As an oncology fellow pursuing an academic career, one of the major challenges I face is the arduous process of multi-tasking and time management to balance my clinical duties and my research activities. In addition to taking care of my clinic patients and conducting several clinical research studies, I have had to find an efficient way to keep up with the developments reported in the literature.
Through current literature, I learn about many practice-changing clinical trials, novel insights into the pathogenesis and molecular mechanisms underlying various malignancies including newly identified potential therapeutic targets, and many newly approved drugs and therapeutic approaches to different types of malignancies and hematologic disorders. The sheer volume of clinical studies, case reports, and review articles available in print journals and online creates a daunting mountain to face.
One of the most successful senior investigators at my institution always told fellows that we should follow the “hour-glass” model of knowledge and skill acquisition in order to succeed in the academic world. According to this model, at the beginning of your fellowship you should focus on understanding general principles and acquiring a wealth of actionable knowledge in general oncology and hematology. This knowledge is needed for safe and efficient care of patients. Then, in the latter parts of fellowship and during the junior faculty years, the focus should shift to becoming the “world expert” in a particular area of research interest through detailed and comprehensive reading and learning. In the later phases of an academic career, after becoming an established investigator in a specific area of interest, the focus can be broadened again to encompass other possible areas of interest.
I have tried to follow this model during my fellowship training. As a result, during my second and third years of fellowship (the narrow neck of the “sand-glass”), I have devoted the vast majority of my time to expanding my knowledge in the micro-details in my area of expertise and the focus of my future academic career: pathogenesis and management of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Achieving this goal successfully required that I dedicate a lot of time to keep up with the countless new research papers in these areas while conducting my own clinical research. The natural result of this shift to a narrow focus during the latter parts of my fellowship was that I have had little time to keep up with the rapidly expanding literature in other areas of oncology and hematology disciplines.
It is important to me to keep updated on general hematology and oncology developments for a number of reasons. First, this information helps me to appropriately treat my clinic patients, who present with a variety of malignancies and hematologic diseases. Also, since I have pursued dual certification in both hematology and oncology, I need to be prepared to take the boards. Last but not least, I have a relentless desire to be aware of all the new exciting developments in the fields of oncology and hematology. Senior fellows interested in academic careers share this challenge: How to tackle the never-ending stream of published literature. In attempting to maintain a balance, I have found several strategies and resources to be quite useful.
First, since it is virtually impossible to read every medical journal on regular basis to keep up with new oncology and hematology research, a reasonable alternative for me was to focus on the leading MDS and AML journals. I also read at least one of the clinical journals that regularly tracks and summarizes the major papers and developments in the field. One such resource is the “Oncology and Hematology Journal Watch,” which summarizes key hematology and oncology research papers from more than 250 medical journals and offers clinical commentary from experts in the field. The American Society of Clinical Oncology (ASCO) produces “ASCO News,” which also presents many updates in oncology research. In addition, I always try to read two of the leading journals in the field, Blood and Journal of Clinical Oncology (JCO), as well as the oncology/hematology articles in the New England Journal of Medicine (NEJM). Recent review articles can also be very helpful in keeping updated in a particular area without devoting as much time as it takes to read every new clinical research article. Each of the major journals in oncology and hematology publishes serial reviews of current hot topics in the field. For example, for benign and malignant hematology, I find the “How I treat” review articles in Blood to be good reviews of the current status of the literature on that particular subject.
Second, in addition to reading journals, another helpful resource that I frequently use are the audio updates that can be downloaded in mp3 format and so I can listen to them on my iPod while working out or while driving back and forth to work. For example, the oncologic educational activities produced by Research To Practice are distributed by mail to subscribers or can be downloaded from the website. These educational materials include audio interviews with experts in the field, casebased panel discussions, studies of patterns of care, and other programs that are delivered in an easy to follow format.