Of all the transitions in medicine (starting med school, then med school to residency, supervising roles), I still feel that the transition into fellowship was the hardest and yet the most fun.
I transitioned from internal medicine residency into a hematology oncology fellowship. This meant I had minimal clinical experience or knowledge in my chosen field because this is how it is with oncology. It’s a highly specialized field, and you can’t learn well until you’re in it.
There were three fun things that really helped ease the transition:
1) Attending physicians suddenly looked to me for advice.
I went to fellowship at the same institution where I trained for residency. Within the first few months of fellowship, it was surreal to be stopped in the hallways by the doctors who were supervising me just months prior, and they started to consult me for advice on cytopenias, clots, or cancer.
While I still staffed these patients with my heme/onc attendings, it was nice to be viewed as an expert with a more equal footing.
2) I was finally doing what I had wanted to do.
As a fellow, it was exciting to finally be in the specialty I had worked for years to get into. I was working with great people and learning the forefront of the field. This was exciting, and I still look back on that time as full of energy and intrigue.
3) I was further honing my interest.
When you’re in a field day in and day out, you can finally start to see what parts of it you enjoy and where you’d like to spend more time.
For me, this was solid oncology (rather than hematology), developing patient relationships and helping them navigate complex decisions. I could start to see my career path emerging, and this was a really exciting thing to expericence.
There were two things I knew would be hard, and were quite challenging:
1) Fellows clinic
The hardest part of the first few months of fellowship was jumping into the continuity clinic as a fellow. My first year was a hematology clinic with an underserved patient population who needed my care quickly. Cancer can’t wait. This meant my half-day clinics were filled with complex patients with challenging diagnoses. I quickly tried to learn the nuances of leukemia, multiple myeloma, and other complex conditions.
Many of these conversations were with patients whose first language was not English. Having an interpreter (in person or via a screen) was common in these clinics.
Due to these challenges, the first few months of the clinic were tough. I’d spend hours reading about a patient’s history and appropriate treatment plan. I’d also email experts on campus to ensure they were being treated appropriately. All of these things took time.
The learning curve was steep, and I learned a lot quickly. But it wasn’t easy.
2) Home call
As a fellow, we took home call for a week at a time (this schedule has now changed where I trained, and thankfully there is now a nocturnist who covers BMT calls).
As a fellow, this often meant working all day and covering inpatient teams, consults, and patient calls at night. The volume during the pandemic was quite high, and there were many nights I got little to no sleep.
The challenge was the sleep deprivation that persisted for a week at a time. I had only previously experienced this level of sleep loss postpartum, and I don’t recommend it to anyone.
Thankfully, we were able to make changes to this schedule after I graduated from fellowship. It can be particularly challenging if you’re facing home call in training. Rest when possible, work with inpatient teams to eliminate unnecessary calls, and (hopefully) find better staffing solutions so this can get better for others.
Finally, some high-yield advice for the transition to fellowship:
Expect that old friend of imposter syndrome to creep back up. You’ll question your qualifications and your capability. Know that you are right where you should be. If you knew everything about your specialty, you wouldn’t need to do a fellowship. Trust yourself. Trust the process.
If you're taking boards in internal medicine, pediatrics, surgery, or another specialty within the first few months of your fellowship, prepare way in advance. Make a study plan for boards months ahead of time so your boards don’t cause undue stress during your first few months of fellowship.
Ask your more senior fellows about their top resources for studying and learning. It’s different for each specialty, but this can be a game changer. For heme/onc, there are NCCN and ASCO guidelines, and the podcast Two Onc Docs is very high-yield. Get familiar with top resources so you don’t waste time on outdated or lesser-value resources.
Finally, celebrate where you are. Celebrate the big wins, yes, but the small ones, too. Did you master a new procedure? Celebrate this. Did you learn to counsel a patient on a particular treatment plan? Celebrate this. Make sure to take time to appreciate the wins along the way.
Wishing you all the best as you transition into fellowship. Be kind to yourself on this path.