The Importance of Hematology/Medical Oncology Fellowship

Samuel A. Kareff, MD, MPH

I first became acquainted with the African proverb, “If you want to go fast, go alone. If you want to go far, go together,” during the most clinically challenging year of my graduate medical education: PGY-4, or the first year of a hematology/medical oncology fellowship. During simultaneous learning of the basics of chemotherapy and fighting off yet another wave of COVID-19, I also sought mentors in hematology and oncology to guide the development of my research pursuits. Luckily, I matched with 3 superior mentors and sponsors during my fellowship; however, this is not the case for every trainee. According to a survey of oncology trainees and early-career faculty (n = 306), respondents who were underrepresented in medicine (n = 64) were less likely to have a primary mentor compared with those who were not underrepresented in medicine (n = 242), at 66% vs 80%, respectively (P = .015).¹ Now that I have completed my fellowship, I hope to share my reflections on the benefits, challenges, and critical elements of effective mentorship in hematology/oncology.

Benefits of Mentorship

Although many benefits of mentorship have been reviewed, such as transitioning through traditional paths into academic practice, private practice, or drug development, the intangible products of mentorship are equally, if not more, valuable.² Trainees must balance competing demands during hematology/oncology fellowship, varying from knowledge streams that consistently change to intricacies in patient populations and clinical trial design. It is often the mentor to whom a trainee turns for guidance when our field’s algorithmic recommendations cannot be routinely followed. For example, one mentor/ sponsor’s real-world experiences in various clinical settings, including academic, hybrid, and private practice, yielded invaluable insights that cannot be found online or through formal recruitment avenues. Without her guidance, my job search would have been much more complex.

Challenges of Mentorship

Despite the various tangible benefits of mentorship, some challenges are also worth noting. Time is by far the most limiting factor. However, other difficulties may weigh into any mentor-mentee relationship, such as overcommitting, ghosting, and even backstabbing on the mentee’s part.³ Some strategies that might overcome these missteps include clearly stating one’s career goals, embracing failure as an inevitable part of growth, and remaining open to longitudinal feedback.⁴ Additionally, mentees might not only rely on a single mentor to propel their success but obtain multiple connections that serve various roles, including professional coaches, sponsors, and connectors.⁵ Looking outside one’s institution also yields multiplicative benefits for networking and connecting.

Strategies for Mentorship

Mentoring and mentorship strategies will vary based on the mentor-mentee dyad. Throughout my fellowship, I have found the following methods particularly helpful:

1. Set Repeating Calendar Invites

Hematology and oncology are busy in terms of the complexity of patients seen and the emotional intensity required to practice. It is imperative that any trainee seeking mentorship or other career advice schedule such conversations well in advance. One of my mentors and sponsors serves in numerous institutional, national, and international roles, necessitating his constant availability outside working hours. We ensured adequate face-to-face time by scheduling bimonthly check-in meetings before deadlines and other pressing issues.

2. Show Up (to Clinic, Didactics, Conferences)

As the saying goes, half of life is about showing up. The hematology/oncology fellowship is a particularly challenging training period due to the lack of many of the fields’ subspecialty concepts being taught in medical school or residency. Although the clinical demands of fellowship can be trying, it is important to prioritize yourself and your career success by being present for as many educational and networking opportunities as time (and stress) permit. By attending various diseasefocused clinics, nearly every didactic session offered by my fellowship, and local, national, and international conferences, I have been fortunate to meet multiple mentors and sponsors among general and disease-specific oncology organizations. These individuals remain precious to me personally and my career growth.

3. Promote Those in Earlier Stages Than Yourself

Fellows must remember that, despite their own need for mentorship, they too can serve as mentors and sponsors for trainees in earlier stages than themselves. Indeed, elements of the “hidden curriculum” demonstrated by fellows often have downstream effects that manifest later in the careers of other trainees.⁵ During my chief fellowship year, I helped formalize a disease-focused working group that produced several research initiatives and served as a safe space within the complex graduate medical education network to discuss concerns, anxieties, and other pieces of advice. This community continues to be bolstered to this day, and I am both proud and nostalgic as I leave it behind.

4. Leave a Lasting Example

Ralph Waldo Emerson defined success as leaving “the world a bit better” and this maxim applies to both mentors and mentees. Whether demonstrating this example in the clinic with patients or on rounds with mentees, the hematology/oncology clinician must leave a lasting example for those around them. Indeed, many of us (me included) naturally gravitate to these types of practitioners, launching us toward the hematology/ oncology training journey. As my training ends, I hope we all pledge to leave the best lasting examples we can.

Samuel A. Kareff, MD, MPH, is a medical oncologist and hematololgist at Baptist Health in Boca Raton, Florida. He was formerly the outgoing chief fellow of hematology and medical oncology at the University of Miami Sylvester Comprehensive Cancer Center/Jackson Memorial Hospital in Miami, Florida.

References

1. Idossa D, Velazquez AI, Horiguchi M, et al. Mentorship experiences are not all the same: a survey study of oncology trainees and early-career faculty. JCO Oncol Pract. 2023;19(9):808-818. doi:10.1200/OP.22.00643
2. LaCasce A, Graff S, Gao J, Close J, Boulmay B. Preparing fellows for graduation: perspectives on career guidance. Am Soc Clin Oncol Educ Book. 2019;39:609- 614. doi:10.1200/EDBK_242603
3. Vaughn V, Saint S, Chopra V. Mentee missteps: tales from the academic trenches. JAMA. 2017;317(5):475-476. doi:10.1001/jama.2016.12384
4. Chopra V, Arora VM, Saint S. Will you be my mentor? four archetypes to help mentees succeed in academic medicine. JAMA Intern Med. 2018;178(2):175- 176. doi:10.1001/jamainternmed.2017.6537
5. Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: a scoping review. Acad Med. 2018;93(4):648-656. doi:10.1097/ACM.0000000000002004