Expert Interviews: Julie Bloom, MD, and Aaron Simon, MD, PhD

Julie Bloom, MD, is an assistant professor in the Department of Radiation Oncology at the Icahn School of Medicine at Mount Sinai, where she specializes in the treatment of gynecologic and breast malignancies, and is a Partner Physician at the New York Proton Center. Her path to the specialty began with a single moment at tumor board—and her perspective on patient care, research, and what it means to walk alongside someone through their cancer journey offers a window into why radiation oncology continues to draw passionate, curious minds. Below, she shares her story with our readers.

Q: When were you first exposed to radiation oncology, and what drew you to it over other specialties?

Early on, I knew that I wanted to work with cancer patients. I felt this was an area that was extremely rewarding and rapidly evolving. I was on an otolaryngology rotation sitting down at tumor board when I was struck by one particular individual from a specialty I had never heard of: radiation oncology. This individual was humble, well-spoken, and seemed to know data from all 3 major oncologic disciplines. He epitomized patient-centered and evidence-based care, and provided input that changed the trajectory of the patient’s plan.

I thereafter chose to do an elective in radiation oncology. By the end of the first week, I was 100 % sure radiation oncology was where I was meant to be. What most captured me was that these doctors truly cared for their patients. Secondary to this, I appreciated the evolving landscape and technical aspect of radiation planning.

Q: What does a typical day look like for you, and what do you enjoy most about it?

One of the things I enjoy most about my career is that I have no one “typical day.” On average, a day for me includes at least 1 or 2 of the following: seeing patients in clinic, brachytherapy, working on clinical research, and/or tackling the “behind the scenes” of radiation care, such as contouring and plan review.

What I enjoy most, by far, is my patient interactions. Working with someone and her family during a challenging time can be difficult, but is extremely rewarding. Secondarily, I love how interdisciplinary radiation oncology is — from physics to radiation therapy, interacting with highly motivated colleagues is one of the things I look forward to most when coming to work every day.

Q: What skills or qualities do you think are essential to thrive in this specialty, and what advice would you give to a student just starting to explore it?

One quality I believe is essential is to be detail-oriented—there are a lot of nuances to radiation therapy, and missing even a few small details could drastically change a patient’s treatment plan. It’s also imperative to be a team player, whether that’s troubleshooting with therapists, discussing plan adaptations with physics, or collaborating on clinical trials—radiation oncology is a team sport, and is most enjoyable when played as such. For students exploring radiation oncology, my advice is to approach each day and rotation with an open, inquisitive mind. What parts of the day do you enjoy most? Find what excites you, and pursue it.

Q: What does it mean to you to accompany a patient through their cancer journey?

To accompany a patient through her cancer journey is our greatest privilege. We have the opportunity to be with patients through, often, a very harrowing and life-changing time. For some, there is the potential to be cured after enduring extensive oncologic treatment—and you are fortunate enough to be a part of her life for years beyond. For others, cancer is not something that will be cured, and finding a balance between what that individual values and how you can best help during this vulnerable time is the most valuable thing we can do. It is a privilege that should not be taken for granted.

Aaron Simon, MD, PhD, is a radiation oncologist and Associate Residency Program Director at the University of California, Irvine, specializing in central nervous system malignancies and stereotactic radiosurgery. His background in functional MRI and bioengineering informs both his clinical practice and research.

Q: What First drew you to radiation oncology?

I don’t think there was just one thing. I had just completed my PhD dissertation in Functional MRI when I first heard about radiation oncology from an older student in my program, so the imaging aspects of it may be what first caught my eye. But I think, like a lot of medical students, one of the first things that really stood out to me during my rotation was how much time my mentors (residents and attendings) spent talking with their patients and counseling them about their care. That ability to form a connection with a patient without some of the time pressures I felt on other rotations was really appealing. I think I was also really drawn to the pace of the medical decision-making. Except in certain emergency situations, there was always time to think about a decision, reconsider, go back to the literature, talk to a colleague, and make sure you were making the best possible choice in each situation.

Q: What is one thing you wish students understood about CNS radiation oncology or SRS?

Probably that the technical work that you do, the treatment planning, is just one small part of the job. Many patients with CNS malignancies will experience recurrences no matter how carefully their treatment is planned or how advanced the technology is. A big part of the work, and one that one can never truly master, is helping each patient and family member navigate a really difficult time in their lives. Figuring out what information they need to know and how best to tell it to them, how to offer reassurance or comfort without creating false expectations; these are the daily tasks that will challenge you throughout your career.

Q: Where do you see AI helping radiation oncologists, and where should the field be cautious?

AI, or at least machine learning, has already entered clinical radiation oncology in a number of ways that are helpful, from speeding up repetitive tasks (eg, auto-contouring of normal structures) to providing a second set of eyes on imaging challenges (eg, automated detection and tracking of brain metastases) to standardization of best practices (eg, automated or AI-assisted treatment planning). What I worry about with AI is that it is often presented as something of a black box. It has an output, but we don’t know how it got there, and we don’t always know when or why it fails. What will happen when we are no longer training ourselves to perform standard tasks? Or when we begin to ask it to do things we never could? I don’t think we have developed good solutions to these problems, and for that reason we should proceed with caution in adopting new tools, even if they promise increased efficiency or new insights.

Q: As Associate residency program director at UCI, what makes a student stand out on rotation?

On a rotation, I think the first thing I notice is whether the student really wants to be there, is excited about what they are learning, and is trying to make connections between the patients they see and the concepts they’re reading about. Another is that they really care about the patients and demonstrate compassion. I think that if someone is excited to be at work and cares about the patients, they are already a long way toward being a great resident.

Q: What advice would you give to students without a home radiation oncology department?

If you know you are interested early, in your preclinical years, it doesn’t hurt to reach out to people at other institutions to ask about research opportunities. Video conferencing technology may have made our lives an interminable series of meetings, but it has also made cross-institutional collaboration easier than ever before. A lot of clinical research no longer requires physical presence in a lab, and so there are a lot of opportunities to find projects outside of your own institution. Of course, when it comes time for 4th-year clerkships, it will be helpful to complete at least one, and potentially a few, away rotations in radiation oncology departments. Completing these early in your 4th year will give you time to get letters of recommendation for your applications.