Cardiology Fellowship Training Research Articles

Program Directors Survey on the Impact of the COVID-19 Pandemic on Cardiology Fellowship Training

BackgroundThe COVID-19 pandemic catalyzed unprecedented changes to medical education, including CV fellowship programs. CV fellowship PDs offer a unique perspective regarding the impact of the pandemic on CV medical education. ObjectivesThe 4th annual Cardiovascular Diseases (CV) Fellowship Program Directors (PDs) Survey sought to understand the impact of the COVID-19 pandemic on CV fellows and fellowship programs. MethodsThe survey contained 31 items examining the clinical, educational, and academic impact of the COVID-19 pandemic on CV fellowship programs. ResultsSurvey response rate was 54%. Most respondents (58%) represented university-based programs. Most PDs felt that changes to clinical practice during the COVID-19 negatively impacted fellow education in cardiac catheterization (66%), outpatient cardiology (52%), nuclear imaging (51%), and echocardiography (50%). Despite improving attendance, 75% of PDs felt that virtual educational conferences adversely impacted interaction between participants. Only 22% felt they improved fellow education. Most PDs (85%) reported a negative impact of the pandemic on fellow well-being and burnout, and 57% reported a decrease in research productivity among fellows. Even though virtual recruitment allowed programs to interview more competitive candidates, most PDs felt that virtual interviews adversely impacted interactions between their fellows and candidates (71%) and their ability to convey the culture of their program (60%). ConclusionsMost CV fellowship PDs felt the COVID-19 pandemic brought changes that negatively impacted the clinical training, didactic learning, academic productivity, and well-being among cardiology fellows. The implications of these changes on the competency of cardiologists that trained during the COVID-19 pandemic deserve future study.

Abstract 13876: Women Face Unique Obstacles During Pediatric Cardiology Fellowship Training

Background: There are persistent disparities in career advancement for women physicians in pediatric cardiology. We sought to explore differences by gender in fellowship experience, as these may set the foundation for long-term gender inequity. Aims: To describe and compare fellowship experiences, career aspirations and family obligations of men and women in pediatric cardiology training. Methods: We performed a national survey of pediatric cardiology fellows examining mentorship, scholarly and DEI work, clinical experiences, career intentions and family commitments. Descriptive analyses were performed. Results: A total of 176 responses were included in the analysis (men=74, women=102). Most fellows were white (69%) and aged 30-34 years old (68%). Men and women reported similar mentorship, scholarly and clinical experiences, and influential factors in their decision to pursue subspecialty training. More women plan to pursue advanced imaging training (42% vs. 24%, p=0.04), to have administrative responsibilities (27% vs. 14%, p=0.06), and to work part time during their career (28% vs. 5.6%, p=0.001). Men reported greater interest in teaching (93% vs. 83%, p=0.04). While similar proportions of men and women were married, the spouses of women were more likely to be employed (91% vs. 71%, p=0.002). Among fellows with children, more women than men planned for additional children (75% vs. 25%, p=0.0004). Among fellows without children, more men than women planned for additional children (93% vs. 74%, p=0.01). Women were more likely to report delay in childbearing due to training (71% vs. 40%, p=0.0002), that childbearing decisions were influenced by the risk of radiation exposure (22% vs. 0%, p<.0001), and the use of assistive reproductive technologies (11% vs. 1%, p=0.01). Conclusion(s): Women and men in pediatric cardiology fellowship have similar training experiences and career aspirations yet differ in their plans to raise families. Women face unique obstacles to childbearing and child raising during training. Motherhood in pediatric cardiology may be a vulnerable period during career development and advancement.

Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice?

Condolence letter (CL) writing after the death of a child is an important opportunity for humanism. Pediatric cardiology fellowship training now recognizes the importance of palliative care, but rarely includes CL education, despite its fragile patient population. To address this professionalism gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship. This study investigated the impact of the curriculum on pediatric cardiology CL writing, and broader CL practices and beliefs. Pediatric cardiology fellows at a high volume urban academic program from 2000 to 2022 were divided into two cohorts (exposure to CL curriculum [2014-2022] vs. no exposure [2000-2013]) and responded by anonymous electronic multiple choice and open ended survey to assess the CL curriculum and describe current CL practices and beliefs. Impact of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence were utilized for group comparisons. The overall survey response rate was 59% (63/107). Cardiologists who participated in the curriculum (64%, 35/55) were more likely to report writing CLs (80% vs. 40%; P < 0.01). Impactful curriculum elements included the opportunity for all fellows to contribute to a CL (78%) and identifying a primary fellow to write the CL (66%). A majority (>75%) of curriculum participants agreed that formal teaching increased their frequency, ability, and comfort in writing CLs. Development of condolence expression educational programs in pediatric cardiology training should be expanded.

