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    Clinical Fellowship: It’s all in the delivery

    "Do not study to pass the test. You study to prepare for the day when you are the only thing between a patient and the grave." -- @medicalaxioms

    I started writing this blog more than a handful of times. Each time, I stopped after a few sentences because I wasn’t satisfied. It didn’t feel right. It was coarse and floundering, so I started again. Now 2 months into my maternal-fetal medicine fellowship, I realized the reason I was not compelled to submit is because I was not able to translate the fellowship experience into words.

    Fellowship is defined as a relationship among a group of people who have similar interests, be it clinical or research—an interdependent relationship at that. Pragmatically, fellowship is a means to become a subspecialist and it sure sounded like a nerdy and heavenly academic safe space; so, sign me up! I chose to complete a fellowship because I wanted to be comfortable taking care of the most medically complicated women during pregnancy. I wanted to viscerally understand the underlying molecular mechanisms of maternal physiology related to pregnancy, and honestly, I wanted to be really good at doing that amongst colleagues in the same pursuit. I yearned for an intellectually inspiring clinical family.

    Here is the thing nobody tells you: Fellowship is oftentimes awkward, at times quite lonely, and usually (to some level) pretty self-directed. At the beginning, you feel like a house guest, an awkward one at that. Not quite a resident, not quite faculty, a communication intermediary who is always lurking and stalking the clinical mysteries on the floor, ready to discuss a topic and happy to share the most recent article of interest with anybody even mildly willing to listen. As a fellow, you’re neither here nor there. You are the new kid on the block who does things just a bit differently, but enough for them to know you are not “one of us.” The nurses aren’t quite sure what to make of you and the faculty practice susses out if they can trust this young new grad in their turf.

    Having spent a handful of years as a graduate student, I appreciate and understand self-directed learning, but fellowship is different: Overnight, you must transform from a regimented resident into a wanderlust scholar on a mission that you define. Growing up, I imagined myself as the next Indiana Jones or Jane Goodall, a visionary explorer inspired by intense curiosity for the world and driven by a thirst for discovery. My life experiences have shaped and cemented this desire. However, I resolved to pursue discovery closer to home; I became a fellow. “Discovery awaits,” I told myself as I fervently tried to see the fetal left outflow tract between the 3-vessel cardiac view, knowing that practice makes perfect and hoping that perfection would someday come.

    Next: Pursuit of happiness and success in OB/GYN

    Today I finally submitted this blog because I realized that I made a commitment to become an academician. I was able to open my eyes and realize that fellowship is different than residency because now mentorship goes far beyond the transfer of knowledge and skills. I’ve received showers of invaluable guidance from mentors and advocates who have inspired me to continue as a teacher and mentor in the future. And here’s the thing, no 2 fellows are the same. Each fellow’s training experience brings to an exciting and constantly changing medical subspecialty a unique voice, one enriched by diverse life experiences.

    Embracing, rather than fighting, the sometimes-haphazard environment of fellowship has helped me realize that it is exactly what I was looking for—a chance to be a researcher, a laborist, and a consultant. I can soak up being an apprentice, learning an art, counseling patients, and performing new procedures. The day-to-day balance is slightly less awkward, more smooth-operator. As a fellow, you are expected to be at all places at all times, yet never running. I have fully accepted that I have 3 fully protected years, each a stepping stone, to become an expert, to reignite my passion for research and for every bit of obstetrics that stole my heart. So here’s to discovering a balance between awkward and contented, becoming a teacher while remaining a student, and finding fellowship in fellowship. Stay tuned. 

    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles

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    • UBM User
      Dr. Afshar's thoughts are all so well expressed that little remains to annotate. Still, the presumptions here are that fellowships are academician training grounds, whereas a large number of my MFM colleagues are working as community resources. In addition, one should note that becoming a fellow in MFM is becoming the obstetrician's obstetrician as well as the intensivist so often imagined MFM-ers to be. A solid clinical background should be sought and a tight adhesion to a clinically competent mentor will allow the (increasingly rare) fellow and post-fellowship physician to be as comfortable in the OR as in the Ivory Tower. Beware of the person who can tell you what to do but not help you do it. Hands are as important to train as heads.

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