Navigating the Residency and Fellowship Experience by Creating Opportunities in Oncology With Waqas Haque, MD

Oncology Data Advisor: Welcome to the Oncology Data Advisor Fellows Forum. Today, I'm joined by Dr. Waqas Haque. Thanks so much for coming on today.

Waqas Haque, MD: Thanks so much, Keira. It's great to be here today.

Oncology Data Advisor: We're really excited to have you as the newest member of the Fellows Forum. Would you like to introduce yourself and share a little bit about your medical training journey so far?

Dr. Haque: For sure. I am currently a second-year Internal Medicine Resident at New York University (NYU) in a Clinical Investigator Track (CIT). I grew up in Dallas, Texas. I did most of my schooling there. I went to medical school at the University of Texas (UT) Southwestern in Dallas and graduated in 2021. Before med school, I took some time studying in England and doing a master's degree there. Then between my third and fourth year of med school, I was a summer scholar at Johns Hopkins, where I earned a Master's of Public Health.

The transition to residency was really important for me to get more exposure to my interest in health economics and clinical trials and clinical research, which I've been involved with. Right now, I'm actually applying for the Oncology Match. So, fingers crossed, and we'll see what happens later this fall. In terms of my training, I mentioned my master's degrees and then being at UT Southwestern for med school. I'm looking forward to an academic oncology career, which I can talk about a little bit later. And in my free time, I like to explore Manhattan, check out the new coffee shops, and stay involved in some different kinds of volunteer nonprofit work.

Oncology Data Advisor: Awesome, that's great. So, right now you're a Resident in a Clinical Investigator Track. What is your focus with this track, and what opportunities has it provided?

Dr. Haque: Just to give a brief introduction, the Clinical Investigator Track within NYU is pretty similar to the standard Internal Medicine Residency. It's still three years long; you're not taking any extra years to complete the residency. But you get more elective time for research, and then you also get more mentorship, and you get plugged in really quickly to find research managers at the beginning of your residency. That can be a daunting challenge when you're starting in a new city, a new place, and a new institution, when you have to navigate the whole landscape and try to find someone who's going to be a good mentor.

In terms of that, my research is really with the Melanoma Division. I work with Dr. Jan Mehnert and also Dr. Jeff Weber on various melanoma projects. More recently, I've been working with the genitourinary (GU) oncology folks on finding ways to increase diversity and clinical trial recruitment through electronic health record (EHR) algorithms. So, that's kind of the focus of my research. Over the past year, we've had monthly returning meetings where we learn about research. We connected other researchers in the CIT, and there are about five or six of us per class. It's a pretty small, tight-knit group, but the fact that we're all being engaged in research and sharing it kind of puts the pressure, so to speak, to keep on pumping out more work.

Oncology Data Advisor: What are some of the specific research projects you've conducted or some of the ones that you've enjoyed working on the most so far?

Dr. Haque: When I first joined residency, the CIT Director at that time was Dr. Berger, who's a cardiologist. But when I mentioned my interest in oncology and looking at those sorts of fields, he actually plugged me in with a lot of oncologists really quickly. That's how I got involved in melanoma research from the very beginning of residency, which was a huge blessing.

In terms of the melanoma projects I've worked on, I mentioned mainly retrospective analyses. I've done one project looking at outcomes of mucosal melanoma, which is not as well characterized as other forms of melanoma due to having less trial data and also having a much lower incidence in terms of melanoma overall. I've been doing some work on the optimal sequence between immunotherapy and targeted therapy for patients with advanced melanoma. I've done some health policy research, as well, that was recently presented at the American Society of Clinical Oncology (ASCO), the annual oncology conference, which is in Chicago every year. I just came back from that a couple weeks ago.

So, that's sort of been my melanoma research, but looking forward for this year, I'm trying to learn a lot more about data science and machine learning. I think that's where the new wave of oncology research will really be fruitful. I'm actually working on a project where we're trying to find ways of using the EHR to find patients who are not as well represented in clinical trials—like African American patients, Hispanic patients, or females—and then finding ways to give a nudge in the EHR so that providers can recruit them for a clinical trial if they're eligible. It's a very early-stage project, but I'm actually applying for a health equity grant to get that kicked off, and I'm going to be focusing on that for the next year.

Oncology Data Advisor: Awesome. It sounds like a really interesting and important project.

Dr. Haque: Definitely. I think clinical trial diversity is very important in oncology, not just for testing the efficacy of drugs, but also for giving us better data about what kinds of side effects patients have and fostering trust between groups that have been underrepresented historically and the medical system.

Oncology Data Advisor: For sure. So, you mentioned that you're planning to apply to fellowship this year. What are some of your plans for that and what you're looking forward to in your fellowship experience?

