Fellows as Teachers: Paying It Forward

Fellows as Teachers: Paying It Forward

Inas Abuali, MD, FACP

Feb 11, 2021

I have often jokingly referred to myself as “procedurally challenged” during medical training. Truthfully, I have never enjoyed doing procedures as a medical student nor as a resident. Even when my surgical attendings told me that my technique showed promise, I knew that a procedural-based specialty was not for me. As a hematology oncology fellow, I admit I hated doing bone marrow biopsies as a junior fellow. Interestingly, this is where having a terrific teacher can serve to change your outlook. Working with an attending I really admire in my last year of fellowship helped boost my confidence immensely. Teaching me how to refine my technique so that the procedure caused minimal pain and discomfort to the patient helped me become proficient in something I had previously disliked doing. While I will never be drawn towards doing procedures, I realized that one can become comfortable and skillful enough at tasks they may not particularly enjoy. This made me reflect on how our training is shaped by those who devote their time to helping us turn our weaknesses into strengths, and after whom we role model the clinician-educators we aspire to be.

In medicine, we all have a responsibility to pay it forward. Here are some thoughts on how to integrate teaching into your day-to-day workflow as a fellow.

  1. It is important to remember that there is always something you can teach.

Transitions in training are particularly hard. Starting out in hematology oncology as a junior fellow can be a daunting experience, as we often feel like nothing in our previous medical training had prepared us for the nuanced language of this specific fellowship. However, there is always something that you can teach a junior trainee. It could be as simple as tips on how to effectively round and how to write an H&P or progress note. A junior trainee often benefits from an explanation of the general framework of how to approach a problem. Basic clinical pearls related to patient cases is something we can all teach during the day-to-day clinics and wards.

  1. Be creative about how to integrate learners into your workflow.

A challenge we frequently encounter is the sheer volume of the tasks we personally need to complete, which often leaves us wondering how much time we can really devote to our learners. I learned from my seniors and attendings that effective teaching is often integrated within the workflow. Think out loud as you complete tasks to give the learners an opportunity to observe your thought process. If you are rounding in the hospital, use the time while walking from one area to another to recap some teaching points. Send a quick email at the end of the day with a relevant article or learning point. Find tasks for the learners that are suitable to their level of training, since being inclusive is imperative in fostering an effective learning environment.

  1. Tailor the teaching to your learner’s goals and needs.

Take the time to understand your learner’s objectives out of a particular rotation. A resident aspiring to go into hematology oncology has different objectives from a medical student who is interested in a surgical career. The first may be interested in understanding an overview of workup and staging for malignancies, while the latter may want to understand more hematology basics and perioperative hematologic management. You will not know unless you take the time to ask and to then tailor teaching points and objectives accordingly.

  1. Involve junior trainees in scholarly activities and help them build their network.

There is so much you can do to help a junior trainee in their career path. Offering them an opportunity to collaborate on a research project, that aligns with their career goals, can be invaluable. When possible, introduce them to someone who can serve as a mentor or a sponsor. Discuss with them relevant opportunities, such as conferences or professional societies that could be of value to their specific trajectory.

  1. Ask for feedback.

While some of us are more naturally inclined towards an educator mindset, the truth is that effective educators are those that continue to hone their skills via active learning and ongoing integration of feedback. In my junior faculty years, for instance, I learned from my learners that I need to improve my feedback-giving skills. This prompted me to enroll in various institutional and societal “teach the teacher” courses and to specifically work on this deficiency area. Over time, I have constantly asked my learners to give me feedback on how I give feedback so I can continue to improve.

  1. Be kind—always.

We are more than our professional identities. Always take the time to know your learner. The best clinician-educators are those that take a genuine interest in the well-being of their learners. Ask someone about their interests outside medicine. Ask people how they are doing and take the time to actually listen to their reply. We learn best from those whom we perceive as truly caring about us as individuals. The world, in general, and the culture of medial training, specifically, can use more kindness!


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