I remember holding my grandfather’s hand as he took his last breath, a soft sigh that meant the end of all the hardships he endured while battling metastatic colon cancer. I vowed then to become a hematologist/oncologist. Watching a family member suffer through an advanced stage of cancer gave me profound insight into the fears that accompany a terminal diagnosis. I always admired the compassion required of a cancer specialist and yearned for a career in which I could develop meaningful long-term relationships with my patients.

Throughout medical school and residency, I prided myself on my ability to build strong rapport with patients and draw from my personal experience with bad news to empathetically console those in distress. However, as fellowship began, my bountiful pocket of empathy quickly ran low, and I struggled to recharge between the seemingly endless consults and beeping pagers.

The first few months of my fellowship were riddled with long days that ended with choosing between eating dinner, exercising, or sleeping. Surely there would be no time to do all the above and still survive the next day filled with conferences, consults, and chemotherapy orders. Here I was, starting at the bottom again, a position I was all too familiar with during my first years of high school, college, medical school, and residency. This hierarchical structure typically meant that every first year of training entailed more time spent studying and working longer hours, while simultaneously being underacknowledged by the senior staff.

I became callous, especially toward patients who would note that, as an Asian American woman, I looked younger than my age—too young to be making critical medical decisions. I lost patience with those who would angrily ask, “Isn’t it all in the chart?” when I asked them about their medical history.

I became extremely sensitive to microaggressions from my colleagues, who appeared equally drained. It was difficult at times to maintain the same level of passion for medicine I once had, but I soon realized that I was limiting myself from becoming a successful physician. As a new fellow, I was burning out and simply did not know how to cope.

While We Take Care of Others, Who Takes Care of Us?

The effects of my burnout, like an angrily shaken soda bottle, resulted in episodic explosions that splashed on those who deserved it the least—my significant other, my immediate family members, and my friends. I envied those in my nonmedical support system who already had sizeable incomes and growing families, while I struggled to study for national board exams and pay off my student loans. It is difficult for me to think about the friendships that faded away due to the many birthdays, baby showers, anniversaries, and vacations I missed because of nights and weekends spent working.

It took a few more months of settling into fellowship, and new onset heartburn, before I understood that I had to care for myself in order to properly care for others. It became clear to me that I was sluggish and inefficient on the days I went to work sleepdeprived or nauseated with hunger pains. I thought I was maximizing my time. In reality, I was cheating my patients and putting my own health at risk.

This realization pushed me to make my own physical fitness a top priority. I rarely skip meals these days. I make time to go to the gym for a few evenings every week. I took up kickboxing again, a hobby I’d neglected during my residency. As a result, I’m more energized and motivated to work through my 12-hour shifts.

I also made a conscious effort to reach out to senior faculty members and other fellows, all of whom helped me tremendously to remain resilient, rediscover my passion for medicine, and recognize that I had the ability to take care of patients with cancer. One mentor told me that after a long day of seeing patients, it often helps to unwind by reflecting on what motivated us in the first place and pinpoint what makes our work meaningful. Personally, it is the little things that remind me of how lucky I am to be a doctor—whether it is a warm smile from a patient, a handwritten thank-you note, or a hug of gratitude. These small nuggets of appreciation make this job a privilege and help keep me from burning out.

The most useful advice came from a social worker at the cancer institute, who met with the fellows weekly to discuss our emotions in a safe space, gave us tips on how to achieve restful sleep through meditation, and advised us on other helpful breathing techniques. She emphasized the importance of fueling our brains with good nutrition, which is essential for optimal functioning. During one group activity, each fellow was asked to share his or her own way of reducing stress. For some, relieving burnout took the form of listening to music or going for a jog to raise endorphins; for others, lengthy venting sessions with coworkers or even trained medical professionals were therapeutic.

In May 2019, the World Health Organization officially recognized burnout as an occupational phenomenon.

 Furthermore, the disturbing rates of physician suicide indicate an absolute need for every healthcare institution to address physician wellness.

