Fellowship-basic

Question 1

what is your name?

Answer 1

Kohei

Question 2

1, Can you tell me a little bit about yourself?

Answer 2

-I was born and raised in Tokyo, and partially in my childhood, I lived in Michigan from 8 to 12.
-I finished medical school, IM residency, fellowship in Japan and had been pursuing my career as a thoracic medical oncologist. I realized a large gap in cancer care that could not be addressed by chemotherapy alone, and ultimately moved to the US with the hope to proceed with geriatrics and palliative fellowship.
-Currently, I am an internal medicine resident at Mount Sinai Morningside and West, which I enjoy learning with peers.
- Over the past few years, I enjoyed collaborating with the Department of Geriatric and Palliative Medicine for multiple research and case reports, mentored by Dr. Afezolli, Dr. Fogel, Dr. Uemura, and Dr. Mulholland.
- I am passionate about finding new perspectives from each patient, which led me to publish 16 case reports. Recently serving as project mentor, building my mentoring skills.
- I am an active learner for leadership skills and team building skills, which I have been developing through my ongoing commitment to a leadership workshop as a facilitator produced by MD Anderson Cancer Center.
-I am willing to pursue my career in geriatrics and palliative care, utilizing my background in oncology, to become a unique contributor.
-Extra fact about me is that I am also a father of two children.
Key points
-go over training briefly
-selling points; research with the Department, mentor in case reports, Leadership and team building (JTOP)

Question 3

2, What made you want to become a doctor?

Answer 3

One big reason is my strong interest in the whole person care. When I was in high school, I read a book titled blackjack. It is about a surgeon changing patients’ lives through his caring process, not limited to surgery. A lot of effort was put on describing emotional process and I was moved by each episode. I was surprised to find a field that can be both academic in science and humane in nature, which gradually drew my attention to the field. Thereafter, I met many physicians seeking for role models, and hearing their passion towards patient care, I was sure that this would be my lifework.

Question 4

3, Why do you want to go into geriatrics and palliative care?

Answer 4

My desire to come to geriatrics and palliative care started from a conflict that I faced when I was an oncologist in Japan. Japan is known for its highly aged society, and as a thoracic medical oncologist, I was treating a large number of older cancer patients. Chemotherapies has been effective with new strategies and compounds, but I could see that prolonging survival alone was not enough to maximize care. Managing geriatric features, symptoms, discussing goals of care, balancing treatment intensity and toxicity- those were poorly handled. I gradually realized that geriatrics and palliative medicine are the piece that could be better optimized for a better CARE in older patients with serious illness. I value the human touch in medicine, and ultimately decided to move on to this different layer of training.

Question 5

4, Are you pursuing geriatrics or palliative care eventually?

Answer 5

Both of geriatrics and palliative care can be options for my future career. I am particularly interested in applying the field to the cancer population. At this point, I am more interested in pursuing my career as an onco-geriatrician. This is an underrecognized field, but focuses on 1)managing geriatric features, 2)optimizing cancer treatment intensity through geriatric assessment along with its intervention. A high level of collaboration with oncologists is crucial. From palliative medicine perspective, supportive oncology is also a field of interest for my career.

Question 6

5, Why did you pursue you career in oncology?

Answer 6

I was attracted to the narrative perspective of cancer medicine. As a thoracic medical oncologist, I was diagnosing stage 4 lung cancer, conducting chemotherapies, and dealing with end of life. Patients had prognosis of roughly 1- 2 years, and it was common for me to see each patient in a variety of setting in a longitudinal way. Supporting their daily life and achieving their wishes through their trajectory, walking step by step with their emotional changes, and eventually life story coming to an end. There were so many perspectives that I felt I wanted to support as one human.

Question 7

6, Why did you decide to quit oncology/transition to geri/pal?

Answer 7

I felt the human touch of medicine, the proportion of care, was not well appreciated in the field. It was always improving survival and developing new compounds that were valued. I realized a slight mismatch with my core value (which I value CARE and human touch of medicine) and how oncologists approach cancer medicine. My strong desire to maximize cancer care motivated me to transition from oncology to geri/pal.

Question 8

7 Did you consider hem/onc for your fellowship?

Answer 8

It did come to my mind, but I soon declined. This is mostly because I was already an oncologist in Japan, and this would not add any additional value to me, and does not resolve the conflict I had when seeing older patients with serious illness. Without oncology fellowship, I will not be able to handle chemotherapy, but I believe this will still be a field that I can engage by collaborating with oncologists.

