I had the pleasure of working as an outpatient extern at Epic Heart and Vascular and as an inpatient observer at HCA Houston Northwest for 4 weeks under the direct supervision of Dr. Khan and his amazing team. As one of my main interests is interventional cardiology, I had many expectations from this rotation and to say the least; it definitely lived up to them.
At the start of our rotation, the thing that I appreciated the most was that Dr. Khan had an individual conversation with each of us talking about our expectations, our life journeys, our goals, and our plans for the future. He gauged each of our strengths and weaknesses and individual interests and helped us out during our rotation accordingly.
I look up to Dr. Khan as a mentor and as someone who I aspire to be as such I reached out to him on multiple occasions for career advice, and possible career trajectories as an aspiring cardiologist. He went out of his way and took out time of his hectic schedule to give me advice based on my life plans.
During my days at Epic Heart and Vascular as an extern, I was taken full-on as part of the team. We were assigned different roles helping different providers each day. We were all welcomed warmly and made to feel like a part of a well-oiled machine. We took up our daily tasks with much excitement and fervor and quite literally were the doctors. With full access to the EMR; eClinicalWorks, I conducted patient histories and physical examinations as well as medication reconciliation and counseling on possible drug interactions as well as lifestyle modifications.
The EMR gave me the window to experience the workings of the US healthcare system and allowed me to compare the interface with other EMRs that I have used on my previous clinical rotations like Epic and Allscripts. That being said, this experience has added the workings of another EMR into my repertoire.
I’ve always wanted to learn Spanish and so one of the highlights of my rotation was using google translate and the Spanish translator app to translate and communicate with Spanish patients; which made up the bulk of our patient encounters. Many patients lauded my efforts and this was also a fun way to break the ice with my patients as well before getting into the details of their visit. During clinic days, I took patient histories and helped with case management and plans for conditions like Angina, Atrial fibrillation, Atrial Flutter, Hypertension, Hyperlipidemia, Varicose veins, etc.
I also had the opportunity to experience multiple outpatient procedures like Varithena, Vaniceal, Radiofrequency ablation, non-thermal ablation, and angiography. I was taught about the various conditions, the indications as well as the anatomy and the procedures. Coming from Pakistan; many of these procedures are not the norm, and so I greatly valued this exposure. I also took part in procedures like cardiac stress testing, echocardiography of various conditions as well as Ultrasounds most notably of varicose veins, and Carotid arteries; where I learned about the operating techniques of the machine, the different patient positions needed, location and tributaries of different arteries and veins. Despite being very interested in anatomy, I’ve often struggled with it; however, Ms. Kanzi was very helpful and solidified my knowledge of vascular anatomy and its respective relations and landmarks.
During inpatient days, we participated in rounds and patient management and had a thorough discussion about the conditions afterward. The inpatient experience gave me a real-time view into what I see my future as, it solidified my perseverance as I pursue my career goals and further instilled in me a great appreciation for the field of Cardiology. However, the most interesting parts, especially for me as an aspiring cardiologist, were the interventional procedures. I had the pleasure of being part of various procedures like Cardiac catheterization and stent placement. What followed the procedure was an intense discussion regarding the indications and preferences that needed to be considered for stent type and placement. One of the main determinants was the Fractional Flow Reserve versus Coronary Flow Reserve; which he skillfully explained using anecdotes and ideas taught to him by his mentor. He evaluated my knowledge of cardiac and coronary anatomy as well as the anatomy of the venous systems of the lower extremities. Following the interventional procedures, he educated me regarding the different types of stents and their indications, and I helped with calculations of pulmonary artery wedge pressure using data from the procedures as well as the next steps regarding patient management and follow-up. Working so closely with Sr. Khan filled me with immense respect not only for him and his humility, but also Cardiology; since even minor things like changing a medication from a beta-blocker to a calcium-channel blocker change the quality of life for patients in so many ways, and that’s what truly matters in our field as physicians.
Furthermore, we had in-depth discussions about the future of interventional cardiology and the patient populations and procedure rates and their respective locations within Houston and Texas in general; Texas being my primary location of interest as I apply for the Match this year. He encouraged me and motivated me to further hone my skills and knowledge and impressed upon me the importance of taking the leap and not letting fears take over. These discussions will always be a source of direction for me.
Dr. Khan impressed upon the importance of research and being up to date with up-and-coming studies, and as such I had the pleasure of presenting a study on the landmark EMPEROR-preserved trial as well as a paper on its post-hoc analysis. This study is very relevant, especially to cardiology clinicians in daily patient management as it dispels some myths and sheds light on the benefits of using SGLT-2 inhibitors in patients with HFpEF regardless of the use of baseline diuretics. I was able to exhibit my skills of public speaking, my confidence, as well as my knowledge of the relevant topic and the analyses used in this study.
Dr. Khan’s feedback was very valuable for my personal and professional growth, and I am grateful for his words. He praised my interpersonal skills, my journey so far, as well as my effective use of the EMR, which solidified my confidence in my skills; in addition to my knowledge of patient management as well as vascular anatomy. He was particularly impressed by my presentation on the EMPEROR-Preserved trial. He supported my motivation and interest in Cardiology as a future career; for which he offered great words of wisdom.
In conclusion, this 4-week rotation was an all-immersive experience. The whole team made us feel at ease and their commitment and work ethic was very heartwarming and inspirational.