In the Trenches With the Fellows

Mili Arora, MD, comes from a family of physicians, but she didn’t always plan to follow that path. In fact, that family history initially turned her away from a life in medicine. She majored in engineering as an undergraduate before realizing that she missed working with people. Hematology/oncology, she realized, gave her a chance to both treat patients and indulge her interest in research.

“Something about being on the cutting edge at all times was very appealing to me,” she said. “I found myself very attracted to hem/onc [hematology/oncology], which got me into medicine. It was a circuitous path, but I’m happy I wound up here.”

Arora earned her MD at George Washington University in 2009 before moving west to be with her husband, a native Californian. Upon finishing her fellowship at UC Davis Medical Center in 2015, she immediately joined the program as associate director. She was promoted to director in 2021.

Arora had always thought she’d be leading a laboratory, doing basic and translational science. But she discovered during her fellowship that she had a passion for medical education.

“That really became abundantly clear in my second year of fellowship, when I realized, ‘Wow, what actually makes me the happiest are my clinic and educa-tion, with a little bit of research on the side,’” she said. “[That] seems like an almost impossible career to find. But I think I got lucky in that when I finished [my] fellowship, our former associate program director was transitioning out.”

Arora had been chief fellow during her third year and was quite vocal about the changes she wanted to see in the program. With the associate director’s role opening, she was in the right place at the right time. “It was a very smooth transition and a lucky one for me,” she said.

Arora talked to Oncology Fellows about changing the fellowship program at UC Davis, the effect the COVID-19 pandemic has had on her trainees, and the importance of working late nights with her fellows.

What were you hoping to find in a fellowship program?

I was looking for a place where I could get a strong clinical foundation because I knew that as much as research is a huge part of hem/onc, being a good clinician and a comfortable clinician is something I wanted from my training. I also knew I wanted to train at a comprehensive cancer center. That was important to me because of my research interests. [So] I wanted to be certain I was training at a comprehensive cancer center but [also] at a place where clinical training was prioritized. That’s what I found at UC Davis.

What did you want to change about the program at UC Davis?

When I finished [my] fellowship, we were on the cusp of hem/onc becoming more disease specific. Whereas before there were a handful of drugs we were using for all diseases in hem/onc, in 2015, things were [more] nuanced with our therapies. I had awesome training, [but] I did feel that some of the [program structure] was a little archaic. There were just a few treatments, and we were training a general hematologist/oncologist.

I had a lot of ideas about changing our entire curriculum: our inpatient rotations, [our] outpatient clinics, [and] the way our didactics were organized. Those ideas happened to be realistic, and [our] leadership was very open to [them].

About half of your career in medical education has occurred during the pandemic. How has that affected the program?

The pandemic has been incredibly impactful on every aspect of our training and for our trainees. From a clinical standpoint, [we’ve moved] more to telehealth visits, and that’s really challenging in hem/onc. How do you navigate that? From a research standpoint, we’re not having the meetings for our fellows to be able to network and do the things they typically do from an education standpoint. All our didactics are virtual, so we lose a lot of [the] in-person learning that is so important.

It’s been hard, and it’s made me recognize even more that I need to roll my sleeves up. I’m someone who likes to get in the trenches. I am always in the work room with the fellows, masked of course, [and I try] to [be] involved in any way I can. I recognize [we don’t know one another] outside of the pandemic, and there’s so much lost. I have made a concerted effort to get to know them as much as I can in a pandemic-safe way. I spend a lot of late hours here with the fellows because I want them to know that I’m here with them, they’re not alone, we’re a team, I’m listening, and I get it.

Fellowship is busy and stressful during the best of times, and the pandemic has made that worse. How do you help your trainees manage their stress in such a stressful time?

The best thing that I can do is listen and act on their concerns. We have heard from them that as patient anxieties have increased or changed with the pandemic, [patients] reach out to our fellows more often on call. As a result, our fellows are more burned-out on their calls. We’ve changed [the] way we do [both] patient calls and [fellows’] call nights by removing them from the fellows’ duties.

Action speaks more than anything else, and when our trainees recognize that leadership is hearing them and making changes based on what they’re saying, they feel heard. That’s an environment that you can thrive in. It’s important to have a constant dialogue with the trainees and be willing to act on their concerns. That’s been incredibly helpful in maintaining their wellness.