A Primer for New Fellows

Jill Gilbert, MD

Welcome to another professional milestone. As you embark upon your hematology-oncology journey, I want to tell you a few things I wish I’d known years ago. By way of introduction, let me say that I completed my fellowship in 2001 and have remained in academia. I have served in various capacities at several universities, focusing largely on professional development, and am a mentor for the American Society of Clinical Oncology Leadership Development Program. My thoughts are based on my experiences and observations.

Expect Rigorous Training

The stakes are higher now that you are fellows, not residents. The goal is to prepare you for any situation and clinical scenario, and this is important because lives are at stake. So, your consult rotations will seem never-ending, and you’ll get little sleep on call nights. That’s all part of being an oncologist.

Expect to be tired but develop a sustainable self-care strategy. You cannot control the number of patients who need your services, but you can control how you handle the rigor of your training. Training in this subspecialty is a choice and an honor. Give yourself permission to ask for help, take an extra day off if you need it—with input from leadership—and take deep breaths. Your program believes in you and believes that you can do it. Out of all the applicants, they picked you for a reason.

Don’t Overstretch Yourself

See previous section. You are going to work hard, probably harder than ever. The nights will be long, the work will be challenging—even on the best days—and both fatigue and coffee will be your constant companions. But an exhausted fellow is an ineffective physician.

Only you know how much you can handle and where you need to draw the line. Fellowship, like all of oncology, is a team sport, and you will need to ask your teammates for help. Every program has “pop-off valves” to help with high patient volume and promote personal wellness. Learn about these resources and take advantage of them.

Realize Faculty Is on Your Side

They care about you and want to help you succeed. They are invested in your future because, once again, they chose you. Assume that they have good intentions, but notify leadership if this seems not to be the case.

Remain Professional

A lapse in professionalism is the quickest way to derail a promising career. Some of the most common lapses involve arrogance (you’re right and everyone else is wrong), victim mentality (others are always to blame for bad situations), habitual distrust (you focus on the negatives), and passive resistance (your silence is misinterpreted as agreement).

One of the most important skills you can have is the ability to think about alternative ways to achieve a desired outcome. Don’t try to rally a fellowship class or program around your perceived grievance because the resulting chaos and hostility will reflect negatively on you.

Recognize Cognitive Distortion

We can all be our own worst critics, but the truth is that our thoughts about ourselves are not necessarily correct. I commonly see trainees and faculty who zero in on the one criticism they received while ignoring all positive feedback.

For days or months afterward, the person focuses on the negative reaction and sets up a spiral of shame and self-doubt. Coupled with the stress and fatigue of a hem/onc program, this way of thinking can destroy anyone’s mental health. Try to recognize cognitive distortion and find a colleague who can assess the situation objectively and help you look at the issue differently.

Manage Up

This can be a difficult concept to grasp. It is not the same as arrogance. Managing up means that you let mentors and program leadership know about your successes. It’s not bragging, which asserts that you are better than others. It’s about leveraging your successes into greater career opportunities.

As a former program director, I can tell you that if you are successful, the program as a whole is successful. Telling people about the amazing things you’re doing will increase your networking opportunities and the sponsorship and mentorship you’ll get within and without your institution.

Remember that a fellowship is like a long job interview. Even if you don’t intend to stay at the hospital after graduation, the way you handle and prepare yourself during this period will affect the rest of your career. Good luck, and don’t forget to have fun.