Crane Helps Fellows Navigate a Fraught Time in Gynecology

Erin K. Crane, MD, MPH, didn’t know she wanted to be a gynecologic oncologist until she experienced the speciality.

Like many medical students, she had a plan for her career; she was going to specialize as an ear, nose, and throat surgeon. She postponed her ob/gyn rotation until the end of medical school because she was certain she wouldn’t like it.

“As it turned out, I actually really enjoyed it. The first time I set foot in an operating room with a gynecologic oncologist, I knew that it checked all the boxes in terms of really interesting surgeries, women’s health, cancer—which I find fascinating—and chemo-therapy,” she said. It’s all those things together. A lot of people who go into ob/gyn think that gynecologic oncology is depressing and obstetrics is great, and it’s so much fun delivering babies. But if you ask any of us gynecologic oncologists, we would take our job over that any day.”

Crane recently established the 3-year gynecologic oncology fellowship at Atrium Health Levine Cancer Institute in Charlotte, North Carolina, and serves as its director.

During their first year, fellows collaborate with faculty and translational researchers to develop and present a thesis at a national conference and generate publications. In their second and third years, they participate in core gynecologic oncology rotations, education didactics and conferences, surgical cases, outpatient clinics, inpatient care, and chemotherapy coordination and consultation.

Crane said that students from the University of North Carolina and Wake Forest already train at Levine, a high-volume cancer center where approxi-mately 1200 new patients a year receive gynecologic oncology services. The Institute is thus well positioned to train oncology fellows. Because education has always been a part of Atrium Health’s mission, adding a fellowship fit in nicely with its mandate.“

Despite the fact that we’ve been regarded as a community hospital for a long time, all of us are involved in academics and societies,” she said. “It just made sense with the resources that we had available here and our passion for education that we’d start a program.”

Crane talked to Oncology Fellows about helping trainees care for their own health and wellness, navigate the politics surrounding gynecologic care, and the lessons she hopes they take away from the program.

Oncology Fellows: What was it about gynecologic oncology that caused you to change your focus?

Crane: The field of ob/gyn is so diverse that when you’re in residency, you get exposed to...extremes of care: mater-nal fetal medicine, which is all about maternal and fetal physiology, vs oncology, which is about cancer and an older population, vs reproductive endocrinology. A lot of it has to do with the residency program that you’re in, and the diversity within that as well. I don’t think it’s uncommon for residents going into ob/gyn to de-cide [on a subspecialty] when they’re in residency and have a little bit more time in those subspecialties.

But I do think it extends to other specialties as well. If you look at general surgery, for example, there’s so many different surgical subspecialties. And I think until you get exposed to more of those and kind of day-to-day life and residency, you don’t always know right away.

What happens when a fellow comes to you and wants to pursue something other than gynecologic oncology?

When residents express an interest in gynecologic oncology, as a division, we’re really supportive to make sure that they get involved in research, that they’re in the operating room, that they do away electives some-times to really get their feet wet and understand what the life of a gynecologic oncologist is like. If they come to us after that and decide it’s not the right path for them, it’s important to know why and to make sure that they’re making the decision for the right reasons.

I would say, if a fellow came to me and said that they weren’t certain about their career choice, it’d be a little more concerning because [a fellowship is] such a big commitment and obviously has implications for their lives in the fellowship program, so that would certainly be something we take more seriously. But again, same ques-tions, you know, why do you feel that way? Is there some-thing we could be doing better...something that you feel like you’re not getting that you need...[and how] could...[we] facilitate that? I think that would be our reaction.

Gynecologic care has become very politicized. How do you help fellows provide care when care may be the source of political conflict?

It’s challenging because all of us, regardless of what subspecialty we’re in, are passionate about women’s care and making sure that women have access to the services they need. Yet our hospital, in particular, is largely government-funded, so there’s obviously conflicts that arise. On a personal, day-to-day level, just continuing to provide the best care that you can for your patients and advocating for them and supporting each other during these difficult times is the best that we can do.

But on a larger level of political scale, there are many ways to become involved and to take action, from philanthropy, to boots on the ground in Washington, DC, and in the community. I would say being true to yourself, taking care of your patients, and making the right decisions, that’s really the most important part on a day-to-day basis of what we can do. We know, though, that as gynecologic oncologists and more experienced surgeons that that may affect our practice, what we’re seeing coming in as a result of some of the politics. We don’t really know yet what the implications are of that, but we have an idea. So that’s something that’s evolving as well.

What advice do you give a fellow facing a complicated situation with a pregnant patient for whom the recommended treatment is abortion?

We’ve been dealing with patients who are pregnant and have cancer for a long time. The standards of care are well established, and sometimes it does involve an abortion. If that’s the case, we’re in a state where we can still perform them legally and not be prosecuted. But if that changes, then we’re going to have to make decisions about what’s best for patient care. And if we can’t provide that here, [make] sure that we get patients to an area where it can be provided.

But we’re here to support our fellows. I think if they were ever in a situation like that, we wouldn’t expect them to have to make a decision on their own. An important part of the program is being here to support them and having our faculty and staff available and division heads and directors available to...support women and support our trainees.

Politics aside, fellowship is obviously an extremely stressful time. How do you encourage your fellows to take care of their own health and wellness?

We actually have a wellness curriculum here that’s part of our residency, so that was already up and running. When we started...[the] fellowship, we just naturally folded that into the mix. For example, on didactic mornings, which are Thursdays, once a month there’s wellness time for residents to go and take care of personal appointments and have personal time; that’s been extended into the fellows’ schedule as well. [We make] sure that there’s adequate funds and education for learning and the time off, make sure that they take time off—that’s guaranteed— and, of course, paying attention to work hours and making sure that those aren’t violated.

Our expectation is that while they’ll work hard, they’ll also have time for personal care and taking care of themselves and their families if needed.