By the time you finish electrophysiology (EP) fellowship and begin your first “real job” you have completed a minimum of 8 years of postgraduate training. At every stage of your career, you have likely heard that this transition is the “hardest” and this is “the biggest transition.” As you embark on your career as a junior attending you again hear words of encouragement and warning from friends, colleagues, and mentors about the next big step. Being equipped with a strong clinical and procedural training and heeding the advice from those around you goes a long way during your initial months as an electrophysiologist.
As a junior attending, I am reminded daily of the sage guidance I have received from my mentors. Their cumulative advice can be condensed to a few key points: (1) get to know your teammates, (2) become familiar with the supplies in your lab, (3) know when to ask for help, and (4) know when to stop.
Get to know your teammates: this includes everyone you work with in the office, clinic, and lab. Your office staff are the “face of your practice” and can be immensely helpful as you learn to navigate the world of running an outpatient practice and scheduling procedures. If you are fortunate enough to work with fellows and advanced practice providers, get to know their strengths and individual skill sets. You will be working alongside a variety of anesthesiologists, nurse anesthetists, EP lab nurses, technicians, and representatives during cases. These individuals contribute in innumerable ways to the care of the patient. When you have a challenging case or a stressful situation it is important to know that you can trust your team. Form a working relationship with referring physicians and general cardiologists. As proceduralists, we are dependent on these relationships. Introduce yourself to the cardiac surgeons in your practice, as they are another source for referrals and—more importantly—there may come a time when you need their assistance during a case.
Know your supplies: As a fellow you likely developed preferences for specific catheters, sutures, sheaths, guidewires, leads, and electroanatomic mapping systems. Realize that your new lab may not have the identical complement of supplies. If your lab staff are willing to order your preferred supplies, this can improve your comfort during cases. Alternatively, if you have never used a particular catheter or sheath, make sure you familiarize yourself with the product in advance.
Know when to ask for help: As a procedural subspecialty, with many complex procedures and challenging clinical situations, the thought of practicing electrophysiology in a silo, without the ability to ask for assistance, can be daunting. Realize that in this small EP community there are many avenues to ask for advice and guidance. Whether this means reviewing an electrocardiogram with a prior co-fellow, reaching out to an attending from fellowship to discuss a complex procedure, or seeking a second set of eyes during a case from a more senior electrophysiologist, I have found valuable guidance and assistance from multiple sources.
Know when to stop: In our field we are trained to seek the best procedural outcomes for our patients. Whether that means rendering the patient noninducible during an ablation or achieving optimal resynchronization / selective left-bundle capture, we seek to achieve favorable results. The desire to achieve “perfection” must be balanced against concerns for patient safety. Learning when to stop during the index procedure, after you have exhausted all of the tools and techniques available to you, without exposing the patient to additional time on the table or additional risks is a valuable lesson.
In summary, the transition from fellowship to a junior attending comes with many exciting new challenges and opportunities. As you hone your skills, continue your pursuit of lifelong learning, and care for patients, keeping these thoughts in mind will serve you well during the early stages of your career.
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Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosures: The authors have no conflicts of interest.
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