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Becoming an Oncologist: My Fellowship Journey

Jul 06, 2021

Megan E. Emmich, DO, is currently a PGY5 starting her second year of fellowship in hematology/oncology at UConn Health – University of Connecticut School of Medicine in Farmington, CT. She is excited to serve as a member of the ASCO Trainee & Early Career Advisory Group for the 2021-2022 term.

Please describe your training path thus far.
ME: It is very humbling to think that I started this journey over 10 years ago. At the College of the Holy Cross, I declared a biology major with pre-med concentration and French minor. Through a summer internship program at Holy Cross, I was given the opportunity to work as a research intern in a skin cell biology lab at Chanel, Inc. and that was my first professional exposure to bench research. I knew then I wanted to learn more about clinical research; I wanted to know more about study design, the teams involved, and how to help patients, and, specifically, how to bring about health. 
Following graduation, I accepted a position as a clinical research coordinator in the Sarcoma and Bone Oncology Division at the Dana-Farber Cancer Institute (DFCI). I spent 3 years as a research coordinator supporting the clinical group which conducted over 10 clinical trials. It was the experience I gained from working with this group which confirmed my decision to go to medical school and to pursue oncology.
When considering where to pursue my medical degree, I found that the philosophy of an osteopathic medical school fit in line with how I wanted to approach treatment of my patients. At the University of New England College of Osteopathic Medicine, the emphasis on treating the whole person (body, mind, and spirit) and combining structural and functional relationships began my deeper understanding of how medicine is both a science and an art. Knowing that I wanted to be an oncologist, this truly was a great place to start.
After completing medical school in 2017, I began an internal medicine residency at UMass-Baystate, in Springfield, MA. I participated in a leadership program that provided monthly professional development education and leadership skills. I then used these skills and led Baystate’s ASCO-sponsored Cancer Interest Group (CIG) during the last 2 years of residency. In 2020, I started my oncology fellowship at UConn and I look forward to engaging with the ASCO community as a fellow.
What precipitated your interest in oncology?
ME: Biology! I knew even in high school that I wished to become a physician and I had an inkling towards oncology; I was fascinated by biology. My time at DFCI certainly affirmed my decision to pursue oncology. In my role as a clinical research coordinator, I started to realize just how complex the human body is—both in disease processes and biopsychosocial factors—and it made me curious to learn more. I worked with a multidisciplinary team of nurses, physicians, and patients who demonstrated the concept of a team approach in medical care, and it was where I continued to develop my strength in communication skills. 
How has your fellowship experience differed from residency/internship and medical school?
ME: I continue to appreciate the culture of scholarship as a fellow and am excited to engage in more research opportunities. The structure, as compared to residency, can be faster paced, but with self-guided reading and learning, I enjoy delving into the topics on the subspecialty level. There is a wealth of information to know and the learning will be lifelong. Further, I have come to appreciate that level of proficiency gained in internal medicine and it is exciting to utilize my skillsets to meet the challenges in the subspecialty world of oncology.
Describe a typical day, or week, in your fellowship program.
ME: It is always busy and there is always something to learn. Throughout our 3 years at UConn, our fellowship enables us to rotate through three different institutions, which provides broad exposure while also being able to learn classic cases. We have several tumor boards to attend, some of which are mandatory, and other tumor-specific boards such as lung, breast, and CNS. We have our weekly continuity clinics as well as specialty clinics which we rotate through monthly. On our inpatient service, the fellow manages the service both with hematology and oncology consults, as well as inpatient chemotherapy admissions; it is a team effort with our attendings, advanced practice registered nurses, and residents.
If you have to pick one aspect, what aspect of your fellowship experience has been your favorite? What aspect is the most challenging or frustrating?
ME: The best part of fellowship, by far, is the opportunity to get know and learn from my patients. I am the physician who is their advocate and commits to working alongside my patients to recommend treatment that is specific and maximizes overall quality of life. I am always appreciative of the questions my patients ask. We go beyond discussions about the diagnosis and management and, in doing so, build a relationship which is based on trust. During this process, I am able to learn from each of my patients how best to manage their symptoms because I understand their clinical, social, and family concerns. 
A challenging aspect of fellowship, particularly in the first year, is the transition from an internal medicine resident to a fellow and the steep learning curve of hematology-oncology. The amount of information can seem overwhelming at first, but it all comes together.
What do you wish you had known before you started fellowship? 
ME: That’s a tough question. Honestly, I knew to expect to feel a bit overwhelmed, so I tried to remind myself to take things step by step and ask for guidance. Also, since the schedule can vary, sticking to a manageable exercise routine was a key element for me.
What advice or pearls of wisdom do you have for the trainees who are starting their fellowship this month?
ME: Breathe! Give yourself time to study, to read, and to take care of yourself. It can certainly feel like a big jump from internal medicine residency to oncology fellowship, but you have 3 years of training ahead of you and senior fellows who will be excellent resources. The field of oncology is rapidly changing, so stay up with the research. Utilize resources like the National Comprehensive Cancer Network clinical practice guidelines, read The ASCO Post, and take advantage of the tools from your ASCO membership such as ASCO-SEP and the Training & Education section of ASCO.org for fellows.
Is there a personal experience that shaped your professional journey and led you to where you are today? 
ME: It has to be my patients! I have so many fond memories of wonderful patients and their families at DFCI who inspired me and motivated me to become the physician I am today. In residency I was so fortunate to learn from my patients, to help educate and support them, and to focus on shared decision making. Now in fellowship, I look forward to continuing to expand my patient-physician relationships as an oncologist.
Throughout my years of training, I have found many mentors (in medical school, residency, and now in oncology) who have guided me, coached me, and helped me reflect—and still do!—and led me to where I am today, but I will never forget my first encounter with Jack*. 
Our first conversation on the phone led me to believe I would have my work cut out for me. Jack wanted to go hunting and solve the groundhog problem in his backyard. He put his wife on the call and for 30 minutes I became witness to their comical conversation about the best time and date for his first chemo. Listening in, I had insight into this gentleman’s life: he was a husband devoted to his wife, a proud father and grandfather. Jack, a Naval engineer, asked many questions. He provided a great perspective and inspired me to keep that perspective for all of my patients. At times, he was a stickler, and I always laughed a little trying to anticipate his next question, but my rapport with Jack and his wife was truly memorable. His passing was not my first loss of a special person, but Jack was one of my first patients, and that made it a harder loss. I am a better oncologist having met Jack. He inspired me to work harder, get answers, and gain insight. I was an active listener and some days that was truly my only job. My relationship with Jack reminds me every day that patients come into our lives to teach us how to be compassionate physicians.

*Name and details changed for privacy.

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