Question 9

7-1, Did you consider geri/onc or palli/onc for your fellowship?

Answer 9

I certainly did, but I soon declined. Both of geriatrics and palliative was necessary to address the conflict that I had when I saw older patients with cancer, and I ended up valuing this over becoming an oncologist. Without oncology fellowship, I will not be able to handle chemotherapy, but I believe this will still be a field that I can engage by collaborating with oncologists.

Question 10

8, Why did you choose our program? What makes this program appealing/special to you?
8-1, MSH

Answer 10

I have a strong interest in approaching older patients with cancer, and this makes pursuing geriatrics and palliative care integrated fellowship particularly important. Mount Sinai has the largest integrated program in the nation with great mentors that I am already collaborating with to approach my field of interest. Taking into account the well established service serving for a diverse population, high level of collaboration with oncology, peers that we learn together, I cannot think of a different program. As a resident at MSMW, I have rotated geriatrics outpatient, palliative consult, supportive oncology, and home visiting. My rotations made me comfortable that this is just the right program for me.
Key structure
-why you want integrated
-why sinai integrated is good
-how you feel Sinai is your home

Question 11

9, Any plans for scholarly activity over 8 months?

Answer 11

I am hoping to conduct a clinical research to fill in the gaps of onco-geriatrics. This could be geriatric assessment/intervention and chemotherapy outcome/QOL related.
QI to improve understanding of geriatrics approach to cancer medicine for hem/onc fellow may be an interesting topic as well. In the long run, collaboration with geriatrics and oncology is the key but geriatricians are not always available for cancer patients. Structuring an educational material for oncologists to become a “little-g” themselves, is one of my goals.
Keywords;
-research outcomes not appreciated for older patients; quality of life, symptoms, caregiver burden, admission/ED visit rate

Question 12

10, What can you say about negative aspects of this speciality?
11, What challenges do you think this specialty may face in the future?

Answer 12

Patients that we deal with tend to be old, frail, and/or have serious illness, and a lot of times the trajectory tends to be poor and irreversible. Breaking bad news can be emotionally challenging. While we hope to support them, maintaining our resilience may be a big topic.

Question 13

12, What are your career plans after the fellowship?

Answer 13

I am thinking of becoming a palliative-trained geriatrician serving for the cancer population that can highly collaborate with oncologists. I am imagining that the institution that I would be working would be cancer centers or large hospitals with department of oncology.
1)Establishing onco-geriatrics care model which is underrecognized,
2)Engaging in clinical research to fill in the gaps between geriatrics and oncology,
3)establishing educational program or materials for oncologists to function as “little-g”,
are approaches that I am excited to take. Supportive oncology track would be within my interest as well.
Keywords; care model, research, education for little g

Question 14

12-1, Any institution you are imagining?

Answer 14

Mount Sinai- where I have been working and collaborating
Memorial Sloan Kettering Cancer Center- Has geriatrics department and is the leading institution in the field of onco-geriatrics. Speaking with Dr. Korc brought me positive insights as well.
University of Hawaii Cancer Center- The director of the cancer center is my personal mentor and he has an idea to establish onco-geriatrics care in his cancer center. I may as well take part
MD Anderson Cancer Center- Also has geriatrics department serving for cancer patients. I am collaborating with MDACC by facilitating team building and leadership workshop together.
University of North Carolina/Duke University/University of Rochester- Also leading institution in onco-geriatrics

Question 15

12-1, what is your vision/mission?

Answer 15

I have a vision to build a community where older patients with cancer can receive personalized treatment and care. I hope to support their trajectory as a geriatrics/palliative care physician.
1)establishing onco-geriatrics care model,
2)engaging in clinical research to fill in the gaps between oncology and geriatrics
3)establishing an educational program to help oncologists become “little-g”,
are approaches I am excited to take.

Question 16

13, (For geri program) You might be interested in palliative care fellowship as well?

Answer 16

Yes, palliative care would be within my scope of interest, since I am hoping to serve for cancer population. However, my main track would still remain geriatrics because I am interested in onco-geriatrics, which is a field to approach geriatric features for older patients with cancer and suggest optimization of treatment in collaboration with oncologists to avoid overtreatment.

