Transcript A Guide to the Subspecialty Fellowship Application Process

A Guide to the
Subspecialty Fellowship
Application Process
VCU Internal Medicine Residency Program
J. Christian Barrett, MD
Division of Hematology/Oncology
Virginia Commonwealth University
Roadmap
• Selecting a subspecialty
• Scholarship during residency – important
or not?
• What are fellowship directors looking for?
• The application process
• Resources
• Questions
Selecting the right specialty for you
• Experience in the field – rotations
• Discussion with specialists
− Private practice AND academic
− Faculty, fellows at own institution
• Discussion with academic advisors
− Faculty, program directors
− Mentors
• Questions that guide choices …
Selecting the right specialty –
questions to answer
• Do you want to focus on
− specific organ system (cardiology or GI)
− multi-systemic (ID or oncology)?
• Do you derive more satisfaction from dealing with
− acutely ill patients
− long-term management of disease
• Do you enjoy
− focusing on a specific disease or set of problems (such
as a cardiology consultant)
− the care of the entire patient (for example, serving as
a comprehensive provider to renal dialysis patients who
require long-term care from their specialist)?
Selecting the right specialty –
questions to answer
• Do you prefer to have a
− prominent inpatient component
− an outpatient focus?
• What kind of patient mix do you prefer (age, gender,
problems, setting)?
• What are the “hot areas” for scholarship in the
discipline under consideration … if interested in
academics, how do you see yourself focusing in the
future?
• Are you interested in procedures?
• Where geographically do you hope to settle and what
is the job market in that region?
Other issues to consider
• Competitiveness of specialty
− Stats available on positions filled through
match – www.nrmp.org
− Home institution faculty and fellowship
director
− Program director – honest appraisal of
candidacy
• Importance of “scholarship” and personal
commitment to pursuing during residency
− Particularly pertinent to cardiology and GI
• Visa issues, including time limitations
Self-Appraisal
• Personal reflection (HONESTY!!!)
− Personal value system
• Rank order priorities in life
• Compare with the work specific priorities
• Reconcile incongruity
− Personal aptitude
• Assess your competitiveness
• Assess your specialties competitiveness
• Reconcile (or at least recognize) potential
incongruity
A word on scholarship and its role in
the selection process for fellowship
• Prominent for most of the competitive
fellowships and programs
− Programs may be measured on ability to
produce funded research scholars
− Training grants may be focus of success
and may be primary funding for positions
in programs
− RRC requirement for accreditation of
fellowships
− Reflective of “spirit of inquiry”
A word on scholarship and its role in
the selection process for fellowship
• Pursuing scholarly activity
− Identify research mentor early in training
(PGY1 year essential for Cardiology/GI)
− Rare for residents to develop their own
research questions
− Most will join ongoing project
• Try to carve out a piece that can be yours
− Hypothesis-based research more valued
than descriptive projects or case reports
A word on scholarship and its role in
the selection process for fellowship
• In absence of scholarly productivity …
− Develop an understanding of academic
values and scientific inquiry
− Be prepared to explain what scholarship
means to you
− Remain open to becoming excited about
opportunities for scholarly activity …
emphasize what you are attracted to with
regards to scientific inquiry
What do the
subspecialty
fellowship directors
(FPDs) want ?
2002 Survey by Cooke et al…
• Surveyed FPDs in cardiology, endocrinology,
gastroenterology and rheumatology
• 330 responses
• Three selection criteria – most important
− Clinical performance (PD letter)
− Interview evaluation
− Interpersonal skills
• Residency reputation frequently assessed
• Research and chief medical residency
important to procedure-oriented programs
Gayed Survey of Cardiology Programs
• Surveyed cardiology fellowship directors
• Important factors (most to least important)
− Negative comments or hints of problems in IM
PD letter
− Personal comments from IM PD
− Personal aspect of interview
− Letter of recommendation from cardiologist
known by the fellowship director
Gayed Survey of Cardiology Programs
(continued)
• Important factors continued (most to least important)
− Performance during an elective at fellowship site
− Rank order in the residency class
− Genuine interest in research
− Being a graduate of a US medical school
− LOR from nationally known cardiologist
− Resident at institution with well-known cardiology division
− Participation in research
− Assessment of medical knowledge during interview
− Publications prior to fellowship
− Performance on ABIM certifying exam if avail.
