 was created 15 years ago with the goal of reporting on topics of interest to hematology and oncology fellows. This publication strives to provide an adequate representation of topics that support the diversity of careers and practice types and that are important to our readers. As the editor in chief, I recognize that the most important topics are ones generated by the audience, so I am asking all readers to please participate in the following brief inventory of relevant topics. Please also indicate whether you would be interested in contributing to an article about a topic. As the editor in chief, I seek to elevate your voices and support what is meaningful to you. Thank you in advance for your input, and I look forward to sharing the results. 

What topics would you want to see explored by 

Introduction to practice within the pharmaceutical industry 

Introduction to a career in government-based practice 

Mentorship, sponsorship, and coaching: What is it, and how does a fellow find it? 

Keeping up with information overload: Voices from the field 

Burnout in oncology: How to prevent and intervene 

Advocacy 101: What it is and how to get involved 

Late-breaking and practicechanging data in hematology/ oncology 

A day in the life series as told by practicing hematologists and oncologists

Treatment controversies in oncology: Experts weigh in 

Navigating a difficult patient or family 

Physician online reviews: What they are and how to optimize online reputation 

The power of social media in hematology/oncology: The return on investment and how to optimize social media presence 

If you wish to contribute to Oncology Fellows as a writer or have a topic that you would like to see explored in a feature piece, please email 

 for more information. Thank you, again, for helping to create a blueprint for the future of this publication.

Articles

Participate in the following brief inventory of relevant topics to let us know what topics you want to see explored by Oncology Fellows.

A Chance to Choose Your Own Oncology Fellows Content Adventure

Taking the proper preparatory steps throughout a hematology/oncology fellowship can help smooth the transition from fellow to attending physician, according to David Russler-Germain, MD, PhD.

“I’m a lymphoma attending physician-scientist, so my fellowship training was on the unique side because I did what’s called the Physician-Scientist Training Pathway. However, most of the lessons I try to share with [trainees] are universally applicable to anyone doing traditional clinical training,” Russler-Germain said.

In an interview with Oncology Fellows, Russler-Germain discussed his experience transitioning from a fellow to an attending physician following the completion of his hematology/oncology fellowship program at Washington University School of Medicine in St Louis, Missouri, in 2023. He highlighted the areas of his training that he found useful during his transition and the biggest adjustments during this time, and he shared advice for fellows preparing to make the jump to becoming attending physicians. Russler-Germain is an instructor of medicine in the Division of Oncology at Washington University School of Medicine.

 What could make or break a fellow’s program experience?

 For most fellows around the country—and my experience was like this—the front end [of training is] loaded with inpatient consult rotations plus a smattering of outpatient clinical rotations. As you transition into the second and third year of fellowship, you become more and more subspecialized, especially as an aspiring academic and for those who train at large tertiary centers.

I enjoyed all aspects of fellowship, even clinics that were unrelated to areas of my research or eventual career. So much of that [enjoyment] depends on the individuals you work with. For example, in a neuro-oncology [rotation], you’re not working with every neuro-oncologist in clinic for months; you’re working with probably just one once a week for a few months. [Therefore], what they have going on in their professional sphere, what their clinic staff has going on, and who their referrals are during those few months can make or break how much you learn and how much you’re able to contribute to the team.

Going to a fellowship where the culture is good, you enjoy your training, and [you] have a successful training experience with all the attendings is aspirational but not always feasible. I believe individuals must be proactive
to ensure that a few different things don’t happen during your fellowship. It takes investment by both the trainees and the program to accomplish it.

The first [factor] is letting [trainees] operate at the highest level of their training. How much of your time as a [trainee] is spent doing physician-level tasks as opposed to non–physician level tasks? Let’s say you’re the first-year oncology fellow on the inpatient oncology consult team. These are patients with new diagnoses of cancer getting evaluated in the hospital, or they [may] have a prior cancer diagnosis. For example, if they have a known history of colon cancer treated 4 years ago at a community site, how much is it the fellow’s job to track down the clinic notes, pathology reports, and radiology reports from that patient’s prior cancer journey from another hospital years prior? [Comparatively], are there nurse coordinators or medical assistants whom the fellows have access to help accomplish that?

Those are the [individuals who] would do all that vital work in the outpatient setting so that the fellow is not personally faxing the records request form, receiving the fax, and filing it. Many institutions don’t offer their inpatient fellows any of these support services, but it can potentially ruin your training if you spend half of every day following up on faxes, sending records requests, and trying to track things down. Having individuals to help you delegate is very important.

