Fellowship

Although I usually explain what a fellowship is by describing it as an extension of residency, being a fellow is different than being a "super-resident." Although I am still a trainee focusing on a subspecialty, my role and responsibilities have expanded a bit. From a clinical standpoint, I have less busywork or "scutwork" - I no longer scribble down vitals during prerounding in the morning or write daily progress notes. But I am responsible for the big-picture of all the patients on the team. I help determine the daily plan for each patient, warding off decompensation, tuning patients up for leaving the ICU. It is easy in many medical settings to simply go with the predetermiend plan, to assume that what was decided yesterday is still good today, and my goal is to challenge that, make sure we are thinking of each goal fresh and independently. I also act as a gatekeeper to the ICU; all the patients who come in, through transfers, the operating room, the emergency department, the floor, and from codes go through one of the fellows. A lot of this clinical responsibility is new for me, and I have a lot to learn.

Even from a nonclinical standpoint, my role and responsibilities have changed. I am learning to teach residents. Teaching takes practice and experience, and I'm already figuring out how best to walk someone through a new procedure or explain my clinical decision making. As a fellow, I will participate in quality improvement and research projects. I work at a systems level, calling the nursing supervisor daily, working with unit charge nurses, and speaking to our transfer center. While I enjoyed my small little bubble as a resident, I'm learning about the bigger medical picture now.