a guide to the subspecialty fellowship application process vcu internal medicine residency program...

A Guide to the Subspecialty Fellowship Application Process

VCU Internal Medicine Residency ProgramJ. Christian Barrett, MDDivision of Hematology/OncologyVirginia 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

http://www.nrmp.org/

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”


• 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


• 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


• Top 8 items in order…− 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


• 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− Applying during residency− Extracurricular activities


• Cardiology and Gastroenterology vs others− Rated considerably higher…

• Publications• Research experience

− Rated considerably lower…• Elective at the fellowship site


• 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


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


• Infectious Disease− 300 positions/123 programs


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

• Allergy and Immunology• Cardiology• Critical Care Medicine• Endocrinology• Hematology• Gastroenterology• Geriatrics• Hospice and Palliative Care• Infectious Diseases• Nephrology• Oncology• Pulmonary Medicine• Rheumatology

http://www.aamc.org/eras

The application process – ERAS and NRMP

• NRMP – www.nrmp.org − As of 2009

• 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

− http://www.aamc.org/students/erasfellow/start.htm

− Specific program information− Process information− Form downloads− Resources− Addresses for letters

http://www.aamc.org/students/erasfellow/start.htm


ERAS – how it works1. 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− 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.ama-assn.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




http://www.aamc.org/students/cim/

http://www.ama-assn.org/ama/pub/category/2997.html

http://www.ama-assn.org/ama/pub/category/2997.html

http://www.acponline.org/counseling/index.html

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)

a guide to the subspecialty fellowship application process vcu internal medicine residency program...

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