Editorial introductions.

Editorial introductions.

Impact of the COVID-19 pandemic on cardiology fellowship training in a sub-Saharan African training centre: an African perspective.

The impact of the COVID-19 pandemic on cardiology fellowship training in sub-Saharan Africa (SSA) is not known. This study aimed to determine the impact of the COVID-19 pandemic on fellowship training, and reviewed the adaptiveness of the existing training systems. We conducted a three-month data survey related to the cardiology fellows' clinical exposure at the Aga Khan University Hospital, Kenya, before the COVID-19 pandemic and compared it with a three-month period during the pandemic. Hospital data volumes for patients' contacts, ambulatory and catheterisation laboratory procedures recorded during the periods of March to May 2019 (three-months pre-COVID-19) and March to May 2020 (three-months during the COVID-19 pandemic) were analysed. A comparative fellows' logbook evaluation of recorded cases was also conducted for the two study time periods. In addition, fellows answered a survey questionnaire related to their roles and responsibilities in the hospital, their views on cardiology training during the COVID-19 pandemic and the pandemic's impact on their training. There was a significant reduction in the volume of patients and cardiac procedures during the COVID-19 period compared to the pre-COVID-19 period. In the same line, the number of fellows' training episodes reduced significantly during the COVID-19 pandemic compared to their performances before the pandemic. Fellows felt that the COVID-19 crisis has had a moderate to severe impact on their fellowship training. They however noted an increase in the provision of virtual local and international meetings and conferences, which supported the training positively. This study showed that the COVID-19 crisis resulted in a significant reduction in the total volume of patients and cardiac procedures and, in turn, the number of training episodes. This may have limited the fellows from achieving a great amount of skills base in highly technical skills by the end of their training. Opportunities for post-fellowship training in the form of continued mentorship and proctorship would be a valuable option for the trainees if there is a similar pandemic in the future.

Educational Experience of Interventional Cardiology Fellows in the United States and Canada

BackgroundThe COVID-19 pandemic and iodinated contrast shortage may have affected interventional cardiology (IC) fellowship training. ObjectivesThe aim of this study was to investigate the educational experience of first-year IC fellows in the United States and Canada. MethodsA 59-question online survey was conducted among 2021-2022 first-year IC fellows in the United States and Canada. ResultsOf the 360 IC fellows invited to participate, 111 (31%) responded; 95% were from the United States, and 79% were men. Participants were mostly from university programs (70%), spent 61 to 70 hours/week in the hospital, and had an annual percutaneous coronary intervention case number of <200 (5%), 200 to 249 (8%), 250 to 349 (33%), 350 to 499 (39%), 500 to 699 (12%), or ≥700 (3%). For femoral access, a micropuncture needle was used regularly by 89% and ultrasound-guided puncture by 81%, and 43% used vascular closure devices in most cases (>80%). Intravascular ultrasound was performed and interpreted very comfortably by 62% and optical coherence tomography (OCT) by 32%, and 20% did not have access to OCT. Approximately one-third felt very comfortable performing various atherectomy techniques. Covered stents, fat embolization, and coil embolization were used very comfortably by 14%, 4%, and 3%, respectively. Embolic protection devices were used very comfortably by 11% to 24% of IC fellows. Almost one-quarter of fellows (24%) were warned about their high radiation exposure. Eighty-four percent considered IC fellowship somewhat or very stressful, and 16% reported inadequate psychological support. ConclusionsThis survey highlights opportunities for improvement with regard to the use of intravascular imaging, atherectomy techniques, complication prevention and management strategies, radiation awareness and mitigation, and psychological support.

