How to get the most out of your vital capacity during fellowship By Devika Rao Completing three years of pediatric pulmonary fellowship is a long, arduous task, and I was proud to make it through the many anxiety-provoking phases of fellowship and graduate from the pediatric pulmonary program at Boston Children’s Hospital last June. Reflecting upon my fellowship training, I have compiled some advice that I hope will be helpful to other fellows at all stages of their training. 1) Start thinking about research opportunities right away. Seek a project and a mentor that will make you happy. Follow your passion, and then make sure you find the appropriate project and mentor. Talk to many different mentors and “interview” them. Ask them about their strengths, the guidance they can offer, how regularly you will meet, what their expectations are, and if you will be able to publish. 2) Keep a list of interesting patients. You will have lots of presentations to give for the rest of your career, and having cases to illustrate your teaching points will enhance your presentations. Also save interesting radiology/pathology images (after de-identifying them) and interesting PFTs. 3) Seek out interesting patients for your clinic. This is best accomplished when you are on the inpatient or consult service. Keep a stack of your business cards with you and hand them out to families. You are ultimately responsible for your own education, so if you feel like you don’t have enough of a type of patient, then find one, or find someone who can help you find one. If you do this early in your fellowship, you will have the benefit of following these patients for almost three full years. 4) Sit down. When you’re seeing a patient, whether in clinic or in the ICU, find a place to sit down, even if it’s on the edge of the bed. Not only will your patient feel that you are making time for them, but you will also make them feel more comfortable. We spend so much time on our electronic devices and sitting down helps remind us the importance of establishing good rapport with patients. 5) Learn your physiology. Read and study West’s and/or Leff’s book on respiratory physiology. You can always fall back on physiology when you’re trying to figure out a particular case, even if you’re not familiar with the disease process. 6) When you’re frustrated with someone, look for the good. There are very few people in the world who are inherently evil. Yes, this applies even to that attending that seems to disagree with everything you suggest, and to that parent calling you for a prescription refill at 11 PM on a weekend. Take a few deep breaths, and remember the good stuff – that parent ultimately loves their child, and that attending just has a different valid point of view. Recognizing differences is also part of the learning process. 7) Never forget the importance of humility. Arrogance leaves you close-minded to possibilities on the differential diagnosis, rubs your colleagues the wrong way, closes the door on the opportunity to learn and gives you a bad reputation. 8) Never put off looking up a topic. Try to look it up right away, even if it’s not as thorough as you would like because chances are, you will never get to it in the future. This helps to avoid the ever-expanding list of things to look up in the future. 9) To finish that paper, disconnect yourself from the e-world. Schedule time to turn off your email, turn off your phone, and put in earplugs if you have to signal colleagues that you are unavailable. This will help you finish that first draft of that paper that has been on your mind. 10) Get involved, give back. No fellowship program is perfect, but you can help make it better by being an active member, which helps channel negative energy into something positive. For example, during my second year when I was put in charge of orientation for the incoming fellows, I decided to add my own touch to the orientation process. I compiled helpful articles on .pdf that were distributed to the incoming fellows on a zip drive. I also led the division in a fun, goofy game of “Jeopardy” during lunch on the day of orientation. These were small contributions, but it was a great way for me to exude some positive energy during a tough fellowship and create some smiles along the way. 11) Start the job seeking process early, but don’t stress. Remember, the reality is that you are wanted. You may not realize it, but you are. Starting thinking about what elements make up your “dream job” when you’re a second year fellow. Is it being close to family? A certain research mentor? To begin, network at major conferences, query the attendings in your department, and sign up for ped-lung (ped-lung.org). Fellowship is no-doubt, a difficult three years, but it can be rewarding, especially by the time you become an attending. Good luck to all the new fellows out there! For questions, please contact me at devika.rao@utsouthwestern.edu