Hey SimulD,
Here's my 2 cents for what it's worth:
1. when do you apply for a subspecialty, i.e. what year of residency?
Depends when you want to start fellowship. If you want to start right after your IM residency is done, you would apply during the summer/early fall of your 2nd year of residency. Some people work for a year or so inbetween residency & fellowship to take a break to make $$ and so they apply as third years. For example, I applied in the summer/early fall of 2002 (my apps were all in by Labor Day) and will be starting in July '04. This year, folks who applied actually had their stuff in even earlier (most by August '03).
2. what kind of background do they expect - do you need GI (or whatever) research as a med student or do you do it during your residency? do they look at step1/2/3? is there tests in internship/residency you need to do well on?
Given how ridiculously competitve GI has gotten, getting involved in research or working on case reports with attendings during end of med school and residency would be really helpful both in terms of getting your name on papers and making contacts for letters and for the future. This is so variable -- some folks had publications when applying, others had abstracts in process, some were actively working on projects. I wouldn't expect to get to get too much research done during intern year. I think the bottom line is to be able to have stuff your working on researchwise so you have something to talk about in a fellowship interview. Places ask for Step I and II scores, but I don't know how they use them. No other tests as far as fellowship application. Work on getting into the BEST IM program you can is what I'd advise at this point -- the reputation of your IM program will go a long way on the fellowship interview trail
3. is it easier to get a fellowship at the place you train or do you have to apply to many, many programs?
I have heard that your two best chances for a spot are where you went to med school and where you do your residency. I don't necessarily know that its easier -- it's just that you have connections. I am staying at Parkland for GI, which is where I did my residency. I did apply to about 40-45 programs. I've heard of people applying to as many as 90-100.
4. is there anyway to 'guarantee' a spot - fast track or something like that?
So GI has two tracks, of sorts, when you apply to fellowship. One is a clinical track (3 years) that you do after three years of IM residency, and one is a research track that is 4 or more years (some mix of clinical and lab years) that you can apply to to start after 3 years of IM or if you have a lab and project in mind with a good proposal, ask your IM program if you can fast-track after 2 years of IM (the minimum you can do in order to sit for IM boards in the context of fast-tracking). If you want to do academic medicine and/or wouldn't mind spending time in the lab or on other types of research, the research track is a great way to "lock-in" a spot in that research tracks are funded by NIH or other grants and usually require an interested candidate talking to the right attending in their respective GI department and expressing interest in a reseach track, as long as you are an acceptable candidate in other ways.
5. if you don't get electives during your internship, how are you supposed to figure out what subspecialty you want?
Good question. For the most part, you should get some of your requests for specialty electives. My residency doesn't even have electives for intern year, but a lot of people have some idea what they might want to do before starting. In that situation, request the electives you want for EARLY in your second year, so you can get letters in time to apply.
6. how many people apply to GI? i read on SDN that there are ~300 spots? is there like 500 applicants or 3000?
The last stats I saw said something like 250-300 spots in GI. Unfortunately, without a centralized match, it is hard to put fixed #s on the number of applicants.
Hope this helps. If you have any other questions, feel free to PM me or post them on site. Good luck.
