By Tarek Haykal, MD
As we grow and pass through the different stages of medical training, and since we all have to take many different tests such as in-training examinations and potential board exams, in order to ensure success and pass to the next level, studying remains a crucial and unavoidable part of the whole process.
And while studying in undergrad and then medical school is achieved by simply following a clear pre-set curriculum, it certainly becomes more challenging as you get further in medical training. Even as you reach residency, somehow it is known and well established what works best, what you should or should not know by that point, and how to prepare to pass the board exam, but fellowship is a totally different ball game. Once you are outside of the classroom setting, how do you find and study the right material?
When I finished my internal medicine residency and successfully passed my internal medicine board exams, I was already a couple of months into fellowship. As many of you know, internal medicine residency does not necessarily prepare you well for a hematology and medical oncology fellowship. As a starting fellow, the amount of knowledge one should acquire is out of this world, especially in 2021, when almost every other day a new landmark study is published, a major trial completes accrual, an FDA approval changes the standard of care… Meanwhile, as you try your best to try to learn the new, you also have to go back and study the gold standard and what historically has been done.
This is especially challenging because, during fellowship, there is really no clear curriculum that you follow or a standard textbook that you can read to get everything that you need. In internal medicine training, you can read Harrison as a textbook, study from MKSAP books and questions, and then finish off with the UWorld question bank to be fully equipped to become a board-certified internist. Unfortunately, it is not that simple during fellowship. When you ask fellows, mentors, or even leaders in the field about this, each individual will share with you the resources that worked best for them and not what is commonly a consensus; I was never able to get the same recommendation from two different people.
I can’t say that I have been too successful at studying during fellowship, but here are a few tips that I felt have worked well for me. I think of my fellowship studies as a series of layers—every time I do well at one layer, I am ready to move to the next one.
Layer 1: Establish Your Reference Sources
The first very important layer—and the one that you will need to survive during your first few months of fellowship—is to have quick access to high-yield, straight-to-the-point information. I call it the “learn on the go” layer. In other words, the first step is not to know everything, but to know where to go to find out everything you need.
You will build this layer mostly from reference sources (like UpToDate, NCCN guidelines, and hemonc.org), and also potentially from recent well-written reviews. These tools will be quite handy when you are paged about a curbside question or a consult, or when prepping for a patient in clinic. They will help you to quickly orient your mind in a specific direction, rather than scrambling and feeling incompetent just because you simply don’t know or have not seen such a case before now.
My second tip in that regard would be to always try to learn as much as you can from every case you see. Sometimes you will be too busy or tired to do a lot of reading, and that’s okay, but always try to learn something new. Without realizing it, your knowledge base will grow. You will notice when you encounter a similar case at a later time that you now know more than you thought you did.
Layer 2: Dig in to the Literature
When you are ready and have more free time, going back to the literature is always important, and this is the second important layer of learning. Here, as you gain more knowledge and experience, things become more enjoyable overall. Rather than dry facts that you need to acquire, the information begins to connect to real people and real situations. There is no single right way to learn and internalize this information, so always remember that what works for others might not work for you.
Where do you find such literature? To start, you can simply purchase a comprehensive textbook that has all the disease and treatment protocols; you could also purchase ASCO-SEP or ASH SEP, as these contain updated material and self-assessment questions as well. You can structure your learning around the cases you see by taking a deeper dive into the literature about them. You might learn by writing papers and doing research. You might enjoy purchasing a question bank and completing a few questions on a daily basis to stimulate your knowledge. Finally, you can learn from other fellows and physicians by attending case and tumor board discussions, as well as grand rounds and didactic lectures provided by your fellowship program. I have also seen some fellows register in didactic courses available in large university programs, when available, to learn more about the basics of certain diseases and their management from experts in the field. Try many options to figure out what combination of sources and techniques works best for you.
Layer 3: Stay Abreast of the Latest and Greatest Information
The final layer that I feel is important in fellowship studies is to keep up with the newest data being published. I know that it is becoming harder and harder to stay updated, especially with the flood of research being produced and clinical trials being designed, and I know it is easy to feel overwhelmed by all that as a new trainee in the field. One of the most basic ways to stay in touch with the latest information is to have a Twitter account. By simply following world-renowned leaders in different oncology and hematology specialties, you can always get a sense of the most relevant and important papers to read and follow.
Another way is to become a trainee member in large hematology/oncology societies, such as ASCO, ASH, NCCN, SITC, AACR, and many more. Many societies offer print or digital journal subscriptions and regular email updates for their members, which can keep you updated. Attending the annual meetings of such societies can be a great opportunity to learn, connect with people, and acquire a hefty dose of new hematology/oncology knowledge.
In conclusion, there is no consensus on the right way to learn and study during a hematology and medical oncology fellowship. What works for some fellows does not necessarily work for others. I would focus mostly on “learning on the go” from your clinical rotations and cases that you see and examine on a daily basis. Then, when you have some free time, go back to the raw literature to understand the basics and the historical management for most diseases. And finally, try to stay in touch with the most cutting-edge research being produced and published every day. By doing that for 3 years, and depending on your disease interest and career vision, you should become a well-rounded hematologist and/or medical oncologist ready and equipped for board certification.
Dr. Haykal is a second-year hematology and medical oncology fellow at Duke University. He graduated from medical school in Lebanon and conducted his internal medicine residency at Hurley Medical Center/Michigan State University. He aspires to become an academic clinical researcher and trialist, focused on the care of patients with solid tumors by studying and applying innovative immuno-oncology and targeted therapies. Disclosure.