ABIM Research Pathway -Applying for Residency

ABIM Research Pathway -Applying for Residency Ajit Janardhan Washington University in St. Louis Internal Medicine Residency – Cardiology Fellowship Edward Kim University of Michigan Internal Medicine Residency – Medical Oncology Fellowship

Today’s topics
The ABIM Research Pathway
Traditional Pathway vs. Research Pathway
Differences in structure and application to the Research Pathway at different institutions
Advantages and Disadvantages
Residency application advice
Timeline: what you should do and when to do it
Selecting programs and who to ask for advice
Miscellaneous tidbits of advice
Open forum

Designed by the American Board of Internal Medicine (ABIM) for physicians who are devoted to a career in clinical/basic research
Who is this designed for?
MD/PhD’s or those with significant research experience
Major features:
Shortened length of clinical training
Protected research time with guaranteed salary
Designed to allow physicians to develop research interests & eventually apply for independent funding

“ Traditional” Pathway: Internal Medicine Residency-Subspecialty Fellowship
Internal Medicine Residency – 3 years
Apply for fellowship in 2 nd year of residency
Ph.D definitely helps competitiveness for fellowships–
fellowship programs need fellows to do research (like your PI)
Subspecialty Fellowships - 2-3 years
1-2 years of clinical training
6-12 months of research time
Variable degree of protection of research time

Fellowship Training Time Requirements 12 24 Rheumatology 12 24 Pulmonary Disease 12 24 Nephrology 12 24 Medical Oncology 12 24 Infectious Disease 12 24 Hematology 18 36 Gastroenterology 12 24 Endocrinology, Diabetes, and Metabolism 24 36 Cardiovascular Disease Clinical Months Required Minimum Months of Training Area of Discipline

“ Traditional” Pathway: Internal Medicine Residency-Subspecialty Fellowship
Internal Medicine Residency – 3 years
Apply for fellowship in 2 nd year of residency
Ph.D definitely helps competitiveness –
fellowship programs need fellows to do research (like your PI)
Subspecialty Fellowships - 2-3 years
1-2 years of clinical training
6-12 months of research time
Variable degree of protection of research time
Additional years of research time generally required to develop studies that will be independently funded
NIH K type awards, R01 awards

AKA the “short-track” / Physician-Scientist Pathway / Medical-Scientist Pathway
The Basics
Internal Medicine Residency shortened to 2 years
Fellowship training split:
Spend minimum time allowable in formal clinical training
Research time extended:
3 years mandatory research time (protected from clinical duties)
Normal research time is 6-12 mo, not always protected
80% Research, 20% Clinical (to stay current)
Clinical time is outpatient subspecialty clinic – NOT Floors, O/N Call
These features apply to every program – guidelines are set by the American Board of Internal Medicine

Sample comparison - Cardiology
Traditional pathway
1 2 3 4 5 6 7 8 Medicine Resident Cardiology Fellowship 1 2 3 4 5 6 7 8 Medicine Resident Clinical fellow Research
ABIM Research pathway
1 2 3 4 5 6 7 8 Medicine Resident Clinical fellow Research
Alternate ABIM Research pathway
Research (& Clinical…) Research (& Clinical…)

Advantages of the Research Pathway
Shortened length of general Internal Medicine clinical training
Still do entire length of required CLINICAL fellowship training
Begin research sooner
Increased time to set up research projects, produce publishable data, write grants
Truly protected research time
No overnight call, no backup, no consults
Big deal if you’re trying to do experiments to know you won’t be disturbed
20% clinical / 80% research split allows you to stay current clinically
Fellowship secured earlier
Stability allows better planning of personal life
Inside track to faculty positions
Most institutions view this program as a means to develop faculty

Disadvantages of the Research Pathway
Loss of 1 year of IM clinical training
Must choose subspecialty 1 year early
Waste of time if you ultimately choose a purely clinical position
“ Another long *!&*!&%* program!!”

Things you will hear
Some say –
Residency is the ONLY time to get real training to be a physician –
Therefore you should not shortchange any of the residency because you never know what you may ultimately do
Counter arguments -
How much of your time will be spent doing pure Internal Medicine?
What is the educational yield of third year of residency
No difference in duration of clinical training during fellowship
Trying to develop research projects after fellowship, when burdened with clinical responsibilities (your salary depends on it) is very difficult

Why do institutions participate in these programs?
Nationally recognized need for physician-scientists
Same justification as NIH-funded MSTPs
Much cheaper to hire future faculty from within than from other institutions
Average cost of recruiting faculty is greater than $1,000,000
Fellowship programs get an early crack at people who have a proven ability to carry out research
Prestige
looks good for the residency and fellowship programs

Major categories of programs
Match, then apply to Research Pathway in year 1 of IM Residency
No guarantees of acceptance to Research Pathway (limited slots)
No guarantees of acceptance to particular fellowship
If accepted to Research Pathway, one can generally get a fellowship at same institution
Allergy/Cards/GI vs. Oncology vs. ID/Rheum/Endo
Match directly to Research Pathway
Program guarantees Research Pathway upfront
Must apply for specific fellowship in year 1 of IM residency
Match directly to Research Pathway - Fellowship
Program guarantees Research Pathway AND Fellowship upfront

