The Learning Curve of Fellowship

Conrad Williams IV, MD

Conrad Williams IV, MD, serves as fellow section editor on the Quarterly Editorial Board. In the Q&A below, Williams reflects on the path that led him to hospice and palliative medicine and what, as a fellow, he can expect for his future.

What compelled you to choose to specialize in this field, which is intrinsically emotionally draining?

Entering residency, I had no idea of what palliative care encompassed; to me, it was hospice care. As I learned more about the field, I quickly realized I had found my calling. In medical school, we are presented with and tested on all sorts of diseases and innumerable ways to treat the problems. In residency, however, you suddenly realize there is much more than a disease involved. Patients are not defined by their illnesses, and, especially in pediatrics, there are families that must be cared for as well. Many people choose pediatrics because kids “get better.” While this is certainly true in many cases, I quickly realized that some kids do not get better, and we often fail patients who need us most—those with chronic, life-limiting conditions. Medical school does not prepare us for that transition—we need a disease and an intervention. It is easy to talk about “the hypoplast status post Norwood,” that “CF’er who is back again because he just won’t do his daily home treatments,” or, even worse, “Bed 12.” As hospice and palliative medicine physicians, we are allowed an intimate relationship with patients and families at a time of intense vulnerability. We accompany our patients on the part of their journey that requires the most help; yet, it is the part that many providers distance themselves from because they are not prepared to care for this population.

What also excites me about the field is the potential. The trailblazers in pediatric palliative care are in the prime of their careers, affording those interested in the field an opportunity to learn alongside teams that helped define the specialty. What started as an art is gaining more and more of a scientific identity as the evidence supporting the specialty’s importance in our healthcare system quickly grows. The chance to play a role in creating an identity for what is quickly becoming a more established specialty is exciting.

Was the learning curve initially steep?

A challenge I was not expecting was the difficulty with transitioning from residency right into my fellowship. As residents, we are very task- and checklist-oriented. We get in early for rounds, focus on how to fix our patients’ diseases, and leave all the other “stuff” to social workers, case managers, bedside nurses, child life specialists, and others. Now I cannot do my rounds when our patients and families are sleeping, I cannot do an effective job without sitting down and giving them my time. I have had to make a conscious effort to be more mindful and present during my encounters. As I transition from resident to fellow, I have found it challenging to keep my mind clear and stay present during my visits with patients.

What have been some of the ups and downs?

If I could only do home visits for the rest of my career, I would be happy. To be welcomed into such a private space is an honor and allows me to get to know my patients on a new level. It places me in an comfortable environment, both physically and emotionally. Most families truly value time spent with their providers outside of the hospital.

The biggest “down” has been the geographic separation from my wife. In such an intense and emotional job, I need someone to debrief and relax with. Because my wife is also a pediatrician in fellowship and there were few options for where I could train, we are spending this year apart. Suffice to say, I am not a “phone person.” I have had to rely on coworkers and my chocolate lab, Nola.

What challenges do you anticipate as your career begins?

Fellows often find themselves entering jobs with leadership positions beyond their skills as junior faculty. Halfway through my fellowship, I have begun my job search in earnest with feelings of great anticipation accompanied by the unsettling sensation of my stomach creeping into my throat. In 6 short months, I will be faced with more than just a job as a clinician. Not only will I be developing my style as a hospice and palliative medicine physician, but I will also be labeled with titles such as team leader, administrator, educator, researcher, conflict resolver, and business planner. I will enter a whirlwind of institutional culture and politics, and I will need to remember the rules of sandbox etiquette, all while contributing to the development of a crucial and effective system of delivering high-quality palliative care to children and their families. I have begun to develop my leadership skills and create a network of mentors that can be a resource as I grow into my career.

Conrad Williams IV, MD, is a fellow section editor on the Quarterly Editorial Board. He is currently a fellow with Haslinger Family Pediatric Palliative Care Team at Akron Children’s Hospital, Akron, OH. Contact him at

Leave a Comment