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- Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
- ↵⁎Address correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122.
It is July, and once again I am going through that roller coaster of emotions associated with the changing of the academic year. Some trainees are finishing a phase of their education, and others are just beginning. Some are bidding goodbye, while others are saying hello. It is a time for recalling memories and making new plans, and in aggregate it is one of the most energizing series of events that I experience.
Probably nowhere in society are the individual phases of progression as well demarcated as in education. A student advances from one level to another until a prescribed course of study is completed and a specified degree of knowledge obtained. In academic medicine, this major transition occurs on July 1. However, the summer months also mark a transition in many other areas. Nonacademic medical settings have an influx of new practitioners, as is true of law firms and the business world in general. Since children are usually out of school during this period, it is a frequent time to change jobs or for families to relocate. Even the schedule of television shows is revised during these months. The transition in education is clearly more intense, particularly in medicine as individuals get closer to practicing those skills that they will apply for the rest of their careers. In this regard, fellowship marks a terminal differentiation in that the individual is no longer a trainee but a fully qualified specialist. This is the personal perspective from which I write; that of an educator whose responsibilities largely involve a cardiology fellowship training program.
The feelings usually begin in the spring. I start to feel less needed on the clinical services as fellows exercise the knowledge and judgment that they have acquired. Evening calls for advice don’t come nearly as frequently. Fellows are more outspoken at conferences, and their voice conveys a sense of authority. I begin to realize that these individuals have been continuously maturing under my eyes, in broad daylight so to speak, and have evolved almost imperceptibly into colleagues rather than trainees. No longer are they the neophytes whose knowledge base is just being formed and who are experiencing cases, images, and procedures with which they are unfamiliar. This evolution is even more remarkable for those whom I have known as students or interns.
As we approach June, fellows are implementing plans for the next phase of their careers. More time is spent in recollection, and the circumstances of every event appear to be embellished with each telling. This all seems to crescendo with the graduation party when faculty, staff, graduating fellows, and spouses gather together to celebrate, give thanks, and maybe poke a little fun. The reality is now undeniable; the fellows are done, and the relationship will never be the same even for those who stay at the University of California-San Diego.
The separation is always a bit melancholy for me. It is difficult when friends who have worked together closely over the years are separated. However, there is also enormous pride at seeing what the trainees have accomplished, and knowing that you have played some small role in the transformation from cautious neophyte to confident specialist. It is perhaps a bit like marrying off a child; you will miss them but you are proud to see them take charge of their own family.
No sooner have the goodbyes been said, then the next phase begins … renewal. On July 1, the new fellows arrive and the cycle starts all over again. To me, this is the best aspect of academic medicine. Every summer a new crop of trainees arrives with unbridled enthusiasm and (usually) boundless energy. After years of preparation they are about to concentrate on what they will spend the rest of their lives actually doing. Virtually every activity, regardless of how routine, is potentially exciting. The most ordinary echocardiogram, cineangiogram, or atrial fibrillation case can be a potential adventure. Seen through the eyes of a brand new fellow, all of cardiovascular medicine is exhilarating.
I don’t know if you can put a price on the value of this process of renewal. It is a benefit that we have in medicine that is not available to many other disciplines. It prevents boredom from accompanying the clinical activities done over and over again. The energy and enthusiasm is almost invariably infectious and generally lifts the spirit of faculty, staff, and even on occasion, hospital administration. The first several months of every academic year are almost always the most fun for me.
And so we are in July again, and I am passing through this transition period. We have sent off our most recent class of fellows. We have said our goodbyes and promised to stay in touch. I have again marveled at the transformation which has occurred during the period of training. The pride that comes from knowing that I may have contributed to this maturation is one of the great hidden payoffs in academic medicine. Moreover, the melancholy of this separation has been immediately supplanted by the arrival of new fellows and the renewal of the cycle. I am energized by their enthusiasm and stimulated by their curiosity. There may be some other profession that gets more payback from reproducing itself, but I cannot imagine what that would be. For me, I wouldn’t change it for the world.
- American College of Cardiology Foundation