Dr. Eric Hall, who is serving as the CardioNerds Conference Scholar for the inaugural University of Minnesota Critical Care Cardiology Education Summit, is joined by Drs. Andrea Elliott and Courtney Bennett, two critical care cardiologists who serve on the summit’s planning committee. The summit, which takes place May 30-June 1, features a combination of group exercises, hands-on procedural practice, and discussions relevant to reducing mortality in cardiogenic shock, pulmonary embolism, and cardiac arrest. In this exclusive interview, Drs. Elliot and Bennett talk about the day-to-day life of a critical care cardiologist, advice for trainees pursuing a career in critical care cardiology, and much more.
Dr. Eric Hall: Well, hello, everyone. Thank you for joining us today. I’m Eric Hall, a cardiology fellow at UT Southwestern in Dallas, Texas, and I’m thrilled to be serving as the CardioNerds Conference Scholar for the inaugural Critical Care Cardiology Education Summit, which will take place later this month at the University of Minnesota.
I’m joined today by Dr. Andrea Elliot and Dr. Courtney Bennett, who are both critical care cardiologists who serve on the planning committee for the upcoming summit. Dr. Elliot completed her cardiology fellowship and critical care fellowship at the University of Pittsburgh Medical Center and currently serves on the faculty of the University of Minnesota. Dr. Bennett completed her cardiology fellowship at Lehigh Valley Health Network and her critical care fellowship at the Mayo Clinic, where she currently serves as the medical director of the cardiology ICU there. Thank you very much for joining us today, Dr. Bennett and Dr. Elliot, and welcome to both of you.
Dr. Courtney Bennett: Thank you.
Dr. Andrea Elliott: Yeah. Thanks for the warm introduction, too.
Dr. Eric Hall: And I thought we might start out today by just getting a sense from both of you of what drew you to the field of critical care cardiology in the first place.
Dr. Courtney Bennett: It’s a complex answer, multifactorial contributors to that, but I always loved both cardiology and critical care. I was drawn to a lot of the specific aspects of hemodynamics and specific aspects of cardiology, which is why I originally chose to pursue cardiology training, but during my cardiology training, I still couldn’t let the critical care or acute care aspect go. I loved the pathophysiology. You figure out the acute contributors to the pathophysiology and then you are able to offer interventions that, really, you would see the effect on your patients and the patients improving within minutes to hours of providing those interventions.
And then at the same time, I couldn’t let the feeling go that I could better serve my patients by having that critical care skillset, often being grateful for the consultative care we have, but sometimes feeling that there was too many cooks in the kitchen and maybe care of our patients would be more efficient and more streamlined if we also had that critical care technical skillset, as well.
Dr. Andrea Elliott: I would totally echo everything that Courtney has said. It’s a multifactorial issue for me, as well. So, I would say that I was drawn to both cardiology and critical care from the beginning. When I was an internal medicine resident, I really struggled to decide should I go into pulmonary critical care or cardiology. I ultimately decided to do cardiology first. And the same way as Courtney, I really just was always drawn to my time in a cardiac ICU, and I really enjoyed the pathophysiology that I saw there.
So, the pathophysiology in that patient population, that intensity of illness is really what is really meaningful to me. In addition to that, and again, echoing Courtney’s sentiment, I really thought that having an intensivist in the cardiac ICU was important. I saw some modeling of that in my training and felt that that wholistic approach was really, really to both the patient’s benefit, the family’s benefit, and the care team.
And then finally, I think the other thing that was really a draw to me, as well, I really enjoy procedures and those things that we do in the ICU. I also really, really am drawn to that end-of-life discussion, so those discussions that happen only in the ICU. I think that being a physician is a privilege. You are allowed to be in people’s lives at really, really critical moments that, otherwise, you don’t have the opportunity to recognize and see humanity at its most powerful. And that’s sometimes at the beginning of life, and I’m very certain I don’t want to deliver babies, and at the end of life. And I think it can be done really well and really beautifully and help families through that. And so that’s also a very important part of my job to me.
