Research Tracks

I considered doing this as well and the reason I decided not to was that third year is a great year for supervisory roles and teaching. Since I want to go into academics more to teach than for research, I thought being a supervisor and teacher my third year would be a very valuable experience.

Just to clarify, the only true "research path" through the ABP is still 6 years. You do an extra year of research in your FOUR year fellowship at the expense of a TWO year residency. The 5 year paths are fast-tracking paths but you dont do any additional research than you would with the traditional path. One pathway allows you to finish your residency in two years for people that are just really smart, and the other allows you to give up a year of research in your fellowship if you have already spent a lot of time doing research in the past (designed to get MD PhD's quickly into a role of physician scientist in the field of pediatrics). See the ABP website for more info about each of the pathways.

I agree with oldbearprofessor about certain subspecialties being more amenable to fast-tracking, such as NICU. But for "multi-system" specialties such as heme-onc, ID, PICU, ER, and others, the additional exposure third year may be helpful. But even for very specialized fields, like cardiology, many patients are complex and will have a very close relationship with their cardiologist, and thus may rely on them for many of their general pediatric issues.

Also, there are other aspects of fast-tracking that I found difficult to ignore as well. First, it seems that it is much more difficult to go to another institution to fast track. Many of the pathways require you to maintain a continuity clinic your PL-3 year (i.e., your first year of fellowship) which may be difficult to set-up at a different institution. Also, it makes scheduling a nightmare if the program needs to schedule you for clinic and call for fellowship in addition to a half-day per week general pediatric continuity clinic. Furthermore, many of the pathways do not allow you to sit for your general pediatrics boards until much later, like after you have finished for your fellowship. So you will have to take the general peds and subspecialty boards after fellowship. Having a two year peds residency and not being allowed to sit for the board until 2-4 years after finishing your shortened residency seems difficult to me.

But keep in mind, I am not a scientist, so those pathways weren't exactly designed to appeal to me anyways. I definately think it is a great option for physician-scientists in order to prepare them well for research. It is important to get these bright minds into research as soon and as much as possible in order to keep pushing the field in the direction in which it is going.

I looked into fast-tracking and decided not to because I did not want to do my desired fellowship at my residency institution, and the few outside programs I discussed fast tracking with wanted residents who completed a 3 year residency. Also, I did not like the eligbility requirments for taking the gen peds boards and I thought the third year of residency would be good for a lot of reasons. I discussed the process at length with my PD so I know a lot about it. I will answer each question below. Of note, I did not ask about fast-tracking during my residency interviews, nor was it ever brought up to me.

1. There are several things that go into fast-tracking. First, you need approval from your residency PD. They have to feel you are clinically competent enough to support your fast-track application. They also have to feel that the program is big enough that they can afford to get you out early and still have enough residents to cover all of the services that you no longer will be available for your third year. They also have to do a lot of work in order to have you fulfill the requirements to fast track. It isnt as easy as just doing the first two years of residency. You basically need to finish three years of residency in two years. You will need a certain number of months of certain rotations (e.g., x number of PICU months, ER months, gen peds supervising senior months, etc.). If your program has the schedule set up that you do many of these as a third year resident (which every program will), they need to tailor your second year schedule so you do some of your third-year rotations as a second year. Also, there is an inservice training score requirement to be eligible, and it is ridiculously high. It used to be 450, and I think they increased it to 480, which I believe is around 80% correct. Fewer than 1% of PL-1's score higher than a 480 and fewer than 5% of PL-2's score higher than a 480. Even as a PL-3, fewer than 10% score higher than 480. So it is definately possible, but exceedingly difficult.

2. It is easiest to fast track via the SAP by staying at your home insitution. Going elsewhere can be very difficult. I emailed PD's for my fellowship at other programs and they were not very amenable to providing that experience. Their biggest concern seemed to be scheduling. As part of the SAP requirement, you have to continue your half day a week gen peds cont clinic during your first year of fellowship. Having 6+ fellows to schedule call and subspecialty clinic is difficult. But to additionally have to schedule a half day per week gen peds continuity clinic made things even more difficult. Your fellowship and the programs to which you want to go may be different, so I would email the PD's at your desired programs early in your intern year, because for many fellowships you have to apply 18 months before your desired start date. Early fellowship applications (~18 months ahead of time) include cards, NICU, HONC, Allergy, maybe a few others too. Also, if your desired fellowship does not have a match process, it may be easier to fast track to another institution. Cards, HONC, PICU, Allergy for sure all have matches, and I think NICU and ER too.

3. I think it depends. If it is a top-tier fellowship program in a competitive field, I imagine they will have ton of highly qualified applicants who completed a three year residency. This may place you at a disadvantage. If it is a less competitive fellowship or a less competitive program, it may distinguish you from other applicants. This would be a better question for fellowship PD's. I would discuss it with various fellowship PD's when you start your residency program.

4. I didnt ask about fast tracking in my interviews. I dont know how it will be perceived. i would talk to your med school advisors and maybe other people on SDN that may have asked about it.


As I posted previously, fast tracking has a lot of advantages, but keep in mind that there are a lot of downsides. The most significant I think is the fact that you are not eligble to sit for your boards until after you finish fellowship. For me, I couldnt imagine having to take gen peds boards three years after my last exposure to general peds. If you did ER or PICU, it may be doable, but I think it would be very difficult after a field such as NICU or cards (or other single organ system fellowships). I compared it to someone having you take USMLE Step 1 after your intern year. Plus you would have to study for gen peds boards and subspecialty boards at the same time.

Your third year provides a lot of time to teach, supervise, and provide another year of exposure. All of this may not do as much for your learning curve in terms of knowledge in comparison to your first 2 years, but it will do a ton for your confidence as a clinician and your leadership skills. Also, keep in mind your third year of residency is a call-light more laid back year in most programs, so doing two busy residency years and then jumping right into a busy fellowship for another three years is very stressful. Also, it isnt very conducive to starting a family, if that is in your cards.

So put a lot of thought into the decision. If it is right for you, go for it, but don't overlook the advantages of doing things a little bit more slowly.

Mutterkuchen said:

I am starting to begin thinking about my upcoming interviews and was wondering how this worked. I went to the ABP website and understand how the pathways work in theory.

1.Do you just apply for the fellowship match after 1 year of residency training (if interested in doing the SAP--the 5 year pathway)?

2. Do you have to stay at your current institution or can do you apply to other institutions?

3. How are you perceived by fellowship program directors--is it a liability from an admissions point of view, especially from outside institutions, to have only 2 years of gen peds training?

4. What things should I be looking for or asking about during my residency interviews this winter?

Thanks in advance for any thoughts or opinions. I am currently thinking about critical care--NICU or PICU or possibly cardio.

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