A Case for Task-Shifting in the Management and Care of Patients With Heart Failure in Ghana: Experience From Yale University

The Resident in Training Educational Stipend (RITES) award was instituted by the Ghana Physicians and Surgeons Foundation of North America in 2015. Ghanaian physicians working and living in the United States sponsor the RITES program to enable fellows-in-training from Ghana to benefit from the Yale Partnership for Global Health Program. The program offers an observership and research mentorship experience at Yale University School of Medicine. As the 2022 RITES awardee, author D. A., shadowed the heart failure (HF) service at Yale University School of Medicine after completing cardiology fellowship training in Accra, Ghana.

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Essential nonclinical competencies for cardiovascular specialists imperatives for training.

C. Richard (Dick) Conti was a pioneer in innovation…not only in clinical and academic fields, but also in the exposure of academicians, clinicians, and trainees to various environments for expansion of their knowledge base…and world view. In an evolving environment of systems of medical care, engagement in management and planning by physicians and all members of the care team is essential to ensure quality for patients and to develop processes that work effectively for practitioners. This is particularly true in cardiovascular disease, where the majority of physicians are now part of integrated healthcare systems.Such integration can have advantages, but can also lead to a perceived and real loss of professional control over the practice of medicine. As health systems grow, even those practitioners who remain "independent" require the ability to actively engage in system programs, processes, and planning. Tools to effectively contribute to such skill sets are not commonly part of formal training.This communication describes the needs for training in nonclinical competencies, some current resources, and a model for formal integration of such instruction into cardiology fellowship training. An approach such as this honors the memory of Dick Conti, as an educator and leader who continuously looked for avenues to improve the practice of cardiovascular medicine.

Developing a curriculum to improve cardiology fellows\u2019 training in pregnancy and cardiovascular disease

BackgroundExposure to pregnant women with cardiovascular disease (CVD) during cardiology fellowship training is limited and without a standard curriculum in the United States. The authors sought to evaluate a dedicated curriculum to teach management of CVD in pregnancy to improve general cardiology fellowship training.MethodsThe authors developed a dedicated CVD in pregnancy curriculum for the general cardiology fellows at a large academic medical center in the fall of 2019. Fellows’ knowledge was assessed via a board-style examination and exposure and attitudes related to the care of pregnant women with CVD were evaluated with a needs assessment questionnaire before and after the curriculum.ResultsOf the 17 fellows who participated in the curriculum, 12 completed the needs assessment pre-curriculum and 9 post-curriculum. The mean (SD) number of pregnant women with CVD cared for by each fellow in the inpatient and outpatient settings were 0.75 (1.29) and 0.56 (0.73), respectively. After the curriculum, all fellows reported awareness of available resources to treat pregnant women with CVD, while a majority disagreed that they receive regular exposure to pregnant patients with CVD in their training. The authors observed significant increases in fellows’ confidence in their knowledge of normal cardiovascular physiology of pregnancy, physical exam skills, and ability to care for pregnant women with valvular disease and arrhythmias from pre to post-curriculum. A total of 15 fellows completed the board-style exam pre-curriculum and 15 post-curriculum. Fellows’ performance on the board-style examination improved slightly from before to after the curriculum (64.0 to 75.3% correct, p = 0.02).ConclusionsA dedicated curriculum improved cardiology fellows’ knowledge to recognize and treat CVD in pregnancy and improved confidence in caring for this unique patient population.

Common indications and impact on clinical management of overnight, inpatient transthoracic echocardiograms performed by pediatric cardiology fellows

BackgroundOne of the core competencies of pediatric cardiology fellowship training is to perform and interpret transthoracic echocardiograms. Each institution is responsible for developing a curriculum surrounding this skill, yet there is little literature about the most common indications and the utility of these studies. ObjectivesThe aims of this study are to determine the most common indications for overnight, inpatient transthoracic echocardiograms in pediatric patients performed by fellows and to evaluate their impact on clinical management. MethodsRetrospective chart review was completed for all transthoracic echocardiograms performed overnight by pediatric cardiology fellows during a one-year period. Study indication, result, and ordering hospital unit were obtained. Transthoracic echocardiograms impact was classified based on documentation in the medical record. ResultsTwo hundred and twenty-five overnight transthoracic echocardiograms were performed on 186 patients; 46% had underlying structural heart disease. The most common indication was for assessment of left ventricular function (40.9%). The Heart Center (combined cardiac intensive care unit and step-down unit) was the most common ordering unit (40%). Fifty-four percent of studies were documented in the medical record as having impacted clinical decision-making. The indications resulting in the highest clinical impact were evaluation of shunt patency (100%) and confirmation of prenatally diagnosed congenital heart disease (86%). Clinical impact of overnight, inpatient transthoracic echocardiograms was higher in patients with known heart disease compared to those without (67% vs 43%). ConclusionPediatric cardiology fellow education should emphasize early training for assessment of left ventricular function and high impact indications in patients with congenital heart disease. Impact of overnight transthoracic echocardiograms is highest when used in children with underlying heart disease.

