Physicians are familiar with the 5 stages of grief: denial, anger, bargaining, depression, and acceptance. 

Dealing with conference abstract notifications follows a similar path: disbelief upon receiving the automated email, excitement about being selected for an oral presentation, anxiety about the road ahead, and finally, of course, success.

The anxiety phase is understandable because a successful oral presentation requires both high-quality content and high-quality delivery. The former can be stressful because you need to summarize your research accurately yet concisely. The latter can be stressful particularly for trainees presenting their research to an audience of more experienced clinician-investigators.

Luckily, as the great Louis Pasteur, PhD, once said, “Fortune favors the prepared mind.”

 Breaking down your oral presentation into specific content-related and delivery-related domains can help you remember what to rehearse and what to include—not just before and during your presentation, but also after. (

: When preparing your slide deck, your research is the star. Don’t waste the audience’s time on anything else. After your title slide, your second slide should include your conflicts of interest even if you don’t have any; it’s good practice for the future and will help prevent you from becoming an unfortunate statistic.

 Slides 3 and 4 should briefly introduce the rationale for your study. It can be tempting to pour more information into this section because you know the subject area so well, but keep in mind that your audience does too.

Consider putting your Twitter handle on your first slide, if not the footer for every slide (register for a Twitter account if you haven’t already). Much of the dialogue at scientific meetings now takes place via Twitter, and you should be there to see and own your narrative.

: This is what the crowd has come to see, even if it’s 7:30 am on a weekday after festivities the night before. Remember to devote at least 1 slide each to your objectives, design, results, and discussion. In your discussion, be sure to comment on the strengths and weaknesses of your study. No study is perfect, and your audience will surely ask about those important points during the Q&A session.

In the rush to deliver results, many presenters make the mistake of glossing over study methods. Don’t. Your audience will want to know whether your results are generalizable to the patients they treat or the research they conduct. Better to include some detail in your slides, even if you don’t read every word out loud, because you will definitely be asked about it during the Q&A.

: This part tends to go smoothly. Include a slide with future directions and conclusions, and then a slide listing your acknowledgments. You should thank your mentor first but be sure to thank your collaborators behind the scenes: labs you worked with, biostatisticians you conferred with, or training grants or career development awards that helped fund your study. After this slide, you can consider appending some supplemental slides with graphics (eg, actual blot results or extra Kaplan-Meier curves) if you think they may come up in the Q&A. No need to make them fancy or to add too much text—these slides only need to see the light of day if someone asks about them.

: Don’t forget about the usual tips for any PowerPoint presentation—brief bullets, readable font sizes, understandable graphics, etc.

 Be the change you wish to see in the world and avoid the dreaded, “I know you can’t read this slide, but…” disclaimer.

: Rehearse your slides out loud and ideally in front of others. A good rule of thumb is to spend 30 to 60 seconds per slide. If you need more time, you probably have too much content on that slide.

: Time to show off! You are the expert in the room. Try to minimize slide animations, which can be distracting and can thwart an audience member trying to take a picture of you and your full slide. Never rely on a laser pointer. It might not work when you’re up on stage, and you will invariably have to choose between the screen on your left versus your right. If something is truly worth highlighting, do so with bolded/underlined text or with arrows.

: During the Q&A, look for friendlier questions from the moderators and then the occasional questions that are actually comments. Try rehearsing your use of stock answers such as, “We hadn’t thought of that, but I can look into it and get back to you.” Or, “We don’t think that X will negatively affect our data, but it’s a very important consideration for the field to be aware of.” Resist the urge to argue with someone who questions your results. Your abstract has already won the day by being accepted, and that audience member may well be the reviewer for the manuscript coming down the line.

: Finally, a couple helpful tips for presenting your slides:

• Prioritize looking at the audience instead of reading off your slides.

• Try to avoid unfamiliar abbreviations or idioms. Your audience may pronounce terms differently or may not know what the metaphorical “elephant in a room” is.

And there you have it: a structured guide to giving your first oral presentation at an academic conference. It’s a lot of work but also a lot to be proud of once the dust settles. Good luck!

1. Palmore TN, Henderson DK. Fortune favors a prepared health care system. 

. 2012;156(1):54-55. doi:10.7326/0003-4819-156-1-201201030-00011

2. Boothby A, Wang R, Cetnar J, Prasad V. Effect of the American Society of Clinical Oncology’s conflict of interest policy on information overload. 

