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A Guide to the
Subspecialty Fellowship
Application Process
 pp
 VCU Internal Medicine Residency Program
 J. Christian Barr...
Roadmap
 • Selecting a subspecialty
 • Scholarship during residency – important
   or not?
 • What are fellowship director...
Selecting the right specialty for you
 • Experience in the field – rotations
 • Discussion with specialists
    − Private ...
Selecting the right specialty –
questions to answer
• Do you want to focus on
   − specific organ system ( di l
         i...
Selecting the right specialty –
questions to answer
 • Do you prefer to have a
    − prominent i
           i   t inpatien...
Other issues to consider
 • Competitiveness of specialty
    − St t available on positions fill d th
      Stats    il bl ...
Self Appraisal
Self-Appraisal
 • Personal reflection (HONESTY!!!)
    − Personal value system
       • Rank order prioriti...
A word on scholarship and its role in
the selection process for fellowship
 • Prominent for most of the competitive
   fel...
A word on scholarship and its role in
the selection process for fellowship
 • Pursuing scholarly activity
    − Identify r...
A word on scholarship and its role in
the selection process for fellowship
 • In absence of scholarly productivity …
    −...
What do the
subspecialty
fellowship directors
(FPDs) want ?
2002 Survey by Cooke et al…
 • Surveyed FPDs in cardiology, endocrinology,
   gastroenterology and rheumatology
      t   ...
Gayed Survey of Cardiology Programs
 • Surveyed cardiology fellowship directors
 • Important factors (most to least import...
Gayed Survey of Cardiology Programs
(continued)
 • Important factors continued (most to least important)
    − Performance...
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
 • Surveyed
    − 562 responding FPDs (of 1,088 sent)
    − 81.3% of...
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
 • Top 8 items in order…
    −   Fellowship interview***
    −   LOR...
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
 • The next 10 items …
    − Publications
    − US Medical School
  ...
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
 • Cardiology and Gastroenterology vs others
    − Rated considerabl...
2004 Survey of FPDs and IMPD by
Mikhail and Bernstein
 • University vs. Community-based
   fellowship programs…
   f ll   ...
The Match—2009 Appointments
    Match 2009
   • 1067 certified programs participated
       • 969 filled (91%)
       • 98...
The Match—2009 Appointments
    Match 2009
• Gastroenterology
   − 361 positions/153 programs
      • 1.9:1 applicant to p...
The Match—2009 Appointments
    Match 2009
• Pulmonary/Critical Care
   − 410 positions/124 programs
      • 1.5:1 applica...
The Match—2009 Appointments
    Match 2009
• Endocrinology
   − 213 positions/112 programs
      • 92% filled (50% with US...
The application process –
ERAS and NRMP
 • ERAS – www.aamc.org/eras
    − F 2009
      For
       •   Allergy and Immunolo...
The application process –
ERAS and NRMP
 • NRMP – www.nrmp.org
    − A of 2009
      As f
       •   Allergy and Immunolog...
The application process:
The Match 2009 timeline
 • Late June – Fellowship applicant
   materials available for download
 ...
The application process - timeline
 • Jan-April – interviews occur
 • April 8, 2009 – ROL submission begins
 • June 3, 200...
The application process - timeline
 • Allergy and Immunology
    − Similar timeline with match on May 29, 2009
 • Pediatri...
ERAS
• ERAS Fellowships Applicant Site
   −   http://www.aamc.org/students/erasfellow/start.htm
   −   Specific program in...
ERAS – how it works
 1. Contact the ERAS Fellowships Document
    Office (EFDO) to obtain “electronic token
              ...
5. ERAS receives notice of completed
   application and transmits documents to
   programs
6. Examining boards receive and...
The application components
 • Curriculum Vitae (CV)
    − Automatically generated if ERAS
    − Merideth to discuss next w...
Letter from Program Director
 • One of the most important components of the
   application
 • Emphasizes performance withi...
Letter from faculty
 • Recommend that letters come from faculty
   within discipline to which resident is
   applying
 • S...
Personal Statement
 • Brief is better – aim for one page or less
 • Do not just restate CV content
 • Communicate enthusia...
Personal Statement
 • Avoid
    − Actual findings of a project unless it has yet to
      be published
    − Approaches in...
The interview
 • Opportunity for applicant to project
   enthusiasm, uniqueness, i
     th i         i         inquisitive...
The interview – candidates should
                           should…
 • Be confident but not arrogant
 • Prepare to ask on...
Commonly asked questions
 • What distinguishes you from other candidates?
 • Why are you interested in this field? This pr...
Post interview
Post-interview dialogue
 • May be one of most challenging aspects of
   the
   th process f th candidate
  ...
Post interview
Post-interview dialogue
 • Not-in-match programs post-interview
    − May call residents soon after intervi...
Resources and Important Websites
 • www.nrmp.org – match information, match data from
   p
   prior y
         years, time...
Summary
 • Know your deadlines
    − Do not wait until last minute for letters
 • Focus on the consistently important thin...
Questions
The Match—2008 Appointments
    Match 2008
• Cardiology
   − 1,264 applicants for 699 positions/164 programs
      • 99.1%...
The Match—2008 Appointments
    Match 2008
• Gastroenterology
   − 622 applicants for 325 positions/150 programs
      • 9...
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  1. 1. 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
  2. 2. Roadmap • Selecting a subspecialty • Scholarship during residency – important or not? • What are fellowship directors looking for? • The application process • Resources • Questions
  3. 3. 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 …
  4. 4. 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)?
  5. 5. 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?
  6. 6. 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
  7. 7. 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
  8. 8. 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”
  9. 9. 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
  10. 10. 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
  11. 11. What do the subspecialty fellowship directors (FPDs) want ?
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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)
  22. 22. 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)
  23. 23. 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)
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. ERAS • ERAS Fellowships Applicant Site − http://www.aamc.org/students/erasfellow/start.htm − Specific program information − Process information − Form downloads − Resources − Addresses for letters
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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,
  34. 34. 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
  35. 35. 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”…
  36. 36. 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
  37. 37. 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 …
  38. 38. 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
  39. 39. 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?
  40. 40. 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
  41. 41. 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
  42. 42. 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
  43. 43. 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???
  44. 44. Questions
  45. 45. 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)
  46. 46. 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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