1. How to be a Successful Interventional Fellow: Top 10 Rules

2. Presenter Disclosure Information
David R. Holmes, Jr., M.D.
The following relationships exist related to this presentation: No relationships to disclose

3. Quality trumps quantity.
Practice ahead of time.
Discuss with other interventional fellows – easier to ask ‘stupid’ questions.

4. Devise a simple curriculum to cover all important topics in depth during the year.
Teach junior fellows: it helps crystalize key points, listen to their questions.
Balance time committed to study and time committed to research.

5. “Well, why don’t you nibble on some of my droppings?” replied the bull. “They’re packed with nutrients.”
A turkey was chatting with a bull. “I would love to be able to get to the top of that tree,” sighed the turkey, “but I haven’t got the energy.”

6. The turkey pecked at a lump of dung, and found it actually gave him enough strength to reach the lowest branch of the tree. The next day he reached the second branch and finally, after a fourth night, the turkey was proudly perched at the top of the tree. He was promptly spotted by a farmer, who shot him out of the tree.

7. Management Lesson
Bull#$&* might get you to the top, but it won’t keep you up there.

8. Know the patient/clinical presentation.
Treat the patient; not only the artery.
Learn from other people’s mistakes, better than learning from your own.
Learn techniques from different people and then come up with your own.
Keep it simple.
Risk free PCI is not doing it.

10. Always be ready for surprises….
Read after the case, if not before.
The patient is always right, believe him/her.
A good intervention is a planned intervention, don’t keep changing goals.
Technical skills are good, but it is mostly the cerebral part that matters.
Always be ready for surprises….

12. Recognize your limits; don’t push your luck.
At the beginning of the year, ask the previous guys for their top 10.
The most important decisions may be
Whether to start a case, and
When to stop
Be nice to the allied staff.

13. Work with consultants. Everyone has something to teach.
Don’t get upset about not being primary operator. Position #3 in a rotational atherectomy case will teach you more than you realize.
Every case has learning points.
“Attack the fall line”

14. When you hear of tips or tricks, write them down immediately
When you hear of tips or tricks, write them down immediately. Good memory but short.
Take every opportunity to discuss as many cases as possible with your interventional fellow colleagues. This is especially important given the rarity of acute complications.
Quality > quantity. Period.
You will learn lots about your own personality during this year – use this knowledge productively.

15. A little bird was flying south for the winter
A little bird was flying south for the winter. It was so cold, the bird froze and fell to the ground into a large field. There, a cow came by and dropped some dung on him.
As the frozen bird lay there in the pile of cow dung, he began to realize how warm he was. The dung was actually thawing him out!
He laid there all warm and happy, and soon began to sing for joy.

16. A passing cat heard the bird singing and came to investigate
A passing cat heard the bird singing and came to investigate. Following the sound, the cat discovered the bird under the pile of cow dung and promptly dug him out and ate him.

17. Management Lesson Not everyone who #$%&’s on you is your enemy
Not everyone who gets you out of #$%& is your best friend
And, when you’re in deep #$%&, it’s best to keep your mouth shut!!

18. Accepting a suboptimal guide can turn a 20 minutes case into a 4 hour nightmare..
Read the fun stuff in interventional journals, e.g. case reports, novel approaches.
Know your patient. It is surprising/frightening how often you find things out that can significantly alter management.
When arriving at a case, don’t be afraid to ask your consultant whether antiplatelets, heparin, etc., are on board. Then ask again.
Listen to your patients.
Arrive early and get to know the patient before the procedure.

20. You can learn something from every one; consultant, fellow, nurse, technician.
Attend as many seminars and lectures and be updated as much as possible.

21. An eagle was sitting in a tree resting, doing nothing.
A small rabbit saw the eagle and asked him “Can I also sit like you and do nothing?” The eagle answered “Sure, why not”. So, the rabbit sat on the ground below the eagle and rested.
All of a sudden, a fox appeared, jumped on the rabbit and ate it.

22. Management Lesson
To be sitting and doing nothing, you must be sitting very, very high up

23. Team work. Thank your team members.
Be involved in academic activities.
Teach junior fellows and residents. It’s fun and both of you will learn from it.

24. ? ? ? There is no such thing as a stupid question
Remember: primum non nocere. The enemy of a good result is a perfect one.
Be involved in research.
Create good working relationships with the other interventional fellows. Divide the work equally and learn from each other.
Don’t be afraid to ask questions.
There is no such thing as a stupid question ? ? ?

32. There is no such thing as a stupid question? ? ?

35. Always be ready for surprises….

37. CP

38. CP

40. Downhill Risk Assessment: The Intuitive Approach
“Uh oh” CP

41. Advice from the Experts
“Attack the fall line” CP

42. Advice from the Experts
“Always keep your weight centered on your skis” CP

44. CP

46. CP

47. CP

48. CP

49. Frog?
Alligator? CP

52. David R. Holmes, M.D. Mayo Clinic Rochester, MN
Management Lessons
David R. Holmes, M.D. Mayo Clinic Rochester, MN

53. An eagle was sitting in a tree resting, doing nothing.
A small rabbit saw the eagle and asked him “Can I also sit like you and do nothing?” The eagle answered “Sure, why not”. So, the rabbit sat on the ground below the eagle and rested.
All of a sudden, a fox appeared, jumped on the rabbit and ate it.

