The Importance of Relationships and Elective Rotations for the Fellowship Application Process

I know that I’ve said this before, but it is important to cultivate relationships, especially in a small professional community such as pathology. In medical school, it was fine to focus on learning from our lectures, doing well on boards, and performing competently on the wards. This triad was enough then to secure us good letters of recommendation for our residency applications. And most programs invited candidates supposedly based on a magic number calculated from these aspects of our applications. Additionally, most programs, since we have a match and so as not to have to scramble via the SOAP, would invite about 10 candidates per position available.

However, for the fellowship application process, it’s a different ball game. We do not have grades for rotations and most of us have not taken our boards before we apply. So it is no longer as heavily numbers-oriented. Most of our personal statements will not be that different from each other, I would guess. So, the two things that stand out in my mind as having the most impact on receiving an interview invite (at least in my experience), are our letters of recommendation and our CV’s. I know that at every interview, aspects from one or both of these were discussed. Since I was a non-traditional medical student, most often what was brought up from my CV was my extensive research background (I was originally going to be a PhD molecular neuroscientist), long path to residency (I have 4 degrees), and reasons for getting an MPH (two of my main foci were molecular and infectious disease epi because I thought that I’d be interviewing for MGP and clinical microbiology fellowships right now). I also had to explain any gaps in my training.

As far as the CV goes, I think it’s most important to show a consistent commitment to your area of interest through publications, abstracts/poster or platform presentations, and leadership positions with advocacy organizations in your desired subspecialty area. But remember to do things that you are passionate about and not just to put on your CV! Attending national/state/local meetings provides an outlet to meet the experts in your future field who not surprisingly, you may end up interviewing with during the fellowship application process. More weight is now placed on relationships. If you have great letters (or better yet, a phone call or personal email sent on your behalf) from a colleague that the fellowship director knows, you are more likely to be chosen for an interview. Also, if you are a well-liked internal candidate or external candidate who spent time rotating at your dream program, then you also have increased chances of being chosen for their fellowship. Some programs (or subspecialties like some forensics programs that I’ve heard of) either require an “audition” rotation or heavily favor candidates who did rotate with them. So I STRONGLY recommend figuring out what fellowship you want as early as possible and to do an elective rotation (if it is not your own program) at your dream program during your PGY-2.

I cannot emphasize enough that showing what you can bring to your future fellowship by doing an elective rotation before the application period (early PGY-3) and interacting with your future interviewers can only help you. I wish someone had told me this when I was a junior resident. If the program chooses to interview you after you’ve rotated there, it generally means that you’re more competitive than others who they may interview because they know and like you and feel that you meet their competency requirements. I have not had any elective rotations yet so I was surprised at one of my interviews to learn that all the current fellows had completed a 2-month rotation there before they had applied. I had been told just before I left for my interview that this program heavily prefers those who have rotated there but it wasn’t as obvious as when I was told this during the lunch with the fellows. Even though they interviewed only a few candidates, it will be difficult to tease out how much an elective rotation factors into the final decision. I will always wonder if I do not receive an offer.

At this point, the competition is much fiercer than it was for residency, often with only 2-3 candidates invited to interview for each available spot from what I was told at some of my interviews. But I’m not sure how this number varies based on the competitiveness or popularity of each program. I can tell you that the programs I interviewed at would fall under the ‘very competitive’ category so other programs may interview more. But you could always ask the program coordinator how many they plan to interview and how many positions are truly available. They often will let you know if a future position is already filled by an internal candidate. Sometimes, I was given only one day or a few days to choose for scheduling an interview and if I couldn’t on those days, the program moved on down their list. So make sure to ask for lighter rotations and no call during your anticipated interview months (Sept-Jan). This is especially important with small residency programs or those with multiple hospitals to cover where it may be difficult to find someone to switch call coverage with you.

Since applications are accepted and interviews are conducted earlier than in the past and positions may have already been (un)officially promised to internal candidates, research programs and apply early! I do so dislike the word ‘networking’ because to me, it sounds insincere and calculated, but whatever you do, make opportunities for yourself to build relationships with and show your interest to your future colleagues before you have to apply. If you need some financial help to do an external elective, apply for ASCP’s subspecialty grant by clicking here and applying before January 16, 2015!