Chapter 25: Education in Breast Medical Oncology

Chapter 25: Education in Breast Medical Oncology

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Description

Dr. Hortobagyi explains that medical education includes two parts: the technical information a physician needs to practice and learning that comes via mentoring. Dr. Hortobagyi describes good mentoring and the kinds of career questions a good mentor can help a fellow or young faculty member confront.

He then discusses principles of research mentoring and how it is connected to funding of medical education after the M.D. He notes that a fellow has six or more years of training after the M.D., but is “still green behind the ears,” a situation in which mentoring is key for preserving quality of care and research.

Dr. Hortobagyi ends this session with the observation that he himself did not have strong mentors, but he observed how strong mentorship influenced the careers of many of his colleagues.

Identifier

HortobagyiGN_04_20130128_C25

Publication Date

1-28-2013

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The AdministratorThe Administrator Personal Background The Educator The Leader The Mentor Education Education at MD Anderson On Education On Mentoring Education at MD Anderson Professional Practice The Professional at Work Collaborations Leadership Mentoring

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Gabriel Hortobagyi, MD:

All right. We didn’t talk much about education.

Tacey Ann Rosolowski, PhD:

No.

Gabriel Hortobagyi, MD:

Education is a critically important part of our specialty and medicine in general. And education has two different very important components. One is sort of the technical part of it—the acquiring knowledge and acquiring the knowledge of finding where to find more knowledge, which with today’s technology it has been somewhat easier. And I think that part is very important because while you don’t—as a physician in training, you don’t need to learn absolutely everything there is nor can you. You do need a certain basic amount of information that is clearly at your fingertips at all times—that’s stored up here. You can’t just Google everything. You have to have a really in-depth knowledge of medicine in order to be a physician of any sort. And then beyond that, some of the intricacies and some of those things that change rapidly—there are many, many tools that you can use—electronic tools that are wonderful. And you just have to make sure that you consult those that are legitimate as opposed to the crazy ones. Perhaps an equally or more important part of medicine is the mentoring part, and the mentoring part is very important in part because it provides an example to those who come behind you and to show how you organize your life—how you behave, how you interact with people, with patients—and what is the right way to keep a balance between life and work and all of those things. And second because mentoring can really shortcut a number of very time-consuming, decision-making processes.

Tacey Ann Rosolowski, PhD:

Such as?

Gabriel Hortobagyi, MD:

For instance, in academic medicine—where am I heading with my training? Some people come to train with us and they know exactly what they want to do. Others are much less certain. They don’t know what’s on the other side of their training program. So sitting down with those people and going through their thinking process and the advantages and disadvantages of what would happen if they went out to private practice or if they stayed in an academic environment—what happens if they became physician educators, what happens if they became physician scientists, what happens if they got some additional training? What if in addition to a degree in medicine they got a degree in law or a degree in public health or a degree in something else? And it’s very hard to do that on your own without the experience and the knowledge and the resources of someone who has ten, twenty, thirty, forty years ahead of you. So that is an important part. And if you are involved in research, not all of us start with a full knowledge of all of the research techniques and what we do with all of the pitfalls of doing a certain type of research. So it helps very much for someone who is helpful enough and critical enough to point out what you’re doing right and what you’re doing wrong—and at the same time not competing with you.

Tacey Ann Rosolowski, PhD:

Uh-hunh (affirmative). I had an interesting conversation with people in faculty development a while ago, and they were talking about how mentoring has changed so much because the time demands on every individual has increased so dramatically.

Gabriel Hortobagyi, MD:

Yeah. Yeah.

Tacey Ann Rosolowski, PhD:

And how maybe even that the mentoring of someone—stopping in to somebody’s office, sitting down, having a coffee or going out for a drink, and having an hour-long discussion—that those days maybe are gone. And how do you see that? And how do you see mentoring—ideally how it takes place—and then maybe how mentoring has to change, given people’s responsibilities and time demands?

Gabriel Hortobagyi, MD:

Yeah. So the environment is clearly changing. And I think eventually we will—as a community—need to rethink the process of who and under what circumstances should fund medical education—especially postgraduate education because your undergraduate, to some extent, is no different than going to law school or going into any of the other professions. The student pays for the privilege of being educated. But after graduation, most of the funds today come from either the federal government—Medicare, to a large extent—or some funds that institutions—academic institutions—carve out from other somewhat obscure sources that I call robbing Peter to pay Paul. And it’s not a tenable model in the long term because Medicare is going to continue to cut back on reimbursements, which means that most of the institutions will end up subsidizing Medicare as opposed to getting something out of it for medical education. And yet it is critically important to maintain and, in fact, enhance mentoring because if you—probably fifty, sixty years ago, if you finished medical school and went out to practice, you were reasonably well prepared for the time. But today that is not true. Today that’s not true. And in fact, our fellows—and remember, a fellow in medical oncology at this institution finishes and has already had six or more years of training after graduating from medical school and still is green behind the years—you know? And so additional training and mentoring is really critically important unless we really want to compromise our level of care and our level of research and our level of commitment to the education of the next generation.

Tacey Ann Rosolowski, PhD:

So what does and what should mentoring look like that will preserve the highest quality of care and research?

Gabriel Hortobagyi, MD:

A mentor should be an experienced individual who is willing and able to dedicate sufficient time to serve as a sounding bar—to advise, to listen, to critique both the good and the bad—and who should be committed to the professional development of the other person. It can’t be just a casual thing where someone shows up in your clinic and sees your patients and then adios. So there has to be some time carved out. There has to be some time dedicated exclusively to mentoring independent of other joint activities. And there has to be some thought given to that perspective, and you need to understand what the other person is struggling with, what the other person is trying to decide, where they are heading. Have they even figured out where they were heading?

Tacey Ann Rosolowski, PhD:

What was a watershed moment for you when you received some really key pieces of mentoring or instances of mentoring?

Gabriel Hortobagyi, MD:

Actually the watershed event was not about what I got or I did not get but what I saw in some of my colleagues who—how should I say this—who under the guidance and with the support of a strong mentor were able to succeed in a more direct manner and in a shorter period of time. I just wrote a letter in support of a colleague and a friend who is about—probably ten years younger than me and who is being promoted to distinguished professor of something at a different institution. And this person—graduating from a relatively small program in oncology—was just catapulted up the ranks because that person had three or four truly strong and outstanding and dedicated mentors who made sure that they moved this person ahead. And it made a huge difference. It made a huge difference. And I have seen that in several of my successful colleagues. I don’t think that that ever happened to me to that level. All right. And I’m not complaining. I have done very well, so I can’t complain. But some things would have been much easier for me had I had someone who was looking over my shoulder saying, “I can open the door for you.” And so that’s where I saw how important this was. And then later with that knowledge I have been able to sort of push ahead some of my own junior faculty, and it is wonderful to see that—how they succeed.

Tacey Ann Rosolowski, PhD:

Well, I will turn off the recorder now so you can—

Gabriel Hortobagyi, MD:

All right.

Tacey Ann Rosolowski, PhD:

—speak to your next person. And I’m turning off the recorder at 3:39. Thank you very much, Dr. Hortobagyi.

Gabriel Hortobagyi, MD:

Thank you.

(end of audio)

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