How to be a Successful Interventional Fellow: Top 10 Rules

1. How to be a Successful Interventional Fellow: Top 10 Rules

2. Presenter Disclosure Information David R. Holmes, Jr., M.D. The following relationships exist related to this presentation:No relationships to disclose

3. Quality trumps quantity. • Practice ahead of time. • Discuss with other interventional fellows – easier to ask ‘stupid’ questions.

4. Devise a simple curriculum to cover all important topics in depth during the year. • Teach junior fellows: it helps crystalize key points, listen to their questions. • Balance time committed to study and time committed to research.

5. “Well, why don’t you nibble on some of my droppings?” replied the bull. “They’re packed with nutrients.” A turkey was chatting with a bull. “I would love to be able to get to the top of that tree,” sighed the turkey, “but I haven’t got the energy.”

6. The turkey pecked at a lump of dung, and found it actually gave him enough strength to reach the lowest branch of the tree. The next day he reached the second branch and finally, after a fourth night, the turkey was proudly perched at the top of the tree. He was promptly spotted by a farmer, who shot him out of the tree.

7. Management Lesson • Bull#$&* might get you to the top, but it won’t keep you up there.

8. Know the patient/clinical presentation. • Treat the patient; not only the artery. • Learn from other people’s mistakes, better than learning from your own. • Learn techniques from different people and then come up with your own. • Keep it simple. • Risk free PCI is not doing it.

10. Read after the case, if not before. • The patient is always right, believe him/her. • A good intervention is a planned intervention, don’t keep changing goals. • Technical skills are good, but it is mostly the cerebral part that matters. Always be ready for surprises….

12. Recognize your limits; don’t push your luck. • At the beginning of the year, ask the previous guys for their top 10. • The most important decisions may be • Whether to start a case, and • When to stop • Be nice to the allied staff.

13. Work with consultants. Everyone has something to teach. • Don’t get upset about not being primary operator. Position #3 in a rotational atherectomy case will teach you more than you realize. • Every case has learning points. “Attack the fall line”

14. When you hear of tips or tricks, write them down immediately. Good memory but short. • Take every opportunity to discuss as many cases as possible with your interventional fellow colleagues. This is especially important given the rarity of acute complications. • Quality > quantity. Period. • You will learn lots about your own personality during this year – use this knowledge productively.

15. A little bird was flying south for the winter. It was so cold, the bird froze and fell to the ground into a large field. There, a cow came by and dropped some dung on him. As the frozen bird lay there in the pile of cow dung, he began to realize how warm he was. The dung was actually thawing him out! He laid there all warm and happy, and soon began to sing for joy.

16. A passing cat heard the bird singing and came to investigate. Following the sound, the cat discovered the bird under the pile of cow dung and promptly dug him out and ate him.

17. Management Lesson • Not everyone who #$%&’s on you is your enemy • Not everyone who gets you out of #$%& is your best friend • And, when you’re in deep #$%&, it’s best to keep your mouth shut!!

18. Accepting a suboptimal guide can turn a 20 minutes case into a 4 hour nightmare.. • Read the fun stuff in interventional journals, e.g. case reports, novel approaches. • Know your patient. It is surprising/frightening how often you find things out that can significantly alter management. • When arriving at a case, don’t be afraid to ask your consultant whether antiplatelets, heparin, etc., are on board. Then ask again. • Listen to your patients. • Arrive early and get to know the patient before the procedure.

20. You can learn something from every one; consultant, fellow, nurse, technician. • Attend as many seminars and lectures and be updated as much as possible.

21. An eagle was sitting in a tree resting, doing nothing. A small rabbit saw the eagle and asked him “Can I also sit like you and do nothing?” The eagle answered “Sure, why not”. So, the rabbit sat on the ground below the eagle and rested. All of a sudden, a fox appeared, jumped on the rabbit and ate it.

22. Management Lesson • To be sitting and doing nothing, you must be sitting very, very high up

23. Team work. Thank your team members. • Be involved in academic activities. • Teach junior fellows and residents. It’s fun and both of you will learn from it.

24. Remember: primum non nocere. The enemy of a good result is a perfect one. • Be involved in research. • Create good working relationships with the other interventional fellows. Divide the work equally and learn from each other. • Don’t be afraid to ask questions. ? There is no such thing as a stupid question ? ?

32. There is no such thing as a stupid question ? ? ?

35. Always be ready for surprises….

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42. Advice from the Experts “Always keep your weight centered on your skis” CP987247-3

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