Cardiology fellowship in the era of coronavirus disease (COVID 19)

Since Coronavirus disease (COVID-19) was declared a pandemic on 3/12/2020 by the World Health Organization (WHO), diagnosed cases have continued to be on the rise worldwide, even though rates of new case detection seem to be stabilizing here in the United States [1]. This pandemic has impacted delivery of healthcare as well as health care workers in many aspects. In this article we discuss the impact of COVID-19 on cardiology fellowship training, early career concerns of fellows in training, and some suggestions to help training programs to cope with these challenges. It remains unclear how this pandemic will impact our health systems for the foreseeable future and thus a call to action is needed to reassess education needs and strategies of trainees during the pandemic not only in the interest of our FITs but also their future patients.

Cardiology Fellowship Training One Year into COVID 19 Pandemic: The Philippine General Hospital Experience

The previous year, 2020, was one challenging year for everyone, most especially to the healthcare workers. We experienced a pandemic no one ever imagined that would happen in our lifetime. Medical frontliners, the People Giving Hope, were called and were given the responsibility of taking care and defending the patients from the unfamiliar enemy, the COVID 19 virus. With the changes brought about the pandemic, transformation of the cardiology fellowship training also happened. Three Cardiology fellows in training gives us a sneak peek of how the pandemic affected their lives after a year of battling the virus. KEYWORDS Covid 19, Cardiology, Training

Increasing Diversity in Cardiology: A Fellowship Director’s Perspective

BackgroundUnderrepresented-minorities (URM) remain few in number amongst practicing cardiologists and across cardiology fellowship training programs in the U.S. Increased diversity is needed across the entire field and is particularly necessary within graduate medical education cardiology fellowship training programs.ObjectivesThis cross-sectional study was performed to identify which strategies were supported and implemented by cardiology fellowship program directors (PDs) to increase URM representation, to determine which entities hold the responsibility to increase diversity according to program directors, and to quantify URM representation in cardiology fellowship programs.MethodsA 15-item survey was submitted to all American College of Graduate Medical Education (ACGME) accredited cardiology fellowship programs via electronic mail.ResultsOf 250 cardiology fellowship programs, 71 responses were received (28.4%). The number of URM faculty varied from 0-1 to more than six, and URM faculty held leadership roles in most programs (62.0%). A total of 16 respondents (22.5%) were URM program directors. Most respondents agreed that diversity was important to their training program (85.9%). The majority endorsed direct recruitment of URM applicants (60.6%), opportunities for applicants to connect with (54.9%) or be recruited by URM fellows (54.9%), holistic application review (67.6%), promoting mentorship by URM faculty (69.0%), URM faculty involvement in applicant interviewing (54.9%), and increased recruitment of URM faculty members (73.2%). Program directors allocated major responsibility to increase diversity to fellowship programs (71.8%), residency programs (63.3%), and medical schools (53.5%).ConclusionsThis study found that most cardiology programs have URM faculty in leadership roles, and nearly a quarter of the surveyed program directors were URMs. Cardiology program directors endorsed and employed numerous strategies to increase diversity and URM representation in fellowship programs. Additionally, program directors held fellowship training programs most responsible for increasing URM representation in the field of cardiology.

Pediatric Cardiology Fellowship Training in Exercise Medicine: A General Needs Assessment.

