- Email: [email protected]
Successfully Pursuing a Nonclinical Mini-Fellowship: Lessons Learned
RESIDENTS’ AND FELLOWS’ COLUMN KRISTINA E. HOQUE, MD, PHD
Successfully Pursuing a Nonclinical Mini-Fellowship: Lessons Learned Ian R. Drexler, MD, MBA, Michael L. Loftus, MD, MBA The ABR’s transition from requiring radiology residents to complete three examinations during their four years of training to requiring that they sit for just a single examination at the end of the third year has led to comprehensive changes in residency programs’ curricula [1-3]. One of the most profound shifts has taken place during the fourth year of residency. Whereas fourth-year radiology residents previously spent much of the year away from clinical services as they prepared for oral boards, they now have a unique opportunity to take an in-depth look into one or more areas of clinical interest. Although some residents see this as an opportunity to devote additional time to the subspecialties they will subsequently pursue as fellows, others choose to broaden the scope of their training by exploring modalities and services they would not otherwise be exposed to during their fellowships [4]. At my institution, the option exists to complete two 4-month-long mini-fellowships during the fourth year of residency. During my third year of training, I realized that this provided a unique opportunity to pursue my health care–related interests outside of radiology. As such, rather than pursuing a standard clinical mini-fellowship, I completed a 4-month-long nonclinical mini-fellowship within the hospital’s Quality and Patient Safety
(QPS) division. Here I propose six steps any resident can take to explore his or her interests outside of clinical radiology, in the context of my own mini-fellowship experience.
1. Seek Departmental and Institutional Support Generating a creative idea for a minifellowship is a fruitless endeavor if you are not permitted to proceed with your plan. Therefore, pursuing a nonclinical mini-fellowship requires the support of your radiology departmental leadership. Be prepared to face pushback, but be clear about your motivations and your intention to work just as hard, if not harder, as you would on a standard clinical radiology rotation. Before deciding on my minifellowships, I opted to meet directly with my department’s chairman to discuss my clinical and nonclinical interests, and he gave my quality and patient safety mini-fellowship idea his full support. A nonclinical mini-fellowship may also require support from outside the radiology department. If you already have a contact from the department with whom you will be working, you should use that person to help organize your rotation. If you have difficulty making progress, ask your department chair to reach out to his or her colleagues on your behalf. In my case, I needed approval from the hospital’s QPS
ª 2016 American College of Radiology 1546-1440/16/$36.00 n http://dx.doi.org/10.1016/j.jacr.2016.06.024
division, so I e-mailed the head of that division to arrange an introductory meeting.
2. Set Goals and Expectations It is important to have a framework in mind when starting any mini-fellowship, whether you are doing a standard subspecialty mini-fellowship or a nonclinical mini-fellowship in hospital administration. You must have clear objectives and a way to evaluate your own progress throughout the minifellowship. To start, make an outline of the goals you hope to achieve, and set specific tasks to complete along the way. Create a rough draft of what you envision your mini-fellowship might look like, and bring it with you whenever you meet with faculty members to plan the mini-fellowship. Once you have created a more formal vision for your experience, consider creating a charter that clearly outlines your goals, objectives, and measures of success. Having multiple deliverables throughout the mini-fellowship will not only keep you motivated but also will provide objective criteria by which you can be assessed when the mini-fellowship has ended. As an example, this paper was a formal part of my mini-fellowship’s expectations and is something I worked on throughout my mini-fellowship.
1
3. Make Yourself a Part of the Team Pursuing a nonclinical minifellowship can be difficult simply because you are putting yourself in a role that has never existed. Many institutions may have never had such an intern before and would not know how to incorporate you into your division of interest. Thus, you need to work directly with the divisional leadership to ensure that you are integrated into the division just as you would expect any other full-time employee to be. Within a week of starting my mini-fellowship, I was introduced to everyone as a member of the QPS team at departmental meetings, which allowed me to meet the people I would be working with. 4. Keep an Open Mind It is important to enter a nonclinical mini-fellowship experience with a positive attitude and an open mind. Although you may have thoroughly planned out your mini-fellowship, you may encounter opportunities you did not expect. Any chance you are given to learn a new skill or gain knowledge should be taken full advantage of. For instance, though I initially planned to focus much of my mini-fellowship work on lowering hospital-associated infection rates, I discovered that I had a passion for regulatory work, which led to my involvement in a mock Joint Commission survey and
subsequently to my participation in an actual Joint Commission survey.
