July 19, 2023

Letter to a Rising Ultrasound Fellow

Stephen Alerhand, MD
Rutgers New Jersey Medical School

E. Liang Liu, MD
Emory University School of Medicine

Dear Pre-Fellowship Me,

I graduated from Ultrasound Fellowship 5 years ago. My energy level is a little lower, my gut a bit bigger (for Steve, not Liang), and my beard has a few streaks of gray (same). Nevertheless, I hope to perhaps impart some wisdom as you embark upon this momentous year.

1. Arrive to fellowship with a plan. What do you wish to achieve in the clinical, academic, research, and administrative realms? 

The year passes by quickly. By the time you move to your new city, learn the EMR, and take a moment to breathe, it’s already time for the written boards. Before and after that, you have already started applying and interviewing for jobs. By the time winter holidays come and go, you’re halfway through the fellowship year that is the building block for your career. Yet, you haven’t published anything, used TEE in cardiac arrest, or tried the latest nerve block. Remember that you will never have so much protected clinical time again. Make it count.

2. Remain open-minded to opportunities.

You may have heard what prior fellows worked on or accomplished in fellowship. There may be a roadmap set out for you already. But you have no idea what aspects of POCUS or emergency medicine may surprise you. This is the year to say “yes” to as much as you can handle. You never know which door will open further opportunities for you down the road.

3. Maximize output from a single piece of work.

When you have a cool case, present it at Morning Report. Then write a FOAM blog post, turn that into a local lecture, and submit a write-up for publication. Now, you’re a topic expert. Might as well present on that topic regionally or nationally. You’ve already done the work so make sure to showcase it!

4. Be bold.

Use the fellowship role as an opportunity (and excuse) to branch out and make connections. The more established experts in our field are approachable, active mentors looking to share opportunities with young, hard-working, aspiring ultrasound superstars.

5. Execution is everything. Be a closer.

Coming up with an idea is easy. Finishing the job is difficult. Those people make the biggest impact, signal their ability to get the job done, and thus garner more opportunities based on that reputation. Just as important as it is to say “yes” to opportunities, you must follow through. The ultrasound community is small and your ability to deliver on promises does not go unnoticed.

6. Be conservative in your clinical management and see patients at an appropriate pace. 

You may feel obligated to prove yourself at a new institution, but give yourself grace. Be thorough with your patient care, do not rush the process, and do not feel guilty about that extra CT scan. The last thing you want is to be called into your new Chair’s office about an M&M early in your career.

7. It’s a long road. There’s plenty more opportunity to come.

It’s one year of a long career. Despite all your ambitions, you will not accomplish everything you wish during the coming year, and that’s okay. Just because fellowship ends does not mean we stop learning, connecting, and pushing both our career and the specialty forward. It’s a great community to be a part of, and I have no regrets. 

Me (5 years out of fellowship)

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