. 2016;2(12):1653-1654. doi:10.1001/jamaoncol.2016.2706

3. Alexandrov AV, Hennerici MG. How to prepare and deliver a scientific presentation. 

. 2013;35(3):202-208. doi:10.1159/000346077

4. Blome C, Sondermann H, Augustin M. Accepted standards on how to give a medical research presentation: a systematic review of expert opinion papers. 

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5. Giagounidis A. Editor’s corner: don’t forget to KISS your audience! ASH Clinical News. Published February 1, 2020. Accessed April 9, 2020. bit.ly/3d1X3J5

Articles

Breaking down your oral presentation into specific content-related and
delivery-related domains can help you remember what
to rehearse and what to include.

 Prepping for Your Invited Oral Presentation

The first Wednesday of December is a significant date for eager physicians seeking fellowship positions via the National Resident Matching Program. On this day in 2019, 567 successful candidates representing 75% of total applicants were selected as hematology and oncology fellows across 143 programs registered with the Accreditation Council for Graduate Medical Education.

Program-level data show that approximately half of new fellows will train at private hospital systems and half at government-affiliated institutions.

 Most government-affiliated training programs operate in conjunction with state universities or county hospitals. Although many fellows will rotate through US Department of Veterans Affairs facilities, only 3 combined hematology and oncology programs are administered directly through the federal government: the National Institutes of Health (NIH) Clinical Center (CC), the National Capital Consortium at Walter Reed National Military Medical Center, and the San Antonio Uniformed Services Health Education Consortium. Part of the US Department of Health and Human Services, the NIH offers civilian fellowship positions; the others exclusively train commissioned military officers. 

The NIH program is unique among fellowship programs, with roughly 1 in 3 NIH oncology fellows electing to continue federal employment beyond training. Given the limited exposure of most trainees to the significant role of the federal government in cancer research and drug development, it is important to consider how to attract talented new graduates to civilian careers in government service.

From 1950 to 1973—and corresponding to the wartime periods in Korea and Vietnam—an amendment to the Selective Service Act colloquially known as the Doctor Draft brought the best and brightest to the NIH CC to train as physician-scientists through the NIH Associate Training Program (ATP).

 The ATP produced a generation of faculty who later spread across the country as leaders in their respective fields. The majority of ATP affiliates entered academic medicine and were more likely to achieve professional success as full professor, department chair, or dean relative to their nonaffiliate peers.

 ATP affiliates accounted for 9 Nobel laureates and 10 recipients of the National Medal of Science between 1985 and 2007.

The “Doctor Draft” was suspended in 1973, and the ATP closed in 1992 following a shift in NIH funding to a system of extramural grants.

Today, the NIH Intramural Research Program (IRP) remains fertile ground for investigators to launch a professional career. The modern IRP is a sprawling biomedical science institution and employs approximately 1200 principal investigators across the 27 institutes and centers that comprise the NIH. The National Cancer Institute (NCI) is the largest NIH member and employs approximately 79 medical oncologists.

Located within a 310-acre campus in Bethesda, Maryland, the NIH CC is the world’s largest clinical research hospital and provides care gratis to patients with cancer via research protocols funded by the NCI and National Heart, Lung, and Blood Institute. Of the more than 600 oncology-related studies that are currently active at the CC, many are first-in-human trials of investigational anticancer therapies.

Housed at the CC, the NCI’s Center for Cancer Research seeks to attract ambitious junior investigators through the Physician-Scientist Early Investigator Program (formerly the Clinical Investigator Development Program) and the Lasker Clinical Research Scholars Program. The Early Investigator Program provides 3 to 5 years of funding, lab space, and mentoring to support early career independent research.

 Lasker scholars receive tenure-track appointments with the potential for 10 years of funding.

 The federal government offers generous benefits to recruit and retain talent including comprehensive health care, employermatched retirement contributions, and a defined-benefit pension program. Up to $50,000 of annual student loan debt forgiveness is available through the NIH Loan Repayment Program.

 The NIH also supports a work-life balance with programs promoting wellness, continuing education, and family care.

Part of the NCI’s extramural program, the Cancer Therapy Evaluation Program (CTEP) funds and organizes an extensive network of cancer research and clinical trials to evaluate new anticancer agents.

 CTEP physicians oversee both the Experimental Therapeutics Clinical Trials Network and the National Clinical Trials Network Program.

