Education Is a Personal Mission

Santosh Saraf, MD, changed his major 3 times as an undergrad at Penn State University, bouncing from premed to mathematics to marine biology before settling back into medicine. He was studying deep-sea ecosystems when his desire to become a physician became clear.

“I took a course on the biology of aging and got really interested in biology,” Saraf said. “I focused on algae and applied my math background to understand the genetics.

“The first and second year [of premed] have a lot of general courses, and you don’t get really into the depths of the field you're interested in,” he continued. “Once I was able to experience the science of medicine, I liked it more.”

He went on to earn his medical degree from Temple University in Philadelphia, Pennsylvania, then completed his internal medicine residency and a hematology/oncology fellowship at the University of Illinois at Chicago (UIC). He later got a master’s degree in clinical and translational research from UIC School of Public Health. Today he’s an assistant professor of medicine in the Division of Hematology/Oncology and fellowship training program director at UIC.

Saraf said he’s always been interested in education, even as a medical student and a resident. He spent 8 years working with fellows as a faculty member. “It’s a really important personal mission to make sure that we are educating the next generation, giving them the opportunities that people gave,” he said.

Saraf spoke to Oncology Fellowsabout helping his first-year fellows through the COVID-19 era, learning how to deliver bad news, and handling unethical behavior in the program.

How has the fellowship experience changed with COVID-19 when you haven’t had the normal level of face-to-face interaction?

It’s been a big challenge. I still feel bad that with our first years, we haven't really had the chance to meet and physically interact with them. It’s probably hard for them when they're first starting at a new institution. We do a lot of our lectures in didactics and journal clubs in pathology through Zoom and Webex. We actually have better attendance using these tools, but I think that there is a lot of face-to-face interaction that's lost.

What were the most valuable lessons from your own fellowship experience?

Each provider has something special to teach you, and you can take the positives from different faculty members. With some, I really appreciated how they spent time with the patients. For others, I liked how they started at the microscope before seeing the patient. I had lots of positive experiences with faculty that I’ve tried to capture and emulate. With the didactic, there was a lot of self-learning. All of those things together helped my clinical skills, as well as my basic knowledge.

What do you want your fellows to take away from the program?

The most important takeaway is the clinical part of the training—knowing how to interact with the patient at the time of diagnosis and knowing how to explain the disease, the treatment options, and the process for treatment. [It is also important to learn how to] explain the prognosis and, at the end of the road, talk about palliative and hospice care and effectively communicate with the patient and the family when discussing goals of care. That’s something that we've been really trying to grow as part of our pro-gram over the past year or two.

Educationally, I want to make sure that they have a solid foundation in understanding the science of diseases and therapies. Because we're an academic institution, we also want to encourage our fellows [to participate in] scholarly activities, including research. That could be clinical bench or translational educational activities; educational activities tailored to students, residents, and fellows; and educational activities to the community. We really want to have well-rounded fellows that have both clinical and scholarly knowledge.

Many physicians say they don’t get much training in delivering bad news. Is there a way to craft one’s fellowship to get that experience, even if it's not explicitly part of the curriculum?

It’s a very, very tough thing. It’s one of those traits that you pick up from faculty. [Some faculty] do it well and you say, “Well, I want to do this when I interact with a patient in this situation.” Then there are some you see that you never want to emulate. I had one faculty member come into the room, sit down, and just stare at the patient for what seemed like a long time, but it was probably only about a minute. That is the kind of interaction that makes the patient really uneasy. We have to learn what not to do as much as what to do.

One of the other important things to discuss with patients is palliative care. That’s something we've recently developed as part of our curriculum. It’s something that's really underemphasized in many programs. Our palliative care team provides didactics, and trainees hear lectures on the topic. There are also inpatient and outpatient experiences where they learn how to communicate bad news and develop end-of-care, hospice-type plans with the patient.

What do you tell your fellows about reporting harassment or other negative experiences that can come up in a workplace?

We’ve developed resources for fellows if these situations happen. We have an open line of communication if there is a problem arising. Our fellowship coordinator, our associate program director, and I are available. We really try to keep our phones and our emails on so fellows have the option to report something right away. We strongly encourage them to report any of those situations either anonymously or to a faculty member.

Each of our fellows is linked with a faculty advisor. We try to match them by their interest. For example, if there's a young mother in the program, we might try to pair her with a young mother faculty member or a member who might share the same experiences. That way, they might have a bit more open communication. We have those advisers meet with the fellows regularly.