5. Work With Challenges as They Arise Just as you may encounter opportunities you did not know were available, you may also find that some doors you thought were open are actually closed. Indeed, it is inevitable that you will face challenges during your nonclinical minifellowship. It is important that you consider each obstacle as an opportunity for improvement rather than as a dead end. If you cannot address issues on your own, reach out to one of your colleagues or your rotation sponsor, and continue going up the divisional hierarchy until you find someone who can help. When I was inadvertently left off of several divisional e-mails, which made it impossible to ascertain meeting locations, I made a colleague aware of the issue, and it was promptly fixed. 6. Network, Network, Network Within the confines of the radiology department, residents get to know a set group of people: radiologists, technologists, radiology nurses, and departmental managers. With nonclinical mini-fellowships, you have the opportunity to branch out and expand your network. You never know whom you will meet during your time as a mini-fellow or whether a new connection will lead to a future leadership position or even a career opportunity. Although
I was working with the QPS division, I used my mini-fellowship to make connections with people from nursing leadership, medical affairs, and operations, which led to opportunities to participate in several hospital-wide committees.
CONCLUSIONS My time as a QPS mini-fellow was invaluable. Before deciding on doing a mini-fellowship in the radiology subspecialty you will be focusing on for the rest of your practice, consider taking this last opportunity in your training to explore an area of interest outside of radiology, particularly one that will provide you with new skills and knowledge that you can bring with you as you begin your career. No matter what your passion outside clinical radiology, these six steps will provide you with the tools to create a valuable learning experience that will allow you to explore new fields or build on existing areas of interest. REFERENCES 1. American Board of Radiology. Initial certification: diagnostic radiology. Available at: http:// www.theabr.org/ic-dr-landing. Accessed December 30, 2015. 2. Amis ES, Baker SR, Becker GJ, et al. Panel discussions in radiology: changes in radiology training and new examination format. AJR Am J Roentgenol 2008;191:W217-30. 3. Madoff S. Impact of the ABR examination changes on residency. J Am Coll Radiol 2009;6:290-1. 4. Nicholson BT, Sizemore AW, Gay SB. The new radiology residency fourth year under the new curriculum: a survey of current residents’ thoughts and suggestions about its design and purpose. J Am Coll Radiol 2010;7:294-8.
Ian R. Drexler, MD, MBA, and Michael L. Loftus, MD, MBA, are from the Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York. The authors have no conflicts of interest related to the material discussed in this article. Ian R. Drexler, MD, MBA: Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th Street, Floor 8A, New York, NY 10065; e-mail: [email protected].
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Journal of the American College of Radiology Volume - n Number - n - 2016
Successfully Pursuing a Nonclinical Mini-Fellowship: Lessons Learned Ian R. Drexler, MD, MBA, Michael L. Loftus, MD, MBA The ABR’s transition from requiring radiology residents to complete three examinations during their four years of training to requiring that they sit for just a single examination at the end of the third year has led to comprehensive changes in residency programs’ curricula [1-3]. One of the most profound shifts has taken place during the fourth year of residency. Whereas fourth-year radiology residents previously spent much of the year away from clinical services as they prepared for oral boards, they now have a unique opportunity to take an in-depth look into one or more areas of clinical interest. Although some residents see this as an opportunity to devote additional time to the subspecialties they will subsequently pursue as fellows, others choose to broaden the scope of their training by exploring modalities and services they would not otherwise be exposed to during their fellowships [4]. At my institution, the option exists to complete two 4-month-long mini-fellowships during the fourth year of residency. During my third year of training, I realized that this provided a unique opportunity to pursue my health care–related interests outside of radiology. As such, rather than pursuing a standard clinical mini-fellowship, I completed a 4-month-long nonclinical mini-fellowship within the hospital’s Quality and Patient Safety
(QPS) division. Here I propose six steps any resident can take to explore his or her interests outside of clinical radiology, in the context of my own mini-fellowship experience.
1. Seek Departmental and Institutional Support Generating a creative idea for a minifellowship is a fruitless endeavor if you are not permitted to proceed with your plan. Therefore, pursuing a nonclinical mini-fellowship requires the support of your radiology departmental leadership. Be prepared to face pushback, but be clear about your motivations and your intention to work just as hard, if not harder, as you would on a standard clinical radiology rotation. Before deciding on my minifellowships, I opted to meet directly with my department’s chairman to discuss my clinical and nonclinical interests, and he gave my quality and patient safety mini-fellowship idea his full support. A nonclinical mini-fellowship may also require support from outside the radiology department. If you already have a contact from the department with whom you will be working, you should use that person to help organize your rotation. If you have difficulty making progress, ask your department chair to reach out to his or her colleagues on your behalf. In my case, I needed approval from the hospital’s QPS
ª 2016 American College of Radiology 1546-1440/16/$36.00 n http://dx.doi.org/10.1016/j.jacr.2016.06.024
division, so I e-mailed the head of that division to arrange an introductory meeting.
