Tick, tick, tick, every year in June you can hear the clock ticking louder and louder waiting on July 1st to arrive. It’s the most magical time of the year in Graduate Medical education. New fellows arrive, full of hope and excitement, not knowing that they are just seconds way from the $%&^ hitting the fan! The start of every new academic year is a bit like standing still in a whirlwind of activities gone wrong—exciting, high-stakes, and just a little chaotic.
As a fellowship coordinator, I live in this beautiful in-between space: part teacher, part counselor, part air traffic controller, part mother hen. The calendar flips to July 1st, and all hell breaks loose! We are juggling clinical rotations, onboarding paperwork, orientation schedules, new ID badges, IT requests, pager assignments, iPhones that don’t work and parking passes that don’t “pass” and—don’t forget— you need to know where everyone is supposed to physically be on Day One, all 42 fellows.
The Sweet Spot
The last week in June when you feel almost ready, you are so close, but not there just yet. Schedules are sent out, rosters made, food ordered, and invites sent out. You’ve rehearsed your presentation and updated it daily to include all the new rules / updates we’ve made in the last year. I swear, you can hear my brain cells dying a slow, painful death!
But then—BOOM— no, it’s not fireworks, it’s July 1st, The new fellows have arrived!
Orientation: Two of the longest, most boring days of the year and it’s time you will never get back, ever….
New fellows have arrived, they are wide-eyed and eager, trying to absorb everything you tell them, from where to park, to how to find a good, bone marrow harvest. They are all stepping into Hematology/Oncology, a subspecialty role, with more autonomy, higher expectations, and a brand-new team to integrate with.
Meanwhile, on our end, we’re fielding last-minute changes:
- “Trying to find that one email you swear you sent, but clearly didn’t”
- “This fellow’s license hasn’t cleared yet.”
- “Lunch arrived an hour early, nobody want’s cold pasta”
- “One laptop won’t turn on.”
- “The room I booked 6 months ago was double booked.”
- “Faculty members have last minute schedule changes —again.”
Every year, onboarding brings its own special type of chaos. Some years it's the surprise you get when you think to yourself, nothing could get worse. Just wait, it will! Other times it's the lunch arriving an hour early, who eat cold fish, or the badge reader battery dies. But no matter what, we pivot, adjust, and smile through it all. You never want to show weakness, they will thin you from the heard. I’ve seen it done!
It’s Not Just Logistics—It’s Culture
Beyond the logistics, onboarding is a culture. It’s the first impression the new fellows will get of their program. The controlled chaos will show them we have the grit to stand with them through the good, the bad and the ugly. I always want my fellows to feel welcomed, supported, and ready to thrive. I take on the fellows for three years, just like my own children, and I want them to know I will be there for them.
We try to plan activities that will bring all the fellows together. This is where leadership matters. We strive for inclusiveness by doing icebreakers. We plan for weeks to make sure we’ve made the correct mentor assignments and strive to provide clear communication channels. Our program wants to build trust from day one. Trust is not easy to gain but it is easy to lose.
Pure Chaos
According to Oxford University Press (n.d.), chaos refers to "a state of complete disorder and confusion" (Oxford University Press, n.d.). It’s not just noise, it’s movement, energy, excitement. It’s the look of pure panic of a new fellows’ face, as they prepare for their calling. And... by the end of that first week, when the name tags are straight, lab coats are buttoned, and cars are parked, something great happens and things start to click.
I remember why I do this. Every text, every call, every early morning setup—it’s all for them, the future of medicine, our next leaders in the Hematology and Oncology world.
Here’s to another academic year. Buckle up buttercup!
Resources
Oxford University Press. (n.d.). Chaos. In Oxford Languages. Retrieved June 26, 2025, from https://www.google.com
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