 At CTEP’s Investigational Drug Branch, medical officers work as a conduit between academic investigators and pharmaceutical companies to produce clinical development plans for CTEP agents.

 Medical officers review letters of intent for proposed clinical trials, prioritize the proposals, and supervise the protocol writing process. CTEP, not the study investigator or pharmaceutical company, assumes regulatory responsibility for each trial. 

Located at NCI’s Shady Grove campus in Rockville, Maryland, CTEP employs oncologists in all stages of their career. CTEP staff are afforded protected professional development time, and many participate in patient care and fellow education at the NIH CC. 

Located in Silver Spring, Maryland, the FDA is the executive agency responsible for the oversight of more than 20,000 FDA-approved prescription drug products, 400 FDA-licensed biologics products, and 6500 medical device product categories.

At the FDA’s Center for Drug Evaluation and Research (CDER), 33% of the agency’s $5.7 billion budget is dedicated to the regulation of human drugs.15 As part of CDER’s Office of New Drugs, the Office of Oncologic Diseases (OOD) oversees development, approval, and regulation of drug and biologic treatments for cancer and hematologic malignancies. OOD is currently staffed by more than 130 physicians, scientists, and regulatory project managers across 3 solid tumor divisions and 2 malignant hematology divisions.

FDA physicians work collaboratively within disease-focused teams to review investigational new drug applications, new drug applications, and biologic licensing applications required to safely conduct clinical trials and bring new therapies to market.

FDA physicians work in a multidisciplinary setting with experts from chemistry, manufacturing, pharmacology, toxicology, statistics, labeling, safety, and many others to evaluate each new drug’s potential benefits and risks. In the postmarket setting, the FDA continues to provide ongoing safety oversight for drugs following the initial approval process.

The Oncology Center of Excellence (OCE) was authorized by the 21st Century Cures Act, signed into law on December 13, 2016.

 Officially established in January 2017, the OCE leverages the combined skills of regulatory scientists and reviewers with expertise in drugs, biologics, and devices. The OCE works with centers and offices across the FDA to expedite the development of oncology and hematology medical products and supports an integrated approach in the clinical evaluation of new cancer therapies. With a mission to achieve patient-centered regulatory decision-making through innovation and collaboration, the OCE has launched many new initiatives, including Project Socrates, Project Facilitate, Project Community, Project Orbis, and Project Renewal.

The FDA seeks motivated graduating fellows interested in cutting-edge hematology/oncology, clinical trial design, and the regulatory science of drug development.

 Richard Pazdur, MD, the director of OCE, encourages a culture of academic leadership and professional development. Physicians at the FDA publish original research and present at national conferences.

 They organize workshops and symposia where thought leaders and regulators work together to engage the community and incorporate the voices of patients and physicians into trial design. Those interested in continuing clinical practice can do so as part of their professional development. The FDA also offers a strong federal benefits package for qualified candidates.

Excluding government employees, the current US hematologist/oncologist workforce is estimated at more than 12,000 physicians providing care across 2200 practices.

 Although the number of oncologists employed in federal agencies is small in comparison, the impact of their work is significant. Benefits like insurance, retirement, and leave are relatively standardized across these federal jobs, and compensation is variable but generally in line with academic university employment.

A starting position in the federal government does not mean closing the door on clinical medicine. Oncologists at the NIH and FDA continue to see patients and have successfully returned to patient care–focused roles after starting their careers in government. For those who choose to develop their career at the NCI or FDA, they will gain experience in clinical trials and drug development, which is highly desired by academic cancer centers and the pharmaceutical industry. 

Graduating fellows seeking a rewarding and intellectually challenging career on the frontier of cancer drug development would be well served to consider a position of federal service at the NIH or FDA.

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

The authors acknowledge the Intramural Research Program of the Center for Cancer Research, the National Cancer Institute, the National Institutes of Health, and the Oncology Center of Excellence at the FDA for support in the production of this article. The authors also acknowledge the editing contributions of Bonnie L. Casey.

Results and data: specialties matching service 2019 appointment year. National Resident Matching Program; 2019. Accessed May 12, 2020. https://www.nrmp.org/fellowship-match-data/

Accreditation Council for Graduate Medical Education (ACGME) – Public. Accreditation Council for Graduate Medical Education. Accessed January 22, 2020. bit.ly/2A2Ardf

Park BS. The development of the intramural research program at the National Institutes of Health after World War II. 

