Training for the Future: A Day in the Life of a Surgical Fellow

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Spend the day with gynecologic oncology fellow Emeline Aviki.
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5:25 am: It was dark when gynecologic oncology fellow Emeline Aviki left work at 1 in the morning. It’s still dark when she comes back only four hours later.

The day’s choreography starts when she pops into her office to grab her white coat and scan the schedule. “Every second counts,” Dr. Aviki says.

The next stop is an essential one — coffee. Then it’s off to the races.

Building Expertise

Dr. Aviki is a fellow in MSK’s Graduate Medical Education Program. At any given time, there are about 400 full-time clinical trainees like her who are at MSK to learn from leaders in cancer care and research.

“It can be really confusing for patients to understand all the different people coming into the hospital room with white coats,” says Monika Shah, Chair of MSK’s Graduate Medical Education Committee.

Typically, doctors first complete medical school. Then they move on to a residency program, where they spend three to five years training in their desired specialty area.

“After residency, some choose to pursue more specialized training in a focused area,” Dr. Shah says. “This is called a fellowship program.”

MSK offers more than 80 such programs.

I love operating because there is a clearly defined problem, and I can fix it. I get to make an immediate impact on a woman's life.
Emeline Aviki gynecologic oncology fellow

“A fellow is a trainee who has had a lot of training already and has chosen to superspecialize in a certain area,” Dr. Aviki says. For her, it’s gynecologic cancers, such as ovarian, uterine, and cervical cancer.

6:00 am: Dr. Aviki meets with a resident on the tenth floor to check on their patients from the night before. It’s standard for fellows to be on the front line of patient care.

“With the supervision of a faculty member, our fellows are responsible for the bulk of our inpatient care,” says Mario Leitao, Director of the Gynecologic Oncology Fellowship Program. “Fellows are the captains of the inpatient team.”

6:40 am: It’s time to prepare for one of Dr. Aviki’s favorite parts of the day: surgery. “I love operating because there is a clearly defined problem, and I can fix it,” she says. “I get to make an immediate impact on a woman’s life.”

On this day, Drs. Aviki and Leitao are operating together. “It’s really rewarding to teach fellows because they ask questions, challenge us, and keep us on our toes,” Dr. Leitao says.

Being a teaching hospital benefits MSK as a whole, as well as its patients, Dr. Shah says. “Trainees elevate everybody,” she adds. “The opportunity to provide mentorship enriches all of us.”

7:00 am: Dr. Aviki heads to the preop area to talk to her patient before surgery.

“I start by explaining my role and reassuring them in their choice of hospital,” she says. MSK has some of the most experienced gynecologic surgeons in the world, and Dr. Aviki takes pride in being able to tell her patients that they’ve chosen one of the best possible places to be. “This gives them a lot of comfort,” she adds.

7:30 am: Surgery is underway. Depending on the type of surgery, Drs. Leitao and Aviki could be in the operating room for the next two to ten hours. On any given day, they might perform between three and seven surgeries.

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Balancing Act

MSK fellow Emeline Aviki with her family

Dr. Aviki with her family. Photo courtesy of Emeline Aviki

12:30 pm: Surgery is over, and Dr. Aviki checks off a few things from her to-do list before it’s time to go back to the OR. She visits patients again, catches up on email, and eats lunch with some fellow trainees.

2:30 pm: Dr. Aviki video calls her two-and-a-half-year-old son, Asher. A spouse and working mom of two who consistently logs 18-hour workdays, she makes sure to find time to stay connected.

“I touch base with my kids throughout the day whenever I can,” she says. “I think it makes it easier for them and helps me feel like I’m not missing out.”

The demanding schedule of a fellow requires a balancing act, and it’s one that Dr. Aviki sees as black and white. “Weekends, when I’m not working, are all about family. Other times, it’s all about work, and that’s OK,” she says.

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Advancing the Field

3:00 pm: Dr. Aviki stops for a quick coffee and heads to her office to spend time on her research, which Dr. Shah says is a crucial aspect of training at MSK.

“At a place like MSK with cutting-edge science, the way to change the landscape of cancer care is to provide not only the best clinical training but also the best opportunities to be successful in research,” Dr. Shah says.

MSK gynecologic oncology fellows typically spend the first year of the four-year program in a basic science lab, where they study general scientific concepts before applying them to cancer care. But Dr. Aviki’s research took another path.

“I received an MBA before my residency, so I’m focused on improving the affordability of cancer care,” she says. “It’s my way of bridging the two worlds and advancing my field.”

4:30 pm: Dr. Aviki has a question about whether a patient is a good candidate for surgery, so she checks in with another gynecologic oncologist with whom she is training. “Our faculty are our resources. They’re always there to help and teach us,” she says.

Training the next generation is vital, says Dr. Leitao, who has been a surgeon for 15 years, since completing his own fellowship. “I’m not going to be here forever,” he says. “It’s important to train young doctors so that we can continue to improve the care of women with cancer.”

5:30 pm: After 12 hours at work and a few more to go, Dr. Aviki is somehow still brimming with energy. It could be all the coffee, but she attributes it to something else. “I love every single day at work,” she says. “I love my patients, and I love making a difference. There’s nothing else I’d rather do.”

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Comments

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Wow- I’m tired just reading about Dr Aviki’s day.! What a talented, compassionate and dedicated surgeon . Thanks for sharing !

This was a great piece seeing the dedication, hard work and training these fellows go through to be one of the best in their field thanks to MSK!

I have the honor of working in the OR with Dr. Aviki, she is fantastic!