fellowship – Lablogatory

Selective Pathology Fellowships

So, what are selective pathology fellowships? They are 12 month fellowships that originally provided advanced competency training in subspecialty areas but would not result in ABP certification at their completion (eg – surgical pathology subspecialties). There are 3 tracks of these types of fellowships encompassing 80 currently ACGME accredited programs with 155 available positions as of the writing of this blog post (12/17/14): A) selective pathology-surgical pathology, B) selective pathology-focused AP, and C) selective pathology-focused CP. These programs can either be non-accredited programs (NAPs) or ACGME-accredited programs (AAPs) and the ACGME requirements for such fellowships can be found here.

These fellowships can be a stand-alone 12 months, as many of the surgical pathology selective pathology fellowships tend to be, or can include an extra year. Examples of extra year selective pathology fellowships include the New York City’s Office of the Medical Examiner and University of New Mexico’s forensic neuropathology/cardiovascular pathology fellowships and the Houston Methodist Hospital’s hematopathology fellowship (http://www.houstonmethodist.org/SelectivePathologyHematopathology), both of which require a second year beyond the traditional fellowship in these subspecialty areas. Methodist’s hematopathology selective pathology fellowship can be completed alone but will not lead to eligibility for ABP board certification in hematology, so it is preferable to combine it with the traditional hematopathology fellowship.

These fellowships either provide additional focused diagnostic training in areas important for these fields and/or opportunities for research. If there is a second year, funding is provided by the institution and not the Centers for Medicare and Medicaid Services (CMS) like it is for residency, and so this limits the numbers of these types of fellowships. Traditional AAPs are eligible for funding from CMS while NAPs are not. Some institutions instead of selective fellowships provide a second “junior faculty” or “clinical instructor” year.

Reference:

JC Iezzone, A Ewton, P Chévez-Barrios, S Moore, LA Thorsen. Selective Pathology Fellowships: Diverse, Innovative, and Valuable Subspecialty Training. Arch Pathol Lab Med, April 2014; 138: 518-525. http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2013-0454-SA

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

Decisions That Will Impact the Direction of My Pathology Career

So, I’m in Midway Airport in Chicago with a 2.5 hour layover back to the East Coast from my West Coast tour of fellowship programs and interviews. I flew on 5 separate flights and interviewed at 5 programs in 4 cities in 3 states over the past week. Quite a whirlwind schedule to keep even if it wasn’t exacerbated by the fact that I’ve had a wicked flu the entire time (and still am sick as I type). But I look forward to getting at least one night’s comfortable sleep in my own bed and spending some time with my kitties before I start with my first East Coast interviews (2 in 1 day) on Monday. I’m very fortunate that my program director, program coordinator, and fellow co-residents have been supportive, especially when I’ve had to switch multiple days on-call.

On the left coast, I interviewed at 3 hematopathology and 2 molecular genetic pathology programs with overlap at one program where I interviewed for both hemepath and MGP. All of the people that I met at each program were people who I felt that I would like to become colleagues with (and who will be my colleagues in the future). But despite this fact, each program was vastly different from the other and I am reminded that these next decisions about where I’ll spend my fellowship years will probably impact the direction of my career more so than any other decision thus far. The people who will touch my life will help shape the pathologist I will be!

I thought that I had adequately prepared my list of questions that I carried around to each interview but I found that each interaction spurred additional new questions that I had not thought of prior to the interview. Many times, my interviewers had anticipated some of my questions and had answered them as we talked even before I asked. The current fellows I went to lunch with were very helpful in answering my questions and telling me about their lives within their fellowship programs. For me, the “fit” and culture of my working environment is important – finding colleagues who treat each other with respect and notice when others might be struggling and help each other out. I value a strong teamwork mentality as much as I appreciate a rigorous academic environment that will push me to be the best that I can be.

Having come from a graduate research training environment in what I might call some of my formative years, I also value an environment that spurs creativity. I enjoy being able to have open door policy discussions where we bounce ideas off each other and challenge each other in a positive manner to “think out of the box.” I know that research will be an integral part of my future career, hopefully along with hematopathology sign-out and molecular genetic lab directorship (even if it is not for the entire lab but possibly just the molecular hematopathology portion of it). The question for me is whether that research will be more basic science (which means I’d probably be committing to more like 80% research, 20% clinical in terms of my service duties) and on a K-R01 grant track as a physician scientist or will be more toward translational research where I can apply some of the knowledge and skills I gained during my graduate and MPH training. I was very flattered that at my first interview, the fellowship director told me that I could come back after my fellowships to do a post-doc with him and one of his mouse models of hematopoietic disease.

