Postgraduate fellowship training is an essential cornerstone in medical training.
Arnon Lavi, MD
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:
Results from several North American surveys reported similar arguments for pursuing a fellowship among residents and fellows.1,2
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.