r/Cardiology

Hey guys, need some advice on the EP fellowship program I'm in. My co-fellow and I are pretty unhappy with our setup, but I'm not sure if we're being too critical. I'd like some perspective from others.

Program is at a large University hospital. Fellows do 4 lab days a week, 1-2 cases each, sometimes 3. (2 fellows/year; total of 4 fellows). 3 labs. Fellows do all the consents, pre-op orders, procedure notes, etc. The faculty are heavily dependent on the fellows - if there is no fellow to get consent for a particular case or do orders, it's a huge deal. Having said that - this part is not a big gripe. We want to be involved with and do as many cases as there are available. Although the case volume per fellow seems low at times, perhaps this is standard. I do think we have a good mix of cases with healthy complexity.

The one full clinic day we do is a big grievance. It's routine to see 35-45 patients. The EP fellows prep all the notes, see all the patients, and finish all the notes afterwards. If a fellows needs to take a clinic day off, he/she needs to arrange coverage by another fellow. The same goes for the lab - each of the three labs needs to be covered by a fellow at all times. If you need to be away, you either need to get another EP fellow to cover for you, or find a gen cards fellow to cover. My PGY7 co-fellow is doing the clinic coverage next week for a PGY8 fellow who will be out and therefore has two back to back clinic days of 35-40 patients each. We're stuck spending most of our downtime prepping or completing clinic notes when we should be studying EP.

Additionally, we don't do any consults, device clinic, or device interrogations. This seems like necessary education for an EP fellow. I'm not sure how one can finish an EP fellowship without having any structured device education outside of learning how to implant and extract. We do some device management in clinic, but at 40 patients/day, there's only so much you can do or learn there.

We have no structured didactics. 90% of the talks or discussions we get are from industry reps, with the other 10% being inconsistent education from two early career attendings (who are excellent educators but not incentivized in any way for their mentorship).

It sometimes feels like we spend more time prepping and writing notes, consenting, and putting in orders than we do scrubbed into cases or otherwise learning EP.

Perhaps I'm being too harsh, I don't know. Would appreciate any perspective and advice.

Using both ECGsource and O'Keefe for ECG coding practice, but getting pretty different scores due to ECGsource undercoding a lot of things that definitely should also be coded for. Thoughts on what to do for test day? Should I just never code for LAE or non-specific ST changes since not getting the points is technically better than losing a point for selecting an answer? Also ECGsource says sinus arrhythmia is normal ECG but O'Keefe says sinus arrhythmia is normal variant ECG. Any insight into which one to choose on test day since normal/normal variant are where the bulk of the points come from on those?

Upcoming Cardiology resident (non US based, and currrently an IM pgy1) I have always been passionate about cardiac EP, but lately i have rubbed shoulders with some IC and I love the adrenaline and the rush yet i believe I will do way better in devices and pacemakers compared to structural things.

So my qs, are there any emergency situations where an EP has to place a pacemaker at 3 am in the morning? or is a temporary PM placed until EP comes in the morning and does the job. thanks

Hello all,

I’m currently in general cards fellowship, interested in doing interventional afterwards. All the interventional staff get access blind, without US use. My concern is that I have neuropathy in my left fingers, so can’t feel radial pulse well there, which makes getting access blindly challenging.

Mh question is, would this be a dealbreaker for doing IC fellowship? Is getting radial access blind almost an unsaid requirement for being a good IC fellow?

THA

Hey guys, just wondering how well new IC attendings get paid in the nyc/ nj area. I heard a lot of private practices pay fresh IC and non invasive folks the same as they start. Is this true?

Hi everyone.

I am a structural interventional cardiologist in New York graduated with structural fellowship from NYU for those who it’s been the # cardiac hospital now 3 years running ( not to brag just sharing my journey ).
Prior to that internal medicine in Michigan and Cardiology and interventional Cardiology fellowship in Michigan as well originally I come from Pakistan and Img

Literally, the reason behind this post is I’m happy to take any questions that you guys may have with regards to nuances around the match how to set your application past what is important what isn’t important the competitiveness of the training fellowship itself the rigors that are involved whatever question you may have

I have reviewed both internal Medicine and Cardiology fellow applicants more than happy to tell you what looks good on an application what doesn’t.

If anybody has a question like can you DM me just please go ahead and do it. I have no issues with that.

M3 interested in cardiology and considering EP. When did you know you did/didn’t want to do EP and if there is anything I can/should do at this stage to get more exposure or prepare. How helpful is research, how EP-specific does it have to be, and when should I start pursuing it? Is a mentor helpful or necessary and when should I look for one? Anything else I should consider?

Wanted to get an informal sense of how much sleep cardiology attendings get across different subpecialties.

Myself, I'm finishing general fellowship and I've found that my body needs relatively more sleep (almost 9 hours if I don't set any alarms - although I'm not sure how much of this is chronic sleep debt at this point). I have found the call to be relatively taxing.

I am a doctor in Australia who has encountered a strange local deviation from best practice guidelines in the hospital I work in. For context, in our hospital all TPN orders outside ICU must be run past our Gastro team for approval, however that isn't the interesting part. The interesting part is that the Gastro team looks at the location of the PICC on the CXR prior to approval and will not approve TPN unless the PICC line is well into the right atrium, approximately halfway into the atrium. A tip at the CAJ is considered too proximal.
While I understand that they might justify this by saying it ensures the rapid dispersal of the hyperosmolar TPN solution, surely the risk of tachyarrhythmias and damage to the heart supersedes this benefit?

Anyway since I don't have cardiologists on speed dial so I wanted to get a cardiology perspective on this here?