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Navigating the gray zone and defining a fellows job
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Have you ever thought about what a fellow’s responsibility is? What is our role in a clinical team?
I have always conceptualized this stage of my career as a gray zone. You are not completely in charge and you are usually not the main caregiver for the patient; that’s the intern’s or resident’s job. I can’t tell you how many times I stayed in the Critical Care Unit doing nothing but figuring out when was the appropriate time for me to leave. Residents can sense our confusion because we start asking them repeatedly: Is there anything that I can do to help out? At 5 p.m. that is not just a question; it is an encrypted message that means “I am out of here.”
I decided to non-scientifically investigate this topic by talking to different people in our program: medical students, interns, residents … really, what do you expect from a fellow?
Phil Gray, a 4th year medical student, probably gave me the best answer of all: “I expect a fellow to know how to read an ECG.” The answer may seem naïve, but I think he meant more than just reading the actual ECG; medical students expect our support and visualize us as a practical learning resource. They may perceive us as more approachable than an attending physician; from a teaching perspective, we should take advantage of that.
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Clarissa Barnes is an intern at Hopkins. When posed with the same question, she said, “When it comes to the care of a patient, I expect the fellow to know the big picture.” Interns are extremely busy checking all the boxes on their to-do list. Our job is to stop them once in awhile and change their perspective for a few minutes. What do you think is going on with this patient? What are the possible outcomes? What is the long-term treatment?
Mosi Benet, a 3rd year resident, will start his cardiology fellowship at the Cleveland Clinic next July. Mosi expects to be available 24 hours to help out and answer questions. “A resident should never hesitate to call a fellow in the middle of the night if he or she feels uncomfortable dealing with a clinical situation,” he told me. “I would rather work with a hands-on fellow.”
The bottom line is that we have to communicate more with team members and realize different people may expect different things from us. I have always judged my performance based on my perception of what a fellow’s role should be; because of that, I bet I disappointed some team members in the past. Do not make the same mistake. The next time you find yourself wondering what your role is or what is expected from you, my advice to you is just ask.
For more information:
- Juan Rivera, MD, is a Fellow at the Johns Hopkins Ciccarone Center for Prevention of Heart Disease and a Member of the Cardiology Today Fellows Advisory Board. He also writes a cardiovascular prevention blog for Hispanics called Corazon Hispano. The blog can be viewed at: corazonhispano.blogspot.com.