September 22nd, 2011
Follow the Fellows: The Fellows Get Their Sealegs
Aaron C. Earles, DO, William Kent Cornwell, MD, Erica Sarah Spatz, MD, MHS and Kathryn Jesseca Lindley, MD
For our new series at CardioExchange, “Follow the Fellows,” we have invited physicians from various cardiology fellowship programs to document their course through their training. In their second post, the fellows continue to discuss their initial concerns and experiences soon after entering fellowship. You can read their first post here.
Bill Cornwell — Being “immersed” in the ICU, I have been given the task of managing complex patients while orienting to a new hospital, working seemingly longer hours than ever before, and wondering how my family is getting along in a new city. As I hope for some dust to settle, residents approach me for advice just as I once sought out my fellow, who always seemed so knowledgeable, confident, and able. I am stretched thin, my mind in several places all at once, and I must remind myself to focus on the task at hand. Am I the only one who feels this way, or are the other fellows facing a similar challenge?
Over a quick lunch we commiserate, share some quick anecdotes and I discover that I am not alone. This line of work demands a certain degree of fluidity to respond well to ever-changing conditions and be comfortable amidst some chaos. The terms may be clichéd, but this truly seems to be a trial by fire, and success requires quick adaptation. Onlookers might counter that this is an overreaction but I believe that anyone who has walked down this path knows what I mean.
Aaron Earles — Every fellow I spoke with has told me that they too had the same fears and hesitation about becoming a specialist. The first ECHO board review session I attended with the seniors was one of the most intimidating events I have encountered to date. I was completely lost. The session leaders seemed to be speaking a different language. But a couple of sessions and a few pep talks from upper-level fellows later, and the concepts started making better sense.
Fellowship, to this point, has been on par with my expectations. My second month was on the consult service which took some adjusting. I have said “I don’t know the answer to that” more often than I feel comfortable, but my attendings have been wonderful. I have never once felt intimidated by asking for help or an explanation. That brings up a good point — everyone knows you are there to learn and not to know how to do everything. I am fortunate to have three wonderful senior fellows to help me acclimate to this new environment. They take time to explain difficult concepts and thus far have given me excellent advice. They look out after me, but give me just enough autonomy to learn.
Kate Lindley — I am getting my sea legs. I respond confidently to pages about patients on my service. I called off a STEMI in the ER with little reservation (I did still run the EKG by my senior afterwards). I have a comprehensive plan for my patients – it might not always be right, but at least I have solid reasoning behind my decision-making. I have a lot to learn, but I have to trust that next July I’ll be ready when I receive my first stat “I’m going to need you” consult from a new first year. Most of the fear and anxiety has now resolved, replaced by excitement for the interesting pathology and rich learning environment I’m submerged in. I look forward to facing novel patient-care questions all day long…and then making it home in the evening in time to hit up the local ice cream joint before my daughter needs to get to sleep!
Erica Spatz — Rarely, do we expose our wounds, humility, fear, shame — as in “I didn’t know what was going on or what to do” — followed (hopefully) by “I called my attending.” I admit to owning all of these emotions. And while I have faith in our system of training (as evidenced by the confidence exuded by fellows just one year ahead), I have found that my best weapons for taking call are those that have guided me through all of my professional transitions:
Let the patient be your compass. (1) A careful history and examination will always lead you down the right path. (2) There are no ‘bogus’ consults when patient care is at stake. When consulted it is because the resident/clinician needs help taking care of the patient. They may not be able to articulate the appropriate question, but they have exceeded their knowledge or skills.
Communicate; be a team player. (1) Call on others for help, including co-fellows and attendings. (2) Communicate your thoughts by articulating a differential diagnosis; seize every opportunity to contribute something meaningful. (3) Disclose when or what you do not know; it is almost always appreciated by the patient…and certainly by your attending.
Seek wisdom. Learn from mistakes. Days are long. Partners, kids, and friends await. Still, take time to reflect — to reinforce what was learned, to question what does not add up. Seek feedback — take stock of the quality of care being delivered and question whether this is the best we have to offer. Aspire to be a better physician each day.
Chicken soup for call? I hope Mom approves.