Microsoft PowerPoint - A Guide to the Subspecialty Fellowship ...

A Guide to the Subspecialty Fellowship Application Process pp VCU Internal Medicine Residency Program J. Christian Barrett, MD Division of Hematology/Oncology Virginia Commonwealth University g y

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 ( di l ifi t (cardiology or GI) − multi-systemic (ID or oncology)? • Do you derive more satisfaction from dealing with − acutely ill patients − long-term management of disease g g • Do you enjoy − focusing on a specific disease or set of p g p 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 i i t inpatient component ti t t − an outpatient focus? • What kind of patient mix do you prefer (age gender (age, gender, problems, setting)? • What are the “hot areas” for scholarship in the hot areas 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 − St t available on positions fill d th Stats il bl iti filled through h match – www.nrmp.org − Home institution faculty and fellowship y p 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 issues

Self Appraisal 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 f ll hi d − Programs may be measured on ability to produce funded research scholars − Training grants may be focus of success and may be p y primary funding for p y g positions in programs − RRC requirement for accreditation of fellowships f ll hi − 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 jo o go g p oject w ll 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 i l d i tifi inquiry i − 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 t t l d h t l • 330 responses • Three selection criteria – most important − Clinical performance ( letter) p (PD ) − Interview evaluation − Interpersonal skills • Residency reputation frequently assessed • R Research and chief medical residency h d hi f di l id 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 well known − Participation in research − Assessment of medical knowledge during interview − P bli ti Publications prior t f ll i to fellowship hi − 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… − Fellowship interview*** − LOR from known specialists*** − LOR ffrom IMPD*** − University-based residency − Interest in research*** − No H1-B visa − Elective at the fellowship site*** 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 − Phone call from IMPD − Well-written personal statement − LOR from attendings outside of specialty g p y − 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… f ll hi − Rated higher by university programs… • University based residency University-based • 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 Match 2009 • 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 Match 2009 • Gastroenterology − 361 positions/153 programs • 1.9:1 applicant to position ratio • 96% filled (70% with US grads & 21% non-US) 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 Match 2009 • Pulmonary/Critical Care − 410 positions/124 programs • 1.5:1 applicant to position ratio • 97% filled (51% with US grads & 32% non-US) 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 Match 2009 • Endocrinology − 213 positions/112 programs • 92% filled (50% with US grads & 35% non-US) • N h l 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 − F 2009 For • Allergy and Immunology • Cardiology • Critical Care Medicine • Endocrinology • Hematologygy • Gastroenterology • Geriatrics • Hospice and Palliative Care • Infectious Diseases • Nephrology • Oncology • Pulmonary Medicine • Rheumatology

The application process – ERAS and NRMP • NRMP – www.nrmp.org − A of 2009 As f • Allergy and Immunology • Cardiology gy • Critical Care Medicine • Endocrinology • Gastroenterology Gastroenterolog • 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 li i

The application process - timeline • Jan-April – interviews occur • April 8, 2009 – ROL submission begins • June 3, 2009 – ROL submission ends at 9PM 3 • June 17th, 2009 – Match Day at noon • Subspecialties and programs not joining the match follow similar timeline but may have rolling admission process lli d i i

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 −H Heme-Onc runs N M O Nov-May

ERAS • ERAS Fellowships Applicant Site − 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 electronic token” to access the ERAS system • EFDO is the “deans office, central p , processing g 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 4 S l i i documents to specific programs

5. ERAS receives notice of completed application and transmits documents to programs 6. Examining boards receive and process 6 E i i b d i d 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 • A ti l t unique characteristics of th Articulates i h t i ti f the applicant, highlights scholarly activities • Important to comment on the candidate’s candidate s potential for scholarship and an academic career • Recommend requests submitted by October 16th q y • If ERAS, need ERAS cover letter and waiver • If non-ERAS, need envelopes/labels and stamps non ERAS,

Letter from faculty • Recommend that letters come from faculty within discipline to which resident is applying • Should articulate resident s performance resident’s • 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 p • 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 g − Poor grammar, awkward sentences − Hollow platitudes … “I am enthusiastic about the discipline/research” p • Say something that supports these points − “interesting patient approach” • Use sparingly to springboard demonstration of p gy p g 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, i th i i inquisitiveness i iti • Opportunity for program to critique residents on demeanor and content of answers • Candidate should …

The interview – candidates should 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 q • 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 Post-interview dialogue • May be one of most challenging aspects of the th process f th candidate for the did t • Send follow-up note to each program − Thank and point out unique point − Email is usually acceptable − Avoid generic notes − Comments such as “near the top of my list list” or “one of my top choices tells one choices” fellowship that program is NOT top

Post interview 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 s ould t y to sc edule atc , es de ts should try schedule programs most interested in first • Pre-match calls Pre match − 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 p prior y years, timelines , • http://www.aamc.org/students/erasfellow/start.htm - AAMC ERAS site – ERAS application and supporting resources, timelines, p g , , program information • http://www.aamc.org/students/cim/ - AAMC careers in medicine website – resources for job applications, interviewing, specialty selection, etc • http://www.ama- assn.org/ama/pub/category/2997.html - AMA Frieda website – program and specialty information program information, 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 • F ll Fellowship b i day 1 of your i t hi begins d f intern year!!! !!! • With regard to scholarship − Interest > Publications > Experience p • Consider an on-site elective in the subspecialty field???

Questions

The Match—2008 Appointments Match 2008 • 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 Match 2008 • 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)

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