Regionalism:
I've noticed that a large bulk of many program's residents end up doing fellowship (or even faculty positions/practicing) in the same place geographically, either at their own institution or someplace next door. I'm guessing this has to do with a combination of comfort zones, personal ties friendships w/in department, family, and local professional connections being the strongest connections.
Connections- the programs:
Look at where the recent grads ended up at. History repeats itself. Often times, you can see suggestive patterns. For instance, Yale had three grads go to Thomas Jefferson for either fellowship of faculty position. Someone must know someone.
Connections- yours:
In order to bust regionalism, I noticed that a UCLA senior resident did the slick thing of keeping in close touch faculty from med school on the other side of the country. (In parallel, his wife did a similar thing for her non-medical career in their old city.) When panning for fellowship options, people in their old city anticipated their potential availability and recruited both of them hard.
On your own wings:
A senior resident from Michigan told me that after giving a talk at one of the meetings, he was being approached by programs at top places, inquiring whether he might be interested in a fellowship.
Fluidity between the "tiers":
At least two of BU's current residents are going to MGH next year. One of them is going into MGH critical care, despite BU not have a critical care unit. She made the best of it by doing a visiting elective at MGH and probably got her foot in the door that way.
Residents from Cornell are going to MGH too.
trajanman said:
I'm curious, I assume you can go anywhere from the "top" programs. Can I go to a "top two" program from a next level program for fellowship easily? Lets say CCF to Partners, for instance. Or Michigan to UCSF. Or, is it all about making connections with colleagues? Also, how much does reputation of your residency program matter in obtaining faculty positions? These questions are from someone who doesn't have a subspecialty picked out yet.