So now that I've matched...

[TUGM]

Feel extremely lucky and blessed to have matched my #1 neurology program. I have a Transitional Year to complete, which is going to be fairly cush from what I hear. This gives me an opportunity to get a head start on some research and obtaining extra knowledge.

Just wondering if any one had any advice or suggestions on what kind of things I need get done during residency to match that NCC/Stroke/IR fellowship… being a goal directed person, and tasting the sweet nectar of the success that hard work can bring… I'm setting my sights high - Columbia, MGH, Hopkins.

Also, don't worry - I'm not a slave to ambition lol… I will thoroughly enjoy the next several months before the butt-kicking starts.

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[typhoonegator]

Even a cush TY doesn't leave a ton of room to screw around. That said, for NCC and stroke at the big programs, separation comes from having a clear career direction (as long as the clinical base is there). Being interested in IR is great, but most NCC and stroke programs don't want to have the impression that you are using them to gain an IR fellowship thereafter, so it is possible to differentiate too early. Having an early track record demonstrating interest in research, QA, education, global health, etc. will make you stick out.

You mention research and I would advise you to consider whether "research" to you constitutes bench work, clinical research, or case reports. You could write a case report today. Clinical and bench research takes a lot more effort, education, and foundation-laying, to varying degrees. The people reading your CV (me) know this, and so you need to be honest with yourself about how much work you really want to devote to things outside your clinical programming. Writing eight case reports as first author in the New Bohemian Handbook of Clinical Neurology Quarterly might take up a lot of your time, but will not given anyone the impression that you're a serious researcher. Not everyone needs to be a clinician-scientist, but to rise to the top of the application pile at a premier program, you will need to figure out how you want to play the game. You might say that isn't fair, but you have to understand that those programs get applicants who have first author publications in Nature Neuroscience and PNAS. When everyone's letters of recommendation say they are "clinically strong" and are "highly recommended", publications speak to organization, professionalism, determination, and intelligence.

If research isn't your game, that's also fine. But put yourself in the PD's shoes. A good PD will want to know before you even come in to the fellowship program that: 1) you can handle the clinical load, 2) you won't get sad and quit, and 3) you won't be a huge hassle to get placed in a job post-fellowship. Fellowships are defined by the track record of their fellows, and PDs don't want people not getting jobs. Now place yourself in a Chair's shoes. They want to hire someone that has a clear and marketable set of skills that the applicant brings to the table beyond just the clinical skills of the position (everyone has those). So having done 5 trips to Haiti for rural ICU experience with a goal to set up a permanent NCC relationship between Haiti and a US institution is exciting because it is marketable and adds to the department in a tangible way. Same with a track record in quality improvement in family experiences in a neuroICU. A chair will see that this is a "value added" asset to your hire. These people are busy and make fast decisions; being able to quickly define who you are and what you do is exceedingly important and separates you from other applicants.

Oh, and remember, clinical skills still comes first. Those medicine rotations will be important if you want to be an intensivist or stroke doc someday.

 

[TUGM]

First of all, thanks for your valuable input, as always.

During my PGY-1 my plan was to gain a strong foundation in medicine, and take more than one ICU rotation, to gain experience in that setting outside of being a doe-eyed medical student. My research, as far as my first year goes, was probably going to be limited to case reports or something smaller in nature, and to gain acquainted with the world of research.

My interests lie more in clinical research, as opposed to bench work. I participated in bench work during medical school, and though some of it was interesting, I enjoyed being involved in clinical trials and the like (though I was limited to data-mining). I am hopeful to participate in these bigger projects once I start my PGY-2 neurology program.

It may sound idealistic (impractical?), but my dream is to become a physician that can perform acute/elective neurovascular procedures and interventions well, and follow my patients from admission to discharge or step down from the critical care unit. Having extra training in an ACGME stroke fellowship would allow me to hone my outpatient skills, and improve my general training for IR. I have noticed that many stroke and NCC programs don't like the idea of their fellows pursuing IR, so how does one balance these desires and convey equal interest in all of the above?