Mentorship for me is really big. I really want to find a program where the faculty take an interest in my career. I want mentors who look out for my future career and who will guide me toward opportunities that will enhance it. Mentors who will support me and make those all-so-important phone calls to help me get my first job, or better yet, offer me my first job. It is not far-fetched to think ahead that I might want to lay down roots where I complete my fellowships so that is an additional factor to consider when it comes time to make the final decisions.

Each program varied with respect to educational philosophy and resources. More so than I previously realized that they would even though I’ve been in two residency programs that I can compare. But right now, I compartmentalize everything I see and learn from each interview and just try to soak everything in like a sponge without assumptions or judgment. I’m placing those observations aside in my head until the time comes that I will need to think about them (which will probably be the end of this month or the very beginning of the next).

It has become very clear to me that being self-motivated and proactive to make opportunities for myself when they did not necessarily exist within the formal structure of my residency program has been a pivotal aspect of getting me this far in interviews. If your program does not have a resource available (eg – NGS for a MGP-minded person like me), then find one and gain access to it (eg – I will go to Rutgers for my last molecular pathology rotation to help with NGS clinical testing validation, and hopefully, a hematopathology elective rotation at an institution with a higher volume and diversity of cases than I can see at my own program)! If you are interested in a particular subspecialty, get involved in research, tumor board presentations, and sign-outs in that area (eg – look at hemepath cases on your free time or on the weekends if that’s what you like) from your first year as much as you can. Whining is not allowed nor is a quality that will help anyone so don’t waste time complaining about aspects of your programs you cannot change. Make your destiny happen rather than be a mere participant in it by accepting the status quo! Good luck to my fellow residents who are also on the interview trail! May we all find our future homes for the next phase of our careers very soon!

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

The Road Less Traveled By Has Made All the Difference

Hello again residents, I hope that you enjoyed the recent posts from your colleagues about their experiences at the 2014 ASCP Annual Meeting. Hopefully, we’ll see you there next year in Long Beach, CA during October 28-31, 2015 and we can celebrate Halloween together! I’ll let you know in late winter/early spring 2015 when the abstract submission period opens for those interested in being chosen to present during the oral and poster sessions. And congratulations to those residents recently appointed to various ASCP subcommittees! As always, let me know if you’d like to get more involved and I’ll pass on your info.

So I’m writing this post from the air while flying from Newark to San Francisco via a layover in Phoenix. When I arrive at SFO, I would have spent 9.5 hours today traveling. In fact, I’ve flown every month since I moved home to NJ this past July either for conferences where I presented posters or meetings for national leadership positions I hold in organized medicine organizations.

I’m tired from all the travel but at the same time excited to finally start my fellowship interviews. I postponed them until November when I’d have a month free from most of responsibilities I’ve had the last few months. The only responsibility I have this month is to serve as the ACCME/AMA monitor at the Ohio Society of Pathologists meeting for CAP. But November is actually somewhat late for interviews. Some of my PGY-3 friends who interviewed early have already matched to their fellowships because they were given offers at or shortly after their interview at programs that have rolling admissions (which is quite common).

So if you’re a PGY-2, I suggest asking to have your letters of recommendations written and ready by end of July 2015 at the latest and send out your applications in July/August or as early as the application period opens at your programs of interest. Spend early 2015 researching programs and refining your personal statement and CV so that everything is ready early. But the bottleneck most likely will be your LoRs so make sure to follow up with your letter writers to make sure they are completed in a timely fashion. Also remember to follow up with programs to make sure your applications are complete because I had lost LoRs that delayed the process, and one program that I did eventually get an interview at, never received my initial application because the email address was incorrect on their website.

If you’re a PGY-1 and unsure of what you want to do for fellowship, make yourself opportunities in 2015 to help answer this question for yourself early. For 2014, concentrate on learning on your rotations, especially surgpath/grossing. Ask to have rotations of interest or electives in your chosen subspecialty completed by second year so that you can make this decision and so that you can get letters from attending physicians in your subspecialty area. PGY-2 is also your opportunity to shine during an external “audition” elective and possibly be considered almost as an internal candidate at your top program if you schedule one early before you apply. You can even apply for a subspecialty grant from ASCP (deadline is Jan 16, 2015) to help fund your external elective expenses.

Get involved in research in your area of interest, participate in and ask to present monthly at tumor boards for your area of interest (go above and beyond the minimum!), get involved in the lab validating tests (for CP oriented folks), and attend CME meetings in your area of interest (I used to attend Chicago Lymphoma Foundation Rounds even when not on the hemepath service) – anything to learn more about and show your interest in your chosen subspecialty. Also think about getting involved in a resident leadership position within the organization that represents your interests (eg – ASCP, CAP, USCAP, Association of Molecular Pathology, etc) and take your responsibilities seriously in this role because pathology is a small specialty. Word gets around if you do your job well (and also vice versa). The connections I’ve made in these positions not only allowed me to meet inspiring pathologists who will be my future colleagues but also helped me in terms of letters of recommendation.

