From the Guidelines
Clinical fellowships that are clinically based include Cardiology, Gastroenterology, Oncology, Pulmonology, Nephrology, Infectious Disease, Endocrinology, Rheumatology, Critical Care, Hematology, Emergency Medicine, Pediatric subspecialties, Geriatrics, Pain Medicine, Sleep Medicine, and Transplant Medicine, with a focus on direct patient care and hands-on training. These fellowships typically last 1-3 years and involve hands-on patient care, procedures, and clinical decision-making under supervision, as seen in pediatric cardiology fellowship training, which includes core training and advanced training guidelines for fellows across each specialty area 1.
Some key aspects of clinically based fellowships include:
- Hands-on patient care and procedures
- Clinical decision-making under supervision
- Development of advanced diagnostic and treatment skills specific to the chosen subspecialty
- Eligibility for board certification in the subspecialty upon completion
- Focus on managing complex cases within the field, such as in pediatric cardiology, where fellows should achieve technical competence in performing and interpreting echocardiograms 1.
In pediatric cardiology, for example, core fellowship training includes achieving technical competence in performing a transthoracic echocardiogram (TTE) and acquiring the knowledge base to interpret and report the studies, with a minimum of 150 echocardiograms performed and interpreted, and an additional 100 reviewed and interpreted during the 3-year training period 1.
Overall, clinically based fellowships provide physicians with the expertise and skills necessary to become competent consulting specialists in their chosen field, with a focus on direct patient care and hands-on training.
From the Research
Clinically Based Fellowships
- Cardio-oncology fellowships are clinically based, focusing on the care of cancer patients with cardiovascular complications 2
- Critical care medicine fellowships are also clinically based, with various pathways available, including internal medicine-CCM, anesthesiology-CCM, surgical critical care, and neurocritical care 3
- Resuscitation and emergency critical care (RECC) fellowships are clinically based, teaching a general approach to the management of undifferentiated critically ill patients in the emergency department 4
- Combined fellowships in critical care medicine and infectious diseases are emerging, providing training in both specialties 5
- Critical care medicine training is also relevant in the cardiovascular intensive care unit, with dual certified critical care cardiologists reporting frequent use of their CCM skills in the CICU 6
Specific Fellowships
- Cardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research programs with dedicated cardio-oncology faculty 2
- RECC fellowships provide graduates with a niche in EM education, research, and administration, and are well suited to practicing in any ED practice model 4
- Combined CCM-ID fellowships may help regenerate interest in the specialty of infectious diseases, with hands-on patient care and higher salaries being obvious attractions 5
- Dual certified critical care cardiologists report that their additional critical care experience is necessary in their practice to effectively deliver care in the modern CICU 6