Oncology Fellow Advisor presents our Day in the Life series. In each segment, we interview a prominent thought leader about how he or she got into the field of oncology and his or her typical workday.

In this issue, we interview Timothy Gilligan, MD, program director of the Cleveland Clinic’s Hematology-Oncology Fellowship, director of the Late Effects Clinic, and a member of the Cleveland Clinic’s Ethics Committee and Graduate Medical Education Committee in Cleveland, Ohio. We are honored to include a renowned fellowship director in this series.

If you would like to nominate someone to be interviewed for our Day in the Life series, please send your nomination via email to oncologyfellowadvisor@mcmahonmed.com.

With several generations of physicians adorning the branches of his family tree, it’s not terribly surprising that Timothy Gilligan, MD, aspired to join their ranks and keep the medical tradition alive into the fourth generation. “I think it was in my genes,” Dr. Gilligan said. “I was exposed to medicine at a very early age. My brother, dad, grandfather, great grandfather—all doctors.”

That he wanted to follow in their footsteps was always clear, but Dr. Gilligan had not always wanted to be an oncologist; he had originally set his sights on being an intensive care physician. A 4-month stint during residency at Brigham and Women’s Hospital in Boston, Massachusetts, with its intensive exposure to cancer care, sent Dr. Gilligan down a different path. “During those months I would stay late at the hospital. After the medical work was done I wanted to talk to [the patients], learn more about what they were going through.” He was moved by the compassion he felt for patients going through a difficult and frightening time, and by the tight bonds he would form with patients in need of care. “Also, when you’re looking at potential death or the fear of death, a lot of the nonsense that you deal with people in other situations drops away; people don’t want to waste their time at that point,” he said.

Dr. Gilligan finds that his experience is not uncommon in people who choose oncology as their medical specialty. “People find it very meaningful, the kinds of relationships and conversations they have,” he said. “If you can get over the fact that there are a lot of sad stories and focus on the fact that these are people who really need good doctors, it’s a very engaging line of work to be in.”

As compelling as oncology is, it never ceases to be challenging, especially to those just beginning to learn the different angles and facets of care and to tackle learning the vast quantity of information they will need to know.

“It is harder than most fellows expect. Our patients are very complicated. They have the emotional stress of the diagnosis, and those with advanced disease have a lot of medical complications. You need to be a good internist, and to get really comfortable with all the complications of cancer medicine,” Dr. Gilligan said. “But if you put in the work and learn how to do this very well, it’s really rewarding to achieve a high level of confidence.”

Oncology is a field rife with published data. There is a lot to learn, memorize, and integrate into clinical care. “There was a time when people thought that anyone starting fellowship should read textbook X in their field, but I don’t think that’s very helpful to fellows. Patients never fit the textbook very well and it’s hard to retain information that way—especially when you don’t have an exam at the end of the month.” A more effective approach may be to see a lot of patients in different clinical scenarios, and to supplement that exposure with reading to enhance retention. “We’re coming to understand that the more active learning is—patient-based and problem-based—the more people retain the information,” Dr. Gilligan said.

No 2 days look alike for Dr. Gilligan, who teaches at the medical school and advises a dozen medical students, has 2 full clinic days each week, and serves as deputy editor of the Cleveland Clinic Journal of Medicine, reviewing articles and developing continuing medical education.“I feel like I wear 5 different hats,” he said. Right now he is working on improving quality of care—specifically the quality of communication between oncologists and patients. “We’ve been working with fellows for a while, but now we’re starting it with staff and faculty physicians at the Cleveland Clinic.”

Looking toward the future, Dr. Gilligan imagines the details will change, but that the overall structure will remain the same. Although he’s been running a fellowship program for 5 years now, he is not eager to give it up. “I like working with the fellows. It’s hard to think that there’s anything more important than training the next generation of physicians,” he said. “The challenge for us is to make it easier for them, not in terms of less work, but in helping them clarify what they need to work on in order to succeed: How do you identify a good mentor? How do you learn everything you need to know to be a good doctor?”

The field of oncology seems to be increasing in popularity, Dr. Gilligan said, and he thinks this has to do partly with the allure of the science and research, and partly because oncology holds more promise and optimism than ever before.

Dr. Gilligan also has noticed that the caliber of oncology fellows appears to be rising as the field becomes more intriguing, and as role models emerge whom younger doctors emulate. “It’s an encouraging thing for a program director to see good candidates apply,” he said.

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