Coming to heme/onc late

[thatsmate]

Hey guys,

I'm an intern in a reasonably well regarded IM residency (top 20?), and I'm struggling with a decision about fellowship. When I started residency, I thought for sure I would do PCCM or possibly cardiology. But as I progress in training, I'm starting to learn that I hate the 'emergent' nature of those fields. The MICU was an absolute grind. I find myself wanting a career where I can actually sit down and think about my patients, rather than just acting to stablize them. I also want a field with a long term relationship with my patients. I did a month of an onc service and I really enjoyed the patient population, as well as the targeted therapies.

The problem is, I feel woefully unprepared for a hem/onc match. My cointerns who want to do hem/onc all seem to have basic science cancer biology phds, while I have a few abstracts I published in medschool- in cards. I've never wanted to be a bench scientist, but being involved in clinical trials sounds engaging. How should I move forward? Should I basically write off the idea of applying to fellowship immediately after residency, in favor of a year of hospitalist/research?

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[gutonc]

Ask for a meeting with the Hem/Onc PD at your program and talk about this. S/he can help hook you up with a mentor who can get you some clinical research pronto. It's not too late but you're going to have to put some effort into it.

 

[thatsmate]

Thanks for the response.

Any tips for the kind of research I should look in to, or the kinds of mentors to look for? I have a tough time wrapping my head around resident research given the time constraints. A lot of people are paying tons of money to publish a case report, which is kind of absurd. How can I approach it practically?

 

[Celestia]

Thanks for the response.

Any tips for the kind of research I should look in to, or the kinds of mentors to look for? I have a tough time wrapping my head around resident research given the time constraints. A lot of people are paying tons of money to publish a case report, which is kind of absurd. How can I approach it practically?

I don't understanding paying money to do research unless what is meant is they have to pay the publisher after the manuscript is accepted? If students/residents are being expected to pony up that money, that is a little abusive, in my opinion. Or maybe they were doing the writing without faculty suppport, which in my opinion is ill-advised because who is going to write your recommendation letter?

Some type of chart review project is probably best because it can be done in your downtime. It still requires a lot of organization and planning, however. A case report is not a bad idea (but academically it counts a lot less than a larger project) as it can be done quickly, although I would try to carefully/ tactfully ask your mentor in advance if you will be expected to pay for publication fees given what you have heard from other residents ... I have heard other faculty colleagues say they will offer a case report as a "test" of commitment, time management and intellectual/writing skills before offering a more substantial project. but in terms of starting pronto - timelines for a chart review project will need to account for protocol development/ IRB approval, abstraction/ developing or refining databases (if there is already a database that can be mined for a new question, this obviously is to your advantage), statistical analysis, and manuscript writing. If you find a project and get your IRB done now, have one or two strategically placed research months next year, you could finesse this thing.

I've tried to help residents do a lab-based project in the past, but this usually turns out to be a mess. I would steer very clear of this, especially with your skillset and interests.

I think there were some residents/ fellows in my training programs that tried to incorporate MPH into their programs which might fit with your interests in clinical trials. And this career path is clearly needed/valued in hemonc, as much as the bench guys. In fact, you will find a lot of those bench guys moving away from it as their careers progress because it is difficult to compete with the PhDs (and money is much better in clinical practice than in continuous agonizing over NIH grant cycles). The sweet spot is to take advantage of your clinical practice (although the background in basic science will be an advantage of course).

You could pubmed all the hemonc faculty at your program if you wanted to be very thorough; or go to the division's website to whittle down the list to people with academic interests that align with yours. But honestly, more important than research interest is the quality of the faculty mentorship.... so try to keep that in mind when getting recommendations from your HemOnc head. You could also ask the IM PD, because they may have a good sense of what research has been done by recent IM residents (successfully) and who their mentors were. Criteria for success is primarily publication in the field, and possibly in conjunction with that, placement into competitive fellowship program?

gluck. Maybe after you do some legwork you can come back with more questions.

PS - in terms of waiting a year to apply for fellowship, you might still consider that when it's time to apply, but that doesn't make it any less important to start developing a hemonc resume right now... if you wait until after residency it will be too late and you will just have to postpone application again.