Thread by @LisaSingerMDPhD

Inspired by @PaulNWilliamz thread to create a 🧵for new #radonc attendings (disclaimer: three-years being attending so feel free to add advice 😊) @roecsg @S_W_R_O and others! 1/20

✅ Checklists are your friends — you may be working with software and systems you didn’t use at your residency and just simming a patient may take many steps in different programs — eventually you won’t need the checklists! 2/20

Introduce yourself! Don’t worry if no one knows who you are. You may have been introduced in an email that went out weeks before your arrival so don’t be offended if your colleagues (esp in other oncology fields) don’t know you! 3/20

To help mitigate hurdle 3- show up!! Tumor boards and other multidisciplinary meetings are a great way to meet your colleagues. Also try to sit at the table even if it’s uncomfortable— no one will see you if you are on a side chair in the far back of the room. 4/20

Because radonc residency covers so many diseases, the reality is you may be treating a site you haven’t treated since early residency — tx paradigms may have changed! @ASTRO_org refreshers and review articles are a great way to get up to speed. Don’t be afraid to ask ?s 4/20

Walking into a consult as a new attending in a disease site you may not feel like an expert (yet) in can be intimidating. Prepare in advance, request missing records so you can synthesize the data and try to identify relevant trials and outcomes in advance 5/20

Communicating reccs is part of the art of medicine and will evolve over time but if a patient asks for percentages it will help to have the data on hand — you will feel better being prepared 6/20

Don’t be offended if a patient switches doctors — you will see this happens with even senior attendings and is part of the consumer side of medicine. You can only do your best as an attg but patients have a right to pick their doctor for any reason, whether you agree or not. 7/20

Even if your center has coverage pools for offline review, try to go back and review your own films at least for a bit — you will learn important info about your sim setup, tumor response, and on-tx issues. You will learn when to re-sim, too! 8/20

If you are in a busy clinic there is never a good time for research — try to schedule specific to-do items in small blocks … if it’s not on your schedule it’s easy for other things to occupy that time. Also everything takes 10-100x longer as a new attg. 9/20

As a new attending you may worry about burdening new colleagues with your vacation coverage but vacation is critical — you only have one life! Schedule the vacation and you will realize others are also taking vacation! 10/20

If you’re a new attending you are likely only so young — ergonomics is critical! As medicine involves more and more documentation try to invest early in a good desk setup. It will save time and money later if you are able to avoid injuries (or at least desk injuries) 11/20

Similarly the free food at conferences may seem convenient as a new attg and you may have survived off free pizza as a resident, but if your metabolism is aging and it’s not nutritious you can only eat it for so long — don’t feel badly about bringing your own lunch. 12/20

If something doesn’t seem right ask questions! You will see your patients every week for weeks and encounter symptoms that turn out to be PEs, acute abdomens, and the many other diagnoses patients have other than cancer. 13/20

If you are treating pts, toxicity is unavoidable in #radonc. Spend time on the informed consent, follow your pts— one of my attgs used to say, you won’t see late tox if you don’t follow anyone. If there is a grade 5 toxicity rate of 1%, you will see it if you tx enough pts. 14/20

Grade 5 toxicity can be very hard as an attg — talk to colleagues who have seen it before. Also if your pt is hospitalized on tx, they will remember if you visit them. As an inpt they are w a new team and they know you bc you saw them weekly and you’re their Dr. 15/20

You may feel like you are seeing a new side of #radonc— insurance denials, peer to peers, cancers that are too high volume to safely treat definitively. Many steps in RT require attg approval so as a resident you may have missed aspects but it’s #lifelonglearning 16/20

After boards (congrats on getting through!), keep up w board renewals, CME, SA-CME, MOC … you may have to recredential at your hospital every couple yrs, it will help to have all your dates of training and license numbers in a folder somewhere 17/20

Since technology is always changing, you may be asked to take on new types of treatments for your practice and you may always feel like a new attg! The good news is all the skills that got you through attg year 1 will come in handy 18/20

Peers, mentors, sponsors, friends are crucial for the many challenges of being a new attg. #medtwitter and life show the many struggles of Drs — gender bias, racism, prejudice, abuse of power, inequities, intolerance— remember that no one can get through a career alone! 19/20

As you embark on being a new attg remember that you were a new MS1, a new intern, new resident and you got through it! And bc life happens and people move you may be a new attg again! Your pts are lucky to have you and it is truly a privilege to practice medicine! 20/20