How can you tell if a program is "fellow-driven"?

[Peds88]

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Hi all! Long time lurker here; thanks to everyone who has unknowingly guided me through this application cycle so far through your posts.

Firstly, here's my background for perspective: I'm coming from a hospital-within-a-hospital program with around 15 peds residents a year and only 9 peds fellows across 4 peds fellowship programs. I am used to calling attendings for consults (as a Sub-I), having attendings as my main teachers, having basically unlimited access to attendings for mentorship, and having attendings ask me (and the residents) directly what our plans for patients are during every step of patient care. I also performed a lot of procedures during M3/M4 year (while supervised, of course).

With my background in mind, one of my big criteria for residency was NOT to go to a "fellow-driven program". However, I am interested in eventually sub-specializing (if I had to pick today it would be Heme/Onc), and I understand that fellows can be a marker for high volume, acuity of care, and research in their field. My big question that I asked on all my interviews was "Is this a fellow-driven program?" and surprise, surprise, all of them said "No! Of course not!" This is even at programs that have upwards of 70 fellows, which feels like it just cannot be true!

My question to all of you is basically... how can you tell if a program is truly fellow-driven or not? Furthermore, does a lot of fellows necessarily = fellow-driven? Can you get good prep training to get into a good fellowship from a program that is not fellow driven? Could I go to a program with a lot of fellows and still get the face-time with attendings I am used to getting?

Sorry about all the questions... This has just really been eating at me all interview season...

 

[Siverhideo1985]

I'll give you my 2 cents: I interviewed all over for residency, ended up at a larger children's hospital and am applying to fellowship now - so that's my bias I guess.

I don't think it matters if you go to a program with a lot of fellows or one with fewer, or wether it is self-described as fellow driven or not. Pick the program that feels right to you (that gut spidey sense is what I'm talking about). If you have a speciality that you are already interested in make sure you pick a program that at least has a rotation or elective in that specialty. In my experience with our fellows and other programs as I am interviewing now...fellows tend to be awesome people to have around...they are closer to residency so they know what it's like and they know the department well...which people to approach for letters, which ones to stay away from. Even if a place has fellows in every department...if they are good people they will let you do the procedures, teach you, guide you and even become your friends.

In the end it all comes down to the type of people, whether fellows or attendings, that you will be learning from, working with and who will guide you through residency. Pick a place for the best mentors and learning environment instead of trying to figure out which one is fellow driven and which one isn't.

 

[Easily_Sunburned]

I'm also very curious to hear fellows/attendings' answers on this front. A lot of the programs I'm interviewing at will have 1 or 2 spots per year. Compared to a program with 4 or 5 or 6 fellows in a year - how does that change the culture for the program and how 'fellow-driven' it is?

 

[IrishCalini]

I'd be curious about this too... Currently trying to decide between programs with 4-5 fellows a year versus 1-2 per specialty... Is there some magic number?

 

[Stitch]

I don't think there's a magic number or obvious way to find this. I did residency in a place with very few fellows (EM and ID were the main ones), which meant that as residents we went to all the deliveries, really ran the floor at night and got great experience. During my fellowship (in a place with tons of fellows) I noted that the residents spent a lot of time doing paperwork (and less time at the bedside), didn't attend that many deliveries, though they still had a good connection with attendings. They were smart and well trained in general pediatrics, but the experience was clearly different. Fellow driven is probably more of a culture than a number. Are the fellows actively engaging and teaching the residents? Are they including the residents in all aspects of patient care? Part of this has to do with the residents as well. If you're not stepping up and being aggressive about getting experience, the fellows may not have time to find you and include you (especially in NICU/PICU situations where things can happen quickly). So if you end up in a place with a lot of fellows, then be forward and active. It may be easier to hide than in a program without fellows where if something isn't done (or is done incorrectly) everyone will look to you.

 

[Easily_Sunburned]

I don't think there's a magic number or obvious way to find this. I did residency in a place with very few fellows (EM and ID were the main ones), which meant that as residents we went to all the deliveries, really ran the floor at night and got great experience. During my fellowship (in a place with tons of fellows) I noted that the residents spent a lot of time doing paperwork (and less time at the bedside), didn't attend that many deliveries, though they still had a good connection with attendings. They were smart and well trained in general pediatrics, but the experience was clearly different. Fellow driven is probably more of a culture than a number. Are the fellows actively engaging and teaching the residents? Are they including the residents in all aspects of patient care? Part of this has to do with the residents as well. If you're not stepping up and being aggressive about getting experience, the fellows may not have time to find you and include you (especially in NICU/PICU situations where things can happen quickly). So if you end up in a place with a lot of fellows, then be forward and active. It may be easier to hide than in a program without fellows where if something isn't done (or is done incorrectly) everyone will look to you.

Thanks very much! That's a really helpful response. I'm currently looking around at fellowship programs, and I think I see what you mean about the different 'cultures' of a place.

 

[Peds88]

Thanks very much! That's a really helpful response. I'm currently looking around at fellowship programs, and I think I see what you mean about the different 'cultures' of a place.

Thanks everyone for getting back to me. I think what I'm really trying to figure out is what programs have that "culture" of being fellow-driven, to the point that it's a detriment to residents. As some of you pointed out, it's more than just a number. But also, I feel like (at least for me) it was really tough to get a sense of that on such a short interview day, and since "fellow-driven" seems to almost be a swear word on the interview trail, I feel like most programs won't be 100% honest.

 

[GoSpursGo]

I mean, there isn't a program out there that is going to say it's "fellow-driven" to the point that it's a detriment. I really don't think there even exists such a place.

To be honest, I think whether you wind up getting the experience you want has a lot more to do with how much you're willing to step up and be involved in the care of your patients. While procedures are going to be a little hard to come by in the NICU and PICU in July-August, that's just how it goes. Fellows were in your shoes just 1-3 years ago. If you step up and present a logical plan for your patients, I find it hard to believe they're going to keep you marginalized on the team. If you ask thoughtful questions, I am sure they will be happy to give you great teaching that the attendings may not have time to sit down and provide. But yes, if you are quiet and seem content to just sit back and write progress notes each day and don't seem particularly interested in their field, they probably won't go out of their way to involve you, either.