Well, at least all that travel and the fact that I have a credit card from a major airline, saved me in terms of paying for interview travel as most of them were paid with frequent flyer points! During medical school, I got an airline credit card at least a year before residency interviews and paid for most of my interviews that way as well. Another way I saved money on interviews back then and again now, is to rent a private room in private residencies for a fraction of the cost of a hotel through the Airbnb app. Sometimes, the programs will give you a list of hotels – remember to ask about discounts for those interviewing at that specific program. Both during residency and for fellowship interviews, some programs are paying for all my expenses except for airfare! Another way to save money is to take rides using the Uber, Lyft, or Sidecar apps especially if you can find a promotion or coupon code. And remember to keep all your itineraries organized using apps such as Tripit or Kayak.

I’ll drive to most of the East Coast interviews. But this week, I have 5 West Coast interviews in 4 cities and pretty much jetting to the airport right after to catch a flight and get into the next state around midnight in time to sleep for my interview the next day. Since I have to use vacation days, I thought it best to interview every day instead of wasting a day for the bi-coastal flight. And lucky for me, I start in San Francisco and end in Seattle where I have friends to chillax with and can do the long cross-country flight back and forth on Saturdays so as not to lose a potential interview day.

I feel fortunate with respect to fellowship interviews. I’m grateful that I received invitations at most programs that I applied to unless they took internal candidates or candidates that they interviewed who submitted applications earlier than I did. I applied for two consecutive fellowships (hematopathology and molecular genetic pathology) and upfront informed programs of my intention in my cover letter. I left it up to the programs to choose in which order I’d complete the fellowships if they were interested in interviewing me for both. I’ve found that most programs were open to my proposal. Three of them even coordinated the interview so that I either had both on the same day or over two consecutive days. Among other residents that I’ve met, the popular combo this year seems to be cytopathology then molecular genetic pathology. Makes it more competitive to get a MGP fellowship as there are currently only 52 ACGME accredited positions and that does not account for those which will go to internal candidates out of that number.

I’ve never been traditional. I graduated college as a super senior (took >4 years and time off working in a biotech company), went to grad school (I have a masters in pharmacology and experimental therapeutics with a focus on transcriptional regulation and signal transduction with respect to molecular neuroscience), worked as a research scientist in molecular and cell biology and transgenics, went to med school in my 30’s, and then completed my MPH (focusing on molecular and ID epidemiology along with minority/urban health and domestic and global health policy and development) before I went to residency.

But just like Robert Frost’s poem, I think that having taken the ‘road less traveled’ has made me into the person I am today and I wouldn’t trade in my experiences for a more traditional path. Along the way, I’ve gained knowledge and skills that I think have helped me to get interviews at great programs and that hopefully will help me develop into the triple threat I aspire to be (hematopathologist, molecular pathologist, and researcher). If this is possible or too naïve a dream, time will only tell. I blog to hopefully share helpful advice or to pass on advice from practicing pathologists that I’ve met in terms of those areas of which I yet do not have experience (eg – job market). As for me, and also for you, advice is only meant to be a trigger to thought. You will need to decide what works for you and work diligently to make your personal goals a reality. As Robin Williams said in one of my favorite movies, “Carpe diem…live EXTRA-ordinary lives.” I believe that he was telling us to aspire beyond mediocrity, to push to change and not merely accept the status quo, and to create our own destiny while not dwelling on those things that we cannot change. When my fellowship interviews are complete, I’ll let you know how the journey went.

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

The Importance of Supportive Mentorship and “Junior Attending” Experiences

Over the last few weeks I have spent more time revising my fellowship application personal statements than I would like. While my attendings have been a great source of feedback, it’s hard to know what fellowship directors would like to see highlighted. But going through this process, I have realized even more palpably than I had previously thought before, that two things have been important in bringing me to this point: supportive mentorship and “junior attending” experiences.

Let’s start with supportive mentorship and the definition of mentor. The word Mentōr derives from the Greek name of the friend of Odysseus and advisor to his son, Telemachus, in Homer’s Odyssey. Therefore, first and foremost, a mentor is an advisor: someone who is more expert and who guides you. But what I’ve found is that a professional mentor is more than a mere advisor.

