A fellowship rendezvous at the Tata Memorial Hospital : Cancer Research, Statistics, and Treatment

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A fellowship rendezvous at the Tata Memorial Hospital

Dhanawat, Aditya

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Cancer Research, Statistics, and Treatment 5(2):p 304-305, Apr–Jun 2022. | DOI: 10.4103/crst.crst_105_22
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To reach a port, we must sail. Sail, not tie at anchor. Sail, not drift.”- Franklin D. Roosevelt

Back in September 2020, I attempted the National Eligibility cum Entrance Test Super-Specialty (NEET-SS) examination in Medical Oncology for the very first time. Not surprisingly, I secured an All India Rank (AIR) of 250. Neither would this rank fetch me a Doctorate of Medicine (DM) residency seat in any of the government medical colleges nor a Doctorate of National Board (DrNB) seat in any teaching hospital. I had been underprepared and had limited practical exposure to oncology during internal medicine residency, as is the case for students and residents in most of the medical colleges in India.

Around the same time, the Tata Memorial Hospital (TMH), Mumbai, released an advertisement for fellowships and non-academic senior residency positions. This institution is regarded as the mecca of cancer care in the Indian subcontinent, and it stands tall just like the pole star in the clear night sky. The advertisement caught my attention and I immediately applied for the solid tumor fellowship position without any hesitation. The formal interview was conducted online due to the coronavirus disease 2019 (COVID-19) pandemic, and I secured the position.

For someone like me who has spent his entire 29 years of life in a single city (Bhubaneswar, Odisha) and has been a day-scholar at his school, college, and during postgraduate training, moving to Mumbai was a very important milestone in life. First, this fellowship experience would enhance my knowledge in oncology, which would enable me to perform better in the upcoming NEET-SS exam. Second, this opportunity would provide a firsthand experience of working in a high-volume tertiary cancer care center. Third, but also important, I would get to imbibe the professional culture of this institution and the experience of life in Mumbai city.

TMH, Mumbai, has served patients with cancer for 80 years and embodies its mottos of service, research, and education. It caters to thousands of new patients annually from India and around the globe. The medical oncology department has been divided into three units – Solid 1, Solid 2, and Hemato-oncology. Solid 1 comprises the breast, gynecology, gastrointestinal, and bone and soft tissue oncology disease management groups (DMGs), while Solid 2 includes the thoracic, head and neck, urology, and neuro-oncology DMGs.

I started my fellowship in solid tumor oncology at TMH in October 2020. The experience has been exhilarating. I rotated across various DMGs in both the solid units. During my tenure, I got an opportunity to work in the geriatric oncology clinic and learn the nuances pertaining to cancer care for older patients. I grabbed the golden opportunity to publish a first author abstract at the American Society of Clinical Oncology (ASCO) annual meeting 2021 on the prevalence of cognitive impairment in older patients with cancer and brain metastases. I was also a part of the team that published another abstract on the retrospective analysis of pulmonary sarcomatoid carcinoma. I saw a large number of patients in the outpatient clinics every day. The investigations and treatment options offered at TMH are straight out of the book, and some of these are not available anywhere else in the country, which makes it a top-notch educational institution. The interactions with the professors and seniors were academically enriching and their words of wisdom were something no book could ever teach.

The NEET-SS entrance exam is conducted by the National Board of Education (NBE) and is scheduled to be held every year in the month of June or July. This single exam decides the fate of thousands of super-specialty aspirants (postgraduate doctors). NEET-SS 2020 was held in September 2020 due to the nationwide COVID-19 lockdown that resulted in delayed postgraduate exit exams across various medical colleges in the country. NEET-SS 2021 exam was initially scheduled for November 2021, again due to the pandemic and nationwide delay in postgraduate exit exams. However, there was another twist in the tale! The NBE decided to implement an entirely new pattern and syllabus for the examination; this news was publicly shared on Aug 31, 2021 (2.5 months prior to the scheduled exam date). This information sent shock waves across the nation among thousands of aspirants, including me, who had been preparing for the exam as per the old pattern and syllabus for almost a year.

I requested study leave to prepare for the NEET-SS 2021 in mid-September 2021, keeping in mind that I would have 2 months in hand to prepare. The professors at TMH were kind enough to oblige. Around the same time, a group of doctors moved the Supreme Court and challenged the decision of the NBE in changing the pattern of the exam at the last minute. Every single day of preparatory leave was spent in anxiety and agony. Anxiety, because we did not know whether to prepare according to the new or old pattern of exam. Agony, because this exam is held once in a year and if you fail, it means one more year of life spent on preparation alone. After nearly a month-long battle between the doctors and the NBE, the Supreme Court directed the NBE to revert to the old pattern of the exam in mid-October 2021. But then came twist number two!

The NBE expressed its inability to conduct the exam according to the old pattern at such short notice. Hence, they proposed that the NEET-SS 2021 exam be held in January 2022. This announcement felt like the last nail in the coffin of an aspirant's dream. Looking back, I realize that those months were difficult not just for me, but for thousands of postgraduate doctors around the country aspiring to be super-specialists. Every day of this extended preparation phase was spent in countless hours of self-doubt, despair, and helplessness. Firstly, there had been a considerable loss of precious time in all the aspirants' lives, all of whom had already completed long and grueling medical courses (both under- and post-graduation). Secondly, the majority of aspirants are in their late 20s to early and mid-30s. By this time in life, all of us have some family, social or financial responsibilities to fulfill. The inability to fulfill them and the requirement to sit at home preparing for an uncertain exam was a huge burden.

NEET-SS 2021 was “successfully” (pun intended) conducted on January 10, 2022, and the results were declared on January 31, 2022. Lo and behold, I secured an AIR 3 in Medical Oncology. Every ounce of this feat was the result of my fellowship experience at TMH. The professors, seniors, patients, and the work culture made a significant difference in my learning and aptitude in problem-solving. This success was made possible due to the combined efforts of my wife and parents, who are the pillars of my strength. Now that the results were out, I eagerly awaited the start of the centralized counseling, so that I could finally begin my DM residency, albeit late by several months. Just as everything appeared to be finally forging ahead, a group of doctors in Tamil Nadu moved the Supreme Court and challenged the Government of Tamil Nadu and the Government of India demanding reservations for the in-service doctors in Tamil Nadu. After another 1.5 months of legal battle involving the Government of India and Tamil Nadu, NBE, the Medical Counseling Committee and the National Medical Commission, the Supreme Court ruled in favor of 50% in-service reservations in Tamil Nadu and allowed the counseling to proceed.

I am neither a legal expert nor an authority in medical education in our country. I am just another aspirant who went through the ordeal of the examination, counseling, and admission process. However, you will agree that there is something definitely wrong with this entire process and several loopholes exist, which need urgent corrective measures. While you ponder this thought, I am all set to begin my residency in Medical Oncology at TMH. On this note, I would like to quote Robert Frost, “The woods are lovely, dark and deep, but I have promises to keep, and miles to go before I sleep.

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Conflicts of interest

There are no conflicts of interest.

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