Findings from a recent meta-analysis showed that 28.8% of physicians in training reported experiencing depression or depressive symptoms.

 Not only do these symptoms affect a physician’s long-term mental health, but they also have significant consequences for patient care. Therefore, it is essential to give providers the right tools to recognize burnout in both themselves and their colleagues.

Female physicians are at particular risk for burnout. Studies have shown that within 6 years of completing training, 22.6% of female physicians no longer work full time, compared with just 3.6% of their male counterparts.

 Approximately 40% of female physicians complete approximately 25 years of schooling and medical training, only to take a part-time position or stop practicing medicine completely in the prime of their careers, due to unresolvable home and work conflicts. This is in part because women continue to take on the majority of the burden of household tasks, compared with men, in male-female partnerships.

There is an added challenge when there are 2 working parents who must negotiate how to split their responsibilities regarding childcare. Even then, the number of hours mothers, including physicians, spend on childrearing continues to surpass that of fathers. It is unfortunate, but understandable, that family responsibilities, chronic problems of unequal pay, and barriers to professional advancement leave some women to feel as if they have no choice but to exit the medical profession early.

The gender disparity highlights a potential modifiable risk factor for burnout. Providing on-location daycare facilities, supporting parental leave, or hiring more staff can decrease overall physical and emotional fatigue, allowing women to continue building a successful medical career while simultaneously tending to family obligations. Ultimately, there is still a significant amount of work to be done in championing wellness in the medical profession for all physicians.

Here are 5 tips I can offer from my experience to prevent and combat burnout:

The first year of fellowship in hematology and oncology requires a deep exploration and an open mind. Attend the American Society of Hematology and American Society of Clinical Oncology conferences to network with other faculty members and fellows. Building connections early on can help reduce the stress of last-minute networking when applying for jobs as a third-year fellow. 

Getting to know your interdisciplinary team while on the wards minimizes burnout by promoting teamwork, enhancing communication, and reducing misunderstandings. Encouraging all members to work at the top of their licenses can help improve workplace relationships and decrease passive-aggressive behavior, resulting in better patient care. 

Don’t be afraid to ask for help. Whether that means seeking mentorship, finding support groups, or obtaining assistance on a complex medical case, your supervising attendings and ancillary staff can help ease anxiety and provide the appropriate resources to guide you through your first year. 

For physicians with children, spending quality time with your patients and family remains a difficult balance to maintain. Hiring household help, recruiting family members to babysit during call days, and speaking with your superiors about flexible scheduling are all considerations that may alleviate the overall burden of being a parent and physician. 

Finally, be kind to yourself and to others. Surround yourself with those who empower you and support your growth as a person and physician. 

World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. who.int/mental_health/evidence/burn-out/en/. Published May 2019. Accessed January 5, 2020.

Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. 

. 2015;314(22):2373-2383. doi: 10.1001/jama.2015.15845.

Paturel, A. Why women leave medicine. AAMC. www.aamc.org/news-insights/ why-women-leave-medicine. Published October 2019. Accessed January 5, 2020.

Articles

Janice Shen, MD, provides advice on how to overcome burnout in order to provide the best care possible for patients with cancer.

Overcoming Burnout as an Oncology Fellow

Postgraduate fellowship training is an essential cornerstone in medical training, especially if you want to develop an academic career. Although the individual decision to train is quite complex, the main considerations usually boil down to several factors:

Gaining specific skills that were not well emphasized during residency 

Exposure to world experts in certain fields 

A chance to see “how things are done” elsewhere 

“Winning” some points that will help you negotiate a contract 

Results from several North American surveys reported similar arguments for pursuing a fellowship among residents and fellows.

I started thinking about applying for a fellowship overseas sometime in the middle of my residency. I had hoped to someday get an academic position, but that would be nearly impossible if I did not do a fellowship after residency. But my country, Israel, is small; there are not a lot of fellowship options in general and none in my field of urologic oncology. If I wanted to do a fellowship, I would have to leave Israel behind.

