Preparing for Oncology Board Certification, Career Transitions, and Combating Burnout

Preparing to take the internal medical boards and then the oncology/hematology–specific boards can be a daunting task for residents and fellows. Adding to that is the transition from resident/fellow to attending. These massive career changes or milestones in the clinician’s life happen almost simultaneously. While there are resources for studying for the boards, little exists for the mental and emotional sides of these career changes.

CancerNetwork spoke with various clinicians in the oncology space regarding this murky area. Here is a look at the process from the perspective of established clinicians, new attendings, and those waiting to sit for their medical board exams.

The biggest takeaways included the high burnout rate, scarce training to become an attending responsible for patients on one’s own, and juggling time between clinic and studying. Highlights from the conversations included the positive sense of community, the mentorships, and the realization that while it may be tough, there is light at the end of the tunnel.

Preparing for the Medical Boards

A common recommendation among the clinicians was to use the American Society of Clinical Oncology (ASCO) question bank, which is part of the self-evaluation program.¹ It also offers a podcast/YouTube series that one can listen to on the go.

“I would listen to podcasts on my drive. I found very good podcasts like
[The Fellow on Call], Two Onc Docs, Oncology Brothers, and Oncology Today With Dr Neil Love. Some of those tend to be a little bit more practice-focused, more clinically relevant. You can still draw from some of that [knowledge] and use it for boards. It’s just something to do while you’re driving. It’s background studying, and a little bit more passive,” said MinhTri Nguyen, MD, a medical oncologist with Stanford Medicine.

Additional resources for preparing for these exams include the American Board of Internal Medicine exam blueprints.

Oncology is an ever-changing field so it may be hard to find specific areas to focus on. The major areas include breast, lung, gastrointestinal, and malignant hematology. Nicholas James Hornstein, MD, PhD, assistant professor at Northwell Health Cancer Institute, highlighted the need to focus only on topics that won’t change or aren’t too new. While hot topics might be top of mind when studying or taking the exams, the core questions and general idea of the exam tend not to divert too much from established practices.

Finding ways to study as a resident or a fellow can be tricky. It takes dedication to carve out time and be able to focus. One common theme among clinicians was that there is no one-size-fits-all approach to studying.

Eric K. Singhi, MD, assistant professor in the Department of General Oncology, Division of Cancer Medicine, and assistant professor in the Department of Thoracic/Head and Neck Medical Oncology at The University of Texas MD Anderson Cancer Center, noted that it’s important to be consistent and find a schedule that is feasible to maintain.

Nerea M. Lopetegui-Lia, MD, assistant professor in the College of Medicine at The Ohio State University Comprehensive Cancer Center-The James, takes time to reinforce “high-yield” topics. She also found that reviewing board questions with her peers and discussing questions on complex topics can help uncover knowledge gaps she wasn’t aware of.

Nguyen, who plans to sit for his oncology/hematology boards in the fall, used his orientation time for clinic to study for the medical boards. He used this transition time between the end of fellowshipand beginning his work at Standford to create his study guides, compiling questions into a book, so when his duties became more intense, he was able to review his already-created study materials.

From Trainee to Attending

An often-not-talked-about part of this journey is going from resident/fellow to attending. While this seemingly happens overnight, clinicians are now expected to oversee their own patients and become leaders.

“The experience of being an attending is incredibly rewarding. Gaining the autonomy to make clinical decisions has been both, empowering and fulfilling. However, I think many of us experience a bit of impostor syndrome, which is common during the transition from trainee to attending. It can be daunting to suddenly be the final decision maker,” said Lopetegui-Lia.

Marc J. Braunstein, MD, associate professor in the Department of Medicine at NYU Grossman Long Island School of Medicine, fellowship program director in hematology/oncology at NYU Langone Health - Long Island, and codirector of the Hematology-Oncology System at NYU Grossman Long Island School of Medicine, created a curriculum to help fellows during this transition.

Curriculum topics include networking, running clinical trials, billing, and professional use of social media. Braunstein has an open-door policy for fellows who graduate, reminding them that they have support during this new part of their lives.

Braunstein reflected on his own transition, and he believes what helped most was having a supportive network outside medicine. As junior faculty, he had to learn how to balance work and his personal life. Time, he noted, was and is his most valuable resource.

During residency and fellowship, Hornstein had the mindset that each day, he needed to show up and pay attention because one day, he was going to be the decision maker.

During Singhi’s career transition, he was able to stay at MD Anderson, and he thought it would be seamless. While the physical part might have been, the mental transition from being the learner to the decision maker was difficult.

“I was very fortunate to have strong mentors here at MD Anderson throughout my fellowship, and they continued to guide me through navigating my new clinical responsibilities as an attending, making sure that I was meeting academic expectations and making sure that I was able to develop a niche within my institution,” Singhi said.

A leadership coach can help with this transition. Nguyen, who specializes in this, knows there are certain areas you need to balance as an early-career oncologist. He helps to align personal values with the demands of a new career such as setting boundaries or managing a team.

Clinician Health During Studying and Career Transitions

Nguyen is conducting a longitudinal study on emotional intelligence during residency training. He and his team are investigating factors related to emotional intelligence, burnout, and health and well-being. The motivation for the study was the lack of a baseline for the resident population for this topic.

Nguyen highlighted a recent ASCO study looking at well-being and burnout among fellows.² Fellows taking the Oncology In-Training Exam were offered an optional postexam survey, and the study compared survey answers from 2013 and 2023. Results showed that of the 2217 who took the exam in 2023, 71% of fellows answered the survey. Of note, 1 in 5 fellows (20%) reported burnout compared with 34% in 2013 (P <.01).

“That [percentage] speaks to a lot of the current needs to providing support for those who are early career and those who are fellows who are about to enter their career. I highly encourage participation with the ASCO Trainee and Early Career Advisory Council. I would also support more work at the institutional and Graduate Medical Education level. While the score has improved, 20% is not something to overlook,” Nguyen stated.

Singhi experienced burnout during his career transition and as an early-career oncologist and said this is a very real and valid concern in the field. To manage burnout, Singhi set realistic and structured goals. He also noted that you need time to decompress, so finding activities that make you feel fulfilled outside work will also help to combat burnout.

A Token of Advice

While everyone has a unique experience with taking the medical boards, making a career shift, and learning to manage this new responsibility, knowing others have come before you and were in the same position can be helpful.

Braunstein emphasized that it comes from the self and learning to become confident in your abilities. “You’ve got what it takes,” he said. “Being a great doctor is not about knowing how to approach every clinical scenario that can come up. It’s more about caring, devoting yourself to your practice and your patients, and knowing where to access the information you need and to whom you can turn for advice on accomplishing cases.”

On studying, Lopetegui-Lia noted that it’s about finding what works for your learning style and identifying the correct resources, whether watching recorded lectures, reading book chapters, or looking over the question bank.

Hornstein reiterated that while taking the boards and balancing a new career can be stressful, it should also be fun. “It’s important to remember that you’re a person, too, and you deserve to enjoy what you’re doing, so just keep that in mind.”

References

1. Banerjee R, Quiroga D, DeCesaris C, Bhutiani N. Navigating the board certification process for your oncology subspecialty. ASCO Connection. February 27, 2024. Accessed May 14, 2025. https://tinyurl.com/y6w8hraw
2. Schenkel C, Levit LA, Kirkwood K, Shanafelt T, Subbiah IM. Ten-year trends in clinician well-being and burnout among oncology fellows in training: an ASCO State of Cancer Care in America Study. JCO Oncol Pract. Published online January 29, 2025. doi:10.1200/OP.24.00200