December 19, 2016 | Ignacio M. Seropian, MD
International

Argentina has a long tradition in cardiology. Rene Favoloro, MD, is considered by Argentineans as the pioneer of coronary artery bypass graft surgery. Julio Palmaz, MD, invented the Palmaz coronary stent and Juan Parodi, MD, performed the first endovascular abdominal aortic aneurysm repair. Although most of these were performed abroad, Argentineans are aware of the importance of research to the field of cardiovascular medicine. Also, research is important to build an academic career, so there’s no argument that doing research as an FIT is the perfect combination. Yet, a day has only 24 hours, and the cardiology training program is very time consuming. So, how you can do it all? This is a question I asked myself several times.

First of all, there are some important differences in Argentina on how to become a cardiologist. After getting a Doctor of Medicine degree (MD), there are several options for cardiovascular medicine certification. Too many in my opinion. The advantage of having many pathways is that individuals can seek out the program which suits them best. The disadvantage is that there is no uniform pathway and, yet, everyone can get certified.

1.) The easiest pathway for people currently working full time or who have already performed another specialization is to attend a University Cardiology Course. At several places, you can attend twice weekly evening lectures, and take regular exams to get a cardiovascular degree. The duration of this pathway is usually two years – internal medicine residency not a pre-requisite. In order to see patients, you must attend at an assigned hospital. Time spent with patients depends on the place, but it is always less than a fellowship. Since the amount of patient exposure is limited, this pathway is mainly theoretical. In some hospitals, you may become an observer during the course, with “little or no actual hands-on” clinical care.

2.) The other intermediate system is called ‘Concurrence’ and is similar to a cardiovascular medicine fellowship training. However, the individual does not receive any wages or financial stipends, is given one free day per week to make a living, and he/she has less hours of in-hospital training than a fellow. It usually takes five years (one in internal medicine and four in cardiology). It is a year longer than a fellowship program, in order to compensate for fewer hours a week. Usually people who couldn’t get a position as a fellow choose this pathway.

3.) A fellowship (called ‘residency’ in Argentina) is the most important and complete way of training. The individual is at the hospital full-time and receives a salary. The duration of this cardiovascular certification pathway is four years, which also includes a preliminary training year of internal medicine. Few medical school graduates can get a cardiovascular medicine residency position because of strict admission requirements. The training can be performed at either public hospitals or private hospitals. Public hospitals are run by the local government and provide free medical care to patients, while private hospitals take care of patients with a health insurance or those who pay out-of-pocket for care.  I was fortunate to have a choice in the selection of my training location. I decided to train at a small private hospital because I think cardiology is really dependent on new technologies (MRI, CT scan, SPECT-CT, interventional cardiology, EP) and these technologies are not always available at public hospitals. However, there is no perfect training location.

As a medical student I enjoyed research. I started as an undergraduate student helping in a basic research lab in cardiology. I worked mostly with rabbits and myocardial infarction. After getting my MD, I took a year off and moved to Virginia Commonwealth University, in Richmond, VA to do translational research, working full time on a mouse model of infarction. Unfortunately, in Argentina there are no MD-PhD programs, but I wanted to come back to my home country. In 2010, I started my cardiology fellowship in Buenos Aires. I had several research ideas and projects, but quickly realized there was so little time! Working from 8 a.m. to 7 p.m. in the CCU, having eight days on call in a month, and being assigned a conference once a week leaves you only time to eat and sleep. So for the first two years, I was barely able to fulfill my duties at the hospital with no research at all.

During the last two years of the fellowship, I was able to finish some experiments with the help of my former research lab’s colleagues. Then I started an interventional cardiology fellowship at a much bigger community-based private university hospital. I was fortunate to find a place where research is a priority and, in addition, had an animal lab for basic translational research (mostly animal models of stenting). Yet, once again, I struggled with time: to become a skilled interventional cardiologist, it is important to perform several procedures (the more procedures, the better), and to become a good, productive basic science researcher, it is important to spend time in the research lab – time away from the cath lab.

For those who like clinical research it may be somewhat easier. One piece of advice that I found useful was to start building my own database. It is important to start with a ‘scientific question’, not to waste time filling data you’ll never use. If you don’t have enough patients, a good place in Argentina is to participate in CONAREC, the ‘Argentinean Council for Cardiology Residents’. It is formed by FITs and has made some nationwide registries in atrial fibrillation, heart failure and acute coronary syndromes from data collected by FITs. But, if you like basic translational research like me, it may be harder. If you work with animal models you’ll need an animal lab, only available at very few hospitals in Argentina. Remember, translational research is not only with mice and rats. You can do research with molecular biology or pathology from patients’ samples, blood, etc.

As usual, the most important thing is to always keep trying and never give up! Since I started my cardiology fellowship in June 2010, I have been able to publish 19 peer-reviewed papers.   

This article was authored by Ignacio M. Seropian, MD, a Fellow in Training (FIT) in interventional cardiology at Hospital Italiano de Buenos Aires in Argentina.