based on a new practicing physician’s skills and interest, on which subspecialty is more important to focus. The ability to confide in an experienced cardiologist who possesses experience and knowledge in a particular area of expertise will undoubtedly alleviate some of the stresses of choosing a subspecialty.
Joining a medical community
A plethora of organizations exist to support new leading physicians throughout their career, and mentorship and learning opportunities are abundant for those involved in medical communities.
Nothing can compare to the knowledge gained through participation in a collective learning setting. Dialogue and engagement with experts and key opinion leaders that allow feedback, ideas, suggestions and an overall exchange of information and innovative thinking are key to an individual’s growth in the cardiology field. HRS also engages physicians in communities of practice, which are groups of physicians who come together to engage, network and share knowledge and best practices with colleagues in similar areas of practice or who have common professional interests through a variety of platforms.
The future of mentorship
Mentorship can help fellows after completion of their training program to cultivate successful, dynamic physicians in the long run, but we need more fellowship programs that combine different curricula, such as combining a structured heart program with an interventional program and an HF program, to give wide exposure to a variety of patient populations with different diseases. Ultimately, these sorts of programs will help develop thoroughly trained cardiologists who are very well-positioned for future subspecialty training or their first practice.
- References:
- Deering TF, et al. Heart Rhythm. 2010;doi:10.1016/j.hrthm.2010.07.026.
- White HK, et al. J Am Geriatr Soc. 2009;57:1270-1277.
- For more information:
- Rahul N. Doshi, MD, FACC, FHRS, is a member of the Heart Rhythm Society who serves as the director of electrophysiology and associate professor of medicine at Keck Medical Center of the University of Southern California. Doshi can be reached at University of Southern California Keck School of Medicine, 1510 San Pablo St., Suite 322, Los Angeles, CA 90033; email: rahuldoshimd@mac.com.
Disclosure: Doshi reports no relevant financial disclosures.