The second [key preparatory factor during fellowship] is [patient] volume. It’s easy to get into a situation where you want to focus on education over training. [A fellow] can be very well educated about cancer from didactics, textbooks, and clinic experiences, but the muscle memory and the decision-making [skills must develop] with volume. As a third-year fellow, you can’t just see 4 patients in half [a] day of clinic and become an expert.

To be able to [practice] on your own, you need to be seeing 6, 8, 10, [or even] 12 patients in a half day [during fellowship] to see the breadth [of] that disease area and get comfortable with not only making the cancer management decisions but also dealing with all of the secondary factors. Let’s say you see 4 patients in a half day as a fellow because you want to learn as much as you can about that patient, their disease, and all the treatments for them. What you’re not learning is what happens when the first 2 patients on your schedule show up 20 minutes late and your whole day is multiple steps behind. How do you balance giving these late arriving patients the care they need while not punishing the rest of your schedule because you’re behind?

There are fellows who nudge their training toward lower volume but greater depth into those individual cases, and there’s a spectrum of how to balance that. On one end of the spectrum, seeing too many patients as a fellow and being unable to read about them and deliver good care is too chaotic, but there’s another end of the spectrum where you’re not seeing enough patients and [don’t become] truly skilled enough after training.

What did you do well during your transition from fellowship to your current position, and were there any aspects you found especially challenging?

Toward the end of fellowship, I tried to push my efficiency and volume, [including] volunteering to see more patients in clinic. Often in your continuity clinics as a fellow, there are the 6 return visits from patients you already know, and there’s 1 new referral. [However], if 2 of the return visits cancel, instead of  just seeing fewer patients, you should ask [whether] you can see others. Being able to think on your feet and see a patient you don’t know anything about other than reading their chart for 5 minutes has to be an intentional challenge you give yourself.

[Because] most academic and private practices do a decent job of not overwhelming you with volume at first as an attending, it gives you the opportunity to slip into a micromanaging perspective where you’re clicking refresh on someone’s labs multiple times a day or you’re double-checking their charts unnecessarily. Understanding that you need to let the clinic operate as it needs to is important, without swinging too far toward the perspective of a subconscious worry that “I’m a novice, so there’s a small chance that I missed something or made a small mistake, but if I micromanage it, maybe I’ll catch that mistake or avert something from going awry.”

There’s a certain level of neuroticism that is helpful early on when you’re independent, but you don’t want to be overconfident. You also can’t be all consumed by micromanaging everything that happens in your patient’s chart and every message that your nurse is or isn’t sending them. In hindsight, I wish I could have let go a little more. I did a decent job, but I probably could have deescalated even further.

What advice would you have for fellows who are about to make the transition to attending physicians?

There are aspects of volume [needed during fellowship] to be ready for busy clinics, and [there are] aspects of bandwidth in terms of how much you micromanage or not. Another aspect is independence of decision-making. I now have fellows and residents in the clinic with me. The default for them might be to defer to me as opposed to going out on a limb and saying, “I would like to do this for the patient today.”

Fellows must accept that sometimes they will be wrong or suggest things that the attending disagrees with. When I see a new or a [returning] patient with a fellow, I say, “What’s their plan for today?” If we are signing their R-CHOP [rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone] orders today, I want the fellow to consider: What are their premeds? What are their prescriptions they’re going home with? Are there any other things we need to worry about today? [I want fellows] getting into the nitty-gritty and trying to own all of the little decisions you have to make as an attending.

It’s important to practice flexing those muscles as a fellow, where a patient comes in and they have some lab abnormalities in clinic and you’re deferring their treatment. As opposed to reading about what to do with elevated liver function tests [LFTs] for a given drug, you should be able to give a guess. Should we get hepatitis testing? Should we do an ultrasound? Do I need to send them for a CT scan? Should I recheck their labs and if so when? Is there a medication I should hold now that their LFTs are elevated? Those are often secondary to learning the nuts and bolts of oncology. Getting in the practice of owning all the decisions for your patients, [and] trying to propose the full plan as a third-year fellow helps get you in the perspective you need when you’re independent.

What could hematology/oncology programs do to better prepare trainees for the transition to attending physicians?

