Research Assessment #4: Fellowship

Source:
Masters, Phillip. "Subspecialty Fellowship Training." ACP Online. American College of
Physicians, n.d. Web. 14 Oct. 2016.
<https://www.acponline.org/about-acp/about-internal-medicine/career-paths/resid
ency-career-counseling/subspecialty-fellowship-training>
Date:
October 14, 2016
Analysis:
One important decision a student must make if they wish to pursue internal
medicine is if they want to partake in a fellowship to subspecialize in a particular field.
The American College of Physicians, or ACP, provides insight into this. Their article
describes questions one should consider when deciding whether or not they wish to join
a fellowship program. The article covers questions about how much interest you have in
a specific specialization, your level of eagerness on learning specific procedures related
to certain subspecialties, and your opinion on different lifestyle and financial
advantages.
Firstly, the article describes the importance of having interest in your topic of
subspecialization. In order to put your best effort into something you may do in the next
three years, you obviously need to have a decent level of interest in your subspecialty.
The article asserts that fellowships require a lot of effort and that for the best possible

experience you need to have genuine confidence and determination to do well in that
subject; naturally, the best way to be determined and confidence is to have that interest.
Similarly, a student should consider how eager they may be when conducting
specific procedures concerning their fellowship. Many subspecialties have tasks not
everybody is fond of. Analyzing dialysis, x-rays, or ultrasound results is not something
all people are interested in. Therefore, its in the best interest of the student to consider
different subspecialties that have procedures that can help them feel engaged and be
comfortable with.
Additionally, it is important to consider lifestyle and financial advantages. Many
subspecialties have extreme amounts of competition and require lots of work hours,
especially if you choose to work in the hospital. People often have a hard time balancing
lifestyle and financial advantages; most students want to have a good amount of
money, but want to avoid overwhelming stress.
These three types of questions are very important for all students to consider
when they wish to pursue Internal Medicine. Its crucial to consider all factors when
deciding something you will do for several years of your life. Lifestyle, financial benefits,
and interest are all vital aspects to consider when pursuing this career.

Subspecialty Fellowship Training

by Philip Masters, MD, FACP
Director, Clinical Content Development
During the second year of residency training, most trainees start to make a
decision about whether to pursue a fellowship immediately after their residency.
This is an important decision because whether you are considering fellowship
application may affect scheduling of rotations and other activities during the rest
of your residency, particularly to accommodate program visits and interviews.
Others may choose to defer this decision to a later point in their residency,
although this will mean that there will be a gap between completing your
residency training and the start of a fellowship. Some individuals find this
attractive as it provides an opportunity for a year (or more) of practice experience
prior to starting more advanced training.
All internal medicine fellowships participate in the subspecialty match offered
through the National Residency Matching Program (NRMP). The Match opens for
submission of applications around the start of the third year of residency with
interviews occurring until mid-November when rank lists must be submitted.
Match day for subspecialty fellowships is in early December of your third year,
approximately 6 months before the start of the fellowship program.

When considering whether to pursue fellowship training, it is important to

consider these questions:

Do you have a deep interest or fascination for a particular subspecialty

area?

Does deep mastery of a more limited content area appeal to you?

Would you be satisfied clinically to care primarily for patients with problems
within a particular subspecialty area?

If a subspecialty is primarily consultative, does that role appeal to you?

Are you interested in performing procedures associated with some
subspecialties?

Are there lifestyle or financial advantages to a subspecialty career that are

important to you?
Unfortunately, the decision about whether to pursue subspecialty training occurs
relatively early in residency training and is therefore often made with limited
information. Many residents make a decision on a subspecialty career based
primarily upon their subspecialty hospital experience or association with an
exciting role model. Be sure to gain ambulatory or community experience in the
subspecialty that interests you before making a career decision as this will better
reflect what subspecialists in that area do away from inpatient or academic
settings. Also, try to have contact with more than one role model before making

career decisions; looking at the subspecialty from many points of view can avoid
uninformed choices.
It is also important to not pursue subspecialty training primarily because you do
not find the practice options for general internal medicine (such as ambulatory or
primary care) appealing. Pursuing subspecialty training is a major career and life
decision, and should therefore be based upon your overall personal and
professional goals and not primarily on excluding other career options. Many
trainees who are undecided choose to delay the decision about subspecialty
training and take the opportunity to work in one or more areas of general internal
medicine to clarify whether they truly want to subspecialize.
Additionally, it is important to consider the practical landscape of fellowship
training. Some subspecialty areas are more popular and therefore more
competitive than others, and this may influence your decision making. Practical
information about the number of fellowship training slots is available on the
American Board of Internal Medicine website and from individual subspecialty
societies.
If you do choose to apply for fellowship training, it is important for you to assess
your qualifications and seek to optimize your credentials for fellowship training.
First and foremost, it is critical that you do well in your general medicine residency
program. Your overall performance evaluation in your residency and

recommendations from your program director and program leadership are one of
the most influential parts of the fellowship application. It is also important to find a
mentor in your institution in the subspecialty area in which you are applying.
Different fellowships have unique requirements and expectations, and it is
extremely valuable to have guidance from someone who knows that particular
system well. This person and others within the subspecialty division at your
institution will likely be helpful in ensuring that your training and experience during
residency will position you well for fellowship application in that area.
You may also wish to visit or perform an elective rotation in a particular institution
where you are interested in applying. While not usually necessary, this may
provide both you and the program with additional information and perspective
about your interest and qualifications for training. Lastly, it is important that you
interview well (see the article in this series on Tips for the First Interview). Factors
such as performance on the USMLE, US citizenship, and completing a residency
program with a specific institution are much less important to fellowship program
directors. If these are concerns for you, discuss them with your residency
program director and subspecialty mentor who may be helpful in addressing
them.