Dr. Haque: So, I did most of my school in Dallas, as I mentioned. I was in the South and in Texas—the weather's obviously very nice there—but one of the reasons I left Texas to come to New York was that I think it's important in different parts of your training to get a little bit of different exposure and see how things work in different parts of the country. Geographically, I'll sort of see where I match, and being in the big city would be nice. But I've done a lot of melanoma research, and I've done health services research, so I want to find a program that can really support the kind of research that I've done in the past. Really, I think any of the major cancer centers can support and foster those interests.

Then I also have an interest in being a clinical investigator. Finding a program that gives me exposure to phase 1 and phase 2 trials, that lets fellows really take charge in terms of that, is another important aspect. So really, it's just finding a program that supports my career goals and gives me the time and flexibility to make those a reality as I transition into the next part of my career.

Oncology Data Advisor: That'll be really exciting. As someone who's currently in the midst of this process, do you have any advice for other residents who are planning to apply about what to look for in a program?

Dr. Haque: Definitely. Obviously, I'm still going through it myself—still in the weeds—so I'm not a full expert on how to match to a specific program. But there are some things that have been important for me so far in at least identifying what programs I want to go to. The first thing I would say is I looked at the program characteristics. The last question was asking about my career plans, so for anyone else who's interested in applying for oncology fellowship, look at your career plans.

Are you trying to be an academic oncologist who wants to be involved in a lot of the clinical trials and being part of different cooperative groups and going to conferences and being a big expert in a very niche type of oncology? Then you want to look at academic programs. If you're looking to be very clinical, if you're not as invested in publishing a lot of research, if that's not what makes you feel as gratified, then look for a program that'll be more clinically heavy. There are programs that will be very clinically heavy the first year, and in the next 12 to 24 months, are going to be very clinically focused as well. But then some programs are very clinically heavy at the very beginning; they kind of upfront it, and then later on, they give you a lot of research time. So, that's definitely the first thing you should look for.

I would also say to look at the location. Is it in a bigger or smaller city? Is it in a rural or suburban setting? Figure out what makes you feel the best academically, professionally, and personally. Also, look at things like how the fellowship is structured. In some fellowships, the clinics are really being driven by the fellows. You get your hands wet and you're doing a lot of extra tasks to coordinate care, but it gives you a better insight into how oncology care is really done. But in some fellowship programs, the clinics are attending-driven, so you have a lot more oversight and supervision. So, you have to figure out which of those is better for you when you apply to programs.

Then of course, if you have an interest in a certain kind of tumor or therapeutic area, then you want to make sure that there are research mentors you can work with at an institution who will support your goals. I would say those are some of the main characteristics that you look for in a program. But I would also say that you have to look at yourself as well. Look at your career goals and look at what you're trying to accomplish and if you have any personal factors that may influence where you want to be. Those sorts of factors, I think, are some of the big things to look for.

Obviously, if you're applying for fellowship, you're doing Electronic Residency Application Service (ERAS^®) for the second time. The nice thing is that you can load a lot of your information into ERAS when you're putting in the application. But it's a lot of the same advice that I would give for applying to residency and applying for fellowship. The first thing I would say is to just be on top of everything and know your dates. Make sure that you're looking at the ERAS program dates. Look at when the token opens and look at when you're able to start putting in your information for the application. Look at when information can be sent out to programs, and then look out for when programs can start reviewing information. It can take up to five business days for documents to be uploaded, including your recommendation letters, your med school transcript, and your performance evaluation for med school.

So, you have to just make sure that you're on top of those things. I actually contacted my med school the very first day that ERAS opened. I just had to make sure that I got that in, and then it was uploaded within three or four days after that. Definitely stay on top of all of your dates and documents, because you don't want to get that rec letter in a month late and then delay your application. Also, following up on that, when you're asking for rec letters, try to ask several months in advance. If you're asking in May or June, it might be a little bit too late to get it on time. But if you ask your letter writer early on for a strong letter, and if you mentioned that ERAS goes out in July, then usually they'll be able to accommodate and make sure that the letter is submitted well in advance of the process time as well.

So, really knowing your dates is the first thing.

The second thing, I would say, is to just make sure that you're looking over every line of your application. If you're in an interview and someone fills out your ERAS, you should be able to look at any line of it and be able to go into more depth about it. Your research, your volunteer experiences, different kinds of things in your background, any notable parts of your training—just be able to explain that in a little bit more depth. I would also build upon this by saying that your personal statement should be started several months in advance; don't start thinking about it just a month or two prior. Even in wintertime, the season before the cycle opens, just start thinking about ideas for your application—what makes you strong, what kind of theme you want to have, how you want to portray yourself.

