OB GYN Fellowship Advice

Discussion in 'Ob/Gyn' started by anonperson, Nov 3, 2013.

  1. anonperson

    Physician 10+ Year Member

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    Other than the interview parts this forum is pretty dead which is a shame compared to the other specialty forums. It is annoying that people come out of hiding to post interview dates but nothing else. I recently matched into fellowship and I thought I would post some advice on matching into a fellowship to help pay it forward. This is not a definitive guide for matching and some of the advice can differ based on the sub specialty. Any replies from other attendings/fellows are more than welcome.

    For med students who are in the process of interviewing and have a choice of programs:

    -If you are dead set on matching a certain fellowship, going to residency program that has that fellowship is generally very helpful for a few reasons. Most programs for REI, Gyn Onc, MFM, Urogyn have 1 spot. A fair amount of these will go to internal candidates and some won't even participate in the match while others will still go into the matching knowing that their home candidate is most likely going to go there. It's not fair, but it's how the game works.

    In addition, programs with fellowships tend to have connected faculty. In all of these specialties, the sub specialist community is generally very small so phone calls and letters of rec play a big role, especially when they come from prominent/known people.

    Not everyone will match at an academic program that has the fellowship they wanted to match in or any fellowship since there are not that many for each sub specialty. If you are still interviewing for residency and didn't get any interviews from places that have a fellowship you want, look at where there graduates have gone the last 5 years. That can give you a decent idea on what is feasible. There are plenty of strong programs that have no fellowships but consistently send people to various fellowships.

    The fortunate/unfortunate thing also is the name/reputation of a program can be very helpful. I saw it firsthand with residents from UTSW or Pitt with weaker CVs/similar CVs get more interviews and more attention because of their program strength/connected faculty.

    For current residents:

    If you are certain on the fellowship of choice, seeking out a mentor is important. I knew during intern year I wanted to do FPMRS and met with faculty to get a game plan for my residency career. I was at a community program and had a bit more leg work to do so coming up with a timeline was important.

    I think the biggest piece of advice I can give is trying to be a strong resident. If you don't like OB or Gyn is irrelevant as a resident. Trying to be strong in every area is important. A strong general background will make you a better fellow regardless of the sub specialty you are applying for. Plus you still have to take the written and oral boards.

    Research: Most fellowships have a year of protected research time and want to see some scholarly activity. It's good to try to get a project going during your residency career that you can at least present at a conference as a poster. Oral presentations are a plus. Publications are of course a major plus. Even if you plan on going into private practice, fellowships are generally at academic centers and there is a requirement for a thesis in general.

    My advice for this is to work on projects that are doable and you can complete in a timely manner. Most residencies do not have protected research time. I worked on my projects when I was post call or on free weekends. They don't have to be huge game changers. They just have to be clear, to the point, and well designed with a reasonable thought process.

    Meetings: Most of the specialties have yearly meetings (AUGS, SMFM etc). Try to make it a point to go and network. Meet fellows and have your faculty introduce you to other attendings/fellowship directors. Networking is important and gets your name out there.

    CREOGs: This is fellowship dependent. Some sub specialties don't place as much importance on this (MFM) versus REI/FPMRS/Gyn Onc. There is also a myth out there that fellowships can't ask you for your score or can't consider your scores. I'm not sure where this came from. As far as I know, CREOG scores cannot be used in seeing if a resident can move on from each year, but for fellowship appointments, I am not aware of such a restriction. Regardless, 95% of the programs for FPMRS asked for CREOG scores for PGY1-3. It is in your best interest to study for these tests and to try to do well, especially when coming from community based programs. There is a bias against community program residents that they aren't as "academic/smart" as residents from university programs, so doing well on CREOGs will help counter this. I had an interviewer tell me that point blank, knowing that I was coming from a community program.

    Letters of Rec: You will need 3-4 letters of rec. Count on a letter from your PD, Chair, and 2 attendings. Get this done sooner as you don't want this to delay you.

