The first year of an oncology/hematology fellowship often requires fellows to absorb a daunting amount of information; after that, many feel more at ease as they transition into their second year, having gained a substantial amount of clinical knowledge.1

“I think there is a point in your second year when you feel that everything is coming together—at least it was that way for me,” said Yuval Raizen, MD, now in his third year of fellowship at Baylor College of Medicine in Houston, Texas.

That said, the second year of fellowship has its own unique set of challenges, as fellows continue to deepen their understanding of cancer care and treatment while knuckling down to identify the direction all their hard work might take them in.

“Oncology and hematology are such complicated fields, with so much new knowledge you have to pick up after finishing your internal medicine residency, that it does take a while before you really start to feel competent managing patients without guidance every step along the way,” Dr. Raizen said. “During the second year is when I hit the point of feeling that I could competently make decisions on my own without the attending.”

The first-year focus on clinical work is meant to help fellows establish a broad base in general oncology, said Teresa Hayes, MD, who is program director, Baylor College of Medicine Hematology/Oncology Fellowship Program; associate professor, Baylor College of Medicine; and chief, Hematology/Oncology, Michael E. DeBakey VA Medical Center. “In the second year, fellows can pick their electives and go to another institution for extra specialty training. Or they can use that time to develop a research program.”

With the option to focus on specific electives, Baylor second-year fellows start gaining more experience in subspecialties. “We rotate through gastrointestinal oncology; some people do breast oncology; and the hematology clinics are a bit more specialized as well,” Dr. Raizen added. At the same time, second-year fellows have the flexibility to increase contact with a mentor and develop a project if they are geared toward a research-oriented career.1,2 “If you have aspirations toward an academic career, that’s the time in our fellowship when you are able to work on that more extensively,” he said.

Because of the high clinical volume, however, working toward a research program can be difficult during the second year. “To not only identify a central project, but also find time to do it—to identify your mentor, put together a research proposal, and carry it out while balancing your clinical responsibilities has been a challenge for a lot of fellows,” Dr. Raizen said.

Of course, fellowship programs vary from institution to institution. “Some programs have all clinical work in the first 18 months with the next 18 months dedicated to research and academic pursuits, while others have it distributed throughout the 3 years. Some programs require research; others don’t,” Dr. Hayes explained. But they do have in common a challenging discipline that demands its physicians to be both medically competent and capable of caring for patients facing a potentially fatal illness. “The nature of the discipline is that you have to develop not only technical knowledge, but also a lot of people skills,” Dr. Hayes said. “You have to work with patients who are facing death and dying, and to have a lot of compassion and the ability to palliate them while you’re treating their cancers.”

For Dr. Raizen, the biggest challenge of his second year was making a decision between pursuing a career in academic medicine and going into a more practice-based environment.2,3 He decided to pursue a practice-based career after identifying what he really likes doing in oncology. “I do enjoy the teaching and interaction with house staff in an academic environment, but I really want to spend the majority of my time in patient care. Ultimately, I realized that was why I went into this in the first place.”

Dr. Raizen suggested that oncology fellows think about their long-term goals and try as early as possible to establish a way to achieve them.4 “If you’re interested in an academic career, the second year of fellowship is an important time to identify a mentor you would like to work with and see if you can create some research opportunities. It’s a little hard to complete something during the third year.”

Dr. Hayes concurred. “It is not easy to find jobs in oncology these days, so in the second year they need to be thinking about their lifetime goals: where they want to practice, whether they want to go into private practice or academia, and if research-oriented, what kind of research they would like to do.”

She recommended making contacts and getting things in order at this point, “because it may take a year or more [for fellows] to develop their ultimate career path.”

References

     

  1. Kircher S, Feliciano J, Ahmed S. A year-by-year look at a fellowship program. http://www.onclive.com/publications/oncology-fellows/2010/August-2010/A-Year-by-Year-Look-at-a-Fellowship-Program. Accessed November 9, 2011.
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  3. Todd RF. A guide to planning careers in hematology and oncology. Hematology Am Soc Hematol Educ Program. 2001:499-506.
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  5. Shanafelt T. A career in surgical oncology: finding meaning, balance and personal satisfaction. Ann Surg Oncol. 2008;15(2):400-406.
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  7. Melnick A. Transitioning from fellowship to a physician-scientist career track. Hematology Am Soc Hematol Educ Program. 2008:16-23.
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