Question 17

14, Tell me about onco-geriatrics

Answer 17

Onco-geriatrics is a rather new field intended to support the care gaps in older patients with cancer. Older patients with cancer have geriatric features such as decline in physical function, psychological function, cognitive function, poor nutrition, polypharmacy, multiple comorbidities, and social needs. In combination of these features, they are vulnerable to chemotherapy toxicities. Studies have shown that older patients tend to value quality of life and maintain function over survival. Despite this challenge, they are underrepresented in clinical trials. Onco-geriatrician will perform geriatric assessment along with its intervention to provide support. Additionally collaborates with oncologists to optimize treatment strength and coordinate personalized care plans. ASCO has GL on geriatric oncology and the SIOG leads this field.
Key structure
-challenges in domains and vulnerability
-outcome preference
-under-represented
-Approach; geriatric intervention/coordinate care/balance treatment strength

Question 18

15, Where do you see yourself in 5 years? 10 years?

Answer 18

In 5 years, I will be working in a cancer center or a large hospital with department of oncology, collaborating with oncologists to fill in the gaps in care and treatment for older patients with cancer.
Over the next 10 years, I will be gathering clinical data to provide further evidence to this field (onco-geriatrics) of unmet needs. Additionally, I will work on establishing an educational program for young oncologists for themselves to become “little g”.
Keyword;
-care model
-research
-education little g

Question 19

16, To what other programs have you applied?

Answer 19

I am applying widely across the nation.
Mount Sinai, Cornell, NYU, UCSD, UCSF, Duke, Stanford,
Hawaii, Montefiore, etc

Question 20

16-1, You are very well establish and you may stay in Mount Sinai as well?

Answer 20

I still have not decided which program to rank high. Yes, there is a chance for me staying, but I am making decision based on the context of individual programs and my family’s preference.

Question 21

17, What do you hope to gain from our fellowship program?
Geripal;

Answer 21

Geripal;
I hope to learn comprehensive care for older patients (with serious illness), including geriatric assessments along with its intervention, symptom management, and GOC discussions. I hope that I would be able to apply these skills when I serve for cancer patients. Additionally, I am eager to work on clinical research related to onco-geriatrics and start gathering data, collaborating with mentors.
Geri;
I hope to learn comprehensive care for older patients, including geriatric assessments along with its intervention,. I hope that I would be able to apply these skills when I serve for older cancer patients. Additionally, I am eager to work on clinical research related to onco-geriatrics and start gathering data, collaborating with mentors.

Question 22

18, What do you think we are looking for?

Answer 22

I think the program is looking for candidates with diverse strength.
-A candidate can be strong in by a strong desire to care for someone. This is different from other field where patient can get cured.
-A candidate can be strong by having a strong academic background and desire. This field has challenge in establishing evidence.
-A candidate can be strong by being a good leader. This field needs multidisciplinary collaboration more than other field, including physical therapists, nurses, social worker, nutritionists, chaplains, and other specialists. A well balanced leader is desired.
I think it would be interesting to accept candidates with diverse strength, so that they can share among peers.

Question 23

19, Why should we want you to come to our program? Why should we choose you?
20, What will you bring to our program?

Answer 23

I have a strong academic background that roots from oncology, and also enjoys mentoring case report publications. I believe this can be shared with my peers.
I am also an active learner for team building and leadership skills, this comes from being a facilitator for Team building and leadership workshop produced by MD Anderson Cancer Center. I am more than happy to brush up this skills and apply in the healthcare setting, sharing with my peers as well.

Question 24

21, What factors would lead you to rank a program high?

Answer 24

I would rank a program high, if the people there are passionate about people. Passionate about patients, passionate about colleagues, passionate about other healthcare professionals. I believe it is the team maturity and culture that is required in a good clinical practice, education and research.

Question 25

22, How do I know you can show initiative and are willing to work?

Answer 25

I am an active learner for team building and leadership skills, this comes from being a facilitator for Team building and leadership workshop produced by MD Anderson Cancer Center. I am eager to apply this skill in a multidisciplinary team, which I believe is core for geriatrics and palliative care.
Also, I am proud of my background, 8 years of practice in Japan and 2 years of practice in Mount Sinai. A great deal of team work took place in multiple setting such as inpatient, outpatient, ED, research, and education. This demonstrates my ongoing passion for patient care and medicine.

Question 26

23, Tell me about your difficult experience with older patients.