    ERAS: It's a pain but review the process later during your second year/early third year. You will have to review the application cycles for each fellowship. FPMRS is a bit earlier compared to Gyn Onc or REI. Stay on top of the timeline and submit your first day possible to have your application in the pool. Places have limited number of invites and an even more limited number of slots. You will also need to get your medical student transcripts/Deans letters to the EFDO for upload as well.

    What to do if you are at a community program with no known faculty:
    I ran into this situation at my residency. I ended up doing an away rotation for a month at a well known program. I got a very strong letter of rec from a prominent attending in the field which was huge on interviews. This letter got mentioned numerous times and was cited as a reason for getting an interview at a few programs. This can be a pain to set up but if you are in this boat, it may be your only way to get a solid letter from a prominent attending. You'll need the support from your administration which can be hit or miss. In addition, it is important to see if your malpractice coverage will extend so you can actually do stuff on your away rather than it just being an observership which is pretty useless. For Gyn Onc, there is the Galloway and Rutledge fellowships for residents during their third year at Memorial Sloan and MD Anderson.

    Interviews:
    Generally laid back. I know for Gyn Onc you will have to give some type of a presentation on a topic. For FPMRS some programs had intense situational questions while others had you do laparoscopic skills. Dumb stuff. Most will ask about interests and any research you did. Why you want to come here. What you are looking for in a program. Etc.

    I had one program ask me a bunch of medically related questions on certain clinical situations. I learned afterwards, they had just asked me those questions because I came from a smaller, less known program while the other residents they were interviewing were coming from UTSW, Mayo etc and they were gauging my academic strength even though my CREOG scores are in the 90th percentile. I was not happy to learn about that.

    Post Interview:
    I sent thank you emails to nearly everyone I interviewed with. Sending actual cards is a pain in the ass and nearly all communication between applicants and programs is via email anyways. Programs are not so subtle in wanting to hear post interview communication to know that you are still interested. It's really not in the spirit of the match but this was nearly universal. Prior to rank list time I sent out some emails of interest. I never sent anyone a number 1 rank email. This is also the time to have faculty make phone calls on your behalf. Again, these are small groups of physicians and a known person making a call goes a long way. It can be a little shady but the fellowship game is like that.

    It can be a grind but once you do match it is worth it. Main thing is making a clear gameplan. The match rates for the various subspecialties is 60-70%. Not a gimme for anyone but with a solid CV a resident can match.
     
  2. REIfellowNY

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    Great topic, one that would have helped me if available two years ago!


    I thought I would add my thoughts. I am currently an REI fellow in NY and would like to offer what I think is a sound way to reach your REI goal.


    Medical School: Nothing much to say here. Don't waste your time with research. Focus on getting the best grades possible, AOA etc. This will help you get that coveted university hospital residency with an in-house REI fellowship. OBGYN has become more competitive recently and I think it really has to do with the sub-specialty options available. (REI, ONC, MFM, Genetics, ID/Global Health, Urogyn, MIS). Although as a field we do not track (separate conversation), I think we have alot to offer in terms of fellowship training. Also, more and more people want to be generalists which I think is great!

    Summary: Do well in school. Step 1 (focus for 230 and above), Step 2 (take before applying, do at least 10-15 points better than step 1).


    Residency: Residency is hard! However, totally doable. The most important thing in residency is to be a good resident. That does not mean be the best surgeon, or be the smartest. It means be friendly, willing to work hard and show competence. Nobody likes a nasty, rude know it all. Also important is what residency you choose. If you know that you want to read three textbooks, publish 20 papers and attend 4 conferences a year...I suggest looking at UCSF/Yale and dont even step foot in NYC. If you want volume/volume/volume then there are excellent community programs for you. The middle ground is the hardest to choose from: UPENN, Brown, Brigham, Upitt, Northwestern, Columbia, Cornell, NYU, UTSW, Baylor, UCLA, BI, etc... When looking at these programs try to get a feel for research opportunity (ie what have residents done in the past, where have they matched etc), but also look at the surgical numbers closely. There are differences and it is important you recognize them.


