Why are we sending final-year Interventional Cardiology trainees back to the AMU?

There’s a question that keeps coming up in conversations with trainees and trainers alike: Why, in the final year of interventional cardiology training, are we sending people back to the Acute Medical Unit? 

Let’s be clear at the outset: this is not an argument against general medicine. Cardiologists absolutely should be physicians. We deal with older, frailer, multimorbid patients. If anything, cardiology is becoming more generalist, not less. But this isn’t really about whether generalism matters. It’s about when it should be taught and at what opportunity cost.

The Wrong Skill at the Wrong Time
Training isn’t just about content - timing matters. Early in training, broad medical exposure makes perfect sense. You build diagnostic breadth, learn how to manage complexity and develop clinical judgement. But interventional cardiology is different.

By the final year, trainees should be doing one thing above all else which is to become safe, independent operators. In practice, that means exacty that: practice. Practice at handling complex PCI, practice at making real-time procedural decisions, practice managing complications, practice using imaging properly (IVUS/OCT) and the most important skill, understanding when not to intervene. These are not theoretical skills. They are built through repetition, continuity, and exposure to real cases. You cannot learn bailout strategies dealing with frailty on AMU. 

Training time is finite
Every week on AMU is a week not spent in the cath lab, seeing complications, following cases through and building procedural fluency. The uncomfortable truth is you can catch up on general medicine. but you cannot easily catch up on lost procedural experience. Recent UK survey data suggest that many interventional trainees plan fellowship training after CCT, often because they do not feel ready for independent consultant practice. That should worry us all.

In 2026 a CCT in cardiology for an interventional trainee isn't perceived by the trainees as a credible qualification to practice independently in the cath lab. This means the training programme isn't doing what it should be.

Let’s be honest: the push for more generalism comes from a real place which is an ageing population, pressure on acute medicine and workforce shortages but that doesn’t automatically make it good training design. There’s a difference between what the system needs and what the trainee needs and right now in 2026, final-year AMU rotations feel less like education and more like gap filling and service provision.

Even more important is that interventional cardiologists don’t spend their time on AMU practising general medicine when they are a consultant. They work in the cath lab, managing ACS pathways, running cardiology services, dealing with complications and complex decision-making. Training should prepare them for that reality yet instead, we’re taking them away from it just at the point of peak specialisation.

Patient safety matters
​This isn't just an educational issue - it’s a patient safety issue. Interventional cardiology is high-risk. Outcomes depend on experience, judgement and exposure to complications. These things are learned in the cath lab not taught in a classroom. If we reduce exposure at the exact point trainees should be consolidating independence, we shouldn’t be surprised if confidence is lower, fellowship training becomes the norm and early consultant years are more fragile.

If we want interventional cardiologists who are strong physicians we should teach general medicine early, reinforce it throughout training and embed it within cardiology contexts (heart failure, ACS, multimorbidity) not bolt it into the final year, when something much more specific should be happening. That’s not balance, its poor sequencing.

Interventional cardiologists don't think the current model incorporating general medicine is a good idea. I've been involved in training and education in cardiology for more than 20 years and a more sensible model would front-load general medicine, sign it off earlier, protect the final years for advanced cardiology and accept that procedural competence needs dedicated time.

If the programme can’t deliver both within the current structure, then we need to be honest about that. This isn’t about resisting change or clinging to subspecialisation, it’s about getting the basics of training right. 

Final-year interventional trainees should be in the cath lab, not on AMU, not because general medicine doesn’t matter but because timing matters more than we’re currently willing to admit.

General Medical Council. Cardiology Curriculum 2022
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McGrath S, Morgan H, Muir D, Hildick-Smith D. Evaluation of the UK Intervention Subspecialty Programme: The Trainees' Experience. Interv Cardiol. 2025 Jun 10;20:e20.