Although these professional arguments are the leading considerations in the decision to pursue a much-in-demand oncology fellowship, there are other non-professional/personal considerations that are usually overlooked or regarded as “second best.” These factors often play a much greater role than the professional considerations in determining whether you should go into a fellowship.

The average medical resident finishes residency roughly between the ages of 25 to 30 years. At this stage, a substantial proportion of residents are either married or in a meaningful relationship. Others already have children. Hence, a decision to pursue a fellowship has a great impact on the candidate’s family.

Some would say that almost any sacrifice is acceptable if it is for the sake of the breadwinner’s career. But is that true? I will try to shed some light from my personal experience on how my family and I made the choice to leave Israel and pursue a fellowship in Canada.

When I began thinking about pursuing an overseas fellowship, I was 35 and married with 2 little children, aged 4 years and 18 months. My wife had just started a new job and we were thinking about a third child. Financially, we were breaking even, and upsetting that delicate balance seemed unthinkable. Leaving home with 2 children and traveling to a foreign country across the Atlantic appeared unlikely at best.

But as time passed and we were thinking the idea over, we began to get used to it. The obvious pro arguments were the advantageous effects on my professional career and how that would reflect on the chances of securing an academic position at the end. However, we would be putting our family’s life on hold for 2 years and my wife would have to leave her new job and start from scratch in a different country. Also, fellowship salaries are far from enough to support a family of 4 to 5 people. Moreover, the children would have to leave their school to start a new life in a different country with a language they did not know.

Leaving my family behind and traveling alone was not on the table.

While considering all these arguments, we decided that if we were to go overseas, we should regard it as an adventure that would draw our young family even closer together. It goes without saying that relocating one’s family, especially a family with young children, is very challenging. But we reasoned that, if we could balance those challenges with positive experiences, we could transform the obvious disadvantages of moving overseas into potential fruitful advantages. That helped make our decision much easier.

So, after many hours of thought, we decided to take on this adventure. After completing the long application, interviews, and matching process, I matched at the University of Western Ontario in London, Canada. In total, from the time we started thinking about the idea to the time we left home, it has been 4 years. We had added another child by the time we left Israel for the other side of the world, giving us 3 children younger than age 7.

My first year of fellowship is dedicated to research, which is much more relaxed at the beginning than the second, stressful, clinical year. The first few weeks in Canada were very nice as we tried to create a fun atmosphere filled with activities to make it an easy start for the children. But the start of the school year brought with it the cold slap of reality. My wife, who was trying to get used to her new life, had to juggle it all and help the children find their place, while I was busy at the hospital. My children spoke only Hebrew and no English, so those first school days were especially difficult.

Fortunately, with time, we started to settle in. My wife acclimated to our new environment and began making new friends. But probably more importantly, the children adjusted. They started to understand English and make friends, and Canada started to feel like home.

About 6 months have passed since we made this giant leap of faith. It has been challenging, but I hope that we will remember this period as a great adventure in our lives. We decided to make the best use of our stay in North America and use every bit of spare time to collect family adventures. Whenever we can, we like to travel across Canada and the United States to make the best of family leisure time—something we did not have the time to invest in back home.

The main purpose of going on a fellowship is, obviously, professional. But the fellow’s family are a true part of the process together with the difficulties and benefits that come with a fellowship. We take pains to keep our patients involved and take part in shared decision making during patient counseling. The same should go for our families.

Although the sacrifice my family made by leaving their familiar and comforting environment is quite substantial, a lot can be gained from the fellowship period beyond the professional advantages. We have all made new friends, and my children are learning a second language, getting to know a new environment, and collecting lots of great memories. Like so many things in life, it is all about seeing the half-full glass, maintaining a good spirit, and reflecting it in your environment. I expect that in a few years, when we are looking back at this period, we will remember it as an excellent time.

Arnon Lavi, MD, is a UroOncology fellow, London Health Sciences, Centre—Victoria Hospital, in Ontario, Canada.