Answer 26

I cannot exactly recall a good example during my residency, but one that I can think of definitely is an older cancer patient that I encountered in Japan. This was an older gentleman, frail appearing using a walker, somewhat cognitively impaired, well supported by the family. He was diagnosed with stage 4 cancer at my clinic. Chemotherapy in combination with immunotherapy, was tumor-effective, however the patient appeared hopeless every time I see and his physical function declined significantly. He did not seem to have good understanding of the trajectory as well. I realized that chemotherapy is not enough for cancer treatment, and comprehensive care in collaboration with geriatrics and palliative care (or geriatrics) was under-utilized.

Question 27

24, Tell me about your difficult experience with older patients during residency.
25, Tell me about a difficult conversation you handled.
26, Tell me about a difficult conversation you handled during residency.
30, tell me about an interesting patient you have seen during residency.
104, Tell me about a patient you had trouble dealing with

Answer 27

One difficult conversation that I handled was just recently in July while I was working on the medicine floor. It was an older patient initially here for heart failure, but was complicated by pneumonia, intracranial hemorrhage, intubated extubated and on tube feeds, very deconditioned being bedbound and unable to swallow. Gradually medically active issues resolved and I was dealing with ultimate question of PEG vs pleasure feeds with home hospice. Gradually decision was made by the family DNR/DNI no PEG, and pursue pleasure feeds, and poor prognosis was delivered. Family still had the hope for functional recovery and wanted to try pleasure feeds and take the patient home. I was shocked to find out that I was subconsciously directing them to home hosipice. While we need to be reasonable about making them aware of expectations, they always have the right to hope for better and pray. I was ashamed of how I handled the conversation, and realized that there is more to explore.

Question 28

27, How was the residency?
32, What is special/appealing about your residency program?

Answer 28

Residency at Mount Sinai was spectacular surrounded by many of the great mentors and peers. A lot of times people explains amazing clinical and research exposure, but I am personally proud of the team dynamics within Mount Sinai. The residency appreciated diversity, and there was a culture of appreciating psychological safety and different leadership styles. Every block came with another round of building team dynamics, but we were patient overcoming conflicts, appreciate each other and being an efficient team. The reputation of small team building effort over years made strong bond within the community, which was something I have never experienced before. Our team culture made the program merge possible eventually.
Keywords;
Diversity
Psychological safety
Different leadership styles

Question 29

28, What was the challenges you faced during the residency?
29, How was the merge to you?

Answer 29

I think program merge, was one of the large challenges I faced during the residency. Even within the Mount Sinai, two hospitals had different culture and system and there was a large conflict in putting two programs together. The culture of appreciating diversity, different leadership styles, and building psychological safety helped us move forward, slowly uniting as one team.

Question 30

36, Tell me something about you that is not on your CV

Answer 30

I lived in Michigan from 8 to 12. Ice hockey was a hot sport, but I ended up not trying. After returning to my home country and entering medical school, I encountered a chance to start ice hockey in the medical league. I jumped in, started a new sport, and it was a great experience.

Question 31

38. What are your core values?

Answer 31

Commitment, kindness, and family.
Commitment is one strong way of showing leadership.
Kindness to patients and other healthcare workers is my fundamental of being a physician
As for family, I have two kids, 6 and 4. They make my life special and I am careful to balance my work and family.

Question 32

39, What are some of your strengths/weaknesses?

Answer 32

-I would say my strength is multi-tasking. While I fulfill my obligation as a resident, I engage in clinical research, and I am also a father of two, so I have to be very efficient.
-My weakness might be, being emotionally involved. It is core to patient care, but may negatively impact resilience, so I believe I need to be careful.

Question 33

40, Tell me about your hometown/college/medical school
Hometown

Answer 33

Hometown
I was born in Tokyo, lived in Hiroshima from 1 to 8, lived in Michigan from 8 to 12, and then back to Tokyo. There are several places I grew up but I would say Tokyo is my hometown.
-Tokyo is a big city with great chance to meet new people and good educational opportunities.
-If you drive an hour or two, there are rivers and campsites that families can enjoy.
-Now becoming more tourist friendly

Medical School
I was fortunate to enter the best private medical school in Japan, which is in Tokyo. It unique for its early clinical exposure, research opportunities and elective clinical clerkship in the US. I joined clinical clerkship at Columbia University Affiliated Hospital (Harlem Hospital Center) during my 6th year at medical school. Our medical school have a lot of sport teams, and I joined the ice hockey team for 6 years.