I know some fellowships (such as in UCLA) advertise the opportunity to apply for NCC and IR in the same process - do other programs offer similar tracks, or is it usually a one-step-at-a-time sort of deal?

Once again, thank you for all your input and advice - know that it does not fall on deaf ears.

 

[typhoonegator]

A lot of NCC people don't necessarily hate the idea of people going on to IR fellowships after NCC, but they do have concerns that you are just going to soft pedal through fellowship because you don't really want to be there. You're better off giving the impression that you consider IR to be a natural extension of what you want to accomplish in NCC, and that you want NCC to remain a part of your clinical practice. We have trained several people through both NCC and IR tracks, and many of them continue to practice NCC in addition to taking IR call and having scheduled time in the suite for elective cases. It's a doable practice model in the right setting.

NeuroIR fellowships are all very different, and some may be willing to let you apply for a future position. Some will not.

 

[bustbones26]

Feel extremely lucky and blessed to have matched my #1 neurology program. I have a Transitional Year to complete, which is going to be fairly cush from what I hear. This gives me an opportunity to get a head start on some research and obtaining extra knowledge.

Just wondering if any one had any advice or suggestions on what kind of things I need get done during residency to match that NCC/Stroke/IR fellowship… being a goal directed person, and tasting the sweet nectar of the success that hard work can bring… I'm setting my sights high - Columbia, MGH, Hopkins.

Also, don't worry - I'm not a slave to ambition lol… I will thoroughly enjoy the next several months before the butt-kicking starts.

I tihnk it is great that you matched and congrats are in order. That being stated, keep an open mind. You might get to about your PGY-3 year and find out that you absolutely hate stroke/NCC and love movements disorders. Hey, just saying!

If I could get into a delorean and go back in time, here would be my advise.

During your PGY-1 year, make it a priority to pass your step III, whether it be COMLEX or USMLE because without it, you will not be able to obtain a medical license in you PGY-2 year (in most states) and a number of programs frown upon this. Of course, you know that, I am just reiterating that you should learn to love non-neurology. Embrace general medicine, especially if you do think about NCC because drop the N and your left with CC. I cannot tell you how many times I see patients with vague neurological complaints that actually have thyroid disorders, hypogonadism, SLE, sjogren, rheumatoid arthritis, etc. I am glad that somewhere along the way I paid attention!

Now, what to do during your PGY-1 year to bide your time. My program developed a relationship with us from day #1, even though we were TYs or IM interns. So, I spent most of my PGY-1 year working on an IRB approval with a neurology faculty member. Yeah, it took literally the whole year, but whenever submitted, hardly went on the chopping block and was passed immediately. So research began near immediate in my PGY-2 year. Being able to stated on a fellowship application that I was the principal investigator was a plus.

Now, if you do not have any relationship with neurology, then do at least one case report. You will see at least one goody during your PGY-1 year, run with it, do something with it, even if it is not a neurological case. If it is some sort of zebra or fascinoma, share it in the medical literature, even if it is a submission for an image report. Continue the trend of submitting fascinomas during the PGY2 to 4 years. Even if they are outside of your interests.

During PGY-2 to 4 years, don't forget to right the RITE. Programs will come down hard on you if you do not do well on the RITE, even if you find a cure for MS and win a Nobel Prize for it, if you score poorly on the RITE, you will be the pariah of the program.

 

[TUGM]

Once again, thank you both for your advice. Though I am planning to run with my current interests, I will definitely keep an open mind - I really enjoy the whole spectrum of neurological disease and am lucky enough to match at a place where I will be exposed to all of it. I will try to contact my neurology program to see if I can do some leg work on a project, so that I may also start research immediately in my PGY-2 (my TY is in a completely different part of the country).

Can't wait to begin this journey!

 

[drzing]

I love the use of "me" in this thread.