− US citizenship
− USMLE scores
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
• Surveyed
− 562 responding FPDs (of 1,088 sent)
− 81.3% of responders were university-based
• 18 items to rank order
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
• Top 8 items in order…
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Fellowship interview***
LOR from known specialists***
LOR from IMPD***
University-based residency
Interest in research***
No H1-B visa
Elective at the fellowship site***
USLME exam scores
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
• The next 10 items …
− Publications
− US Medical School
− US Citizen
− Research experience
− Chief residency
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Phone call from IMPD
Well-written personal statement
LOR from attendings outside of specialty
Applying during residency
Extracurricular activities
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
• Cardiology and Gastroenterology vs others
− Rated considerably higher…
• Publications
• Research experience
− Rated considerably lower…
• Elective at the fellowship site
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
• University vs. Community-based
fellowship programs…
− Rated higher by university programs…
• University-based residency
• US medical school graduate
• No H-1 visa
− Rated higher by community programs…
• Elective at the fellowship site
• Personal communication from the IMPD
The Match—2009 Appointments
• 1067 certified programs participated
• 969 filled (91%)
• 98 unfilled (9%)
• 3075 certified positions available
• 2940 positions filled (96%)
• 135 positions unfilled (4%)
• 4563 applicants enrolled and certified
• 2940 matched (64%)
• US allopath graduates 85% matched
• Osteopath graduates 52% matched
• Foreign graduates 51% matched
The Match—2009 Appointments
• Gastroenterology
− 361 positions/153 programs
• 1.9:1 applicant to position ratio
• 96% filled (70% with US grads & 21% non-US)
• Cardiology
− 718 positions/169 programs
• 1.8:1 applicant to position ratio
• 99% filled (63% with US grads & 27% non-US)
• Hematology/Oncology
− 449 positions/121 programs
• 1.7:1 applicant to position ratio
• 97% filled (54% with US grads & 35% non-US)
The Match—2009 Appointments
• Pulmonary/Critical Care
− 410 positions/124 programs
• 1.5:1 applicant to position ratio
• 97% filled (51% with US grads & 32% non-US)
• Rheumatology
− 179 positions/97 programs
• 1.5:1 applicant to position ratio
• 92% filled (47% with US grads & 32% non-US)
• Infectious Disease
− 300 positions/123 programs
• 1.2:1 applicant to position ratio
• 89% filled (48% with US grads & 37% non-US)
The Match—2009 Appointments
• Endocrinology
− 213 positions/112 programs
• 92% filled (50% with US grads & 35% non-US)
• Nephrology
− 374 positions/142 programs
• 94% filled (35% with US grads & 56% non-US)
The application process –
ERAS and NRMP
• ERAS – www.aamc.org/eras
− For 2009
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Allergy and Immunology
Cardiology
Critical Care Medicine
Endocrinology
Hematology
Gastroenterology
Geriatrics
Hospice and Palliative Care
Infectious Diseases
Nephrology
Oncology
Pulmonary Medicine
Rheumatology
The application process –
ERAS and NRMP
• NRMP – www.nrmp.org
− As of 2009
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Allergy and Immunology
Cardiology
Critical Care Medicine
Endocrinology
Gastroenterology
Hematology and Oncology
Infectious Diseases
Pulmonary Medicine and Critical Care
Rheumatology
Nephrology
The application process:
The Match 2009 timeline
• Late June – Fellowship applicant
materials available for download
• July 1-Dec 1 to compile application
through ERAS fellowships system
• mid-Nov – select programs to which to
transmit applications
• Jan 7, 2009– ERAS Fellowships opens to
fellowship programs
− NOTE: individual programs set deadlines
after which they will no longer accept
applications
The application process - timeline
• Jan-April – interviews occur
• April 8, 2009 – ROL submission begins
• June 3, 2009 – ROL submission ends at 9PM
• June 17th, 2009 – Match Day at noon
• Subspecialties and programs not joining the
match follow similar timeline but may have
rolling admission process
The application process - timeline
• Allergy and Immunology
− Similar timeline with match on May 29, 2009
• Pediatric subspecialties
− Spring Match runs Jan-June
• Cards, GI, Nephrology, and Pulm
− Fall Match runs August-Dec
• Critical Care, Rheum
− Heme-Onc runs Nov-May
ERAS
• ERAS Fellowships Applicant Site
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http://www.aamc.org/students/erasfellow/start.htm
Specific program information
Process information
Form downloads
Resources
Addresses for letters
ERAS – how it works
1. Contact the ERAS Fellowships Document
Office (EFDO) to obtain “electronic token”
to access the ERAS system
• EFDO is the “deans office, central processing
office” for fellowship applicants
2. Register on the MyERAS website once obtain
token
3. Complete common application form; submit
supporting materials (originals only) directly
to EFDO
4. Select programs; assign supporting
documents to specific programs
5. ERAS receives notice of completed
application and transmits documents to
programs
6. Examining boards receive and process
requests for score reports
7. Programs contact ERAS PostOffice daily to
download application materials
The application components
• Curriculum Vitae (CV)
− Automatically generated if ERAS
− Merideth to discuss next week