As you go through training, you might find some interesting patient cases or encounters, or you might do some more research or have some more experiences, like at a conference, that you can weave into your personal statement. Then by the time you get to your application time, you'll have a really solid personal statement. I would also say that getting feedback on your letter from people, whether it's friends, family, or your mentors, is also really great. Actually, for me, I would say that when I've gone through the application cycle for med school residency and now fellowships, some of my best edits and revisions have actually been from people outside medicine—people with a literature background who are really strong in writing. They make some of the best edits, because they can actually look at your personal statement and help you make it a real narrative, like a real story. That's the other thing I would say.

Then the last thing I would say is to just be informed. Be informed about the programs. Each program has their website, and they'll tell you about what they want for the application, how many reccomendation letters they want to have. Or some programs will mention that on the personal statement, they want you to mention, which research mentors you want to work with or what you see in terms of your career plans. That information might not actually be on the ERAS application itself. So, just do your research and make sure the documentation is right in terms of what you're reporting in the personal statement. Also make sure of simple things, like you're not sending four rec letters when the program wants to maximum of two. Those are small things that you can do to make sure that you're not missing anything.

So, those are some of the main pieces of advice I would give to someone applying. Also, if you can have an email that gives you notifications when you're receiving interviews, or even setting up a new email account just for your interviews, would be nice because most people applying for fellowship are going to be in their third year of residency. You're going to be in the wards or working nights, and then you get an email,and you have to figure out how to triage between doing your work and signing up for the interviews. That can be a little bit more stressful. That's something that I haven't experienced because when I was applying for residency, it was during COVID, so I was at home for the most part. So, that's another challenge that you have to work out with your program. Those are some basic pieces of advice I would give.

Oncology Data Advisor: Those are really great pieces of advice. I'm definitely looking forward to hearing more as you go through this process and hearing more about your research as you go. For residents who are looking to get more oncology exposure during residency, do you have any advice for how they can go about doing this?

Dr. Haque: Yes, that's a really important question. I think a lot of Internal Medicine Residents feel that they get a ton of cardiology exposure, a ton of pulmonology exposure, and a ton of gastrointestinal (GI) exposure, just through being in the wards and through a lot of the rotations done in the ICU, but you don't really get as much time to do outpatient shadowing or outpatient rotations. It can be a challenge in a lot of residency programs to get adequate oncology exposure. I was thankful because within our program, we do have inpatient time for oncology and hematology.

I was actually able to trade in for several oncology rotations, and I did a hematology rotation in the inpatient setting in my second year of residency. Doing inpatient time is important because you'll usually have an oncology attending who you can work with or talk to. If you just say that you're interested in the field of oncology, then they'll find ways to plug you in or find ways to connect you to someone else for more opportunities, which can also include outpatient shadowing.

But really, I think the bread and butter of getting exposure is just through your outpatient time or through your elective time that's not as structured. I would just email oncology attendings in different subspecialties. I was interested in melanoma, GI, breast, and GU, and would just ask for a half day where I could shadow them. Then sometimes I would even do a half-day of one clinic and a half-day of another clinic. You can get exposure to see how they interact with patients regarding what kinds of drugs or diseases you're interested in. That's very helpful. I would say the inpatient time is important to give you opportunities for outpatient shadowing.

Then just really make an effort to ask them what they like about their career and what kind of things they're working on. The more you ask these questions, the more spontaneous opportunities will open up. The way I got involved in the project regarding clinical trial recruitment and diversity was just through shadowing a GU oncologist in my program. I mentioned my interest in biopharma collaborations and health tech and economics, and he happened to work on a certain project. He didn't really have anybody else on it, and that's how I got plugged in. And now I'm kind of the lead on this project. So, just really keep an eye out for opportunities like that.

Also, I would say that it's important in oncology to get involved in some kind of research from the very beginning. It can be a case report, or it can be some kind of retrospective project. Of course, you can always get involved in bigger things like clinical trials or lab research, but those things can take two, three, or four years to get published out there. Unfortunately, with the timeline of residency where it's only three years long, and you're applying for fellowship at the very beginning of your third year of residency, you don't have much time to do these really long-term sort of high-level projects. Finding things that can be published on a sort of quicker term, things that you can present as a poster, are all very important for getting more oncology exposure.

The last thing I would say is to find ways to get yourself out there. There are ways like going to ASCO. You can find conferences to go to. Usually, most programs will give some kind of allotment of time every year, whether it be two or three days, to go to a conference either as an attendee, or even better, as a presenter. For residents interested in oncology fellowship, I would highly recommend going to the ASCO Residents and Students Forum every year. If you get accepted as a poster presentation within the forum, then you get a complimentary registration for ASCO, which saves a lot of money, and it's a great way to network and interface with other residents and other fellows.

