Finding Focus in Fellowship

Like many physicians, Leslie S. Kersun, MD, MSCE, MSEd, has known since childhood that she wanted a career in medicine. She found her calling in pediatric oncology while she was an undergraduate at Dartmouth College in Hanover, New Hampshire, while volunteering with the child life service at a local hospital. The program provides developmental stimulation, support, and advocacy for children’s emotional and psychological needs.

“I met a lot of children with cancer because they were in the hospital the most,” she said. “Then I noticed in medical school that I was really interested in cancer and blood disorders as we were doing those sections. Things kind of all fit together over time. I didn’t have a lot of deciding; each step of the way sort of fell into place.”

She earned her MD at Albany Medical College in New York and was a pediatric resident at Children’s Hospital of Philadelphia (CHOP) in Pennsylvania. She completed her first year of pediatric hematology/oncology fellowship at Children’s Regional Medical Center, now Seattle Children’s Hospital, in Washington and returned to CHOP to finish her training. During her training and early in her faculty appointment, she realized she had a passion for medical education.

“As a fellow, I enjoyed teaching residents and medical students,” she said. “Soon after I finished fellowship, I was given an opportunity to help with the resident rotation on our oncology unit. It was my job to figure out and adjust how the residents were educated when they participated in their oncology rotation.”

Soon after, she became the inpatient medical director in oncology, in addition to becoming more involved with the fellowship program. Later, she was named associate fellowship director and now serves as the program director for one of the largest pediatric hematology/oncology fellowship programs in the country. Except for the year she spent in Seattle, Kersun has been at CHOP since 1996.

She has recently taken on the role of associate designated institutional official and, along with the Graduate Medical Education leadership team, helps to oversee more than 70 training programs at CHOP. Working at CHOP is fantastic, she said. “It’s a great place to work. There’s a lot of expertise and dedication to education there. We have a lovely culture, and there’s always somebody to be able to help you with a patient or a question.”

Kersun sat down with Oncology Fellows to talk about finding the right fellowship program; the challenge of balancing research, patient care, and education as a trainee; and finding one’s focus during fellowship.

Oncology Fellows: You didn't struggle figuring out your career path, but how do you help fellows find their focus when they come into the program?

Kersun: One of the most important things to consider as you’re looking at a fellowship program is what kind of mentorship is available to help you develop professionally. You need to think about the program’s clinical mentorship structure because those faculty members will help you learn how to take care of the patients. Two of the 3 years of fellowship training are focused on research. Depending on what type of research you’re interested in—whether strictly laboratory-based, more translational research or clinically oriented research—you need to consider what type of mentors and resources are available. This is critical as you plan for your career and determine who at that institution can help to guide you on your desired path.

Then, of course, there are the life mentors. These may not be one of your assigned mentors for a particular area. They are faculty who have either chosen a similar path, structured their life in a way that resonates with you, or have advice that can help to guide you.

What should residents look for in a fellowship program?

Fellowship is, for most, the last step in their training before transitioning to a faculty position. It’s crucial to have mentors, resources, and a program that can help to support your career interests and a culture that allows you to thrive during training. Those are really important questions to ask as you’re thinking about applying to a program or if you’re interviewing at a program; [it’s important] to [understand whether] that program can support your development and the areas of your career that are most important to you. It’s a little bit different than residency training. The interview process and aspects that are most important for the program may be quite different.

Typically, people who go into fellowship are looking to go into academic medicine, but is there value in fellowship for people who want to be community physicians?

There’s value in whatever you choose to do, so we don’t feel like those physicians who are in an academic center doing research are more valuable than those physicians who choose to have a primarily clinical career. Our fellowship would certainly train you for whatever career path interests you. In pediatric oncology, there are many fewer opportunities in community medicine or private practice—it’s just not how most practices are structured. Children with cancer and blood disorders are most often seen in a hospital setting because you need a blood bank; lab-based diagnostics; multiple specialties such as radiology, pathology, surgical specialties, radiation oncology; and various disciplines to best care for the patients. It’s not that there aren’t available community or private practices; it’s just less common.

A fellow who comes to you midway through their third year and says, “Dr Kersun, I’m not sure how to get a job.” What do you tell them about taking that next step to actually go to work as a physician and researcher?

We talk with them about it from the very beginning. Our division chief gives a lecture about the process of finding a job that is right for each trainee. He reviews how he can assist in reading cover letters and reaching out to potential employers to help our fellows get connected with opportunities that will fulfill their career goals. He also reviews what fellows should be thinking about accomplishing during training and then how to pick a faculty position that will help to continue to foster their career. Our research mentors and clinical mentors are talking with the fellows as they progress in training about what their interests are and what opportunities there might be for them.

Our program also has instructor positions, which serve as a transition period that lasts 1 to 3 years prior to getting a faculty appointment. This type of position is primarily for fellows who have an interest in research. With only 2 years of fellowship dedicated to research, many trainees haven’t had enough research experience to apply for a grant to support their salary right at the end of training. They can use this transition time to develop their projects further and work with their mentors to move toward independence. They can also serve as an attending physician during this time while further developing their research projects. When they’re finished with that period, they’re ready to apply for a job.