Dr. Courtney Bennett: I would also add to that that, around that same time in my training and around the same time probably in Andrea’s training, as well, there was a lot of recognition of the evolution of the cardiac ICU patient population. So over time, we’ve noticed, and many of our colleagues have published on this, that the patient population is becoming increasingly more ill. They have significantly more comorbidities and they’re requiring more interventions, like ventilation support and renal replacement therapies, that aren’t part of traditional cardiology training. So, for all of the reasons that Andrea also outlined, just recognizing that, over time, these patients have changed that we have in the CICU, as well.
Dr. Eric Hall: I think, building off of that, as trainees, we all have exposure to the cardiology ICU population, but it’s very institution-dependent whether we have the opportunity to work with trained cardiac intensivists such as yourselves. Could you talk a little bit about what your work actually looks like, day by day, and how your time breaks down, both inside and outside the cardiology ICU?
Dr. Andrea Elliott: So, my schedule looks something like this. Pardon me. My schedule is, once every third to fourth week, I am in an ICU, where I, either the cardiac ICU or the cardiovascular ICU, I take a seven-day stretch and I do home call during that time. When I’m not in an ICU, I either spend somewhere between two- and three-days reading echo in the echo lab or a half a day of post-arrest clinic twice a month. And then the rest of my time is academics. So, I do research, clinical outcomes-based research, largely with the ECPR patient population, and I also have some roles in education. So, I’m an associate program director for the general cardiology fellowship and recently developed and am the program director for a critical care medicine program for internal medicine fellows and cardiology fellows.
Dr. Courtney Bennett: I spend about 12 to 14 weeks a year in our cardiac ICU. And our cardiac ICU is made up of purely medical cardiology patients, so we don’t have surgical patients in our cardiac ICU. And again, I spend 12 to 14 weeks a year. We do day and night shift, so we would do a seven-day stretch of days and then our night shifts are broken up into smaller stretches, hopefully to make that more sustainable.
When I’m not in the ICU, I have some administrative time for my clinical practice roles as CICU medical director, and I actually also have some other administrative roles for our hospital practice, trying to help move patients through more efficiently and improve the quality of care in the hospital practice altogether. I also spend a significant amount of time in our echo lab reading transthoracic and performing TEE. And then I also have a role as core faculty in our cardiology fellowship program, as well, and serve as the CICU clerkship director, as well. So quite a few roles filling up my time, as well.
Dr. Eric Hall: It sounds like you both wear many hats there and have a very diverse range of clinical interests. What advice would you have for trainees who are interested in pursuing a career in critical care cardiology?
Dr. Courtney Bennett: So, I think it’s important to consider what your practice will look like, what your ideal practice would look like, when you’re thinking about practicing cardiac critical care. The makeup of cardiac ICUs across the country, as we know from data published from the Cardiac Critical Care Trials Network, are very diverse. The setup varies based on the patient population, what providers are practicing there, what are the primary diagnoses that you’re going to be caring for. Are you interested in managing patients on mechanical circulatory support? Some ICUs, like Andrea’s ICU, may manage much more mechanical circulatory support than our ICU may manage. So, what is your interest and then what skillset do you need to obtain that?
And I would say that finding a mentor to try and help guide you would be very valuable. When I was pursuing this path, I actually didn’t know anyone at that point who had done it. I just knew that I loved it, and I was going to make that work for myself. At the same time, I did have the opportunity to meet Dr. Morrow, when he came to Lehigh Valley Hospital to do grand rounds there, and I told him how much I love procedures and I was thinking about pursuing interventional cardiology, but that I wasn’t necessarily passionate about the daily PCIs and was I going to be doing CTOs or peripheral. Those weren’t really on my radar. It was more like I was more interested in the crash-and-burn patient and the resuscitation aspects. And so trying to find a mentor to help guide you.
And I think what’s really fortunate, and actually, based on the work that Andrea’s doing here, is bringing this field together and many of us can now serve as mentors to trainees like yourself that may be interested in pursuing cardiac critical care.