It’s a 2-way street. Fellows and their programs need to be aware of what each other’s goals, intentions, and needs are, and understand what each side’s areas of improvement could be. The fellows [need to] understand how much more or less stressed they’ll be based on how many patients they are seeing in the clinic. The program could probably oscillate every few years to increase the workload or peel it back to try to work on a wellness perspective for the fellows.

But sometimes it’s not as simple as just turning the dial on the volume of the workload. It’s things [such as] identifying at a fundamental level what resources fellows need to succeed at this higher level of work. For instance, if you’re trying to see more patients in clinic, you need to have a medical record system and a nursing support system that allow them to do that successfully and not add busy work. You should be adding the doctor-type of work for the fellows, including more medical decision-making and more difficult conversations with patients about prognosis and end of life. Our program does a good job of protecting doctors from having to do busy work. Our fellows have access to the secretarial and administrative staff that the attendings have access to. Ensuring your fellows are treated this way makes it easier to optimize their medical training.

Transitioning from a hematology/oncology fellowship to an attending physician role requires strategic preparation. Key factors include maximizing clinical exposure, balancing patient volume with educational depth, and fostering decision-making independence. Programs should support fellows by providing adequate resources and minimizing non-physician tasks. Fellows should proactively seek diverse clinical experiences and practice efficient patient management. Emphasizing decision-making autonomy and managing clinic operations without excessive micromanagement are crucial. Both fellows and programs must collaborate to optimize training, ensuring readiness for the demands of an attending physician role.

A lymphoma hematologist/oncologist who recently transitioned from a fellow to an attending physician shares his experience with the change and tips for fellows.

Preparation is Key to Tackle the Transition from Fellow to Attending Physician

Although most hematology/oncology fellows will treat patients in the community setting over the course of their careers, adequate preparation for outpatient care often falls short during fellowship, prompting instructors to reevaluate their training approach in this area, according to Shubham Agrawal, MD.

“Currently, most fellowship training programs are based in major academic centers, and few, if any, offer specific pathways tailored to community-based hematology/oncology,” Agrawal, a hematology fellow at the University of Minnesota Medical School in Minneapolis, said in a statement to 

. “As a result, fellows interested in community-based careers often need to independently seek opportunities to gain relevant experience. This highlights a growing need for specialized training pathways that align with the goals of trainees aiming for careers in community hematology and oncology. [Because] 80% to 85% of patients with cancer receive treatment in community settings, high-quality and efficient community oncology models are essential to ensuring equitable cancer care. Hence, it is crucial to provide training experiences to equip trainees for their future careers as community-based hematology/oncology providers.”

Agrawal was the first author of a national assessment published in 

, which sought to identify the training needs of hematology/oncology providers practicing in community- or academic-community hybrid-based settings.

 To conduct their study, Agrawal et al developed a cross-sectional online survey study and distributed it to practicing hematologists/oncologists in community-based and academic-community hybrid settings across the United States from March 2022 to February 2023.

The survey included 14 multiple-choice items covering 3 primary domains: current practice setting and satisfaction, opportunities for community-based training during fellowship, and additional clinical/didactic experiences desired during fellowship that could better prepare respondents for community-based careers. It also included 2 open-ended questions: What would better equip a hematologist/oncologist in training to work effectively in your current clinical practice setting? What comments or suggestions do you have regarding a professional development pathway for hematology/oncology trainees with a planned focus in community-based hematology/oncology?

Respondents were also asked to provide information regarding their sex, years in clinical practice, and location of fellowship training. The primary outcome of the study was whether hematologists/oncologists based in community or academic-community hybrid practices felt that they had received adequate training during fellowship to prepare them for their current roles and in their current mode of practice.

“Given that a large percentage of hematology/oncology care is delivered through community-based models, our study aimed to assess the perspectives of fellowship training leadership on preparing fellows for careers in community-based hematology/oncology,” Agrawal said. “The survey’s goals include evaluating directors’ attitudes on the inclusion of community-based training within fellowship programs, the presence of clinical or nonclinical experiences designed to build skills specific to community practice, and their opinions on motivating fellows to pursue community-based career paths.”

Most survey respondents were men (63.2%), White (57.6%), board certified in both hematology and oncology (64.0%), and very satisfied in their current work setting (63.2%). Respondents’ current work responsibilities included outpatient clinical practice (93.6%), training fellows (29.6%), administrative responsibilities (16.8%), engagement with clinical trials (11.2%), inpatient clinical practice (8.0%), research (8.0%), medical education (6.4%), and quality improvement (5.6%). The most common reasons for choosing their current work setting for respondents included location (59.2%), work-life balance (53.6%), desire to be a primary clinician (47.2%), compensation (39.2%), and mentor-directed experience (20.0%).