The aim of this study was to improve understanding of exercise medicine training needs for pediatric cardiology fellows. A survey was sent via email to all (N = 63) pediatric cardiology training program directors in the United States to evaluate the perceived exercise training needs of pediatric cardiology fellows. The survey consisted of multiple-choice responses as well as a few open-ended responses. A 60% response rate was achieved. 74% of programs did not have a pre-existing exercise core program. This type of training was felt to be important or very important in 84%. A wide variability of time allotted for exercise training exists amongst programs from < 1week to > 4weeks, with 2weeks being most common. There was no consensus on a target number of total exercise tests nor types of tests in which fellows should participate. Preferred methods in training consisted of lectures and online media. Less preferred methods of teaching methods included dedicated reading of a handbook, a dedicated rotation, or live webinars. There was general support to develop exercise training competencies as well as the associated online learning materials with a focus on competency rather than target numbers. There is a need for educational recommendations for exercise training in pediatric cardiology fellowships as well as a unified method of achieving competencies.

Editorial introductions.

Editorial introductions.

Navigating Early Careers in Heart Failure in the Era of Novel Coronavirus Disease-2019

Navigating Early Careers in Heart Failure in the Era of Novel Coronavirus Disease-2019

TCT CONNECT-224 Interventional Cardiology Fellowship Training During COVID-19 Pandemic: Facts and Challenges

Background: The coronavirus disease-2019 (COVID-19) pandemic has represented unprecedented challenge to health care system During such global threat, it is very difficult if not impossible to disregard the impact of this crisis on fellows-in-training (FITs) Accordingly, we sought to assess the impact of the COVID-19 pandemic on cardiology FITs in form of their volume of procedures and the challenges they confront during pandemic Methods: Study included cardiology FITs from 5 cardiac teaching centers, a printed survey in form of pdf file was sent to FITs by telegram;the survey consisted of 10 sections and included 43 questions, which focused on number and type of cardiac procedures done by the candidates before the pandemic (from December 2019 to February 2020) and during the pandemic in Iraq (March to June 2020) The survey also inquired on personal protective equipment (PPE) provided to candidates during duties Results: The survey included 49 candidates;77 6% were adult cardiology FIT, 20 4% were pediatric cardiology FIT, and 1 candidate was EP FIT All cardiac interventions dropped with highest rate of drop of volume in structural heart interventions and in diagnostic angiographies The candidates reported undersupply of PPE during pandemic as 59 2% reported crucial need for more PPE supply during duties;22 4% reported no clear protocol in their hospitals to deal with cardiac patients during pandemic;59 2% reported need for regular virtual teaching webinars to upscale education [Formula presented] Conclusion: There is remarkable disruption in cardiology training caused by COVID-19;every effort should be taken by decision-makers to prepare a well-equipped workforce nucleus to counteract this pandemic and improve cardiovascular care Categories: OTHER: COVID-19

Impact of the COVID‐19 pandemic on interventional cardiology fellowship training in the New York metropolitan area: A perspective from the United States epicenter

BackgroundThe healthcare burden posed by the coronavirus disease 2019 (COVID‐19) pandemic in the New York Metropolitan area has necessitated the postponement of elective procedures resulting in a marked reduction in cardiac catheterization laboratory (CCL) volumes with a potential to impact interventional cardiology (IC) fellowship training.MethodsWe conducted a web‐based survey sent electronically to 21 Accreditation Council for Graduate Medical Education accredited IC fellowship program directors (PDs) and their respective fellows.ResultsFourteen programs (67%) responded to the survey and all acknowledged a significant decrease in CCL procedural volumes. More than half of the PDs reported part of their CCL being converted to inpatient units and IC fellows being redeployed to COVID‐19 related duties. More than two‐thirds of PDs believed that the COVID‐19 pandemic would have a moderate (57%) or severe (14%) adverse impact on IC fellowship training, and 21% of the PDs expected their current fellows' average percutaneous coronary intervention (PCI) volume to be below 250. Of 25 IC fellow respondents, 95% expressed concern that the pandemic would have a moderate (72%) or severe (24%) adverse impact on their fellowship training, and nearly one‐fourth of fellows reported performing fewer than 250 PCIs as of March 1st. Finally, roughly one‐third of PDs and IC fellows felt that there should be consideration of an extension of fellowship training or a period of early career mentorship after fellowship.ConclusionsThe COVID‐19 pandemic has caused a significant reduction in CCL procedural volumes that is impacting IC fellowship training in the NY metropolitan area. These results should inform professional societies and accreditation bodies to offer tailored opportunities for remediation of affected trainees.

Editorial introductions

Editorial introductions