Major differences between institutions
Number of positions earmarked for ABIM Research Pathway
Accepting a (ABIM Research Pathway) Participant means sacrificing one 3 rd yr IM Resident in the residency program
Participants only do 2 yrs IM residency
Participants spend less time overall in fellowship training
This means fellowship must hire more fellows to account for your absence from clinical service
Each Participant is guaranteed a salary for 3 yrs of funded research
Thus, it is advantageous to go to a well-funded Dept. of Medicine
Talking the talk vs. Walking the walk
Actual number of people who do join the Research Pathway each year?
Incentives
Money for supplies and salary supplement
Costs of attending meetings & conferences

Other important points
Who offers it?
University-Based Teaching Hospitals that draw large amounts of research funding
Organization and Funding
Some are well organized, formal programs with budgets, others are put together on an ad-hoc basis (less desirable)
Some have a program director & committee that guide your career
Support
Research-committed vs Research-supportive vs Research-permissive
Some programs have the support of the chair & faculty

What’s the Bottom line?
This program is designed with MD/PhD’s in mind to facilitate their entry into academic medicine
If you are considering an academic medical career – you WILL need to do substantive research beyond the Ph.D.
The ABIM research pathway gets you into the lab more quickly and protects & funds your research time

How do you know if this is right for you?
Determine your goals and priorities
Are you interested in a career consisting of Research only, Research & Patient Care, or Patient Care only?
Do you have an interest in a particular field of medicine?
Your thesis topic need not relate to your fellowship field
Perfectly acceptable to not know your field of interest
Do you want the guarantee of the Research Track or Research Track - Fellowhip?
Would you prefer the stability of knowing where you’ll be located for residency and fellowship?

What to do if you’re interested
Incorporate your interest in research into your personal statement
Be as specific as possible: disease, areas of investigation, etc.
Letter writers should know you’re interested in academic medicine
Especially true for your PI
Contact Research Pathway directors – let them know you’re INTERESTED!
Email addresses are usually listed on websites – end of 3 rd year
Do this before you complete your application (ERAS)
IM Residency director and Research Pathway director are rarely the same
Don’t assume that they communicate with each other
When you get interview invitations - make sure they know you’re also applying for Research Track – some have supplemental interview days
Confirm that your interview is for the Research Pathway
Do your homework
Look up faculty and ongoing research (PubMed)
Determine strengths of institutions based on research being conducted, number and funding of researchers
Ask as many people as many questions as possible!

Applying for residency

What to think about if you’re in…
1 st /2 nd year medical school
Two most important things
Find a good lab with a good PI
Step 1 score
Don’t slack off just because you’re MD/PhD
Document your activities – (esp. leadership roles)
Graduate school
Form a thesis committee and defend your thesis proposal early
meet frequently – ideally every 6 months
Let Dr. Frohman how things are going on a routine basis – especially if they are going poorly or are stagnating
He is your biggest advocate and supporter
Inform Carron and Dr. Frohman of your plans to return to medical school as soon as you are seriously considering defending

What to think about if you’re in…
3 rd /4 th year medical school
3 rd year scheduling
Your first rotation will be your worst
Complete the rotation in field of interest before September of application year
All rotation sites are not created equal
Expect to work longer and have less time to study at SBUH
Learn what you can on the wards but focus on finding time to study for the shelf
4 th year scheduling
Completion of a subinternship (sub-I) is a major part of your candidacy
Complete your sub-I before November of application year
If you did not do your clerkship at SBUH, you should do sub-I at SBUH
Schedule “away” electives if you have the time

Letters of recommendation
Minimum of 4 needed for residency application
One from your PI
One departmental letter
Two from attendings
Preferably from established faculty
One from sub-I attending
Remaining should be from clerkship attendings
Ask anyone you worked with regardless of duration of contact
Ask for letters during/immediately after contact
Be safe and ask early for more letters than you will need
No upper limit to number you can keep on file
You choose which letters to use for application
Research Track
Additional supplemental letters from PI’s familiar with your research
Committee members are ideal

Applying for residency
Selecting programs to consider for residency
University hospitals
vs. university-affiliated vs. community
Research opportunities
Reputation
Location
Whom to ask for advice?
MSTP alumni
Eager to help and best suited to understand your situation
Clerkship directors / SB Residency directors
Mentors
Residents

Last few tidbits of advice
“ Dean’s letter” – Medical Student Performance Evaluation
You write it, Dean Schiavone edits it, and Dr. Frohman embellishes it
What to look for and expect on interviews
Be prepared to talk about your research and ANYTHING in your personal statement and application
Fellowship matching success: a good indicator of how program is perceived
Attending Teaching vs. Private Attendings (& private patients)
Resident satisfaction – take the time to talk to them
Get a feel for the residency program director
They play a major role in your daily residency experience and fellowship hunt
Thank you letters
Get business cards from your interviewers AND program directors
Send a thank you letter immediately after your interview
Make them personal and avoid form letters
Near the end of interview season, send a second letter to directors of your top programs to show your interest
Let your number one program know that they are your number one!

Web Resources
ABIM website – research pathway
http://www.abim.org/cert/respath.shtm
Sample program websites
Wash U. http:// meded.im.wustl.edu/application/PSTPFlier.html
Vanderbilt http://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfm
UCSD http://pstp.ucsd.edu/
Stanford http://medicine.stanford.edu/education/scip.html
Columbia http:// www.cumc.columbia.edu/dept/medicine/residency/tracks.htm
Einstein http://www.medicine-residency.org/special_programs/msp/index.html
Residency database
www.ama-assn.org/go/ freida
Ajit Janardhan [email_address]
Edward Kim [email_address]

ABIM Research Pathway -Applying for Residency

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