Fellowship in Cardiology. Chief Resident

I have been practicing internal medicine in New Jersey for 2 years now and have been pleased to be selected as the Incoming Chief Resident 2013-14 for XXXX University Hospital. I have always performed at the top of my class; and in addition to winning numerous awards I have published 10 papers in the last 2 years, 9 as first author. While I have published in a variety of areas, it is cardiology that has most fully stolen my heart and it is this area where I want to turn my full attention at this time. I am especially fascinated by and engaged with rhythm disorders in adults with congenital heart disease. There is need in this area for fully qualified specialists and I am highly enthused about the prospects of my ongoing investigation in this area, circuit mapping in particular, and device therapy for adults with complex congenital heart disease.

One patient that I cared for during my residency stands out, in particular, as an inspiration of my choice of cardiology as my area of greatest specialization. She was pregnant with single ventricle-fontans physiology and had undergone blacock shunt, glenn shunt and finally fontans procedure for her tricuspid and pulmonary valves atresia. Already in her third trimester, she was presenting signs of massive congestive heart failure exacerbated by supraventricular tachyarrhythmia. The strength of our multidisciplinary team all pulling together, however, saved two lives at once with our combined understanding of the anatomy of her cardiac structures combined with electrical physiology, as well as fetal cardiac anatomy and hemodynamics. Our triumph with this patient took my understanding of cardiology to a new level and, over the past few years, I have had the privilege of being involved in the care of several adults with congenital heart disease. This field stimulates my intellect like no other and I thrive on learning more and more about this disease. The challenge and fascination of cardiology are my primary drivers.

I have always excelled in academics, especially the physical sciences. During my five years as an internal medicine resident, I have been exposed to a large variety of diseases in a variety of contexts. As an Indian doctor, I have seen some of the best and some of the worst medicine practiced in the Developing World and I now have extensive experience here in America. I am adept at processing and synthesizing data as well as clinical reasoning based on the physical exam. My hard work has paid off well and I have been honored with gold medals at each stage of my medical career, after completing my education at the top student of my class. I am particularly pleased to report that I am a two time winner of Doctor Dilemma (often called medical jeopardy) on behalf of the State of New Jersey. Our team earned third place among 38 teams participating in the national competition.  Teaching my peers has helped me become a self-directed learner.

I have always been motivated towards research, especially since my undergraduate days. I have been fortunate enough to present 10 posters and publish 9 publications in indexed journals as first author, which include medical images, case reports, retrospective studies and Cochrane meta-analysis. Of these, I enjoyed working the most on the meta-analysis of pulmonary artery catheter. It was a great learning experience as we reviewed 4230 abstracts on pulmonary artery catheter (PAC) of which only 13 randomized prospective studies met our study criteria. We concluded that pulmonary artery catheter did not affect both mortality and the secondary outcomes of length of hospital stay and ICU stay. However, PAC is a diagnostic tool and not a therapeutic intervention, and when inserted and interpreted correctly it can serve as a great aid in guiding treatment decisions. I am trying to extend the current experience gained from the meta-analysis towards comparing the measurements obtained from the PAC to those with echocardiography. 

Cardiology has the best evidence and guidelines amongst all sub-specialties but this is not often translated into practice. There seem to be a gap between the guidelines and real world practice. ‘Getting with the guidelines’ was the second area in which I invested most of my time.  I am the principal investigator of three studies looking into compliance with performance measures in the ICD registry, atrial fibrillation in outpatient setting and hypertension control. The common theme of these studies includes measuring compliance of the physicians with the guidelines which was followed by a simple educational intervention and post intervention follow up. It was astonishing to see that through integration of a reminder phrase in electronic medical records, there was an increase in compliance with the guidelines. I could complete the started project and this has resulted into a published manuscript and based on the results of our pilot study, we will be writing a research grant on the compliance with the atrial fibrillation measures. 

My ability to work as a team player, passion to strive for excellence, excellent communicative and leadership skills coupled with strong academic and research qualities, made me stand apart from the rest and helped me earn the Chief Resident position for the current academic year.

I enjoy both the mechanical and electrical properties of the heart.  I see myself as an academic cardiologist with special interest in rhythm disturbances of adults with congenital heart disease in the next 5 years. I am sure that your program will carve an academic cardiologist out of me and will help me fulfill my dream.

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