Looking back at your days in training, what do you wish you knew then?

We asked our experts what advice they'd share with trainees about what they wish they knew then.

1. Daniel E. Spratt, MD

While this seems like such a simple question, it is so complex as if I knew the things I know now I am sure my actions would have changed...which would lead me to a different life today; the great butterfly effect: https://en.wikipedia.org/wiki/Butterfly_effect.

Trying to put that aside, a few pearls/maxims I often share with students, residents, and fellows:

1. Always try to align your "needs" and your "wants". Don't blindly just do what is asked of you. Proactively shape what fills your day up as much as possible. Master the art of creating your own path respectfully and professionally.
2. It is ok to say no, and you need to learn how to say no in a manner that is professional and respectful and that demonstrates you are saying no for a reason and not because you are lazy, but rather, that task is not aligned with your purpose or current goals.
3. Stay humble and know we are all replaceable. That doesn't mean we don't have value, but one must understand the tiny role any of us have in the scope of a huge multi-billion dollar institution.
4. Never lose track of your purpose. Mine is to provide a positive impact on cancer patients' lives. Stay focused. If you don't actively think about your purpose, you will end up on someone else's path in life heading down a road you don't want to be on.
5. You will be criticized on your journey. Attendings, leaders, program directors, Chairs, random people, etc may tell you that you are doing it all wrong over and over. You must have enough self-confidence and introspection to identify when you have failed versus others trying to tear you down to benefit themselves. This is not easy. Try to listen to the people that matter in your life (family, friends, patients, trusted peers, etc).
6. Don't expect the same from others as you do yourself. Everyone's goals are different.
7. Meetings can be 10-15 minutes. Don't agree for every meeting with your attending to be 30 min or 1 hour unless it really needs to be.
8. Know the currency of the stage you are at in life. If you are a resident then usually the currency is working hard, having a positive attitude, reading and knowing your craft, and getting the work/job done. This will typically be the most important thing that your attendings can use to help you get a job. If you want to be a physician-scientist, you likely will also need the currency of a focused scientific path and scholarly work (papers, grants, etc)....or at least a real potential for these in the future. Publishing a bunch of random junk rarely will help you get a job. Complaining, laziness, being demanding, etc will surely be a great way to make it hard to get hired.
9. Leaders, attendings, Chairs, PDs, etc...just having a title doesn't mean they are smarter than you, are always right, or are a better clinician than you. You must take the good from each person in training and try to filter out the bad or the style that doesn't fit with your personality. You can be a great clinician in dozens of ways, and you need to figure out the kind YOU want to be.
10. Read the book Multipliers. One of the few books I read in residency that opened my eyes to many terrible leaders I have worked under and the many amazing ones. The philosophy of this book changed the way I work in all aspects of my life. Be a multiplier and work with multipliers. Avoid diminishers at all costs.
11. Getting a job is more about "fit" on both ends than it is about a big CV. Do not underestimate the power of your attending or mentor picking up the phone and calling their peers at the center you want to work. That goes a long way.
12. There will be conflict/drama as a resident at some point, but remember this usually disappears within days and is forgotten.
13. Try to keep perspective. As hard as you may work in training, remember that in oncology, on the other end are often suffering, scared, and dying cancer patients. Don't lose perspective (as I type this I am near our pediatric cancer treatment area and heard a child scream in fear who has cancer...).
14. Success is 100% relative. You get to define success. However, your definition of success may not match others and that is ok.
15. Enjoy the ride! We are all so blessed to be physicians and help patients. I still keep in touch with many of my co-residents and it was an amazing time. With everything said above, I likely wouldn't change any of it as my failures helped shape who I am today.

Hard to be profound in the 10 minutes I have free between meetings, but I hope this resonates with someone.

Best,
Dan

2. Debu Tripathy, MD

I wish I knew that one can develop a synergistic clinical expertise and research focus by simply asking questions. The most ponderous questions you generate as you go through your training can drive your career - whether you will focus on the clinical, the research, or both aspects of your queries.

Hypothesis-driven research yields clinical breakthroughs. The riskier questions bring high rewards, and the more straightforward ones may bring quicker answers. Results that benefit your patients are the most elevating. For me, team science is more fun and interactive - and in my opinion, more productive while allowing you to share responsibilities and fruits of labor. Finally, I really enjoy sharing my research with my patients (yes, my clinic tends to run late) - they appreciate the fact that our profession is really looking after them, and that we are passionate about change.

My research question as a 2nd year fellow at UCSF (in 1989) was, "why does this newly discovered gene named HER2/neu make cancer cells more aggressive?" I used anti-sense DNA to knock down HER2 expression and needed a positive control antibody, which I got from a colleague at Genentech. This antibody (named 4D5) worked much better than anti-sense! A colleague fellow, Jose Baselga at Memorial Sloan Kettering, was studying the same antibody in mice bearing HER2+ breast cancer xenografts with encouraging results. Our respective faculty mentors lobbied Genentech to develop this antibody as a drug (which they did reluctantly), and together we ended up conducting and publishing the first humanized 4D5 (trastuzumab) clinical article, a Phase II monotherapy trial in refractory HER2+ breast cancer 7 years later (1). I continue to ask questions that naturally jump out even with the most casual observations - I find those that resonate with others, and we are off to the races. I wish I knew what a good question was worth earlier.

1. Baselga et al., PMID 8622019.

3. Simon M. Helfgott, MD

Wholeheartedly endorse Dr. Daniel E. Spratt's Fifteen Commandments - very applicable to Rheumatology Practice as well.

4. Paul Harker-Murray, MD, PhD

I will work harder than many.

I will be compensated less than many, but enough.

I will love the work I do.

5. Michael Auerbach, MD

My residency was 40 years ago. I wish I know the outcome of my then future work with intravenous iron, the truth about safety and administration, and its role in the management of earth’s commonest malady. It has been a rewarding path, the last 40 years, but at least half of those years were spent learning about the inaccurate folklore of danger.