Feb 25, 2014
By Michael Postow, MD
Memorial Sloan Kettering Cancer Center
Fellowship is an incredibly exciting step in our career development as oncologists. As pre-medical students in undergraduate universities, we studied hard for the MCATs and organic chemistry tests. We then completed hoursof diligent study in medical school and sampled the various fields of medicine on the wards for the first time. During internal medicine residency, we were known as "doctor," and our mettle was tested as we made decisions that directly affected patient care. Now, as fellows, we finally have the opportunity to pursue our chosen profession, engaging in the care of patients with cancer and working to improve their lives through teaching and research. At each step in our medical journey, maintaining a professional attitude has been important. Now, starting fellowship and interacting with patients with cancer, it is more important than ever before. The stress of caring for sick patients and feeling academically vulnerable at this early stage of career development are normal feelings experienced by first-year fellows. If not carefully considered, these feelings could compromise our best abilities to maintain the sense of professionalism to which we hold ourselves. As one goes through fellowship, it may be helpful to keep the following professional considerations in mind.
Maintain a consistent voice with your supervising attending for patients
A large part of fellowship involvesthe direct care of patients under the supervision of an attending and/or faculty physician. At times, patients may ask your opinion on various aspects of their care, even as a "second opinion" to the attending with whom you are working. Though your opinion is certainly important to express, being cautious about first discussing with the attending physician may be helpful to ensure a consistent message is communicated. Never speak poorly about another physician's care plan, instead comment that in your opinion, an alternative would be preferable.
Respect the hierarchy of medicine
Medicine is inherently based upon a structural hierarchy of seniority, prestige, and experience. Though attending faculty members may refer to each other by their first names, as a fellow, it is best to call your attending "Doctor," until he or she indicates a preferenceto be called by his or her first name. This is, of course, especially true when you may be referring to other faculty members, including your fellowship program director or other senior leadership. Addressing emails with "Dear Dr. . . ." is typically best as well.
Dress (at least) as well as your supervising attendings
Residency involved many hours, often overnight, on the hospital wards where scrubs, clogs, or other causal clothes were preferable. In fellowship, however, a good principle is generally to dress (at least) as well as your supervising attending. If they wear a tie and white coat, it's best to do similarly. Patients may also have expectations of how they prefer their physician to appear, and dressing "the part" is all part of the patient experience.
Be careful with social media and electronic communication
Many people are connected electronically through Twitter, Facebook, and a number of additional social networking sites. It is amazing how photos, videos, and comments on blogs can easily turn up in standard Internet searches that patients and/or attending physicians may perform. If you use social media, it is critical to set your privacy settings appropriately and strongly consider keeping photos and comments about your personal life separate from work colleagues. Even comments made in a joking manner by friends or family in these venues may be visible and hard to explain to your professional contacts.
Keep cell phones on vibrate and limit excessive texts and calls at work
Everyone acknowledges that cellphones are everywhere, and it is important to remain in touch with family members and friends. Nevertheless, cell phones have a tendency to ring in important meetings, and it is always embarrassing to be the one silencing your phone in front of the group or even during a consultation with a patient. Texting also introduces a mental distraction from being as efficient as possible with work tasks, particularly during the course of a busy clinic day. It is always tempting to reply to texts immediately, but being able to resist the urge will help your efficiency tremendously.
Teaching and interacting with residents, medical students, and other ancillary staff
As the last step of training before becoming a full-fledged oncologist, fellowship provides a number of opportunities to teach and supervise more junior physicians-in-training, students, and other members of the care team. This can be one of the most rewarding components of fellowship. Despite the well-known hierarchy of medicine, treating the more junior members of the team with the same respect that you would like to receive from your supervising attending is important in maintaining team harmony. Treating support staff members well can also end up in your favor as they will undoubtedly make positive comments about you to your supervising attending.
Setting appropriate expectations and timelines
You will be asked by supervising attendings to complete many requests.While the answer to these requests is typically, "Yes, I am glad to have this opportunity," keep in mind the scope ofyour commitments and timelines. Trying to do everything may lead to doing nothing or becoming so overextended that you create delays in delivering work on expected timelines. Attendings will understand if you politely decline an ask that you cannot responsibly complete within the established timeline. Work with your mentors to find out which projects are the most important.
Fellowship is a wonderful time whereyou have an opportunity to synthesize your past knowledge and training as aphysician and develop into the oncology clinician, researcher, and educator you wish to become. Every program and individual may achieve their goals in unique ways, but keeping in mind some of the general thoughts above may help avoid common pitfalls that could keep you from the successes you deserve.