Findings from the study demonstrated that survey respondents (n = 125) received specific training for a community-based career during fellowship at a rate of 41.8%; rotations in the community clinic/setting (44.8%), community-based clinical trials (20.8%), quality improvement (12%), business and operations (10.4%), and health care delivery research (7.2%) were cited as high-impact experiences during their time as fellows, and nearly all respondents were satisfied with their training during fellowship (98%). Being in practice for less than 10 years was the only factor that was significantly associated with an increased likelihood of receiving community-based training during fellowship (relative risk, 2.13; 95% CI, 1.18-3.86).

In terms of clinical experiences during fellowship that would best equip trainees for future careers in community-based hematology/oncology, respondents indicated rotations in community-based settings (47.2%), direct mentorship from a community-based physician/provider (40.0%), longitudinal clinic for a minimum of 2 years (36.0%), improved education regarding palliative/supportive care or end-of-life discussion (28.0%), engagement with a higher volume of patients (28.0%), and additional clinical trial exposure (20.0%). Extra clinical experiences that respondents suggested to enhance community practice training included clinical/hospital administration, clinical operations, or business/financial aspects of health care delivery (63.2%); health policy issues in hematology/oncology (35.2%); quality improvement/patient safety initiatives (27.2%); health care disparities, diversity, equity, and inclusion (23.2%); research during training (13.6%); and medical education (9.6%).

“Given the changing landscape of community-based hematology/oncology care models, it is imperative to incorporate these experiences in fellowship training to adequately prepare current trainees for their future roles,” Agrawal said.

Agrawal also coauthored a national survey of hematology/oncology fellowship program directors to further elucidate areas of unmet need in terms of preparation during fellowship for community-based careers.

 Agrawal et al conducted a cross-sectional survey of 185 fellowship program directors in the United States via email. The primary outcome was to assess the attitudes of program directors regarding the inclusion of community-based training during hematology/oncology fellowship. Secondary outcomes included assessing whether programs currently have clinical and/or nonclinical training experiences specifically addressing skills relevant to community practice. The survey also included items that evaluated program directors’ attitudes toward the motivations of fellows to pursue careers in community practice.

Survey respondents (n = 53) were mostly from programs in academic tertiary care hospitals (76%), and they had a median of 5 trainees per class. Most program directors had been in clinical practice for at least 10 years (68.0%), were in their program leadership position for 10 years or less (83.0%), and had graduates from their program who pursued careers in community-based settings (96.0%).

“Our program directors’ survey is currently ongoing, but preliminary findings revealed that most program directors reported having graduates who pursued community-based careers, with financial compensation cited as the primary motivation in that decision,” Agrawal said. “However, training opportunities specifically for community-based careers highly varied across programs. The most frequently cited clinical training is rotation in a community setting, [whereas] the most common nonclinical experience is training in quality improvement and patient safety.”

Initial findings from the study, which were presented in a poster session during the 2024 American Society of Clinical Oncology Annual Meeting, showed that among survey respondents, 83% indicated that training experiences in community-based hematology/oncology should be available for fellows during training. Most programs offered clinical community-based experiences (74.0%); however, only 32.0% offered nonclinical experiences in this setting. The most common clinical experience was a rotation in a community-based setting (80.0%), and the most common nonclinical experience was training in quality improvement/patient safety (88.0%).

“Building on the findings from both projects, we have evaluated the current perspectives of practicing community-based hematologists/oncologists and fellowship program leaders,” Agrawal said. “The next steps for this research involve using the findings from our projects to prospectively design and develop evidence-driven training pathways for trainees who are interested in pursuing careers in community-based hematology/oncology, thereby equipping them with essential skills for their future roles.” 

Agrawal S, Patell R, Dodge LE, et al. Defining the educational needs for a community-based hematology/oncology career: a national needs assessment. 

. 2024;20(6):861-868. doi:10.1200/OP.23.00698

Iacoviello A, Agrawal S, Berry JL, et al. Fortifying the workforce: a national survey of hematology/oncology fellowship program directors and training fellows for community-based careers. 