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Khot S, Park BS, Longstreth WT Jr. The Vietnam War and medical research: untold legacy of the U.S. Doctor Draft and the NIH “Yellow Berets.” 

. 2011;86(4):502-508. doi:10.1097/ACM.0b013e31820f1ed7

NobelPrize.org. All Nobel Prizes in physiology or medicine. Accessed May 12, 2020. https://www.nobelprize.org/prizes/lists/all-nobel-laureates-in-physiology-or-medicine  

Clinicaltrials.gov. Accessed May 12, 2020. https://clinicaltrials.gov/

Physician-scientist early investigator program at CCR. Center for Cancer Research. Accessed May 12, 2020. https://ccr.cancer.gov/careers/research_faculty/ccr_physician_scientist_early_career_program

Lasker clinical research scholars. National Institutes of Health. Accessed May 12, 2020. https://www.nih.gov/research-training/lasker-clinical-research-scholars

Supporting scientific discovery. National Institutes of Health. Accessed May 12, 2020. https://www.lrp.nih.gov/

Work/life balance. Center for Cancer Research. Accessed May 12, 2020. https://ccr.cancer.gov/careers/benefits/work-life 

CTEP cancer therapy evaluation program. Accessed May 12, 2020. https://ctep.cancer.gov

NCI Experimental Therapeutics Clinical Trials Network (ETCTN). CTEP Cancer Therapy Evaluation Program. Accessed May 12, 2020. https://ctep.cancer.gov/initiativesPrograms/etctn.htm

An overview of NCI’s National Clinical Trials Network. CTEP Cancer Therapy Evaluation Program. Accessed May 12, 2020. https://ctep.cancer.gov/initiativesPrograms/nctn.htm

Investigational Drug Branch (IDB). CTEP Cancer Therapy Evaluation Program. Accessed May 12, 2020. https://ctep.cancer.gov/branches/idb/default.htm

Fact sheet: FDA at a glance. FDA. Updated October 18, 2019. Accessed May 12, 2020. https://www.fda.gov/about-fda/fda-basics/fact-sheet-fda-glance

Office of Oncologic Diseases (OOD). FDA. Updated November 4, 2019. Accessed May 12, 2020. https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/office-oncologic-diseases-ood

Investigational new drug (IND) application. FDA. Updated May 12, 2020. Accessed May 12, 2020. https://www.fda.gov/drugs/types-applications/investigational-new-drug-ind-application#Introduction

New drug application (NDA). FDA. Updated June 10, 2019. Accessed May 12, 2020. https://www.fda.gov/drugs/types-applications/new-drug-application-nda

Therapeutic biologics applications (BLA). FDA. Updated February 24, 2020. Accessed May 12, 2020. https://www.fda.gov/drugs/types-applications/therapeutic-biologics-applications-bla

 IND application reporting: safety reports. FDA. Updated October 9, 2015. Accessed May 12, 2020. https://www.fda.gov/drugs/investigational-new-drug-ind-application/ind-application-reporting-safety-reports

Oncology Center of Excellence. FDA. Updated March 23, 2020. Accessed May 12, 2020. https://www.fda.gov/about-fda/fda-organization/oncology-center-excellence

 OCE annual report. FDA. https://www.fda.gov/about-fda/oncology-center-excellence/oce-annual-report. Updated February 4, 2020. Accessed May 12, 2020.

 Project Socrates. FDA. Updated January 29, 2020. Accessed May 12, 2020. https://www.fda.gov/about-fda/oncology-center-excellence/project-socrates 

 Project Facilitate. FDA. Updated April 27, 2020. Accessed May 12, 2020. https://www.fda.gov/about-fda/oncology-center-excellence/project-facilitate

FDA’s external engagement and patient advocacy: a dialogue to better inform FDA of needs and priorities. FDA. March 15, 2019. Accessed May 12, 2020. https://www.fda.gov/media/122690/download

 Project Orbis. FDA. Updated September 17, 2019. Accessed May 12, 2020. https://www.fda.gov/about-fda/oncology-center-excellence/project-orbis

 Project Renewal. FDA. Updated February 6, 2020. Accessed May 12, 2020. https://www.fda.gov/about-fda/oncology-center-excellence/project-renewal

 Jobs at CDER: cutting-edge hematology/oncology opportunities. FDA. Updated November 15, 2019. Accessed May 12, 2020. https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/jobs-cder-cutting-edge-hematologyoncology-opportunities

 Gao JJ, Cheng J, Bloomquist E, et al. Benefit of CDK 4/6 inhibition in less common breast cancer subsets: a U.S. Food and Drug Administration pooled analysis. 

