Author + information
- Published online December 21, 2016.
- S1936878X16308002-d0b9bd17197c37c54e8a0933ffde9c87Gaby Weissman, MD∗ (, )
- S1936878X16308002-2bf409984708deee5a95929d5a285ce4Julie Damp, MD and
- S1936878X16308002-a24830af9e32b75031b5112264899de2Chittur A. Sivaram, MBBS
- ↵∗Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Georgetown University, 110 Irving Street NW, Room 1F-1221, Washington, DC 20010
Advances in cardiovascular imaging have led to growth in the number of training programs offering advanced cardiovascular imaging (ACVI). These programs offer additional training beyond the general cardiovascular disease fellowship. As for Accreditation Council for Graduate Medical Education nonaccredited programs, there is a lack of uniformity in these training programs (1). Current documents detail the skills needed for independent proficiency (Level II training), but they largely leave advanced proficiency training requirements (Level III training) to future documents (2). This leaves program directors (PDs) with significant flexibility in developing an ACVI fellowship curriculum.
One important issue for trainees and PDs relates to the professional opportunities available to graduates of ACVI programs. Knowledge of market opportunities may help programs and applicants understand how to better craft the training experience. To that end, we aimed to characterize the state of the post-ACVI-training job environment. We created an online survey designed to identify the professional opportunities available to graduates of ACVI training programs in the U.S. The anonymous survey was administered in February of 2016 to 51 ACVI training programs listed in the American College of Cardiology database of ACVI programs (3). This survey was initiated with cooperation of the Cardiovascular Training Section. Programs were asked to answer the questions presented based on the most recent 5 years of graduates, or in the case of more recent programs, for the duration of the existence of the program.
Nineteen programs responded to the survey (37% survey response rate). These programs reported 180 graduates over the specified time period (mean 9.5 graduates per program; interquartile range: 5 to 11). Positions accepted after graduation included academic (51%), private sector (41%), further training (4%), nonclinical research (3%), and industry positions (1%). Most positions offered a mixture of clinical cardiology and imaging (45% primarily imaging and 42% primarily clinical cardiology). A minority of position were entirely imaging (8%) or clinical cardiology (5%) (Figure 1). Expertise in echocardiography was required in most positions (80%), whereas cardiac magnetic resonance, cardiac computed tomography, and nuclear cardiology expertise was required by about one-half of the positions (53%, 49%, 45%, respectively). Programs were asked to describe the difficulty for graduates to find employment in a position that “encompassed the [imaging] elements in which the fellow had trained.” As assessed by the PDs, 16% of graduates found it “very easy” to find such a position, 32% found it “somewhat easy,” 32% found it “neither difficult nor easy,” 21% found it “somewhat difficult,” and none found it “very difficult.”
Acknowledging the limitations of survey-based investigation and the response rate of our study, and the fact that this survey represents only the perspective of PDs as opposed to graduates, whose insight and experiences are critical to a more comprehensive understanding of this issue, these results offer initial evidence as to the job market for graduates of ACVI programs. There is significant heterogeneity in positions available after graduation. There is a near even split in academic versus nonacademic positions, and in positions that are defined primarily as imaging focused versus clinical cardiology focused. A large number of positions require expertise in >1 imaging modality, and there is a wide range in perception of the ease of finding positions that offer a sufficient imaging focus.
Further information is needed to better understand the nature of ACVI training, particularly in regards to preparing graduates for the transition into the workforce. We believe that the American College of Cardiology and ACVI professional societies are in the position to continue to expand the available data on ACVI training, both during general cardiovascular disease training and during dedicated ACVI training. Unlike training in other subspecialties, imaging expertise and certification may be obtained during both general training and in ACVI training. Therefore, graduates have a wide variety of skills and levels of expertise. This is a challenging environment for ACVI PDs because trainees entering the fellowships have a diverse knowledge base and training needs. As the work environment evolves, training needs will continue to evolve as well. These requirements need to be understood so that ACVI programs can be fashioned to meet the needs of the marketplace. An understanding of the workforce needs will help inform all about the appropriate areas of focus during training. Further information is needed to provide context for these findings; however, we believe these initial data can help guide future investigations.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- ↵Advanced Imaging Training Program Database. Available at: http://www.acc.org/membership/sections-and-councils/imaging-section/training-resources. Accessed February 2016.