2. Set Goals and Expectations It is important to have a framework in mind when starting any mini-fellowship, whether you are doing a standard subspecialty mini-fellowship or a nonclinical mini-fellowship in hospital administration. You must have clear objectives and a way to evaluate your own progress throughout the minifellowship. To start, make an outline of the goals you hope to achieve, and set specific tasks to complete along the way. Create a rough draft of what you envision your mini-fellowship might look like, and bring it with you whenever you meet with faculty members to plan the mini-fellowship. Once you have created a more formal vision for your experience, consider creating a charter that clearly outlines your goals, objectives, and measures of success. Having multiple deliverables throughout the mini-fellowship will not only keep you motivated but also will provide objective criteria by which you can be assessed when the mini-fellowship has ended. As an example, this paper was a formal part of my mini-fellowship’s expectations and is something I worked on throughout my mini-fellowship.
1
3. Make Yourself a Part of the Team Pursuing a nonclinical minifellowship can be difficult simply because you are putting yourself in a role that has never existed. Many institutions may have never had such an intern before and would not know how to incorporate you into your division of interest. Thus, you need to work directly with the divisional leadership to ensure that you are integrated into the division just as you would expect any other full-time employee to be. Within a week of starting my mini-fellowship, I was introduced to everyone as a member of the QPS team at departmental meetings, which allowed me to meet the people I would be working with. 4. Keep an Open Mind It is important to enter a nonclinical mini-fellowship experience with a positive attitude and an open mind. Although you may have thoroughly planned out your mini-fellowship, you may encounter opportunities you did not expect. Any chance you are given to learn a new skill or gain knowledge should be taken full advantage of. For instance, though I initially planned to focus much of my mini-fellowship work on lowering hospital-associated infection rates, I discovered that I had a passion for regulatory work, which led to my involvement in a mock Joint Commission survey and
subsequently to my participation in an actual Joint Commission survey.
5. Work With Challenges as They Arise Just as you may encounter opportunities you did not know were available, you may also find that some doors you thought were open are actually closed. Indeed, it is inevitable that you will face challenges during your nonclinical minifellowship. It is important that you consider each obstacle as an opportunity for improvement rather than as a dead end. If you cannot address issues on your own, reach out to one of your colleagues or your rotation sponsor, and continue going up the divisional hierarchy until you find someone who can help. When I was inadvertently left off of several divisional e-mails, which made it impossible to ascertain meeting locations, I made a colleague aware of the issue, and it was promptly fixed. 6. Network, Network, Network Within the confines of the radiology department, residents get to know a set group of people: radiologists, technologists, radiology nurses, and departmental managers. With nonclinical mini-fellowships, you have the opportunity to branch out and expand your network. You never know whom you will meet during your time as a mini-fellow or whether a new connection will lead to a future leadership position or even a career opportunity. Although
I was working with the QPS division, I used my mini-fellowship to make connections with people from nursing leadership, medical affairs, and operations, which led to opportunities to participate in several hospital-wide committees.
CONCLUSIONS My time as a QPS mini-fellow was invaluable. Before deciding on doing a mini-fellowship in the radiology subspecialty you will be focusing on for the rest of your practice, consider taking this last opportunity in your training to explore an area of interest outside of radiology, particularly one that will provide you with new skills and knowledge that you can bring with you as you begin your career. No matter what your passion outside clinical radiology, these six steps will provide you with the tools to create a valuable learning experience that will allow you to explore new fields or build on existing areas of interest. REFERENCES 1. American Board of Radiology. Initial certification: diagnostic radiology. Available at: http:// www.theabr.org/ic-dr-landing. Accessed December 30, 2015. 2. Amis ES, Baker SR, Becker GJ, et al. Panel discussions in radiology: changes in radiology training and new examination format. AJR Am J Roentgenol 2008;191:W217-30. 3. Madoff S. Impact of the ABR examination changes on residency. J Am Coll Radiol 2009;6:290-1. 4. Nicholson BT, Sizemore AW, Gay SB. The new radiology residency fourth year under the new curriculum: a survey of current residents’ thoughts and suggestions about its design and purpose. J Am Coll Radiol 2010;7:294-8.
Ian R. Drexler, MD, MBA, and Michael L. Loftus, MD, MBA, are from the Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York. The authors have no conflicts of interest related to the material discussed in this article. Ian R. Drexler, MD, MBA: Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th Street, Floor 8A, New York, NY 10065; e-mail: [email protected].
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Journal of the American College of Radiology Volume - n Number - n - 2016