Freilich DA, Nguyen HT, Phillips JL. Factors influencing residents’ pursuit of urology fellowships. 

. 2011;78(5):986-992. doi: 10.1016/j.urology.2011.05.068.

Touma NJ, Siemens DR. Attitudes and experiences of residents in pursuit of postgraduate fellowships: a national survey of Canadian trainees. 

. 2014;8(11-12):437-441. doi: 10.5489/cuaj.2136.

Postgraduate fellowship training is an essential cornerstone in medical training.

Pursuing an Oncology Fellowship Overseas

I was in my last year of medical school in Syria when I lost my father to chronic lymphocytic leukemia. I had encouraged him to seek treatment after seeing him suffer from disease-related fatigue and early satiety because of his huge spleen. I never expected, with my limited knowledge back then, that rituximab could cause such severe tumor lysis syndrome with disseminated intravascular coagulation on the third day of its administration.

I had to take some time off from my school to close my father’s local business. Then, I worked as an English translator for a medical equipment company to earn what was barely enough to support my family. Eventually, I graduated from school and left for the United States to start the long path to becoming an oncologist.

After completing my internal medicine residency from the University of North Dakota School of Medicine & Health Sciences, I had to work for several years to secure permanent residency in the States. Since my dream was to become a physician-scientist and develop new treatments for patients with cancer,I completed a master's of science in clinical research design and statistical analysis from the University of Michigan. Finally, I started my ultimate journey as an oncology fellow at Wayne State University School of Medicine in Michigan.

One month into the fellowship, full of hope and passion, I quickly realized how deep and complicated this specialty is. It was very different from the medicine I practiced before; there are so many genomic alterations to learn—

, microsatellite instability, and PD-1/PD-L1—before I could choose the most beneficial treatment for my patients. Plus, I had to master not only chemotherapy, but also immunotherapy and targeted therapies.

I needed to get up-to-speed quickly. Some of my friends suggested that I skim the National Cancer Care Network guidelines to gain basic knowledge on the management of common cancers. Others suggested I browse a small handbook; still others directed me to watch hematology-oncology board review course videos. I was not able to work on any research projects during the first year. I felt like a wrecking ball, swinging wildly from one rotation to another.

By the end of the first year, I started to develop a special interest in gastrointestinal (GI) cancers, particularly pancreatic cancer. I enjoyed managing those patients, trying to get them to surgery, then adjuvant chemotherapy, all while hoping for a chance of a cure. Even when the chemotherapy is only palliative, I loved the moment when my patient came back to the clinic after a few treatment sessions, free of pain, free of fatigue, and able to eat without bloating or nausea.

At the beginning of my second year, I chose my GI oncology mentor and established my GI clinic parallel to his. I was then introduced to our GI team’s basic scientist, who involved me in several exciting projects exploring new drugs for pancreatic cancer. I learned how to culture cancer cells, perform western blots, create patient-derived xenografts (PDXs), and develop pancreatic orthotopic mice models. I was fascinated by the tumor shrinkage some of these new drugs achieved in the PDXs.

I then started to get more involved in the clinical trials conducted under my clinical mentor’s guidance. I wrote my first phase II trial protocol to test a new drug combination in patients with pancreatic cancer, and I was able to get the protocol approved by the independent review board and the FDA. I also worked with my basic science mentor on a translational trial to test biomarkers in patients with pancreatic cancer. I was then honored to become a scientific member in the tumor microenvironment biology program at my cancer institute.

In the middle of all the excitement, while advancing my academic GI oncology career, I noticed that my prefellowship savings account was getting depleted. I began worrying that I wouldn’t be able to support my family if I stayed in the academic field after graduation. I told myself that it isn’t easy to find private jobs in GI oncology, and even if I found one, it wouldn’t satisfy my career goals.

I sought advice from a member of our faculty who has been in academia for 30 years. He told me, “You will not be poor as an academic faculty. Choose what makes you feel happy when you drive to work every day.”

