Why choose medical oncology? Trainee perspective

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Published: 23 Oct 2017
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Dr Shanthini Crusz, Dr Sarah Duncan, Dr Steve Kihara, Dr Anna Olsson-Brown, Dr Jonathan Lim, Dr Emily Goode, Dr Edward Armstrong

Dr Shanthini Crusz (Barts Cancer Institute, London, UK), Dr Sarah Duncan (Royal Free Hospital, London, UK), Dr Steve Kihara (Loughborough University, Loughborough, UK), Dr Anna Olsson-Brown (The Clatterbridge Cancer Centre & The University of Liverpool, Liverpool, UK), Dr Jonathan Lim (The Christie NHS Foundation Trust, Manchester, UK), Dr Emily Goode (Royal Marsden and ICR, London, UK) and Dr Edward Armstrong (Royal Marsden Hospital, London, UK) spoke with ecancer at the ACP immunotherapy workshop about personal, professional and patient-led experiences that led them to choose specialising in medical oncology.

They share their highlights of working in the field, and offer advice for any junior doctors who are currently considering pursuing oncology.

Dr Shanthini Crusz – Barts Cancer Institute, London, UK
Dr Emily Goode – Royal Marsden and ICR, London, UK
Dr Edward Armstrong – Royal Marsden Hospital, London, UK
Dr Jonathan Lim – The Christie NHS Foundation Trust, Manchester, UK
Dr Steve Kihara – Loughbourough University, Loughborough, UK
Dr Anna Olsson-Brown – The Clatterbridge Cancer Centre, Liverpool, UK
Dr Sarah Duncan – The Royal Free Hospital, London, UK

 

What made you pick medical oncology?

SG: I wanted a career that I knew I wasn’t ever going to get bored of, one that was constantly interesting and oncology definitely is that, especially medical oncology.

EG: I was inspired by motivated and dedicated people that worked above me in that specialty when I was a junior doctor and it was a specialty that gave me an opportunity to be involved both clinically and academically in the field.

EA: I chose to do oncology, treating cancer patients, because I think everybody knows somebody who has had cancer in their family, whether it be their parents or grandparents. I think it’s really important if you have that diagnosis to have it explained well to you and to feel as though you’re well supported going through that treatment.

JL: I like people and I like communicating with people and having that very difficult interactions and I find that a challenging thing. At the same time I’m also a bit of a geek so I like the biological basis of things and also scientific discoveries. So I feel that medical oncology in particular allows me to marry the two so I find working every day a joy.

SK: There’s absolutely nothing stagnant about it, it’s such a fast-paced specialty and it’s probably what you hear a lot of people say when they talk about the positives in oncology but it’s just so true. I think I probably underestimated that as a junior doctor deciding what specialty I may decide to do and that’s just become more apparent.

AOB: It’s very scientific and got a lot of biological background. It’s very exciting because it’s got some of the new and most interesting treatments that we’ve ever had. It’s progressive over my career lifetime, even in five years it has changed hugely. When I look back at the end of my career I’m going to be able to say it’s changed absolutely monumentally, more than any other specialty. And also I really like people and patients and it is a really great specialty in terms of communication skills and getting a good rapport with patients and a good patient-doctor relationship. So it ticks every box.

SD: I picked medical oncology because I wanted a career that I would constantly be learning and have a chance to do a PhD, work with people who were active academically.

SC: I wanted a career in which I made a real impact on a patient’s disease or illness and certainly when you’re treating patients with cancer as an oncologist you have the opportunity to do that.

SD: In other specialties you might see a patient every six months and when you’re on a rotation you would see them only once where for us we really get to know our patients on a regular basis and that’s something that I really enjoy.

SC: I wanted a career that I could form meaningful relationships with my patients and oncology certainly does that. You’re with the patient throughout their journey.

What do you like most about it?

EA: I love spending time with patients and their relatives. It’s obviously a tough condition to treat sometimes and it can have sometimes good news and bad news but helping people through the journey of their treatments is really satisfying.

EG: The patient group, they’re going through really tough times and they’re inspiring. It’s an emotionally challenging job but I think that that’s something I personally find really rewarding and I’ve mentioned the academic side as well as something that’s always motivated me.

