If you’re applying for a fellowship this year or in the next few years, this guide is for you. This can be a stressful time, and here are some things to consider in this process:
1. Start Early if Possible
During my intern year of internal medicine residency, I was still trying to decide between sub-specialties and didn’t make the official decision until the beginning of my second year. Although I had been interested in oncology (and palliative care) for some time, I also wanted to explore other specialties, such as cardiology and critical care. During my intern year, I did a few electives to help further decide.
Often, it is very hard to make a decision. Don’t be too hard on yourself if you don’t go into training knowing exactly what you want to do. Most of us don’t.
It’s okay to explore possibilities and take your time. That being said, if at all possible, try to decide on your specialty a year in advance or more, as this will help you take steps to be competitive for your fellowship.
2. Mentorship and Research
The mentorship we receive and the experiences we have with attending physicians on rotations often highly influence the specialty we choose, both in medical school and in residency. This was true for me. Good mentors are very hard to find, especially those who may have research projects or other opportunities. If you find a good mentor, hold onto them.
During my master’s program, I had an excellent research mentor (that actually began when I took a job as a research assistant). We then continued to conduct research together under her mentorship for the next 8 years while I was in medical school and residency. This enabled me to have several research opportunities, first-author publications, abstracts at conferences, and projects to talk about for both residency and fellowship applications.
Many fellowship programs value research experience highly. If you can get some experience with research before or during medical school or during residency, this can help you later. It doesn’t have to be bench-science research. My research has been primarily in public health and health services research, along with clinical research.
You can also consider quality improvement projects, educational projects, case reports, or medical writing.
If you haven’t yet been able to find a mentor, look at which faculty at your school are doing work in your area of interest and ask around. You will likely need multiple mentors: At least one or more to help you find research opportunities, others to help you get clinical experience, and others to provide encouragement for your fellowship applications.
When you are looking at fellowship programs, be sure to look at the faculty at each program to see who future mentors might be. This will significantly impact the future impact of your career, depending on your career interests and plans.
3. Create a Paper Trail
A mentor of mine gave some very helpful advice: “Create a paper trail of your interests and work.” This essentially means finding opportunities for your resume in your field of interest to show evidence of your interest and dedication to your field.
For example, if you’re interested in hematology and oncology, this may mean taking electives in the field, having a mentor in the field, doing volunteer work with a local oncology group providing services to patients, participating in research in oncology, going to local and/or national meetings (and joining national organizations), or doing other educational activities in the field.
This helps show your commitment to the field and makes you more competitive for fellowship.
4. Letters of Recommendation
A good letter of recommendation from an influential person in your chosen field can open doors for you.
If possible, it really helps to attend medical school or residency in a place that is strong in your chosen field. This allows you to rotate in clinics and hospitals with people who have a strong influence in your field. How do you figure out who these people are?
Look at the full professors (or associate professors). Look at who is leading the departments or who has led them in the past. Look at their work and the papers they have published. Also, ask around. Who are the leaders at your institution?
If you don’t have an opportunity to take an elective in time to request a letter, you can directly reach out to the physician you are hoping to work with. When I was a resident, I took some extra clinic days during my Emergency Medicine rotation to be in the oncology clinics. Yes, this did mean a lot of extra work for me, and working on my days off, but it allowed me to request letters of recommendation I wouldn’t have otherwise had.
On the interview trail later that year, many of my interviewers discussed the letter and the person who wrote it, then the contributions that person has made to the field. I’m certain this helped open doors for me.
Timing: Make sure to give your letter writers at least 6-8 weeks (or more) to write your letter. They are busy, especially if they’re a leader in your field. If possible, send your CV, your personal statement, and a brief summary of the work you did together and the patients you saw together. This can help them form a letter that is more personal. Make sure to thank them for taking the time to write a letter.
5. Personal Statement
The personal statement allows you to tell a story about yourself, your experience, and your reason for choosing this specialty.
Now that I conduct interviews for residency and fellowship at my institution, I read many of these letters. If possible, it really helps to have a memorable personal story. Assess your experiences with patients in your field. Is there a particular patient you can talk about (in a HIPPA-compliant way)? Do you have a personal reason from your past for choosing this field?
Can you craft the story of your experiences and shape it into a future planned direction?
When I was being interviewed for fellowship, I would often be asked not only about my past experience and story but also about my plan within the field of oncology. It can be very difficult to know exactly where the path may lead, especially because we often don’t have much exposure to our field until fellowship. That being said, it helps to craft a story with your best possible guess and to be confident about this when applying (and also knowing that the plan can most certainly change).
And Finally:
Remember that we’re all likely to be happy in a number of fields and specialties. It’s okay to change your mind, opt for no fellowship, or delay the decision for fellowship for a year or two.
As you navigate through this overwhelming process, remember that you’re just one person, and you’re doing your best. If you feel like the stress is becoming too much, take a step back, do something you love, take a breath, and talk to someone you love. You are more than a career and more than a fellowship. Best of luck to you.
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