Making the most of fellowship

Fellowship goes fast. The clinical year feels endless while you are in it, and then suddenly you are signing a contract. The fellows who come out ahead decide early what they want to get out of these years and protect time for it.

Your first year

• Learn the bread and butter cold. Anemia, thrombocytopenia, anticoagulation, febrile neutropenia, tumor lysis, cord compression, immunotherapy toxicity. You will see these for the rest of your career, in any job.
• Own your continuity clinic. These are your patients. Know their pathology, their stage, their regimen and their goals. Your clinic is where you learn to be an oncologist, not the inpatient service.
• Get comfortable with the procedures and the paperwork. Bone marrow biopsies, chemotherapy orders, dose modifications, prior authorizations. Ask the pharmacists and infusion nurses to teach you; they know more than you think.
• Practice the hard conversations. Breaking bad news and goals of care are skills. Watch attendings you admire do them, then do them yourself with feedback.

Pick your mentors early

By the middle of your first year, have a research mentor and a career mentor. They can be the same person, but often are not. A good mentor meets with you regularly, gives you a project that can actually finish, and introduces you to people. Look for someone whose former fellows are now where you want to be.

Choose the mentor first and the project second. A great project with an absent mentor goes nowhere.

Use the in-training exam

The in-training exams each year show you where your gaps are long before the boards. Read the explanations for everything you missed and note the topics. See the in-training exam guide.

Protect yourself

Fellowship lands at the same time as family, moves and finances. Keep sleep, exercise and the people outside medicine on your calendar. Burnout in oncology is common and it is not a personal failure. Talk to someone early if you are struggling.