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 Jobs and training at FDA. FDA. Updated November 19, 2019. Accessed May 12, 2020. https://www.fda.gov/about-fda/jobs-and-training-fda

 Kirkwood MK, Hanley A, Bruinooge SS, et al. The state of oncology practice in America, 2018: results of the ASCO practice census survey. 

2018;14(7):e412-e420. doi:10.1200/JOP.18.00149

 Physician. USAJOBS. Accessed May 12, 2020. https://www.usajobs.gov/GetJob/ViewDetails/544721600

Feature Article

Peter J. DeMaria, MD and Jennifer J. Gao, MD shed light on how graduating fellows seeking a rewarding and intellectually challenging career on the frontier of cancer drug development could be well served to consider a position of federal service at the NIH or FDA.

Career Options for Graduating Oncology Fellows at the NIH and FDA

Increasingly, patients are asking oncologists for guidance and recommendations for the use of medical marijuana (MM). Physicians, too, are looking for advice, particularly since much of the information out there is ambiguous such as, “It seems like there is some evidence that MM can be helpful in certain situations, but we just don’t have enough information to be certain.” 

In the field of oncology, specifically, MM has a special place of interest with its potential for symptom management and palliation. Anecdotal evidence suggests that MM can alleviate pain, nausea, and loss of appetite—common adverse effects for patients undergoing cancer treatment. 

Patients are looking to their providers for answers on MM. Providers, in turn, are looking to their affiliations and governing bodies to fill in the knowledge gaps. However, finding those answers is challenging because of the federal government.

Cannabis plants are believed to have evolved in central Asia roughly 12,000 years ago. In the years since, marijuana has become the most widely produced and used illicit drug worldwide.

 In the United States, however, cannabis wasn’t widely used for recreational purposes until the early 20th century. 

The Marihuana Tax Act of 1937 imposed taxes and other administrative burdens on recreational and medical uses of cannabis in the United States. The Supreme Court struck down the Marihuana Tax Act in 1969. Congress subsequently enacted the Controlled Substances Act of 1970, which, among other things, classified marijuana as a schedule I controlled substance. To be categorized as a schedule I, a drug must have high potential for abuse, no accepted use in medical treatments, and a lack of accepted safety for use of the drug under medical supervision.

There is, however, a history of using marijuana as a medicine. Medicinal marijuana is whole, unprocessed marijuana or its basic extracts formulated to treat symptoms of illness or other conditions. Cannabis extracts were used to relieve stomach pain and vomiting in patients suffering from cholera, rabies, or tetanus as early as the 1800s.

 Today, marijuana and cannabis extracts, both synthetic and natural, have a handful of FDA-approved uses approved including chemotherapyinduced nausea and vomiting, the treatment of anorexia associated with weight loss in AIDS, and seizures.

These approvals evolved from state initiatives to legalize the medicinal use of marijuana. California was the first state to legalize marijuana for medicinal use when voters approved Proposition 215, the California Compassionate Use Act, in 1996. Despite being illegal at the federal level, at the time of this writing, MM in various forms and for a preponderance of indications is now legal in 33 states—with 47 states allowing use of hemp-derived cannabidiol products with less than 0.3% THC Δ9-tetrahydrocannabinol.

Figure 1. Marijuana Legalization by State

In one public opinion poll, two-thirds of Americans say the use of marijuana should be legal.

 Most adults (91%) said marijuana should be legal either for medical 

 recreational use (60%) or legal for medical use only (32%). 

At the University of Oklahoma Health Sciences Center, we have conducted 2 studies looking at provider perspectives on MM. The first was a cross-sectional survey of all oncology providers at the Stephenson Cancer Center in Oklahoma City. We identified 119 possible participants and had a response rate of 34%. We found that most providers do have an interest in prescribing MM (70.7%) compared with having no interest or being unsure (30.3%).

Despite the high interest in MM, most (76.9%) said they felt they had insufficient knowledge to recommend it. In 2018, Oklahoma passed new laws allowing prescription of MM, but only 7.5% of providers felt they had comprehensive knowledge of the new laws while 35% felt they had no or limited knowledge of the laws. Many providers were looking toward leadership at the medical center and respective governing bodies to guide their decision making. A majority of providers (82%) reported modest to significant increase in patient interest in being prescribed MM since the new laws took effect.

