Tricks to Stay Afloat During Your First Year of Fellowship

June 22, 2016

This post is a part of our Life as a Fellow blog post series. This series includes "fellow life lessons" from current trainees in leadership with CHEST.

July 1 is commonly a day of great trepidation for new trainees across the country. Particularly for those starting fellowship, there is an additional unknown chasm of no longer being a resident but not yet (or no longer) an attending. As July nears, I’ve been thinking about the incoming class of fellows and wondering if they will have the same apprehensions that I had. What will the responsibilities be like? What’s my role on the team? Will I get along with my co-fellows? What if I don’t know enough? The first clinical year in fellowship can be demanding, and it’s important to have tools in your arsenal to stay afloat.

  1. Responsibilities. One of the major keys is preparation. Prepare for each block by gathering information from your colleagues specific to the rotation. This can include workflow processes, important telephone numbers, instructions for how to schedule a procedure, or a list of recommended reading material. You will also be performing procedures that you may not be familiar with. Prepare. Review normal airway anatomy and practice on a bronchoscopy simulator prior to your first bronchoscopies. Watch procedure videos (YouTube!) on how to place a chest tube or perform EBUS-TBNA. Mentally going through the steps prior to performing a procedure will increase your confidence. 
  2. Role on the team. Ask your attending for their expectations at the start of the rotation. It’s likely that you’ll be a member of a large team of medical students, residents, and advanced practitioners. Delineating expectations for your role early on can make the rotation smoother and prevent conflicts. If your role is team leader and educator, time management will be essential. Have basic talks already prepared to discuss with your residents and students. In other instances, your role may be a primary provider and responsible for all aspects of a patient’s care.
  3. Co-fellows. You and your colleagues are in this together. Set up a happy hour or get-together in July for everyone. It can turn into a monthly tradition! One idea is to go to a different place every month based on the alphabet—you’ll go from A to Z by the end of fellowship and experience new foods while making lifelong friends in the process.
  4. Resources. No one knows everything, and there is always more to learn. Don’t be afraid to ask questions. This is your time to ask anything and everything. Have your go-to pulmonary and critical care resources at your disposal. Some helpful books and resources:
    1. Respiratory Physiology by John B. West
    2. Atlas of Flexible Bronchoscopy by Pallav Shah
    3. Felson’s Principles of Chest Roentgenology by Lawrence Goodman
    4. High-Resolution CT of the Lung by W. Richard Webb
    5. Essentials of Mechanical Ventilation by Dean Hess
    6. EMCrit podcasts
    7. Critical Care Project

The first year of fellowship can be tough, but it’s definitely fun. And, you’re not alone–there’s a whole community rooting for you!

Dr. Van Holden is a graduate of the University of Kansas School of Medicine. She completed internal medicine residency and chief residency at Rutgers-RWJMS in New Brunswick, NJ. Van is currently a PCCM fellow at University of Maryland Medical Center (Class of 2017). Her research interests include evaluating outcomes from a dedicated lung mass clinic and improving the interhospital transfer handoff process.

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