Author + information
- Prashant Vaishnava, MD∗ ()
- Samuel and Jean A. Frankel Cardiovascular Center, The University of Michigan Health System, Ann Arbor, Michigan
- ↵∗Address correspondence to:
Dr. Prashant Vaishnava, The University of Michigan Health System, The Samuel and Jean A. Frankel Cardiovascular Center, 1500 East Medical Center Drive, Office 2706-SPC 5853, Ann Arbor, Michigan 48103.
In my office at the University of Michigan Cardiovascular Center is a plaque—one accorded to me at the end of my cardiology fellowship. At the very bottom is inscribed “June 20, 2012.” As on numerous occasions since then, I now close my eyes, turn my mind inward and relive the days of fellowship. Most were intense and tough. Some were relatively quieter, quirky, or fun. Every single one had promise—if given a chance, each day of our fellowship would augment our knowledge base, arm us with practical tools for the real world, or nurture us to be better humans.
With an awareness that I did not seize every opportunity, I offer the following list of lessons learned.
Lesson 1: Enjoy the Journey
Success in medicine so often requires forward thinking—thinking ahead to the next step when the initiating step has just begun. As a fellow, I constantly imagined the next step. What would I do? Where would I be? Where did I picture myself in 5 to 10 years? In many ways, I wish I had not been such a forward thinker. Although such forward thinking may be helpful, it limited my appreciation for the journey on which I had embarked. Now, I wish that I had completely thrown myself with reckless abandon into each and every rotation. Even if I was not planning to be an electrophysiologist, I wish I had attended as if that were my destiny. However, an early decision for a particular specialty does not mean you cannot enjoy all the varied opportunities that fellowship presents. I encourage my trainees to savor their fellowships. It is a privilege to have the opportunity to care for patients in a mentored setting. When I catch myself missing the days of staffing my patients with my clinic preceptor or performing rounds with the consult attending, the realization dawns on me that after leaving the cocoon of fellowship, in many ways, I may be on my own.
Lesson 2: Attend All Conferences
In a related vein, conferences are not the same when you are an attending physician. There is much to be learned by scrutinizing electrocardiograms with a master clinician and participating in physical examination rounds with the best of the best. There is a wealth of knowledge to be gained in reviewing complicated real-world cases with a maestro who has years of experience and the willingness to share. Such conferences so closely parallel actual patient encounters. Each conference provides an occasion to learn something practical, to hone your skills, and to think through the complicated cases that we will all encounter. I skipped some conferences as a fellow, and I now wish I could turn time back and attend them all.
Lesson 3: Do Not Listen Through the Patient’s Gown
Fellowship is a time to hone physical examination skills. There are countless examples from my first 2 years of practice in which the physical examination led me to a diagnosis or substantially altered a patient’s management. I learned the value of scrutinizing the audibility of the second heart sound in aortic stenosis. I detected a pericardial knock in my clinic. I was not puzzled by the softness of the first heart sound in acute aortic regurgitation. And, although I paid attention to the physical examination during fellowship, I wish I had done so even more intently. I wish I had never listened through a patient’s gown (it was tough to resist in the early morning hours when I was performing rounds or obtaining consent from patients for the day’s procedures) and had taken the extra time to examine each and every patient properly.
Lesson 4: Do Not Expect Perfection
Some of us grow unhappy with our work, institution, or colleagues. Perhaps this comes out of an expectation of perfection. Those who anticipate fellowship to be perfect will be sorely disappointed. The reality is that no fellowship, institution, or rotation is perfect. No individual—whether a mentor, friend, colleague, teacher, spouse, parent, or sibling—is perfect. Patients are not perfect, and they often do not follow our advice. In everything and everyone, there is good, bad, and shades of gray. We all have bad days, and we all have limitations. I have learned that to expect perfection from each other or our surroundings is a prelude to disappointment. I wish I knew then what I often repeat to myself now: embrace the good and try to change the bad, but also realize that some of it may need to be accepted.
Lesson 5: Observe Interactions Between Your Mentors and Their Staff
The world is not a goldfish bowl. We practice in a complicated system that depends on office staff, medical assistants, and nurses to operate smoothly. Interactions with our staff are a crucial part of what we do. The patient experience often starts with a phone call to a clerk. Yet, when I first started my job, I was not sure what to expect from my staff, what to delegate, or how to provide useful feedback. I wish I had paid attention to my mentors when they communicated with their nurses. How did my mentors establish their expectations? How did they communicate their dissatisfaction? How did they offer constructive feedback?
Lesson 6: Turn Abstracts Into Papers
One of my mentors told me to carve out time to write papers. Put it in your schedule. Again, I wish I had listened. I have learned that it is important to finish what I start. I had a productive career as a fellow, but I left some projects incomplete. Those projects will remain incomplete. Now I wish I had finished the job and written the paper at the time.
Lesson 7: Focus
This is my greatest regret. I wish I had more focus, for it allows one to become an expert in a particular area. Focus on your questions and your dreams to make meaningful and productive contributions. Remember that the challenge is in enjoying the journey while maintaining focus. Delight in all aspects of fellowship, but never lose sight of your aim.
- American College of Cardiology Foundation