Providers felt MM had the highest chance of improving symptoms such as poor appetite, nausea, chronic pain, and poor sleep. Nearly half (45%) felt that MM could reduce polypharmacy, and 69% felt MM could be beneficial in decreasing opioid dependency in oncology treatments.

The same group also conducted a national, crosssectional survey of Society of Gynecologic Oncology (SGO) members. A total of 203 SGO members completed the survey, with 80% of respondents reporting modest to significant increase in recent patient interest in MM.

No providers believed that interest was decreasing.

Regardless of whether they practiced in a state with or without legalized MM, providers said marijuana should not be listed as a Schedule 1 drug (

 = .06). A majority (62.3%) said patients or their families usually initiated the conversation about MM. Most members (65.8%) were looking to their professional organizations such as SGO to provide guidance on MM, as 68.2% of providers felt they did not have sufficient knowledge regarding MM to make recommendations for or against its use.

Figure 2. Symptoms SGO Providers Say MM is Useful for Relieving

Again, physicians felt that MM could be beneficial to relieve nausea/vomiting (79.2%), poor appetite (83.4%), pain (74.8%), anxiety (64.1%), and insomnia (60.3%). The majority of providers felt that MM was more appropriate for metastatic or advanced cancer (82.3%) rather than early-stage disease (29.7%). 

These survey results highlight the dire need for more studies to guide the use of MM in patients with cancer. Both studies showed that oncology patients are increasingly interested in using MM for a variety of conditions.

As a result, providers are under increasing pressure to be knowledgeable about the use of MM and its possible adverse effects. However, many providers feel they lack the resources and training to make informed recommendations for or against the use of MM. 

Because laws and approved usage vary from state to state, many oncologists remain hesitant about making recommendations regarding MM. Furthermore, unless marijuana is changed from a Schedule I drug, it will be extremely difficult, if not impossible, to complete highquality clinical studies that will provide the answers oncologists seek.

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5. State medical marijuana laws. National Conference of State Legislators. Published June 25, 2019. Updated March 10, 2020. Accessed March 15, 2020.

6. DISA Global Solutions. Map of marijuana legality by state. Accessed May 27, 2020. disa.com/map-of-marijuana-legality-by-state

7. Daniller A. Two-thirds of Americans support marijuana legalization. Pew Research Center. Published November 14, 2019. Accessed March 15, 2020. https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/

8. Greenwood A, Castellano T, Jordan B, Richardson DL. Perspectives on medical marijuana; a look at Society of Gynecologic Oncology members. Paper presented at: SGO 25th Annual Winter Meeting; February 6-8; 2020; Snowmass, CO.

9. Greenwood A, Castellano T, Jordan B, Richardson DL. Provider perspective on medical marijuana. 

. 2019;153(3):e17. doi:10.1016/j.ygyno.2019.03.145

Increasingly, patients are asking oncologists for guidance and recommendations for the use of medical marijuana. However, finding those answers is challenging because of the federal government.

Why Oncologists Should Know More About Medical Marijuana

Richard J. Bleicher director of the breast fellowship program at Fox Chase Cancer Center in Philadelphia, Pennsylvania, derives great satisfaction from working with fellows and trainees. He likens the experience to being a parent. 

“I just love the teaching. There’s enormous gratification in taking someone who’s interested in a particular area and teaching them what you know and watching them grow and develop,” he said. “You invest in a trainee, and you watch them grow and go out into the world to do what you’ve taught them to do. It’s extraordinarily gratifying.”

Bleicher also serves as a professor in the Department of Surgical Oncology and leads the breast cancer program. Fox Chase is one of just 59 breast fellowship programs in the United States and Canada accredited by the Society of Surgical Oncology (SSO). In addition, Bleicher is chair of the SSO Breast Fellowship Program Directors Training Committee.

He earned his MD at Temple University’s Lewis Katz School of Medicine in Philadelphia and did his fellowship at the John Wayne Cancer Institute in Santa Monica, California. Bleicher returned to his native Philadelphia to work at Fox Chase about 14 years ago, and he’s directed the breast fellowship program for the past 10. He unabashedly loves his job.

“You need to have a special, caring personality type to go into oncology because it’s a difficult field, and the actual clinical care cannot be separated from the emotional aspect that cancer care requires,” Bleicher said. “The personality type—[an appreciation for] the multidisciplinary nature, the affinity and love for fellow human beings—is common throughout the oncology specialties and, for the 14 years I’ve been at Fox Chase, has been completely ingrained in the atmosphere. The patients see it, they comment on it, and it’s something that makes the job very, very enjoyable.”

