CHEST Thought Leader Blog What I Wish I Did as a Fellow to Help Transition to Being an Attending

What I Wish I Did as a Fellow to Help Transition to Being an Attending

By: Allison Greco, MD

After years of medical training, there is finally a light at the end of the tunnel, the big pie in the sky—your first attending job. I’ve been fortunate enough to have started my own journey as a junior faculty member very recently, and I’ve realized that there were a few things I wish I would have known during fellowship to make my transition from a fellow to an attending a little smoother.

Expand Your “Chalk Talk” Repertoire

In my fellowship, every morning, the ICU fellow would give a brief talk to the residents about some core ICU concept. Over the course of fellowship, I found myself recycling my talks pretty often—I got really good at teaching particular topics, but I tended to stay away from things I didn’t feel confident about teaching.

The reality is that as an attending on teaching rounds, you can’t be as selective about what you teach, and you never know what things your learners are going to ask you about. I’m not saying you should never reuse talks or have your favorite subjects, or that you need to have all the answers, but it is much easier to expand upon your teaching repertoire in fellowship than during a week on service.

Organize Your Library

I spent a lot of time in my second and third year studying for boards. I kept pictures of slides and notes from various lectures and saved references as I studied. These ended up in my phone in any number of locations—photos, notes, and in various apps—and I probably didn’t use them to study nearly as much as I should have.

What I’ve realized now is that these have become incredibly helpful to me as a teaching attending. Whenever a clinical question comes up on rounds, or I reference the evidence behind our clinical practice, I have a ready-made library of charts, pictures, and papers to send out to the team on service. Take the time as you collect the various components of your library to organize them in such a way that you can access them and disseminate them easily. There are a number of free apps and cloud services that are super helpful.

Explore Different Rounding Styles

In fellowship, everyone has their favorite attending to round with. Maybe it’s their organizational style, maybe it’s the way they incorporate teaching, maybe it’s their approach to problem-solving. Be sure to borrow the things that work for you, and disregard the things that don’t. Don’t forget that as an attending, you don’t only get style points—it’s also your job to keep rounds on track. I call it air traffic control. Are we spending too much time talking about one problem and ignoring the others? Are we moving too quickly and glazing over important data or learning opportunities? Most of these managerial skills come by trial and error. If your program is one that allows you to take charge of the team on rounds, use it as a time to figure out what works best for you.

Grow Your Unique Skill Set

Do you have a specific niche that you want to explore? Maybe you want to become credentialed in a specific skill like advanced critical care ultrasound or transesophageal echocardiography. Maybe you want to obtain a master’s degree in medical education, clinical investigation, or health policy, or take a leadership or faculty development course. Fellowship is the best time to accomplish these goals. You will never have time that is carved out solely for your education ever again. Plus, by adding unique skills to your CV, you’ll make yourself more marketable to prospective employers.

The Grass Is Always Greener

As a fellow, I always found myself working toward the next big step when I would finally be done training. The reality is that life as an attending is different from life as a fellow, but the job does come with added responsibility. Now, I wish I was a fellow again. Make sure not to get caught up in the rat race of making it to the next phase of your career that you forget to enjoy the experience of being a fellow.



Allison Greco, MD
Allison Greco, MD, is a junior faculty member in the Division of Pulmonary, Critical Care, and Sleep Medicine at New York University (NYU) School of Medicine. She graduated from Jefferson Medical College at Thomas Jefferson University in 2013 and completed an internal medicine residency at Thomas Jefferson University Hospital in 2016. She served as Quality Improvement Chief Medical Resident at Thomas Jefferson University Hospital from 2016-2017 before joining NYU for fellowship training. She is a member of the American College of Chest Physicians and is the Social Media Director for the American Thoracic Society Section of Medical Education. Her research interests include innovation in medical education, quality improvement, and patient safety during cardiopulmonary arrests and rapid responses.