Choosing Your Own Training Adventure: Where Do You Start?

Leidy Isenalumhe, MD, MS
Clinical Hematology/Oncology Fellow, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida

The American Society of Hematology (ASH) created the ASH Trainee Council to advocate for the issues and concerns of hematology/oncology trainees, including mentorship, publishing, and funding. ASH Clinical News spoke with Leidy Isenalumhe, MD, MS, chair of the Trainee Council for 2017-2018, about the wonderful – but overwhelming – array of careers open to trainees, and the difficulties of transitioning from trainee to attending.

Dr. Isenalumhe is a clinical hematology/oncology fellow at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida.

What are the biggest challenges faced by today’s trainees?

The variety of career options available to hematology/oncology trainees is a blessing and a curse. We only have three years to forge our career path, learn everything we can about hematology or oncology, and essentially lay out the rest of our lives. It can be a confusing, stressful, and overwhelming endeavor, and determining where to start is difficult.

Do you have any advice about navigating those decisions?

Be completely honest with yourself. Ask, “What do I really want to do?” Or, ask yourself the cliché interview question, “Where do you see yourself in 10 years?” Then, document those answers; write down how you want your weeks to look when you’re an attending. Would it make you happy to see patients five days a week? Or do you want to train fellows or work in the lab most of the time?

When you start answering those questions, you can work backwards and break your training into yearly, monthly, and even weekly timelines. Then, pick a focus for each timepoint and determine what you need to do to achieve those goals.

Doing this helped me realize that academic medicine and patient care are equally important to me. I know that I want an even balance between the two. When I start my job search later this year, I know what to petition for during an interview.

It’s so important to know and trust yourself, as well. We have been in the mindset of a trainee since college – always following a specific protocol laid out by someone else. Transitioning into someone who doesn’t need to check with a superior before making a decision can be difficult.

A couple of years ago, someone gave me advice that I took to heart: “Think like an attending.” In other words, think ahead to cover all your bases before an issue develops. If you’re seeing a patient with Philadelphia-positive acute lymphocytic leukemia for the first time, rather than waiting for someone to walk you through the treatment scenarios, come up with your own list: How do I diagnose the disease? What do I do if the diagnosis is ambiguous? How will I treat the patient initially? What if the disease is refractory to treatment? What’s the next treatment option?

Try to engage in active learning. There will be a point when we aren’t in training; the patient is in front of you and you have to make a clinical judgment. Don’t be afraid to speak up; no one will say you’re overstepping your boundaries if you present a thoughtful, researched opinion.

Fortunately, my training experiences have been structured to facilitate the transition from trainee to attending. For instance, at my second fellowship, we had “attending week,” during which we acted as the attending on service. Trainees conducted rounds and decided the clinical therapy for 30 to 40 patients, then we convened with the attending at the end of service.

How have other mentors helped you along your career path?

It takes a village to raise a hematologist; there isn’t one individual who will guide you to success. Different types of people can guide you through your training – even those who don’t fit the typical mentor mold. Multiple junior attendings have helped me, and it’s a different mentoring relationship than one with a more senior colleague. Junior attendings are closer to your “training age” and it can be easier to approach them with questions about the everyday details of training, even something as simple as how to format an email to the head of your division.

What qualities should trainees look for in a mentor?

Essentially, you want to find someone with whom you feel comfortable. Look at how your mentor works with other fellows: Does he or she listen to ideas or offer constructive criticism? Look at their track record: Have past mentees had successful careers? What is your mentor’s availability like? You want to be able to have at least biweekly meetings with your mentor, and you don’t want to have to fight for them.

I’ve realized during training that finding the right mentor can mean changing mentors. It’s your career, not his or hers, so don’t be afraid to look for someone with whom you work better.

Compassion is also important. Life happens – will your mentor be flexible? Work/life balance is something I think should be emphasized more during training because, unfortunately, some people think that choosing a career in medicine means choosing constant sacrifice. I’m not arguing that it doesn’t involve some sacrifice, but we need to find a balance so that our productivity doesn’t suffer.

I’m not saying that I have perfected that balance, as my husband constantly reminds me! However, we can get better at realizing when our lives are too imbalanced; being in perpetual fatigue helps no one.

What are your priorities as chair of the ASH Trainee Council?

As chair, I want to publicize what ASH has to offer for trainees. It was only after I joined the Trainee Council that I discovered the wealth of resources and programs the Society makes available – from sample board certification questions to the ASH Image Bank. I wish I had known about these during my first fellowship, but I am grateful that I had them at my fingertips during my second!

Even as the chair I’m still finding new information! I email everyone in my program when I find new resources, like TraineE-News. The grants clearinghouse has been an excellent resource for finding funding opportunities; it should be your first visit when searching for funding. It’s all in one place! The clearinghouse would definitely have saved me some time the first time I applied for a grant.

I also want to continue raising awareness about non-traditional career paths. It often feels like fellows who want to focus on patient care are stigmatized because they aren’t as productive in research, which isn’t fair to them. We want to train people to be good clinicians, but the first question trainees are asked is usually, “When are you starting your research project?” or “When are you going to publish?” But, not everyone is going to be a researcher.

There are so many different ways to make a career within your niche, and I want to give trainees as much exposure to these as possible.

The ASH Trainee Council provides an amazing opportunity for young hematologists to get involved in shaping the Society’s trainee-focused programs, and the ASH Committee on Training is always looking for new proposals and ideas from Trainee Council members. So, I want to find opportunities to promote alternative career paths. Can we invite someone in private practice to offer their perspective? Can we get someone who works in industry to share their experiences? Everyone has different paths and all of those different paths should be nurtured.