• Letter from Program Director
• Letters from faculty
• Personal statement
• Board scores
Letter from Program Director
• One of the most important components of the
application
• Emphasizes performance within the program
• Articulates unique characteristics of the
applicant, highlights scholarly activities
• Important to comment on the candidate’s
potential for scholarship and an academic career
• Recommend requests submitted by October 16th
• If ERAS, need ERAS cover letter and waiver
• If non-ERAS, need envelopes/labels and stamps
Letter from faculty
• Recommend that letters come from faculty
within discipline to which resident is
applying
• Should articulate resident’s performance
• Emphasize importance of scholarship
potential
• Avoid sending more letters than requested
• May be value in requesting from “national
expert” faculty
Personal Statement
• Brief is better – aim for one page or less
• Do not just restate CV content
• Communicate enthusiasm for discipline
• Communicate spirit of inquiry
• Opportunity to discuss projects in which
participated – why enjoyed, how
involved, etc
− Findings of project less important than
bringing out enthusiasm for scholarly
pursuit
• First do no harm is the “golden rule”…
Personal Statement
• Avoid
− Actual findings of a project unless it has yet to
be published
− Approaches in the PS that cast you in less
favorable light
− Poor grammar, awkward sentences
− Hollow platitudes … “I am enthusiastic about
the discipline/research”
• Say something that supports these points
− “interesting patient approach”
• Use sparingly to springboard demonstration of
other points
− Closing doors in PS … not too focused, want to
appear excited and attracted to multiplicity of
possibilities offered by the discipline and
program
The interview
• Opportunity for applicant to project
enthusiasm, uniqueness, inquisitiveness
• Opportunity for program to critique
residents on demeanor and content of
answers
• Candidate should …
The interview – candidates should…
• Be confident but not arrogant
• Prepare to ask one to two questions of each
interviewer, avoiding topics addressed by brochures,
websites or welcome sessions
− Types of questions asked convey interest
• Provide concise answers to questions
• Maintain professional demeanor at all times; remain
positive
− Eye contact and firm handshake is important
− Remember that interview process begins with first
phone call/email interaction
• Convey genuineness
Commonly asked questions
• What distinguishes you from other candidates?
• Why are you interested in this field? This program?
• Tell me about your research project or interests
• What areas can you improve upon?
• What made you decide to pursue or select
_______(any item from your CV)?
• Where do you see yourself in 10 years?
• What do you like most about your residency program?
Post-interview dialogue
• May be one of most challenging aspects of
the process for the candidate
• Send follow-up note to each program
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Thank and point out unique point
Email is usually acceptable
Avoid generic notes
Comments such as “near the top of my
list” or “one of my top choices” tells
fellowship that program is NOT top
Post-interview dialogue
• Not-in-match programs post-interview
− May call residents soon after interview
asking for relatively immediate decision
− Challenge if interviews not yet complete
− In competitive disciplines without a
match, residents should try to schedule
programs most interested in first
• Pre-match calls
− OK to have PD or institutional rep call on
behalf of applicant - ? impact
Resources and Important Websites
• www.nrmp.org – match information, match data from
prior years, timelines
• http://www.aamc.org/students/erasfellow/start.htm AAMC ERAS site – ERAS application and supporting
resources, timelines, program information
• http://www.aamc.org/students/cim/ - AAMC careers in
medicine website – resources for job applications,
interviewing, specialty selection, etc
• http://www.amaassn.org/ama/pub/category/2997.html - AMA Frieda
website – program and specialty information, program
and career statistics
• http://www.acponline.org/counseling/index.html ACP career counseling website – includes tips on
marketing self, tips for applying to fellowships, etc
Summary
• Know your deadlines
− Do not wait until last minute for letters
• Focus on the consistently important things you can
change…
− Interview skills and preparation
− LOR from specialist (particularly known)
− LOR from IM Program Director
• Fellowship begins day 1 of your intern year!!!
• With regard to scholarship
− Interest > Publications > Experience
• Consider an on-site elective in the subspecialty
field???
Questions
The Match—2008 Appointments
• Cardiology
− 1,264 applicants for 699 positions/164 programs
• 99.1% filled (438/550 US grads & 155/714 non-US)
• Hematology/Oncology
− 724 applicants for 424 positions/122 programs
• 98.1% filled (241/312 US grads & 165/412 non-US)
• Pulmonary/Critical Care
− 569 applicants for 374 positions/121 programs
• 96% filled (182/206 US grads & 177/363 non-US)
The Match—2008 Appointments
• Gastroenterology
− 622 applicants for 325 positions/150 programs
• 96.3% filled (230/319 US grads & 83/303 non-US)
• Infectious Disease
− 344 applicants for 283 positions/118 programs
• 90.5% filled (138/155 US grads & 118/189 non-US)
• Rheumatology
− 251 applicants for 165 positions/95 programs
• 92.1% filled (84/98 US grads & 68/153 non-US)