I have been extremely blessed and grateful when it comes to my mentors. Not only do they advise me but they also think of me when opportunities arise such as a possible research project or publication or to be a member of their CAP lab accreditation team that inspects another institution’s lab. Besides building up my CV, these activities also help me to acquire skills that I will need in my future professional capacity. I at first didn’t necessarily think of including some of these experiences on my CV but after a talk with a fellowship director, realized that these are the types of experiences that they would like to know about – if I’ve had previous experience where I gained a skill, then they feel I will be faster to train in terms of skills that build on that initial skill.

This brings me to my second point: the importance of “junior attending” experiences. What I mean by this term is the opportunity to participate in patient care or directorship duties in as close to a capacity as your attending would have. This could mean initial sign-out without direct supervision (of course, attending review has to occur prior to true verification) in terms of patient cases, whether it be AP or CP cases, or the initial preview of a frozen section. In terms of lab management, this could mean participating in preparation for a CAP inspection or serving on a CAP inspection team that goes to another institution. And in terms of most CP rotations, serving as the primary consultant for primary physicians about lab tests and discussing evidence-based and cost-effective ordering of appropriate tests or developing, troubleshooting, or validating a new assay.

Whatever the attending does in the course of their daily workload is where we should focus on acquiring skills. While writing my personal statement and CV, I talked with fellowship directors, and this became clearer to me. It’s all about having the proper attitude. Yes, there can be a lot of “scut” during our training but in comparison to other specialties (and those who have to do an intern year), we are fortunate to have less of it. Either way, the work has to get done, “scut” or not, so might as well learn from it and you might be surprised how it helps you later. Our attendings are not free from “scut” in their daily work either. If we think of the “scut” as attached to a patient who is waiting for their diagnosis, it makes the work go easier and faster in my opinion.

Having a positive attitude, working hard, and becoming known for certain qualities and skills only help in terms of developing strong relationships with mentors (who will one day be your colleagues) and being given those “junior attending” opportunities. Strive to be the first person they think of in those situations. Remember we are no longer in school and the faster you acquire the characteristics, knowledge, and skills of an attending, the better off you will be when it comes to progressing to the next phase.

-Betty Chung, DO, MPH, MA is a third year resident physician at Rutgers – Robert Wood Johnson University Hospital in New Brunswick, NJ.

Fellowship Choices…Choices…Choices…

So, I’m almost halfway through my PGY-2 and starting to think more seriously about what fellowship to apply for next year. According to the ASCP 2012 Fellowship and Job Market Survey, 69% of residents surveyed decided on their choice of fellowship during their PGY-3 year while only 18% decided during PGY-2. Coming from a heavy research background, I always knew I would do at least a fellowship in molecular pathology and genetics – and I totally enjoyed and rocked my molecular pathology rotation. So that told me that at least I was thinking in the right direction.

But even though I often thought about pursuing CP only, I could never commit to it for fear of not getting a job once I was done training. It was even suggested to me to change my application to CP only by an interviewer at one of the top CP programs when I interviewed for residency and even then could not fully commit. My PGY-1 RISE scores also would support that I am more CP oriented since I either scored near or greater than the PGY-4 average in most CP subjects.

But now, I’m glad I decided to go AP/CP and to wait on that decision until the end of my PGY-1. It was then and at the start of my PGY-2 that I was assigned 3 consecutive months of hematopathology. And for 2.5 of the 4 weeks of my time at the VA, my attending was on vacation so I got more autonomy and had to meet those expectations or I’d be in serious trouble. Sink or swim time. But it was a good experience and made me think about combining a hematopathology fellowship with the intended molecular pathology. Hematopathology was only peripherally on my radar coming into residency even though I enjoyed the hematopathology I did during my hematology rotation at the NIH during medical school. I actually had entered residency thinking I’d do a second fellowship in clinical microbiology and a portion of my MPH concentrated on infectious disease diagnostics, surveillance, and epidemiology in addition to molecular epidemiology.

But I was fortunate during my hematopathology rotations. Sometimes, it takes the perfect storm of unexpected experiences and mentors to really change your perspective, to see something that was always there but not so obvious…at least, not until you’re ready to see it. I didn’t realize before, even though I had done a month of hematopathology previously, that it paired so well with my interests in molecular pathology. Currently, I’m still mulling over the idea in my mind but only in terms of how some personal aspects of my life will affect my abilities to perform in certain settings. And unfortunately, these things may end up dictating my choices more than I’d like. But for now, I’ve put off the final decision to early 2014 and feel a little more breathing room because my journey has become a little bit clearer.

So, did you have a “light bulb” moment or a special person who helped you decide on a choice of fellowship? Let me know in the comments section.

-Betty Chung