The first of July is an important date every year as Fellows in Training (FITs) at different levels of training are starting the year with new goals. First-year FITs are just getting acquainted and comfortable with their new departments and new roles; second-year FITs are deciding on future fellowships and ramping up their research; and third-year FITs are seeing the light at the end of the tunnel. Subspecialty fellows are starting their advanced fellowships, and if not in the same institution, getting to know more about their respective new departments and specialties. Below are my "two cents" on the years of training:

First-year FITs: This is a challenging and intriguing phase of training. Starting with differing strengths, fellows attempt to achieve the most during the first few months in cardiology fellowship. It is a "boot camp" for FITs as they go through learning electrocardiograms, echocardiography, coronary angiography and critical decision making. Many fellows are also preparing for the internal medicine boards with the most common advice heard from my attendings: "Make sure you pass your internal medicine boards." In order to be a good cardiologist, you must be a good internist as you do not want such an exam to hinder your progress in fellowship. It is a stressful period as you try to learn and read about different aspects of managing cardiac patients, as well as prepare for your internal medicine ABIM exam.

Second-year FITs: At this stage, many FITs have developed a strong basis and foundation in their cardiology training. They have also been exposed to all the different aspects and fields of cardiology, from regular clinical work to imaging and procedures. Many second year FITs will have also decided on their future career paths and start working towards them, whether it is interventional cardiology, electrophysiology, heart failure and transplant, advanced imaging, or general cardiology. If undecided, ensure your schedule is set up in a way you that can make your decision within the first few months of the training year. If already set on your career goal towards an advanced fellowship, make sure to spend enough time in that subspecialty in the first few months of the year, prior to the beginning of the application process. This is the time that you should request your letters of recommendation. Thus, spending more time with your letter writers is critical. The better they know you, the more likely a letter will be genuine. Research is important and goals need to be set for the year, especially for projects started in your first year.

Third-year FITs: Several of you are viewed as role models by junior fellows. You resemble the end product of your program and in many programs, you may be relied on to help your first-year FITs transition into the fellowship. As a third-year FIT, you are likely either searching for a job or getting ready to start an advanced fellowship. Many FITs spend the rest of the year in electives, specifically in areas related to their next step. The key during this year is to absorb whatever you can from all different cardiology fields. Develop more of a style and standard for yourself. Understand guidelines, appropriate use criteria and what goes beyond interpreting a test – from communication with referrals to setting plans of action for your patients. It is very important to begin preparation early on for the cardiology ABIM exam. Have a plan set for the months preceding the exam, particularly if you know your schedule will be tough as you start your job or advanced fellowship.

Advanced fellowship FITs: Be flexible, and spend your time adjusting to your new role and perhaps new institution. The cardiology ABIM exam will arrive faster than you think, so be ready! Remember, preparing for this exam is not a week's work and it takes well before starting your advanced fellowship. Time will fly as you enjoy working in an exciting area of cardiology that you have worked so hard to reach. This year marks the end of a training era for many fellows (some, like myself, may choose to continue training). At the end of the year, you will be a mosaic of different experiences and styles.

This article was authored by Karim M. Al-Azizi, MD, structural heart disease Fellow in Training (FIT) at The Heart Hospital – Plano in Plano, TX.