How much should fellowships factor into residency rankings?

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Say you are fairly certain you know which fellowship you'd like to pursue... Is it a must to go to a program that offers that fellowship? What about going to a different program that has a reputable department in that field?

I hope this makes sense. I'm just trying to evaluate the programs in all aspects as best I can. Thanks for your help.
 

babel

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I think the first thing to consider is the structure of elective time and your ability to rotate/make connections in that field. If that specialty isn't really covered at your program, that could be a problem - but so long as you can get experience in it, I would think all options are open to you. I've also heard people complain about certain subspecialty rotations as very "fellow driven", which I take to mean that you, as a mere resident, don't get to do too much.
 

Stitch

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It shouldn't make too much of a difference. When you interview, ask about your field of interest and what the experience there is. Fellowship is more about connections and strong letters of rec from attendings who know you than anything else and there are pluses and minuses to attending a place with a fellowship. If a program already knows and likes you they may be more inclined to take you as a fellow, but plenty of places try not to only fill with in house residents. Diversity is good.

As babel points out sometimes not having a fellowship there can give you more experience doing things in that field. For example in the PICU if there are no fellows, the residents typically get more experience with lines and intubations. Obviously this is field dependent and for something like ID you may get great in depth teaching by the ID fellows. Ultimately it depends on the institution, but don't let a lack of fellowship deter you from going to a residency you particularly liked.
 
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generic

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Good advice. Let's try to make a list of fellowships for which you should probably go somewhere with a good dept:

1. ID (discussed above; want volume/teaching/experience)
2. Allergy/Immunology (very specialized, need to get networked)
3. ER (questionable, but it's so competitive I think it would help to have a connection to a strong home dept and people making calls for you)
4. Cardiology (similar to ER...at a smaller program you might get to "do" more as a resident--but they might ship the complex cases someplace else)
5. Sports Med (VERY small field)
6. Renal (I think it's hard to get enough exposure at smaller places or places without a bunch of kids on dialysis etc.)
7. Genetics (I think you might need the volume/experience/lab support)
8. Heme/Onc (tough to get into, need connections, patients often referred to specialized centers...)

Maybe not so important:
1. PICU (discussed above)
2. Hospital Medicine
3. NICU
4. Adolescent
5. GI (but competitive, so might help to have the connections)
6. Endo
7. Pulm
8. Neuro (unless you're doing a combined program obviously)


Of course, you can go into anything from anywhere theoretically, I just think this is an interesting avenue of questioning...what do others think? Feel free to totally rearrange my list
 

oldbearprofessor

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6. Renal (I think it's hard to get enough exposure at smaller places or places without a bunch of kids on dialysis etc.)

8. Heme/Onc (tough to get into, need connections, patients often referred to specialized centers...)

5. GI (but competitive, so might help to have the connections)
6. Endo
7. Pulm



Of course, you can go into anything from anywhere theoretically, I just think this is an interesting avenue of questioning...what do others think? Feel free to totally rearrange my list

The ones listed (that I included from your two lists) would be the ones I would have picked either because small programs may only have limited services or one attending in this area or because, as in heme/onc, the connections are most important. Obviously, this is subject to opinion....:)
 

BigRedBeta

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I think generally, having a fellowship program in a particular field is not a must have by any stretch of the imagination. However, the volume of patients a service manages is important no matter what. But otherwise there can be other things about a residency program that would trump having a fellowship program in your desired specialty.

For example, if you were interested in ER, you might prefer a program in which there was LOTS of ER, and you got experience there starting in your intern year. Regardless of whether there was a fellowship or not, a program in which during the intern year alone you could expect 40-50 ER shifts would probably be preferable to one in which the only ED experience you got was one month in each of the last two years with each month only having 10 ER shifts and 5 urgent care center shifts (real examples from my residency program vs my home medical school's peds residency).

The other major word of advice is to see how fellows fit into the educational mission of the hospital and the residency program. As mentioned some places are geared towards making the fellows the focus, while others focus on the residents (though even within the same hospital, there can be differences between departments). In some places, fellows are responsible for the decisions and the residents are left to cover the scut. In other places, the fellows are there and essentially act like mini-consultants for the residents - they're there to answer questions from the interns and handle the higher level considerations (like chemo protocols in the heme/onc patients). Finding a program where the residents say they like the fellows will tell you all you need to know.
 
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