. 2024;42(suppl 16):9028. doi:10.1200/JCO.2024.42.16_suppl.9028

Hematology/oncology fellowship programs often lack adequate preparation for community-based practice, despite most fellows eventually working in such settings. A national assessment led by Dr. Shubham Agrawal identified the need for specialized training pathways to better equip fellows for community-based careers. The study revealed that only 41.8% of respondents received community-specific training during fellowship. Key experiences included rotations in community settings and mentorship. A separate survey of fellowship program directors highlighted the variability in training opportunities for community-based careers, emphasizing the need for evidence-driven training pathways.

A hematology fellow discusses findings from 2 surveys he coauthored, which sought to identify gaps in community practice training during hematology/oncology fellowship. 

Community Practice Training During Fellowship Often Falls Short

As I wrapped up my first year of fellowship this summer, I have spent a lot of time reflecting on the challenges, successes, and failures that I have encountered thus far as an inaugural fellow. After a year of clinical training, I remain zealous for both my training and program, but I have been humbled at several junctures along the way.

No one discusses it, but most of medical training is modeling. Trainees gain an understanding of their role and function through learned observation. In my own experience preceding fellowship, there was always a blueprint to success at every phase, whether it be generations of passed-on study guides, tips on how to succeed on clinical rotations or senior trainees you can model yourself after. It was not until this year that I realized how heavily I relied on these preestablished foundations for my own guidance and learning. Specifically, clinical training without a senior fellow can be disorienting and discouraging as there’s an absence of both a standard and litmus to gauge growth.

Given these factors, the first few months of training in a new program felt clumsy. I was uncertain of the boundaries and expectations for myself. Likewise, many of the attendings within my division, although having gone through fellowship training themselves, had not experienced training a fellow before. As a result, early exchanges felt like a dance without a lead, which led to awkward shuffling of expectations and, in some instances, toes being stepped on. 

Not only was I uncertain of how to be a fellow but also my team, including doctors, physician assistants, residents, and clinical staff, had to work on creating a space for a fellow to learn and function. Throughout this process, I have learned that there is a great and unique opportunity in pioneering and molding a program. It’s been quite an honor to work so closely with the division. There have been many lessons learned and below are some of the strategies that worked for us.

Identify and Address What’s Not Working

It sounds simple, but identifying a problem is a crucial first step that can take time and thoughtfulness. More importantly, it has helped me delineate between addressable factors and factors that are outside my control or can be resolved only with time. Identifying challenges also requires engagement of all team members, as it’s easy to have tunnel vision and helpful to have others identify blind spots.

A prime example from my experience in my first year of fellowship was workflow development. In the early trials of fellow rounding, I sporadically conducted fellow rounds throughout the day with the objective of accommodating operating times and maintaining care updates on patients on the floor. However, I was unaware of the workflow disruptions it could cause, which was a challenge noted by the inpatient care team. As a solution, there is now a system of standardized rounding in the afternoon to minimize workflow disruption while creating an intentional block of time for communication.

Keep an Open Forum and Request Constant Feedback

This is a standard that my program director and division strongly spearheaded. A few months into the program, I realized how much feedback was being requested and was circulating from various team members, ranging from attendings to residents. There is skill involved in requesting feedback.

It is well known that broad, generalized feedback is unhelpful. In the same light, requests for feedback should be specific and intentional in order to gather useful and manageable information. This approach was applied
by my program director in the multiple check-ins we had throughout the year as she inquired about various aspects of the program.

Whether it be my surgical, inpatient, or outpatient clinic experience, all questions were very directed. How are my relationships with the inpatient team? What surgical procedures are going well? What outpatient clinical experiences do I feel are lacking? How do I feel about patient counseling and goals of care conversations?

This approach allowed me to provide my program director with specific feedback and prompted me to pay attention to areas I wouldn’t have noticed otherwise. This is a strategy that I have applied to my own role as a fellow and educator by asking for targeted feedback from all team members, including during rounding, surgical teaching, and patient care discussions. Encouraging
an open forum and promoting effective feedback has worked for us to think critically about the program and its growth.

It is easy to fall into a trap of operating in a silo, and it is important to remember to not reinvent the wheel. I found myself reaching out to several colleagues who are fellows at other institutions or departments to seek advice on operations, education, clinical care, and even personal wellness. What I found in my slew of mini surveys was that there are many ways to get a job done and not all solutions are universally feasible or practical. It’s about finding the best fit for you and your program but with the understanding and acceptance of the dynamic nature given its nascency.