By the end of the second year, I began to feel that pursuing an academic career in GI oncology with a focus on drug discovery was the right choice after all. Initially, I didn’t think I could run my own lab if I wanted to focus on conducting clinical trials; however, I found that collaborating with our GI basic scientist gave me what I was looking for: the opportunity to develop new treatments for pancreatic cancer from bench to bedside.

I was announced as the new chief fellow at the end of the second year. Soon after that, I started to work on the fellows’ rotations schedule and didactics curriculum. At the same time, I was preparing to start my interview season to find my future academic GI oncology position. Meanwhile, I got an offer to join a successful pharmaceutical company as a leader for their clinical trials pipeline.

The offer caught me completely off guard; joining the pharmaceutical industry didn’t even cross my mind when planning my future career. However, it was a great opportunity: lots of travel, a role designing the company’s clinical trials on cancer drug discovery, and of course, a higher income. For all its advantages though, a job in industry meant that I would miss the interaction I enjoyed every day with my patients. Ultimately, I decided to turn down the position.

I finally made my career decision and signed with my current institution as a junior GI oncology assistant professor. I’m currently leading several clinical trials as a subprincipal investigator under my mentor’s direction. In a few months, I will take over as the principal investigator. I am sure this will be the beginning of a successful academic career. I hope that one day I will be part of a team that finds new and promising therapies for pancreatic cancer.

Making a decision about your career is not easy, especially when trying to meet the tremendous challenges of fellowship. After I went through the experience of struggling to make a decision, I learned that my colleague was right: What matters in the end is what makes you feel happy driving to work every day.

Mohammed Najeeb Al Hallak, MD, MS, shares his experience with making a career decision while trying to meet the challenges of fellowship.

Oncology Fellows: Making the Right Decision About Your Future

For us, a group of 15 black students at Tulane University School of Medicine (TUSCOM), a visit to the Whitney Plantation in Edgard, Louisiana, was a no-brainer. The process of navigating medical school is pure hell at times, and you need inspiration wherever and whenever you can get it.

We draw inspiration and motivation from one another. New Orleans, after all, was one of the largest slave markets in the country, and the Whitney Plantation is less than an hour from Tulane. There was no better place for a group of black prospective doctors to celebrate our triumph over systems meant to annihilate us. Ledet, a molecular oncology scientist, reached out to his colleagues at TUSCOM with the following email. Eventually, they received international acclaim and an opportunity to have an impact on people far beyond New Orleans.

Over the summer, one of my closest friends from New York City came to visit me. During the stay, we took a trip to the Whitney Plantation, preserved in the Whitney Plantation Historic District near Wallace, Louisiana. That experience was so different from anything I had ever witnessed. The Whitney Plantation is unique compared with ones that celebrate the plantation owners—it is the only plantation museum in Louisiana with an exclusive focus on the lives of enslaved people.

Considering the aforementioned, I presented the idea of gathering the melaninites of the School of Medicine to experience the Whitney Plantation and take a photo in our white coats. I figure that photo will be iconic and speak volumes, and I also think it is an opportunity for us to be reminded of how far we have come.

Prior to this email, I had presented the idea to some of my colleagues, and they were on board 100%, all agreeing this was a necessary trip. I reached out to Joy Banner, the museum’s director of marketing, and she was elated to give us a tour.

My colleagues immediately understood the underlying purpose of this proposition. One may ask, “Why is that unity important?” Our answer is that we have a shared understanding of the importance of remembering the resilience and resistance of our ancestors, which ultimately has afforded us the opportunity to be in the position we are today. Their strength courses through our veins. We are fully aware of that and wholly acknowledge it.

To be candid, this was about our needing something. We needed a soul revitalization. We needed a visitation from souls long gone. We needed to be reminded of our instilled resilience, and the Whitney Plantation expedition on December 14, 2019, did that for us. Fifteen TUSCOM students made it out to the Whitney Plantation, and we are all the better for it now. We went there in all black with our white coats on. Other patrons were in awe of us just walking around.

