It is concerning that the fellows seemed to have been “hidden” during your interview. That said, even when fellows are present in person, I would not necessarily rely on them to give you an accurate picture of the program. In truly malignant programs, fellows may be too afraid of retaliation to be completely honest with applicants.
I would focus more on objective factors that can help you assess the program:
1. What is the call schedule like? How frequently are you on call during the week? How many weekend calls do you have each training year? How many hospitals do you cover when you are on call?
2. How many core faculty does the program have? Generally, the more faculty, the better. You do not want to end up in a program with only two or three faculty members, where only one, or possibly none, are approachable, reasonable, good teachers, or otherwise meet whatever training-related qualities are most important to you.
3. How many months of electives do you have each year?
4. How much freedom do you actually have to choose your electives? Are electives selected by the fellows, or are they assigned by program leadership? Yes, there are program directors who will control what electives fellows are allowed to do. Ask specifically whether there have been situations in which a fellow's ability to choose an elective was taken away or a requested elective was denied.
5. Is there an inpatient service? If so, how dependent is the inpatient service on the fellows? Do fellows have to come in to admit patients to the heme/onc or transplant service? Are fellows responsible for overnight issues that could otherwise be handled by other providers? Are you getting paged in the middle of the night by inpatient nurses for things like Tylenol? Unfortunately, yes, some programs are this poorly structured.
6. How much freedom do fellows have to choose which faculty they work with for continuity clinic? Can you switch continuity clinics during training, or are you essentially stuck with the same attending once the assignment is made? This is particularly important when a program has only two or three faculty members because your options may be very limited.
7. How much of the fellow's clinic is actually independent fellow clinic versus seeing patients with an attending? If you are essentially functioning as a note writer or “note monkey” in fellow clinic, there is a risk that attendings will be incentivized to use you primarily to “move meat” rather than prioritize your education.
8. Are there actual disease-specific clinics? Ask specifically about breast, GI, thoracic, GU, lymphoma, myeloma, leukemia/MDS, etc. “Dr. X sees a lot of breast cancer” is not the same thing as having a dedicated breast oncology clinic with meaningful fellow exposure.
9. If there are no disease-specific clinics, can fellows arrange outside electives at nearby academic centers? If the answer is yes, ask how many current or recent fellows have actually been allowed to do this, rather than simply accepting that outside electives are theoretically available.
I would also ask current or recent fellows about specific examples, rather than just asking whether something is “available.” For example, instead of asking, “Can fellows do outside electives?” ask, “Which fellows have done outside electives in the past two years, where did they go, and how easy was it to get approval?”
If you can get access to the fellows' email addresses and contact them privately, that may be your best option. I would ask these questions directly and, where possible, ask for specific examples rather than relying on general statements about what the program “offers.”
Good luck! No program is perfect, but some are definitely more imperfect than others. The goal is to avoid getting stuck in a program where you regret your decision from the moment you start until the day you graduate.