Question 34

41, Why did you choose the college/medical school that you attended?

Answer 34

To be honest, that was the only medical school I passed, of the 4 I applied. Fortunately, I ended up with the best private medical school in Japan, which is in Tokyo. It is unique for early clinical exposure, research, and clinical clerkship in the US.

Question 35

42, Tell me about your medical education

Answer 35

-My first exposure to the US medical system was the clinical clerkship at Harlem Hospital Center when I was in 6th year medical school. It was a good experience getting to know the systems in clinical practice and education through infectious disease.
-After graduation, I worked as a junior resident, senior resident in internal medicine, then fellowship in pulmonary medicine and thoracic medical oncology. I highly enjoyed engaging in various research projects and publications.
-Outside of my duty, I work with MD Anderson Cancer Center hosting leadership and team building workshop.

Question 36

43, What are some of your hobbies/interest/extra-curricular activities?
44, What are your interests outside medicine?

Answer 36

I enjoy my time with my family. My daughter is 6 and my son is 4. Especially outdoor activities. Going on a picnic, rollerblading, ice skating- those are valuable moments that gives me strength

Question 37

45, What do you do in your free time?

Answer 37

Hiking is one of my favorite. Coldsprings.
Ski, tennis, ice skate, roller blade
-Breakneck ridge, Bull hill loop

Question 38

31, What made you choose MSMW/BI residency?

Answer 38

I chose Mount Sinai program because this was within a large health system, and there were a wide range of possibilities finding mentors and coordinating clinical/research rotation of your interest. I also appreciated the hospital respecting diversity and serving for a diverse population within NYC. Also, Mount Sinai has one of the nations well established geriatrics and palliative medicine department. I thought that by rotating through their service lines I would have a better understanding on my future career.

Question 39

33, How do you feel about the practice of medicine today? What about its future? (ie malpractice, insurance, reimbursements, etc)
34, What is a current issue the healthcare system is facing?
35, What is your biggest fear in the realm of medicine? (or question concerning the state of medicine in general)

Answer 39

I think insurance is a huge issue throughout the world. Where in countries that does national insurance like Japan, covering expensive chemotherapies just to prolong survival for 3 months, I would have to say that it is not well balanced with high financial burden to the country. On the other had in the US, where private insurance plays a bigger role, it makes sense that market principles cover high end costs, but the downside is the health care disparity. Which is better? I do not have a great answer but seeing both systems I see pros and cons.

Question 40

37, Give me some one-word descriptors of yourself

Answer 40

Enthusiastic- whenever I find something interesting, I find myself eagerly participating.
Lets say mentorship- when people reach out with project ideas, I am always thrilled to help them because this is something I enjoy.
Team building and leadership workshop- First I did not know that this was something that could be handled in a workshop. I soon became a facilitator from a participant, and that shows my eagerness.

Question 41

47, Can you tell me about your volunteer work you did?

Answer 41

I am not sure if this is a volunteer work, but being a facilitator at team building and leadership workshop is part of my volunteer activity. (below same from experience)
This is a team building and leadership workshop produced by MD Anderson Cancer Center. I started off as a participant in 2019, and being selected as the most outstanding participant, I was invited to MDACC for 1 month with financial support as an award, and subsequently joined the workshop as a facilitator.
Facilitators and participants are from diverse discipline including physicians, nurses, pharmacists, chaplains and social workers. It is a three day course. First day is lecture on team building and leadership skills. Day 2 is group work on a project, where multidisciplinary team come together and apply their skills. Day 3 is Group presentation of their work. The whole aim was to build a foundation of team building and leadership in cancer care. My role is to facilitate participants utilizing team building and leadership skills in their group work, carefully observing the team dynamics and conflicts they are trying to overcome.

Question 42

48, Have you held any leadership roles?

Answer 42

Yes, I have played several leadership roles.
-Bigger ones are being chief investigator for three research projects. For each of these projects, there were new team member, and we got together to know each other, share a clinical question, and put our tasks together. For Research projects with more team members, a high level of coordination and understanding of team dynamics were required.
-Smaller ones include assigned leadership roles during residency. This includes each clinical rotation with residents, interns and medical students. I tried to understand where each participants stand with their knowledge, goals, and sometimes stepping in to deal with conflicts.
Regardless of the team size, understanding team culture and team dynamics played critical role and my background as a facilitator in team building and leadership workshop has been helpful.