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.

Third, in addition to attending some of the major national and international meetings in AML and MDS that are important for my research interest, I also try to attend one of the smaller regional meetings that summarizes the most important presentations in the international meetings of oncology and hematology. For example, both ASCO and the American Society of Hematology (ASH) organizes several condensed regional “highlights” meetings in different cities throughout the year to print the information to a wider audience of oncologists and hematologists who might not have the chance to attend the main meetings. Some of these highlights of ASH and ASCO meetings are being conducted internationally as well. Many institutions, societies, and agencies also conduct their own “board-review” courses or conferences in specific areas of oncology, hematology, clinical pharmacology, targeted therapies, immunologic mechanisms, and other disciplines.

These approaches have been most useful to me in keeping current in the oncology and hematology disciplines that are out of the scope of my focused research interest. But I’m sure other fellows have developed other useful strategies. I welcome any suggestions of other approaches to this important challenge that faces most senior fellows in oncology or hematology preparing for academic careers.

Amer M. Zeidan, MD is a clinical hematology/oncology fellow at the Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital in Baltimore, MD. Email: Azeidan1@jhmi.edu.

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As an oncology fellow pursuing an academic career, one of the major challenges Amer M. Zeidan faces is balancing clinical duties and research activities.

How Do I Keep Up With the Literature?

	It has already been 12 years now, but the memory is still as vivid as if it just happened yesterday. I met 8-year-old Abdo as my first assigned patient in my first clinical rotation as a medical student in Jordan. He was lying in a hospital bed with refractory metastatic Ewing’s sarcoma that rendered him blind, bed-ridden with massive ascites and craniomegaly. Abdo had failed all conventional therapy and was kept in the hospital for palliative care due to a social situation that prevented his family from taking him home. He used to ask me every day: “When will I be able to see and play with my friends again?” I never figured out the right thing to say. I used to tell him that we needed to get him stronger first. His mother would listen to our conversation with silent tears running down her cheeks. I always wondered how you can tell an 8-year-old kid that he was dying and that all we could do was to make it as painless as possible.

	But I also had a newbie medical student’s unconfessed illogical hope that one day I would come to his room and find him miraculously cured. He used to wait eagerly for me to come to his room, as I found out he loved Snickers bars and would bring one with me each time I visited him. One day I came to his room with his favorite candy bar in hand, but his bed was empty. The cold truth struck me, the miracle had not happened and Abdo had died the night before. That night I realized that curing cancer would be my life calling.

	Twelve years passed quickly, and I joined the hematology/ oncology fellowship program at Johns Hopkins in Baltimore. Approximately 8 pm in a cold winter night, I was finally getting ready to go home after another long, exhausting day in the busy leukemia ward. Just as I was about to leave, I was paged by a nurse saying that one of the leukemia patients was crying, and the nurse wondered whether I would talk to the patient or whether she should call the on-call doctor. I was surprised because the patient had been always very cheerful and upspirited during the 3 weeks I knew her in the ward. She was a 21-year-old college student on an experimental protocol for acute myeloid leukemia that was refractory to 3 different induction regimens. I always admired her bravery, as she smiled and joked with us all the time, despite being very well aware of her dismal prognosis. I went to check on her and found her in tears. Being confined in the hospital for such a long period in an isolation room, missing being out with her friends in New York City, and the reality of her disease had all caught up with her. I sat down and we began chatting. I only remember a few of the things we talked about, including her leukemia, the TV show “Friends,” skydiving, and many other things. By the time I left her room at about 11 pm, she was back in her cheerful mood; and I do not think I’d ever felt more energized or refreshed in my life. Soon after that night, she was discharged to undergo a stem-cell transplant in her home city. Two months later, her father called to thank those who took care of his daughter and to inform us that she had passed away peacefully from complications of her disease.

	Many oncology fellows encounter such heartbreaking situations on a regular basis. Despite all the defensive mechanisms we develop subconsciously to prevent ourselves from getting too emotionally involved in these situations, they do not seem to get any easier. I’m sure we’re all asked the common questions, by friends and relatives and from colleagues in other subspecialties: “How can you deal with dying patients on a daily basis without feeling defeated? Don’t you worry that you have failed them by not being able to offer them anything?” Now I know the answer to these questions. I do not need to be giving chemotherapy, experimental agents, and painkillers all the time to be a good oncologist. It turns out that simple things, such as a candy bar and chatting about skydiving, can go a long way to help my patients feel better. As my young patient with leukemia said in the card she sent me before she died: “It was so reassuring for me to know that someone was genuinely concerned with seeing me through this, and giving me the strength to keep going. Someone that would always support me on my good days, and respond to my concerns on my bad days.” Now I really know why it is so gratifying to be an oncologist. Not only because we get to help cure many patients, but also because we are so fortunate to have the ability to help ease the journey of those who are not cured.

Amer Zeidan, MD is a clinical hematology/oncology fellow at the Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital in Baltimore, MD.

This author shares patient experiences that have taught him how much an oncologist offers, beyond chemotherapy.

Amer M. Zeidan, MD

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