Each of us gained something different from the trip. For some, it was a remembrance of a violent, monstrous, irrefutable crime that still does not have the power to stop our progress. For others, it was an out-of-body experience that left them numb. Before we left, we took these iconic photos in front of an original slave quarter on the plantation.

Those photos wound up in People magazine, on websites for HuffPost UK, CNN, MSNBC, NPR, and on the front page of the New Orleans Times-Picayune. We have been thrust onto an international platform, spoken on news stations, and addressed hundreds of school-age children. We plan to place these photos in classrooms and homes nationwide. Our photo will hang in the halls of K-12 learning institutions from New Orleans to Minnesota, New Jersey, Texas, Georgia, Washington State, Missouri, New York, Washington, DC, and more.

This is only the beginning, but we are grateful for our beginnings. We started a group, the 15 White Coats, and launched a website, www.the15whitecoats.org, to take advantage of this moment. Opportunities to share our story and the impact we intend to make have not slowed down. Our mission is to (1) install 100,000 photos in 100,000 classrooms nationwide by 2022, (2) raise enough funds to aid medical school applicants of color, and (3) place cultural literacy centers in classrooms nationwide. People cannot be what they do not see, and by placing our photo in schools, we further the process of reimagining cultural imagery about who can do what, especially for children. Just applying to medical school costs $3500 on average, and we can help to lighten that burden for folks who simply cannot afford the cost but have all the qualities to be great clinicians. Finally, we need our young people to read books that resonate with their reality, and by placing literature that aligns with their lives, we hope to encourage more literacy.

Our goal is to make photos like these commonplace so we can move on to other issues in humanity. If we are to ever move the needle on breaking down structural racism and its manifestations in the healthcare system, having more people from disenfranchised histories in medicine has to be part of the equation. We are not the ultimate solution, but we are surely part of the remedy.

We’ll close this by saying we are not looking for sympathy. Don’t misconstrue this. This ain’t the story about the unfortunate black folks who survived opposition and are now training in medicine. This is the story about the triumphant queens and kings who illustrated resilience. As Uché Blackstock, MD, once wrote, we chose “bravery over fear.” We do not see that changing anytime soon. The 15 White Coats are here to change the world for the better.

Oncology Fellows: Reminding Ourselves of How Far We've Come

Like all fellowship directors, Gerald Hsu, MD, PhD, program director, Hematology/Oncology Fellowship Program and associate clinical professor of medicine at the University of California, San Francisco (UCSF), is looking for applicants with intelligence, ambition, and a desire to advance cancer research and clinical care. The trick is finding the right combination of talent, intellectual curiosity, drive, and diversity to join the community at UCSF.

But the most important trait, he said, is vision. Hsu is looking for applicants who have a clear idea of what they want to accomplish in medicine and specific ideas about how to achieve those goals. UCSF only accepts 7 hematology/oncology fellows each year, so finding the right people is a challenge.

“In addition to looking for the best fit, we’re looking for people who will best serve hematology/oncology in the future,” he said to 

. “That also means ensuring adequate representation of the diversity [in] this country. In thinking about the composition of who we want to bring in, that factors quite heavily.”

Hsu became the fellowship program director in 2018. He earned his medical and doctoral degrees at Duke University in Durham, North Carolina, before going on to complete his residency at Brigham and Women’s Hospital in Boston, Massachusetts. Hsu performed a fellowship in hematology and medical oncology at UCSF before returning to Brigham and Women’s to serve a yearlong stint as chief resident.

In discussing his work as a fellowship director, Hsu talked about his love for San Francisco, the benefits of working at UCSF, and the best way to present yourself in your fellowship application.

: As chief medical resident, I recognized the importance of medical education in fostering opportunities for personal and professional growth for trainees. It was also a wonderful time to spend a dedicated amount of educational investment in science and medicine again.

My focus when I came [to UCSF] was primarily clinical care and medical education. In the course of my first few years as a faculty member, I was able to build on this interest and develop additional training for a program called Teaching Scholars that provided perspective and opportunity to delve into medical education scholarship.

