Fellowship Is a Time for Growth

Michael J. Robertson, MD, took the road less traveled to a medical career. He was studying English literature at the University of Illinois at UrbanaChampaign when he suddenly knew what he wanted to do with his life.

“Honestly, it sounds weird,” he said. “I had an epiphany walking across campus in the middle of my sophomore year saying, ‘You know what, I really think I want to become a physician.’”

He earned a BA in English literature while playing catch-up in his premed classes. Eventually he earned his MD from the University of Chicago Pritzker School of Medicine before completing clinical fellowship training in medical oncology and a research fellowship in tumor immunology at the Dana-Farber Cancer Institute and Harvard Medical School in Boston, Massachusetts.

He then returned to his Midwest roots, joining the staff at Indiana University School of Medicine in 1996. He’s been working with fellows ever since.

“It’s very exciting to work with young people—to teach them, to help them learn new things, and to learn from them. They’ve got all kinds of ideas and thoughts that old people like me would never come up with,” he said. “It’s very refreshing. I just find it a very exciting thing to keep me alert and learning new things.”

Robertson spoke with OncLive about the value of fellowship, choosing a career path, and the second epiphany that led him to focus on one of the hottest topics in oncology years before it became a viable treatment option.

OncLive: What did you gain by completing a fellowship?

Robertson: It’s a huge growth period. Even after you finish medical school and residency, when you start fellowship, you’re learning a whole new field. You don’t get much exposure to hematology/oncology as a resident, at least not in the days when I was doing my residency. Therefore, it was a gigantic learning experience to just learn all this new material.

My second epiphany was that I decided I wanted to do research in immunotherapy which, way back then, was not what it is today. It was really kind of a black box and a lot of people thought it wouldn’t work. That led me to go in the lab for 3 years to study tumor immunology before I resumed doing mainly clinical things. It’s just a gigantic learning experience.

There are any number of potential jobs for a fellow. What do you tell your trainees about choosing a career path?

You’ve got to make sure what you choose is where your passion lies. You’ve got to make sure it’s [something that] really drives you. The worst thing I can imagine is for someone to choose a path and end up doing something that they find not compelling or not totally absorbing. I tell them to search deep in their souls to see what it is that really makes them click, what really appeals to them, what makes them want to get up every morning and go do it. Whatever that is, whether it’s clinical care, whether it’s clinical research and care, whether it’s basic laboratory research, whether it’s pharmaceutical development, whether it’s public health. Whatever that thing is, you’ve got to figure out what really is you.

Does a physician need to come into fellowship knowing where they want to specialize?

Most of our fellows at IU don’t come into the fellowship knowing for sure what area of hematology/ oncology they want to do. They usually have a pretty good idea of whether they want to do academics or private practice, but they usually don’t know, even if they know they’re going into academics, whether it’s going to be breast cancer research they want to focus on or lung cancer research.

The first year is so incredibly busy, I tell them to just go out there during your first year of fellowship and be immersed in everything and see what grabs you and almost always something grabs them during that first year if they don’t already have a predilection.

It is probably as likely that someone comes in thinking they know what they want to do and they change during that first year as it is that they continue with what they felt they wanted to do when they start. Until fellowship, they don’t really get exposed to the bread and butter of hematology/oncology. It’s usually skewed heavily toward inpatient experiences, which are totally nonrepresentative of most of what happens in our field.

How can fellows make the most of virtual mentorship when it’s difficult to have face-to-face interactions right now?

We still have to have the door open, metaphorically, if not literally. It’s tough to do this kind of stuff remotely, but we have to do it. We still do our meetings, and we still do our conferences, it’s just all done virtually now. That’s not the optimal way to do it. But we’ve still got to make life go on. We can still do those activities face to face, albeit through computer screens, as opposed to sitting across the desk from one another. Although I wish we could do it live, I think this is what we’re going to be doing for a while. I think it works. It’s just not optimal.

What have you learned about improving the process of mentoring online?

One of the things virtual mentoring requires is face time. Even though it’s through a screen, it’s much better to do it face to face. Doing it by telephone-only, you could miss a lot of cues in people’s expressions and gestures—that’s how people communicate. Being attuned to those cues isn’t much harder to do virtually, honestly. Those same cues are there. The main thing is just to try to make it feel as comfortable and as normal as we can. Try to treat it as if we were sitting across the desk from one another and not sitting and looking at a computer screen at one another.

How do you help trainees manage their time and their wellness?

The main thing there is collegiality and being supportive of one another. Fortunately, our program is a very collegial program for fellows and the faculty are very open to one another and talking to one another. Faculty always welcome the fellows to talk with them. If they have problems, we all know that we can find a sympathetic ear to talk to and more than one sympathetic set of ears to talk to. It’s really the fellows supporting themselves and the faculty helping to support the fellows. I don’t know of any better way to do it than everyone realizing we’re all going through tough things and we all have our bad days and we need to support one another. That seems to be what we do in our program very well, I think.