Bleicher talked with Oncology Fellows about the  importance of working closely with a mentor, avoiding burnout, and what to do if your interests change during your fellowship.

With the benefit of hindsight, what do you wish you had known going into fellowship?

: You should try to formulate an idea of what you want to get out of fellowship before you start. Everybody says they want to get a good job or absorb a lot of knowledge, but there are a lot of things that can influence what you absorb during training and a lot of things you may not necessarily focus on in fellowship but that you might want to have exposure to…It’s helpful if you develop a relationship with a mentor and talk out your short- and long-term goals with them. This will help you develop a sense of career objectives and interests beyond the specifics of job opportunities that become available. All these things are important to flesh out in advance and can be done with a mentor even before fellowship, while you’re in residency. 

It’s important to get as much of a sense of your personal goals as your career goals because they interact. It’s particularly important to look for mentors during your fellowship who will help you flesh out those goals. Fellowship is very short. The things that you may want to learn or focus your time on might be different if you want to go into academics versus private practice or want to be an administrator versus a clinician providing patient care. 

Your mentor or program director needs to know those details so they can tailor your exposure during training and maximize your likelihood of success. Your motivations, your goals, your concerns, even your fears, are specifics that can be helpful to talk out with a mentor. As you go through fellowship, your faculty will usually help you gain exposure based upon these details, and a good mentor will prioritize these areas. One of the things I was always told as a fellow is that your “report card” is what you accomplish, get exposure to, and gain knowledge about. That report card? It’s up to you to fill it. But you can ask for guidance in doing so.

Did your interests change during fellowship?

Completely. I did a surgical oncology fellowship, and when I went into it, I thought was interested in GI [gastrointestinal] cancer. As I continued through fellowship, my interests shifted into breast cancer. I felt that it was my own responsibility to figure out what to do with my life and what my interests were, and to try, at the same time, to fulfill my commitments. I felt that everything was on my shoulders, and I didn’t think that faculty would play any major role in that. So I didn’t go to my mentors as often as I should have to get feedback and help. 

Throughout your training, you’re influenced by your own personal interests, the cases you’re exposed to, the faculty who train you, the mentorship you’re given, and the research you do. All these things shape your interests and steer your path forward. Most people’s path to what they do eventually is not a straight line; it’s a winding road.

What did you have to learn when you went into the job market?

What I used to tell fellows when I was a chief fellow and what I tell my trainees now is, “We may tell you that your job is going to be 80% clinical and 20% research when, in fact, it’s going to be 20% clinical and 80% politics.” There are always political aspects that you can’t know about until you are knee-deep in your job. There are human resources nuances that you can only learn on the job because every job is different. These include how specific people interact, what they’re sensitive to and what their biases are, the politics of the institution, who is the gatekeeper for things that you want to get done, and many other behavioral oddities. And this isn’t isolated to medicine. This is true of every job on the planet. 

As a fellow or as a trainee, you’re usually shielded from the politics and the human behavior and even some of the more difficult relationship skills that you need to develop at work to get things done in whatever role you’re in. You can’t possibly know that before you start your job. A good mentor during fellowship with whom you have bonded can sometimes help you from a distance after you enter the job market or at least give you advice for a while after you start. And then sometimes you’re able to develop a relationship with a faculty colleague as staff mentor who can help you at your first job. Certainly, fellowship mentors often help long term with clinical questions or advice even many years after training. 

First of all, it’s important for the program director to know if you have personal situations that foster burnout. Faculty are pretty understanding. There are expectations of every job, including fellowship, that have to be accomplished. But if your faculty and program director are aware of these situations, they can usually provide advice or, in extreme situations, make accommodations. 

That said, you as a fellow are the only person who’s going to know what you’re capable of doing. You need to estimate your own abilities realistically. Fellows frequently try to take on too many things because we’re all idealistic and new projects are always interesting. However, the reality is that you can only accomplish a certain number of things in a given amount of time. You have to be honest with yourself about what you can accomplish. This also may require a frank discussion with your mentor and/or program director. A good mentor will always be willing to have those discussions with you.

Richard J. Bleicher, MD, discusses the importance of working closely with a mentor, avoiding burnout, and what to do if your interests change during your fellowship.

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