SC: Medical oncology allows you to get really involved in the clinical trials aspects of things so I get to recruit patients to trials, I get to treat patients with novel medications, manage those toxicities, see the exciting outcomes, so that’s something that’s really exciting about doing the job on a day-to-day basis.

JL: Year on year we’re using different treatments and year on year there are different discoveries in science. I feel that every year I can use different drugs in different treatments.

SD: I think it is probably the patient contact is the bit that I enjoy the most and getting that chance to really develop a relationship with your patients over a relatively short period of time. So I’ve only been in this job now for, what, six weeks and there are some people that I’ve still met three or four times already and you really get to know them and their family story and the interactions that they have with their children when they come to clinic and it’s really interesting to see that side of it and then see how they manage the side effects and how that impacts their life.

SC: The multidisciplinary team in which I work in, full of really dedicated people and we all want the best for our patients so that’s a really special team to be involved with. Finally, obviously, because of the patients. So my patients are great, their families, they’re lovely people. I learn so much from them, they’re really inspiring how they deal with their diagnosis and their illness and that’s really rewarding.

AOB: I don’t see two patients in the same situation at any point in my day and I can see a research patient, followed by a patient who’s having adjuvant treatment, followed by somebody who is at the beginning of their palliative journey and somebody at the end of their palliative journey all in the same day, every day. So it never gets boring, it never gets repetitive and it’s always really interesting.

What advice would you give to somebody thinking about a job in medical oncology?

SK: It’s very important to get some experience at this specialty and that’s often as a medical student or a young junior doctor about speaking to people in that specialty, be that registrars. It doesn’t have to be formal experience through having a post in the specialty but I did things like a taster week and went along to clinics separately to my normal training to find out a bit more about it.

EG: At medical school try and get involved, go to those placements, specialty modules if you can, as a junior doctor choosing that rotation. If you can do a project you learn a lot more about the specialty. And get off the wards, get to the clinics, because as oncology trainees that’s where we spend a lot of our time.

JL: It’s really spend some time doing rotation in it. Perhaps many people may not have the opportunity to do medical oncology as an F1/F2 job and what I perhaps did which was useful was a taster week where we really understand what medical oncologists do as a consultant because that’s really what your career would be like. Because as an SHO you’re mainly on the wards and you’re really not doing the oncology side of things.

EA: It’s quite an emotive specialty, there’s a lot of emotions that can come with having cancer and the treatment, so it’s really important for doctors such as myself to have other interests and to be able to do things outside just their work environment. So I enjoy going to the theatre or going to art galleries or playing sport and I think it’s really crucial that people have other interests as well as their work.

SD: You need to be prepared that it’s hard work. Oncology is a relatively difficult specialty emotionally. To deal with there is a lot of death but because people accept that and know about that there are lots of support networks in place. So we’ve had an art therapy course that we’ve all gone on to try and help us deal with the more emotional aspects of the job and that’s something that you need to bear in mind, whether you can deal with it, and if you can it’s a great career if you’re academically minded and driven.

SC: Get as much experience as you can, so as a medical student if you can get placements on the oncology wards or the palliative care wards. Then when you do your foundation training and CMT training maybe try and get some rotations in oncology if you can but if not do some taster weeks. But a top tip would be to try and get a mentor, so try and find a friendly oncologist, and there are lots of them out there, that will mentor you, get you involved in projects to try and shape your CV for the specialty interviews.

AOB: Really spend some time in oncology, understand that it is predominantly an outpatient specialty but there is an inpatient role as well and that there are a lot of challenges in terms of time and emotion and you have to make sure that those things appeal to you rather than be something that will end up finding you stressed out and burnt out. So it’s about really getting to understand what the specialty is before you do it.

SK: It is ultimately about being a good physician as well. So I’d also say that when you’re a medical student and a young junior doctor and starting to go through your core medical training actually it’s important to emphasise that that’s really important and a good medical grounding is important as you make your way through different medical specialties, not becoming too narrow and too focussed. It’s good to have a broad base and then be building medical oncology as a specialty on top of that.