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FIT CORNER: Things I Wish I Knew in My First Year of Fellowship

Congratulations! At this point in the year, you have probably overcome the hurdles associated with the start of your general cardiology fellowship. For many of us, these include moving to new city, learning the ways of a new institution, shifting roles from resident to fellow and taking Internal Medicine boards. 

As you begin to focus on navigating fellowship, here is some advice on how to make the most of your training years.

The learning curve feels so steep. Is it just me?
If you're feeling overwhelmed in your first year of cardiology fellowship, — it's a sign that you're exactly where you're supposed to be: at the edge of your comfort zone, where real growth happens.

Cardiology is a vast and dynamic specialty. The learning curve is steep for everyone in the beginning. Even the attendings you admire — the ones who make it look effortless — were once in your shoes, staring down a mountain of knowledge, uncertain whether they’d ever get to the top. What set them apart was the willingness to keep climbing. Don't confuse discomfort with failure — it's just growth in disguise. 

Start with the core concepts and remember that your attendings remember what it was like to be in your shoes. 

Do I need to start a research project now?
Starting research early in fellowship is strongly encouraged, especially if you’re considering:

 
The earlier you start, the more time you have to:

 
But here’s the key: you don't need to have it all figured out on day one. The first few months are about survival, adjusting, and learning the ropes. 

What you should be doing now is:

 
Sometimes a case report leads to a research question. Sometimes a QI project leads to something bigger. Starting something small is better than waiting for the “perfect” project to land in your lap.

When should I decide on a subspecialty fellowship? 
Choosing a subspecialty fellowship is not just about what you are good at. It is about finding what fuels you, fits your lifestyle preferences and aligns with your long-term goals. You do not have to rush to a decision, but you do have to be intentional. 

In your first year of fellowship, your focus should be to acquire experience in all different subspecialties as you complete your clinical rotations. Find what fuels you during calls, asking your attendings and mentors about their day to day lives and lifestyles, and gain as much practical experience as possible. 

In your second year, you should narrow your goals and start preparing. This includes participating in research and/or QI projects in the field of your interest, working with mentors that are practicing in the same field, and attendings conferences on areas of interest. 

Third year is typically when you put your application together and prepare for interviews.

What if I still don’t know?
That’s okay. Many fellows don’t know until late second year — or even third year. Some cardiologists don’t subspecialize at all, and have deeply fulfilling careers in general cardiology, imaging, or prevention.

What should I be reading outside of the hospital? How do I find time?
The feeling of not keeping up with everything you are expected to know can take a mental toll. Setting realistic “micro” goals – reading for 20 minutes or 2 pages etc. guided by the patients you are seeing can help build consistency. Scheduling protected time of 20 minutes, 4-5 times per week, for reading a core text will help build foundational knowledge in key learning areas. 

There are several reading sources you can use as a fellow, and asking your senior colleagues and attendings about their preferred resources will be helpful. Knowledge of recent clinical guidelines is essential in guiding management at the bedside. The ACC offers several electronic resources that can be utilized on the go. These include educational podcasts, clinical decision-making support applications, research article summaries, and clinical guideline applications. In addition, there are self-assessment programs (the SAP series), online courses, and conference recordings that allow flexible, self-paced learning. ACC membership is free to FITs, and signing up to avail several free resources is highly recommended.