new to heme/onc fellowship and struggling

[heartblood]

hey, I just started fellowship in heme onc and realized it’s incredibly difficult - far more difficult than I anticipated. I went from being a solid competent resident to a lost and underperforming fellow. I don’t think I’m the only one but definitely could use some tips. Unlike residency where we leaned on one another for help with rotations, we’re pretty much on your own because you’re the only fellow on a rotation at a given time. Any suggestions for efficiency and studying and navigating the learning curve more successfully on top of long days?

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[HemeOncHopeful19]

Early fellowship was rough and there wasn’t any great source I found to help like the MKSAP did for general IM. I felt like I had to read from different places and try to get an organized big picture of different malignancies and the treatment pathways in broad terms. A few sources I found helpful early on in general rough order of usefulness:

ASH Review Book (this was solid Gold for me for Benign Heme)
NCCN & UpToDate
MDA Board Review Course videos
…
Papers your attendings slam in your face - this can be more important later in PGY4 year and PGY5/6 year IMO

Some people also love the “How I treat” series in ASH but personally I think UpToDate is essentially a giant database of “How We Treat” articles at this point so I tend to focus on that.

 

[gutonc]

Pretend it's your 2nd month of internship but everyone expects you to be an expert on the subject at hand, whatever that happens to be.

First year of fellowship was way more stressful than intern year. But you'll figure it all out.

 

[HaemOnculus]

I didn't feel like a had a good grasp on it until well into 3rd year. Current new attending and I am realizing that I still don't. I think what your feeling is normal. Oncology is such a historical-based specialty in that we do things this way because it worked better than the way we used to. You need the experience and reference cases to gain knowledge It'll get better but don't forget to ask for help if needed and run things by the attendings.

 

[TheBigCat]

It was the most difficult year of training for me. IM residency does not prepare you to be a hematologist/oncologist, which is what a lot of people view you as from day 1 of fellowship.

I agree with HemeOncHopeful, UpToDate has a lot of good stuff. Reviewing the NCCN guidelines in detail before seeing new patients was also a big help. I love "How I Treat" articles, but those tend to be somewhat niche.

 

[CatFactorial]

Watch the MD Anderson board review videos. Good synopses

Hemeoncquestions is also a good q bank for learning

 

[gutonc]

I didn't feel like a had a good grasp on it until well into 3rd year. Current new attending and I am realizing that I still don't. I think what your feeling is normal. Oncology is such a historical-based specialty in that we do things this way because it worked better than the way we used to. You need the experience and reference cases to gain knowledge It'll get better but don't forget to ask for help if needed and run things by the attendings.

I've been out in the world (as a generalist with a focus on GI) for a decade now. On Thursday I saw 22 patients in clinic and 3 hospital consults. I pulled up the NCCN guidelines 4 times, used UTD on 6 patients and PubMed for at least 3. So for roughly half of my patients I needed to (re)educate myself on some aspect of their care.

It gets easier, but it never ends.