Our program is nowhere near perfect, and I do not claim that we have everything figured out. In fact, there continues to be change and development as we work out the nuances of having multiple fellows. I look forward to applying these lessons and gaining many more as we grow our program, and I feel fortunate to have a supportive division that is passionate about fellowship training, education, and oncology.

Reflecting on the first year of fellowship, the author highlights the challenges and learning experiences encountered as an inaugural fellow in a new program. The absence of senior fellows led to initial uncertainty and awkwardness, but also presented opportunities to shape the program. Key strategies for success included identifying and addressing workflow issues, maintaining open communication for feedback, and seeking advice from peers. The author emphasizes the importance of collaboration and adaptability in developing a successful fellowship program, acknowledging ongoing growth and the support of a dedicated division.

Nujsaubnusi Vue, MD, shares reflections on the challenges, successes, and failures that she's encountered thus far as an inaugural fellow. 

Reflections of an Inaugural Gynecologic Oncology Fellow

Although palliative care is a crucial part of the journey of cancer care for a significant number of patients, current training within this area in hematology and oncology fellowship programs often falls short in equipping fellows to adequately provide this care, according to Jessica Bauman, MD. Thus, Bauman and her coinvestigators conducted a pilot educational study to test a longitudinal, integrated palliative care rotation that they hope could serve as a model for other institutions in the future.

“Patients with hematologic or oncologic diagnoses have considerable needs in terms of their supportive care, symptom management, and communication [with providers],” Bauman said. “It is recommended by the Accreditation Council for GraduateMedical Education [ACGME] that hematology/oncology fellows acquire basic palliative care skills, which include symptom management and communication, as well as end-of-life care. Due to the direct needs for patient care, it becomes particularly important for those who are training in hematology/ oncology to learn these skills.” 

During the 2024 American Society of Clinical Oncology Annual Meeting, Bauman presented findings from the pilot study, which included 19 second-year hematology/ oncology fellows who identified patients from their hematology/oncology practice with palliative care needs and referred them to a palliative care clinic. The fellows then followed those patients in the palliative care clinic with a palliative care attending physician and in the hematology/ oncology clinic. The feasibility of the rotation was measured by tracked visits, acceptability was assessed through a survey and semistructured interviews, and fellows were assessed on their palliative care knowledge via a pre- and postrotation survey and knowledge assessment. 

Findings from the study demonstrated that over the 3-year pilot, 51 patients were referred by fellows to palliative care. Fellows participated in 95% of the total palliative care visits (n = 132). Palliative care knowledge (P < .01) and preparedness to provide palliative care (P < .01) both improved significantly from before the rotation to after, according to the knowledge assessment; fellows also showed improvement in 14 of 26 survey items regarding palliative care skill confidence (P < .05). 

All fellows who completed the postrotation acceptability assessment (n = 17) agreed or strongly agreed that the rotation changed clinical practice and that it helped them feel more engaged with caring for their sickest patients. Fellows also rated the rotation as valuable or extremely valuable at a rate of 94%, and 88% agreed or strongly agreed that the structure of the rotation was effective. 

In an interview with Oncology Fellows, Bauman, chief of the Division of Head and Neck Medical Oncology, an associate professor in the Department of Hematology/ Oncology, and the director of the Hematology/Oncology Fellowship Training Program at Fox Chase Cancer Center in Philadelphia, Pennsylvania, discussed the design of the palliative care education program, its effect on fellows who participated, and the future of palliative care education for hematology/oncology fellows. 

Where do current palliative care training approaches for hematology/ oncology fellows fall short?

As a result [of general ACGME palliative care education guidelines], every fellowship incorporates these requirements in different ways. Some may incorporate a rotation, and some may incorporate a lecture set based on various palliative care skills, but it is very different from one place to the other. [Because of] that variability and…the vast amount of information and skills that hematology/oncology fellows need to acquire, thinking about palliative care skills may not necessarily be front and center for many fellowships in terms of training and the literature suggests considerable variability. Given the variability, it’s important to [consider] ways to enhance or augment palliative care education within hematology/oncology fellowship. 

What inspired the creation of the palliative care rotation pilot study, and how was it conducted? 

