It can frequently be difficult to make the transition from internal medicine residency to general cardiology fellowship. It can be quite disorienting – going from managing sepsis, respiratory failure, encephalopathy, and etc. – to understanding various echocardiographic parameters/criteria, valvular disease, multiple imaging modalities, and hemodynamics in the catheterization laboratory. Having mastered the art of internal medicine, you find yourself once again at the bottom of the proverbial totem pole. Oftentimes, starting cardiology can feel like learning an entirely different language and career transitions are not without their challenges. Not to mention, as a fellow there are a completely different set of clinical responsibilities as compared to residency.

While this transition can seem quite daunting at first, having a framework to approach all the different modalities can help with this. As a second-year fellow, here are some pointers I have gleaned along the way that some might find useful:

1. Learn to lead and delegate. As a resident, you were likely more accustomed to being told to follow up on labs, imaging results, making follow-up appointments, placing discharge orders, writing notes, and etc. As a fellow, you will find yourself in a position to oversee a team, usually consisting of several residents, interns and medical students. With a large patient load, it will be important to delegate these tasks while you run the service. It is often said that delegation is the most difficult skill for physicians to learn; trying to develop this skill now, as a fellow, will make the transition to being an attending that much easier.
2. Imposter syndrome. Now in fellowship, you are surrounded by talented and outgoing individuals. At some point, we will all deal with this – feelings of self-doubt. It can be difficult to deal with the constant onslaught of calls, falling behind with reading, or learning new concepts. Dealing with this is easier said than done – having a strong support system, both at home and at work, can be enormously helpful. Aside from that – face the facts: You were recruited by the program for a reason, and you deserve the spot you are currently in. The knowledge and skills will come with time – everyone, including attendings and master clinicians, had to start somewhere. You are at just the beginning of that journey.
3. Knowledge. Nowadays, there are new guidelines, recommendations, and late-breaking clinical trials being released on a frequent basis. At this point, you have probably figured out what study/review styles work best you. If passive learning is your thing, try listening to one of the many cardiology-related podcasts out there; or, if you prefer a more structured learning environment, invest your educational fund in a primary source. Above all else – questions! Always make time to do board review questions, as these will augment your learning in an efficient way.
4. Take time for yourself. Make sure to set apart time for the things that matter to you the most (outside of cardiology)! Taking care of yourself mentally and physically is just as important as becoming an outstanding cardiologist. Whether it is spending time with your family/significant other, investing time in your hobbies, going to a concert, the movies, or the gym – whatever it is that lets you relax and blow off some steam, do it! You will thank yourself down the road.
5. Mentoring. Early on, try to identify attendings and senior fellows who you get along with well and who display attributes, both on a clinical and personal level, that you think are worthy of emulating. Having a mentor to discuss career goals with, ask for clinical advice, or discuss research topics with is very important during the fellowship. It is ok to have more than one mentor – each can address different areas/fields of their expertise, be it career advising, research, or a clinical topic. Be outgoing!

In the end – always remember, fellowship is just the beginning; you are committing to a journey of lifelong learning. There will always be something new to learn or new topics to read up on, regardless of whether you are a first-year, a senior fellow, a junior attending, or a senior attending.