Through that experience at the undergraduate medical education level, I built enough of a background in medical education. That eventually led to this job.

There is no typical day. My commitment to clinical care is 2 half-days per week, [but] it’s really more like 2 three-quarter days of outpatient practice, during 1 of which I’m supervising fellows. I do 4 months on our inpatient service at the San Francisco Veterans Affairs Medical Center, which is a consultant service for both hematology and oncology.

My weeks are built around those clinical care responsibilities. Beyond that, most of my time is spent in various meetings with individuals about the fellows program and meetings representing our program. I don’t know how much time I spend doing email. That’s a lot of it.

We’re looking for the best fit for our institution. I think about UCSF as an institution for pioneers. I think about UCSF as an institution for future leaders, both in lab-based research and clinical research. I think of UCSF as a place that has a broad range of resources to support endeavors that will be coming online for research and clinical practice. Fundamentally, we’re looking for people who are pioneering in their spirit, people who have initiative, people who are committed to excellence in whatever they choose to do.

Everyone has their own approach to looking at an application. My approach is to start with the personal statement, because that is the place where an applicant has the opportunity to communicate with me directly. What I’m looking for is someone’s vision for themselves. Not just their career aspirations, but how they are going to get there. I think about it as providing some broad goals but also very specific ways they’re going to cultivate new skills, what sort of training they’re looking for, the coursework they want to do to reach what they view as their 5- to 10-year career plan. The degree to which you can be really specific about what you hope to achieve serves an applicant well and provides a nice opportunity to discuss how a program might fit with your personal and professional goals.

I’m looking for intellectual curiosity and ways in which that may have driven somebody over the course of their educational experiences. I’m really looking to learn more about people in a personal statement. I care deeply about where people come from and what they’re like. The degree to which you can get that out of a personal statement, and communicate that in a personal statement, is quite a challenge. The best personal statements do all of that.

What is something applicants do that you find unhelpful?

Applicants often start with a patient experience to frame their desire to go into hematology or oncology from a clinical lens. It’s not a bad way to structure a personal statement—you can use a case to highlight all the things I talk about&mdash;but to use a case and say that was one’s inspiration for going into oncology without then providing the vision is probably not going to serve you best.

How important is a desire to do research?

We’re looking for fellows who want to do research in the lab, in the clinical environment, in global health. We want fellows to do research to cultivate that intellectual curiosity, because intellectual curiosity is so fundamental in clinical practice, in developing new research questions, and applying research to clinical questions. That’s a key element to what makes us good physicians.

What’s great about living in San Francisco?

The best part about the Bay Area, in my mind, is the appreciation of diversity and people’s unique differences. The Bay Area is a place where people are genuinely inclusive and, were it not for cost-of-living concerns, it’s the kind of place where anyone can make a home and feel accepted.

It’s a place that’s rich in cultural resources and natural resources. It’s a great place if you love the outdoors. It’s a great place if you love cities. It’s awfully nice to know that you [could] come here and have a cultural home and feel accepted.

What’s great about being a fellow at UCSF?

It’s a large, public institution that is committed to excellence. It’s a place where we are committed to professionalism, respect, inclusiveness, and diversity. It’s a place where visionary people can come and use the resources and commitments of this institution to build something new and different. It’s a place that’s truly forward thinking and prizes intellectual curiosity and vision.

I love that we’re a big university supported by the state of California that’s responsible to the people of California and to this country. There’s a mindset here that your work is supposed to contribute to the greater good.

Like all fellowship directors, Gerald Hsu, MD, PhD, is looking for applicants with intelligence, ambition, and a desire to advance cancer research and clinical care. 

March 2020

Overcoming Burnout as an Oncology Fellow

Pursuing an Oncology Fellowship Overseas

Oncology Fellows: Making the Right Decision About Your Future

Oncology Fellows: Reminding Ourselves of How Far We've Come

Oncology Fellowship Director Discusses His Recruitment Principles