When I went to the forum at ASCO this year, I met several fourth-year med students applying for internal medicine. But I also met several third-year residents who were starting fellowship in oncology from different parts of the country, and it was cool to just get their email or contact info. Later in the year, if I get an interview at their program and I need some in-depth advice on what the program looks like, I can actually follow up and get some advice. And of course, the way I got connected to you all is just by going to ASCO and going to your booth, networking, and just putting myself out there.

So, I would say that a combination of inpatient rotations, shadowing in the outpatient setting, keeping an eye up for research opportunities, and going to conferences are really the best ways to keep yourself afloat of oncology. Then if you want to do things even beyond that, I would say that reviewing materials for oncology and just knowing that stone-cold would be nice to do as you go through residency. The FDA also has a newsletter where they send updates for new drug approvals, which is kind of cool just to see when new things are out there and what things are in the works. And just keeping up with some big journals like New England Journal of Medicine, JAMA Oncology, or Nature, keeping out an eye out for big updates in cancer care, is also nice every once in a while. So, those are some of the tips I would recommend for residents to get more exposure.

Oncology Data Advisor: Absolutely. Those are all great tips, and ASCO definitely has a ton of opportunities for residents and fellows. Are there any conferences other than ASCO that you've been to or that you hope to go to?

Dr. Haque: Yes, so as an Internal Medicine Resident, the American College of Physicians (ACP) Conference is really nice. I've had things presented there, but I've not had a chance to go there just because of COVID. So, ACP is a good conference for residents in internal medicine. For oncology, there's also the European Society for Medical Oncology (ESMO) conference, which is in Europe every year. But ASCO is nice because they have the main conference in Chicago in the summertime, just to kind of make everyone from the West Coast happy that it's not during the winter. But they also have such specialty conferences throughout the year. They have a Quality of Care Symposium in the fall, I believe.

ASCO's really the main one that I've been to. It was my first time going to a conference, but my advice for residents or fellows going to these conferences the first time is to do your research and go to the program guide to figure out what kind of programs you're interested in. There are so many things going on to these conferences that you can't really get great exposure to everything, so just pick one or two things. For me, it was melanoma and machine learning, and I went to some of the lecturers and learned from those. So, just pick a couple areas that you're interested in.

Also, look at the names of people and see if you can get an email or a way to get an introduction. And a lot of conferences, like ASCO, have a residents' track. Every day of the conference, they had a special lounge for residents, fellows, and students where you could actually go and just relax and meet some mentors. They had specialized sessions for learning about a career in oncology, what it's like to work in industry, and advice for getting involved in clinical research. If they have a resident track, I would actually just focus on that, because that's where you'll meet a lot of people who have similar goals as you. So, that's the basic advice I would say about attending conferences.

Oncology Data Advisor: Awesome. That's really great to know. One additional question I'll ask you is, as you continue doing more interviews for the Fellows Forum and setting up some live panels with the other members, are there any topics that you're looking forward to covering?

Dr. Haque: Definitely. I mentioned my interest in melanoma research and a lot of new therapies that I'm invested in working on as a clinical investigator. Another interest I have is making sure that the drugs that I might help develop or help do trials for can actually reach patients and be accessible. So, I want to have more discussions about health policy and about equity in care. A year ago, I published an op-ed on the quantity limits for cancer patients who are prescribed antiemetics, even old-generation antiemetics. There are actually a lot of challenges with patients getting access to basic medicines. I want to talk about things like that, about getting adequate prescriptions, having adequate access to care, and making sure that there's equity in oncology care. Those are some topics that I definitely want to focus on.

But then when there are things like ASCO or other big conferences that come up, I think everyone's excited about the therapy, the latest trial results. Having panels where we can all kind of react and weigh in and give our own analysis on the trials will definitely be very exciting. Overall, I'm excited for a combination of new research updates and talking about economics of cancer care.

Oncology Data Advisor: I'm definitely looking forward to hearing all these updates too.

Dr. Haque: Thanks so much, Keira. It was great being on today, and I look forward to having more conversations in the future.

About Dr. Haque

Waqas Haque, MD, MPH, is a rising third-year Internal Medicine Resident at New York University in a Clinical Investigator Track. As a Clinical Investigator Track Resident, Dr. Haque has balanced his patient care work with a variety of research projects. He hopes to begin fellowship training next year in Medical Hematology/Oncology at an academic program with opportunities to further his work in innovative clinical trial design, value-based care delivery to cancer patients, and becoming an early-stage clinical investigator.

For More Information

Haque W, Sedhom R, Chino F, et al (2023). Payer-imposed quantity limits for antiemetics: everybody hurts. J Clin Oncol Practice, 18(5):313-317. DOI:10.1200/OP.21.00500

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.