For a long time at Fox Chase, we have had a palliative care rotation built into our fellowship. It was both an inpatient and outpatient rotation, but we learned over time that fellows were not as engaged in the learning. We realized that we wanted to change the way we were providing education on the palliative care skillset. We capitalized on the outpatient model that we have in terms of the primary education for our fellows here. Our fellows standardly are in outpatient clinics where they’re caring for patients with hematologic or oncologic disorders longitudinally in 6-month blocks. Because of that, they get to know patients and are very involved in their management, decision-making, and symptom management. Fellows are a part of [patients’] care teams, and we thought that it would be helpful if they are not only learning about the hematology/ oncology decision-making, but it could [also] augment their education and skillset to have simultaneous learning per patient in terms of palliative care skills that are more communication and symptom management oriented. The model that we created is for them to identify a patient [whom] they’re caring for in their continuity clinic for hematology/oncology who has a palliative care need, to refer that patient to the palliative care team, and for them to then see the patient with the palliative care team. This allowed [fellows] to not only learn from their hematology/oncology attendings but also learn—through the same patient [who] they already cared for—more palliative care skills to integrate into their patient management. 

Each fellow referred anywhere from 2 to 4 of their own continuity patients to the palliative care team, and then followed those patients longitudinally, both with their hematology/oncology attending [and] with their palliative care attending. Most of the visits were in the outpatient setting, [because] so much of hematology/oncology is outpatient, but if those patients were admitted, [fellows] would also be involved in the inpatient management.

What was the rotation’s effect on palliative care training for fellows, and how was it received by them? 

The [assessment of the] rotation was 2-fold. One question was whether it was feasible. We wanted to determine whether [fellows] would refer patients [to palliative care]. Will patients buy in, and will [fellows] be able to follow those patients over time? The second question that we asked was: Is this associated with a change in knowledge and/or a change in skill set? 

We found that this was a feasible rotation; of the 19 fellows who participated, all of them were able to refer anywhere between 2 and 4 patients, for a total of 51 patients who were referred over the course of this program. Among those 51 patients, there were 132 palliative care visits, and 95% of those visits were attended by the fellow. Most visits were successful in [terms of] our fellows being able to see the patient, both in their hematology/oncology clinic as well as the palliative care clinic. 

In terms of change in knowledge, we saw…an improvement in palliative care knowledge and in the confidence to deliver palliative care [over the course of the 6-month rotation]. Before and after [the rotation], we had [fellows] rate how confident they were in a host of different types of palliative care skills, including communication, prognostication, and symptom management. We saw improvement in 14 of the 26 items, which included pain and symptom management, prognostication, and working with an interdisciplinary team. 

After the rotation, we also asked fellows to evaluate the rotation and we conducted exit interv iews. The vast majority thought that the rotation was valuable; they thought that it changed their clinical practice and that it helped them engage more in taking care of their sickest patients, which are important findings. 

In a world where we are seeing increasing physician burn out, seeing the value that this rotation brought to them was remarkable. In their exit interviews, many fellows commented on how this rotation increased the meaning of their work, which I believe is particularly valuable as we consider antidotes to burnout. 

What are the next steps regarding research in palliative care training for hematology/ oncology fellows? 

It would be great to use this [program] as a model and incorporate it into other fellowships nationwide. One of the challenges of that is that not every [institution] has a well-integrated palliative care team in the outpatient setting. Additionally, not all fellowship curricula are the same and thus not every [institution] will be able to do this in the same way. 

As a result, a next step would be considering how other fellowships might be able to adopt this kind of rotation how it impacts patient care and fellowship education. Furthermore, we didn’t ask for feedback from patients [who] were a part of this to evaluate this program…. thus [discerning] the patient perspective of this educational program will be important in a future study. 

Bauman JR, Albert M, Chwistek M, et al. A longitudinal, palliative care educational pilot in hematology-oncology fellowship training. 

. 2024;42(suppl 16):9007. doi:10.1200/JCO.2024.42.16_suppl.9007

The director of the Hematology/Oncology Fellowship Training Program at Fox Chase Cancer Center discusses palliative care training for hematology/oncology fellows and highlights a pilot study aimed at improving this area of training.

Vol. 16 Issue 4 | Oncology Fellows

A Chance to Choose Your Own Oncology Fellows Content Adventure

Preparation is Key to Tackle the Transition from Fellow to Attending Physician

Community Practice Training During Fellowship Often Falls Short

Reflections of an Inaugural Gynecologic Oncology Fellow

Pilot Program Improves Palliative Care Training for Hematology/Oncology Fellows