When should fellows ask a question on Primum?
John Syme


Dr. Delasos was on a roll. As a current, 3rd year fellow at Cleveland Clinic, he was going through his typical pre-consult planning for his clinic on Thursday. He was midway through his coffee and three-quarters of the way through his panel when he hit a roadblock. 

The patient was previously treated with immunotherapy for early-stage lung cancer, and was now experiencing disease recurrence. Should he consider chemo+IO or recommend a clinical trial?

In situations like this, where the next step is not in the guidelines, or he is unsure of the correct decision, he faces a choice to make the decision alone or run the case by his attending. Hematology/oncology fellows rely on their attending physicians for situations like this all the time. Attendings have more knowledge and lived experience to impart to fellows, teaching the fellow to become a better physician. More often than not, the attending is the best person to go to when fellows have questions about their oncology cases. 

While attendings are arguably the best resource for hematology/oncology fellows, Primum offers fantastic support to fellows on their learning journey. Speaking to our fellow user base, we have identified a few scenarios where hematology/oncology fellows like to leverage Primum to ask questions.

When fellows want an opinion from outside their institution

Each institution has its own clinical protocol. Sometimes these protocols are formal. Other times they are informal. Preferences and protocols are picked up by hematology/oncology fellows throughout their training. Yet sometimes, an outside perspective can illuminate another treatment approach or strategy not considered. And since many fellows move on from their institutions when they graduate, these outside perspectives may even become the new protocols down the road. Primum allows fellows and oncologists to connect quickly with sub-specialists beyond their institution for a fast, informal outside perspective. This helps fellows as they continue to think critically about their decisions, allowing them to draw different perspectives into conversations with their attendings. Dr. Hadfield, a fellow at Brown, states that “it really helps me learn when I can get a perspective from outside my institution. It is always interesting to hear about the treatment nuances that occur across institutions.”

When the attending is a generalist, and the fellow wants a sub-specialist opinion

Usually, attendings have answers, but sometimes they might not. With over 170 fellowship programs in the country, there are dozens of programs that rely on seasoned generalist attendings rather than a deep bench of sub-specialists. In these scenarios, the fellow typically connects with a mentor at their fellowship institution for advice. Primum offers an alternative. Hematology/oncology fellows use Primum to quickly and easily connect with specialists in solid tumors, liquid tumors, and classical hematology to discuss clinical questions.

When hematology/oncology fellows don’t want to ask a “silly” question

How often have you heard there is no such thing as a silly question? I hear it all the time. Yet, I am still sometimes afraid to ask a question. This feeling affects many hematology/oncology fellows. There is no shame in asking a question on Primum. Primum specialists joined the platform to answer questions! Any question, big or small, is a good fit for Primum. "I am 100% more willing to ask any question knowing that Primum specialists are compensated for each conversation," says Dr. Thomas, a former 3rd-year fellow from LSU.

When fellows don’t want to feel like a burden

As a fellow, your job is to learn. Therefore, you ask a lot of questions. It may feel like you’re asking too many questions. You don’t want to be a burden to your attendings, always running things by them. Dr. Galili, a former 3rd-year fellow at Orlando Health Cancer Institute, says “Primum is great because sometimes I want to give my attendings a break from my questions. Plus, it allows me to break free of feeling like there is a quid pro quo going on. I can ask questions on Primum and know I am not a burden on the specialists.”


Hematology/oncology fellowship attendings are rock stars. They’re performing cutting-edge research, treating patients, and helping fellows on their educational journey. Like an attending, Primum is a helpful educational resource for hematology/oncology fellows. We know that sometimes during their fellowship, fellows would like an outside opinion, the ability to connect with a sub-specialist, or a place to ask a guilt-free question. Primum is here to help. 

Hematology/oncology fellows are our fastest-growing user segment, with over 20% of our users being fellows or graduates less than 1 year out of fellowship. Come join our rapidly growing community of oncologists here. For more information about Primum, sign up for our newsletter here

We look forward to supporting fellows throughout their hematology/oncology fellowship.

John Syme

John is Primum's Head of Operations. Previously, he was a Boston-based life science consultant.