For most doctors, fellowship training represents the final two to three years of formal medical education, and recognition of the unique opportunities of this time period can help aspiring rheumatologists get the most out of their fellowship. Fellowship training is inherently different than residency training, with less structured time, smaller teams (often consisting of only one or two trainees) and more one-to-one mentorship opportunities. These differences can be unsettling to new fellows who have recently completed residency and gained a level of comfort in their former training environment, but they also represent a tremendous opportunity.
Prior issues of The Rheumatologist have included articles on selecting a fellowship program (“5 Questions Aspiring Rheumatologists Should Ask Themselves”) and tips on the transition into fellowship training (“Fellowship Success 101”). This article discusses five focus areas to help fellows get the most out of their training.
1) Develop a Growth Mindset, Coupled with Good Organizational Skills
Time is less structured in fellowship, and a good portion of your education may fall outside time in the clinic or on the wards. Thus, fellowship success can often be tied to good organizational skills.
Many programs offer diverse clinical opportunities and a didactic curriculum, but gaps are bound to occur (e.g., we can’t ensure each fellow will see five cases of relapsing polychondritis). In addition, the fellow who is able to self-identify individual gaps and develop a tailored learning plan to improve upon these areas will be ahead of the game.
It’s important for fellows to recognize that all trainees have knowledge gaps, recognize their own gaps and develop a plan to address them (e.g., develop illness scripts describing the epidemiology, pathophysiology, clinical characteristics, diagnosis and treatment of various diseases and become familiar with rare diseases or uncommon presentations of more common diseases).
A growth mindset allows you to address these shortcomings as opportunities for self-improvement; a fixed mindset will cause you to view these gaps as negative areas that limit and define you.1 Fellows who are mired in a fixed mindset may suffer from imposter syndrome, a term coined by clinical psychologists Pauline Clance and Suzanne Imes in 1978. Imposter syndrome is characterized by feelings of self-doubt and low self-esteem.
A recent trainee in our program said the beginning of fellowship felt like returning to “intern-level knowledge, but with attending-level responsibility [as the consultant].”
To a fellow with a fixed mindset, this can lead to feeling overwhelmed and inadequate. In contrast, viewing these gaps as an opportunity for growth can challenge a fellow to organize learning activities to round out their educational program.
Because knowledge gaps are bound to exist, a growth mindset must be coupled with the organizational skills to address these gaps. We advise all of our fellows to start by setting up a reading schedule. This doesn’t sound as 21st century as podcasts, Twitter feeds or online blogs, but there’s still a place for background reading. Some fellows prefer to read about conditions as they see them in clinic and have difficulty finding relevance outside that setting. The problem with that approach is that you only become familiar with the disease or medication regimen the patient across from you is experiencing.
“The problem with being too busy to read is that you learn by experience (or by your men’s experience), i.e., the hard way,” wrote former U.S. Secretary of Defense General James Mattis. “By reading, you learn through others’ experiences, generally a better way to do business, especially in our line of work where the consequences of incompetence are so final for young men [and women].”
Medical knowledge is acquired and retained with clinical experience and repetition, but learning the foundational concepts of diseases, medications and pathophysiology remains vital. This may be even more relevant in medicine today, when clinicians can quickly look up information online and mistake it for clinical reasoning based on a solid foundation of rheumatologic knowledge.
Reading represents just one part of a self-directed learning plan. Educational research has suggested that spaced learning and testing are two powerful methods to retain information over time. Start a habit of going back and reviewing topics each month that were covered in the didactic curriculum, including patient care and teaching points raised by faculty.
Testing yourself using board-style questions or creating new questions on your own or with your co-fellows can serve as a powerful method to help you retain important concepts.
Additional examples of educational activities include the ACR’s CARE question modules, Rheumatology Image Library review and Rheum4Science modules, as well as additional practice with musculoskeletal ultrasound and board-style question review.
Clinical expertise comes not only from experience, but from a commitment to lifelong learning; establish these patterns in your daily and monthly routines, and plan to carry them beyond graduation day.