Dr. Andrea Elliott: That’s exactly right, Courtney. I think that is fantastic advice. I would add just a tiny bit to that, too. So in addition to thinking about what kind of patients and what kind of ICU you see yourself in, I think one other thing that needs to be clear in a trainee’s mind as they’re thinking about where and what kind of education to get is working backwards from the job description that they would have, so what we were already talking about, who does what and what amount of time they’re doing for their job descriptions. So, job descriptions are quite broad in critical care cardiology or cardiology critical care,, excuse me. And what I mean by that is you can spend anywhere from 100% of your clinical time in an ICU to something just over a few weeks a year in the ICU.
And I think, along with that, you have to decide what you’re going to do in your time outside of the ICU. You’ve already given a few of our examples, but there’s cardiac intensivists who also do interventional or imaging. I don’t have any EP, but heart failure. So, there’s all different training pathways. I think you need to work backwards from what your ultimate goal is, not just what you see necessarily in front of you but interview these different mentors that are out there and see what those different experiences look like so that you can build your own training pathway.
So whether that includes additional training and what order that training comes in, and then selecting a critical care training program that matches your needs, too. So, if you want to be predominantly critical care, most of your time in an ICU, having a little more breadth in terms of your critical care training will be really important. If you’re going to be, for example, an interventionalist, maybe a program that has a paired offering is a more important option. So, I think thinking backwards from your ultimate goal and then building what your career will look like early on is important.
Dr. Courtney Bennett: Yeah, I think, at this point in time, as well, there’s no one clearly defined pathway, I think is something important to point out, as Andrea’s alluding to. So, the ABIM would require a minimum of four years, three in cardiology training and then one focus in critical care training, but there are multiple, at this point in time, multiple pathways that you can take for that same goal.
Dr. Eric Hall: I think, building off that, it seems like the upcoming educational summit will be a tremendous opportunity for trainees to gain exposure and see some of the variety within cardiology critical care. What are you most excited about at the summit? What do you hope trainees will be able to gain from attending?
Dr. Andrea Elliott: I am just most excited to get everybody together and see everybody in the room together, it’s really an exciting time for this field. It’s an exciting time to have so much energy to move this field forward, and I feel that we are lucky to have really great people, both leaders that have built the field, but also this future generation of fellows that are very enthusiastic. And so, I can’t wait to get everybody together. It’s going to be really exciting.
In addition to that, I am really excited that this is a fairly unique conference style where we’ve focused on trying to get people out of their chairs. We’ve tried to build a program where there’s a sampling of the different procedures that happen in the cardiac ICU that are unique to us and then also bring critical care education and literature and hot topics to cardiologists. And then finally, as we’ve already talked a lot about, we really focused and emphasized and brainstormed ways to bring those that have lived through this experience and now are practicing critical care intensivist or cardiac intensivists and those trainees who are looking to follow that same path together and have really carved out time throughout the conference for those networking opportunities.
Dr. Courtney Bennett: Yeah, I would say that Andrea has worked incredibly hard to design an incredible program and it’s going to give the trainees exposure to the other aspects in critical care. There’s significant overlap in the skillsets, but there are still very unique skills that are still only part of critical care medicine training, even antibiotic stewardship, bronchoscopy, very specific components to critical care that the trainees will get exposure to.
The other thing that I’m most excited about, we’ll be able to show the trainees what are the discussions that those of us who are experts in this field are having on a daily basis. And what I mean by that is I routinely get asked, “Why do I need to do critical care? I’m a cardiologist trained person. I’m an expert in hemodynamics. So why do I need to do critical care?” And what I think this program will demonstrate are what are the challenges that we’re discussing every day that really demonstrate the aspects of cardiac critical care as a whole?
For example, therapeutic hypothermia, what are the current recommendations in that? Management of patients with stroke that need to go on bypass, Andrea and I were just talking about that recently. So, there’s a lot of challenges that we face that transcend both areas of expertise and those are the topics that those of us in this field are routinely discussing and unique to cardiac critical care. And so, I’m excited for the trainees to be able to be part of those didactic discussions and debates.
Dr. Eric Hall: Yeah. Well, it sounds like it’ll be a great conference and I’m really looking forward to attending. Thank you both very much for your time today. And for our audience, please be sure to tune in and follow The CardioNerds Conference Scholars to keep up with key takeaways from all your favorite conferences. So, thank you for joining us.