54. Management Lesson
To be sitting and doing nothing, you must be sitting very, very high up

55. “Well, why don’t you nibble on some of my droppings?” replied the bull. “They’re packed with nutrients.”
A turkey was chatting with a bull. “I would love to be able to get to the top of that tree,” sighed the turkey, “but I haven’t got the energy.”

56. The turkey pecked at a lump of dung, and found it actually gave him enough strength to reach the lowest branch of the tree. The next day he reached the second branch and finally, after a fourth night, the turkey was proudly perched at the top of the tree. He was promptly spotted by a farmer, who shot him out of the tree.

57. Management Lesson
Bull#$&* might get you to the top, but it won’t keep you up there.

58. A little bird was flying south for the winter
A little bird was flying south for the winter. It was so cold, the bird froze and fell to the ground into a large field. There, a cow came by and dropped some dung on him.
As the frozen bird lay there in the pile of cow dung, he began to realize how warm he was. The dung was actually thawing him out!
He laid there all warm and happy, and soon began to sing for joy.

59. A passing cat heard the bird singing and came to investigate
A passing cat heard the bird singing and came to investigate. Following the sound, the cat discovered the bird under the pile of cow dung and promptly dug him out and ate him.

60. Management Lesson Not everyone who #$%&’s on you is your enemy
Not everyone who gets you out of #$%& is your best friend
And, when you’re in deep #$%&, it’s best to keep your mouth shut!!

66. “Couldn’t I do a couple of hundred hours of community service instead

67. “Frank…don’t do that.”

68. Title/drp–author: WT/BK– Holmes, D
Sub/drp–Job#: YW8/BK–CP
Subject: Cows
Background: 6,61,232
Plot/brdr: open/BU31 x, y only
Banner/brdr: BU4/BU41
Side title: YW105
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PPT shooting instructions
1 PPT file
(18 images) to server
Text: WT/BK
Highlight: YO114
Subdue: BU31
Footnotes: BU41
COLOR REFERENCE ONLY
Match: CP CP

69. Democratic You have two cows. Your neighbor has none.
You feel guilty for being successful.
Barbara Streisand sings for you.
Political Science for Dummies CP

70. Republican You have two cows. Your neighbor has none. So?
Political Science for Dummies CP

71. Socialist You have two cows.
The government takes one and gives it to your neighbor.
You form a cooperative to tell him how to manage his cow.
Political Science for Dummies CP

72. Communist You have two cows.
The government seizes both and provides you with milk.
You wait in line for hours to get it.
It is expensive and sour.
Political Science for Dummies CP

73. Capitalism – American Style
You have two cows.
You sell one, buy a bull, and build a herd of cows.
Political Science for Dummies CP

74. Bureaucracy – American Style
You have two cows.
Under the new farm program the government pays you to shoot one, milk the other, and then pours the milk down the drain.
Political Science for Dummies CP

75. American Corporation You have two cows.
You sell one, lease it back to yourself and do an IPO on the 2nd one.
You force the two cows to produce the milk of four cows. You are surprised when one cow drops dead. You spin an announcement to the analysts stating you have downsized and are reducing expenses.
Your stock goes up.
Political Science for Dummies CP

76. French Corporation You have two cows.
You go on strike because you want three cows.
You go to lunch and drink wine.
Life is good.
Political Science for Dummies CP

77. Japanese Corporation You have two cows.
You redesign them so they are one-tenth the size of an ordinary cow and produce twenty times the milk.
They learn to travel on unbelievably crowded trains.
Most are at the top of their class at cow school.
Political Science for Dummies CP

78. German Corporation You have two cows.
You engineer them so they are all blond, drink lots of beer, give excellent quality milk, and run a hundred miles an hour. Unfortunately they also demand 13 weeks of vacation per year.
Political Science for Dummies CP

79. Italian Corporation
You have two cows but you don't know where they are.
While ambling around, you see a beautiful woman.
You break for lunch.
Life is good.
Political Science for Dummies CP

80. Russian Corporation You have two cows. You have some vodka.
You count them and learn you have five cows.
You have some more vodka.
You count them again and learn you have 42 cows.
The Mafia shows up and takes over however many cows you really have.
Political Science for Dummies CP

81. Taliban Corporation
You have all the cows in Afghanistan, which are two.
You don't milk them because you cannot touch any creature's private parts.
You get a $40 million grant from the US government to find alternatives to milk production but use the money to buy weapons.
Political Science for Dummies CP

82. Iraqi Corporation You have two cows. They go into hiding.
They send radio tapes of their mooing.
Political Science for Dummies
MOO CP

83. Polish Corporation You have two bulls.
Employees are regularly maimed and killed attempting to milk them.
Political Science for Dummies CP

84. Belgian Corporation You have one cow. The cow is schizophrenic.
Sometimes the cow thinks he's French, other times he's Flemish.
The Flemish cow won't share with the French cow.
The French cow wants control of the Flemish cow's milk.
The cow asks permission to be cut in half.
The cow dies happy.
Political Science for Dummies CP

85. Florida Corporation You have a black cow and a brown cow.
Everyone votes for the best looking one.
Some of the people who actually like the brown one best accidentally vote for the black one.
Some people vote for both.
Some people vote for neither.
Some people can't figure out how to vote at all.
Finally, a bunch of guys from out-of-state tell you which one you think is the best-looking cow.
Political Science for Dummies CP

86. California Corporation
You have millions of cows.
They make real California cheese.
Only five speak English.
Most are illegals.
Arnold likes the ones with the big udders.
Political Science for Dummies CP