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Reprint requests: Nosheen Reza, MD, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, 11 South Tower, Room 11-145, 3400 Civic Center Boulevard, Philadelphia, PA 19104. Tel: + 1 215 615 0044.
The path to becoming an advanced heart failure and transplant cardiologist (AHFTC)
is long and arduous. In the final year of postgraduate training, fellows are expected
to acquire rapidly both inpatient and outpatient expertise in heart failure, pulmonary
hypertension, mechanical circulatory support, and heart transplantation in addition
to numerous other competencies that are now expected in the skillset of an AHFTC.
Moreover, trainees must cement a new, foundational knowledge base regarding the ethical,
social and economic implications of limited-resource stewardship and cardiovascular
health inequities.
2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure
and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence
Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant):
a report of the ACC Competency Management Committee.
but for nearly 3 years, the coronavirus disease 2019 (COVID-19) pandemic has additionally
and irrevocably impacted this particularly vulnerable time in junior AHFTCs’ careers
(Fig. 1). We were frequently “redeployed” as bedside COVID-19 clinicians, working long hours
under, at times, hazardous conditions. The first year of the pandemic truncated the
typical AHFT training experience by nearly 25% as trainees were reassigned from their
native training programs to other patient-care roles and, since then, nearly every
aspect of medical education and health care delivery has been transformed. Enforcing
historical training and fellow-to-faculty transition models amidst this persistent
disruption has meant that AHFT graduates may be underprepared for independent practice,
where we must confront new challenges in clinical decision making; adapt to new institutions,
cultures and workflows; build practices, relationships and referral bases; maintain
productivity; and launch research, administrative and teaching careers. More training
may be beneficial to bolster these skills, though asking trainees to prolong fellowship
is likely to result in further decline in interest in AHFT cardiology.
2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant): a report of the ACC Competency Management Committee.
