It is the time of the year when third year residents transition to first year cardiology fellows overnight. It is understandably a daunting experience but most importantly, congratulations to all! Welcome to your cardiology family!

A question I have been asked several times over the past few months is, "What can I do to prepare for my first year of fellowship?" Personally, stepping into my third year of fellowship, I have realized that my answer to this question was different at different stages of my training so far. I hope to convey a few simple but deep-rooted realizations I've had during my training.

One step at a time

As most of us do, I read a lot of cardiology materials during residency prior to starting fellowship. However, many of us do not realize that "cardiology" encompasses several subspecialties that are subjects in itself and if one doesn't anticipate the extent of knowledge we are to learn in the three years, one may be swiftly overwhelmed by it all. For this reason, it is important to step back, take a moment and learn what is at hand and build from it. For example, if you are on your echo rotation, make a cheat sheet with all the measurements required to read an echo from the ASE guideline documents, perform some yourself with the help of the echo technicians, ask a senior fellow to run you through the basic initial steps of how to review images and then get started yourself using one reference book to begin with and of course, the guidance of the faculty at your institution. If on a cath lab rotation, learn to set the table, obtain radial and femoral access and eventually, engage the coronaries. With time and repetition, it will come more naturally. The goal should be to immerse yourself in the rotation, be sincere and learn as much as possible along the way.

Embrace the feeling of stupidity

I recently read a profound essay by scientist Martin Shwartz, PhD, about the importance of stupidity in scientific research. I would extrapolate this to training in any specialty, particularly cardiology. He points out that most of us took up science because we were good at it, but it is actually the immersion in the unknown that should drive us forward. After completing internal medicine, we are board certified/eligible physicians, and this may trigger a feeling of embarrassment when we don't know something. If I have learned anything these past two years, fellowship – specifically the first year of fellowship – is when one should embrace the feeling of stupidity and ask as many questions as one can. Many programs establish a buddy system with a senior fellow for the first few months and this is especially helpful during the initial on-call nights. Do not hesitate to ask questions even at odd hours as on-call nights can be particularly unnerving. Learning-by-asking fuels innovative ideas, exchange of knowledge and helps build rapport and friendships with our peers and attendings. In my opinion, clinical pearls we learn from faculty are many a times difficult to find in textbooks and choosing not to ask the question could prove to be a greater loss than risking "looking stupid.

Live in the moment

When we transition from medical school to internship, we are often preemptively warned of the steep learning curve and the struggles to expect. However, I would argue that the first six months of fellowship are more difficult than intern year, especially if one has moved to a new city or state. I would emphasize this to all the new FITs out there: We are all in this together and do not think that it is just you who is finding certain things difficult. Make it a point to spend time with co-fellows and senior fellows outside the hospital. Finding ways to detach from work is paramount. Going for a long run, spending time with family or even taking a long nap are just as important as learning to differentiate VT from SVT with aberrancy. 

Find what makes you click

There may come an "Aha!" moment where you find your calling in a subspecialty. If this happens, talk to fellows and attendings in the subspecialty to learn more about what life in the specialty would look like for you 10 years down the line. However, many fellows identify multiple interests within cardiology and find their calling in the practice of general cardiology itself. A quote from Steve Jobs sums it up nicely – "Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do." So, spend time and introspect to find exactly what you love.

Once again, a warm welcome to all the first-year fellows! It's going to be an amazing ride.

This article was authored by Sonu Abraham, MD, an ACC FIT Council Member from Lahey Hospital & Medical Center, Burlington, MA. Twitter: @sonuabrahammd

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