    Intern year: The first 6 months = learn how to be a resident. Learn to write flawless notes, learn to have the information that your seniors want before they even ask for it, know the most about your patients. Cannot stress how important this is. This is your first impression and will stick with you for the remainder of your 4 years. Just do your best and people will recognize this. The second 6 months: Now that you have a feeling for the program, the people, and the opportunities available, start to feel out who would be a good mentor to work with. Specifically for REI/MFM/ONC, this involves someone who publishes alot, but also is resident friendly and allows residents to eventually be first authors. Make sure you are reading; as this is where research ideas come from. Once you decide on a mentor the best thing to do is to tag on to an ongoing project. My advice: start with case reports, case series or retrospective analysis at most. This will teach you to use statistics to your advantage and will be a great experience in learning how to write a manuscript.


    Second Year: This is a good time to start aggressively putting together projects, writing abstracts etc. I will pause and say the following. To match to fellowship you don’t need a lot. What you need is 1 good paper with your name first and a few orals/posters in the field of your choice. Combine this with great letters and a solid reputation program and you will get the interviews you need to match.

    So, that being said it is not a bad idea to get involved with as much as you can. Be careful though as you do not want to step on toes in the process; specifically, other residents and fellows. Continue to develop your knowledge base and surgical skill as a generalist. You never know if you will end up practicing as one.


    Third year: You should really be trying to act as a chief by this time. Get involved with tough cases and be the first to volunteer to cover etc. This will make you seem as someone who is reliable and a go to person when times are tough. Try to also get elected administrative chief for 4th year…this helps.

    Notice I have not mentioned the CREOGS. For REI I estimated about 25% of programs asked for my scores. I did ok overall, but not stellar. I still received interviews at top places that asked for CREOGS. Study for knowledge sake and not for REI applications.


    Letters: Jan-Feb of your third year ask for letters. 3-4 letters tops (Chairman, OBGYN program director, REI director, + 1 more REI if possible). Applications open in March. REI is a tough process as there is no central application system and each program asks for ridiculous secondary materials. SREI.org has all the info you need to proceed. Make sure all apps are in by May 1st, ensuring no deadlines are missed.


    I will not get into personal statement specifics etc as this is something you should all be experts on by now. I can say this: please be generic on your statements. Anything that is even a little off the social norm will not be met favorably.


    Summer of your third to fourth year = stress. Not only will you be applying but so will you co-residents. Be respectful of scheduling issues and coverage issues. I promise people do not forget the person who was not flexible in this respect.

    Ideally shoot for 15 interviews and go to all of them. You never know which program you will fall in love with.

    REI interviews: Simply put a pleasure. Everyone at the interview day deserves to be there. The point of the interview is to make sure you fit personality wise. What this means is simple, can they work with you for 3 years? Will the patients like you? Will you be an asset or liability to the practice? This is very very important, especially in REI.


    Thank you notes: generally not needed. However, I recommend sending interest notes to your top 5 programs. V.IMPORTANT: only tell one program that they are your number one as program directors talk…as do fellows (hint, hint).


    Finally, enjoy fourth year…you should be at the top of your game!
     
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  3. pjs

    pjs
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    2 great posts. I would add decide as early as possible that you are interested in a fellowship and pursue it as stated above. It is very important to do research and present at national meetings -- so you need to start getting involved in research as early as possible (and yes you will have to do most of this in your "free time"). Deciding to apply for fellowship when you reach your third year, can be difficult to catch up on the things that other applicants have been doing for the past two years. The importance of CREOG scores vary depending on the fellowship and the individual program, so do the best you can -- it certainly doesn't hurt to do well and even if the fellowship program doesn't care about it, your PD, faculty etc. do and it will put you in good standing at your residency program if you do well. It goes without saying that you want to be a well liked resident as letters from your PD and Chair need to be superior -- if they don't believe in you -- why would a competitive fellowship program want to take a chance on you?

    Apply as broadly geographically as possible. There are not a lot of programs in any of the subspecialties in any given city, state or region. You need to maximize your chance of matching and if you really want the fellowship, you should be willing to relocate for a few years. Bottom line -- you need to decide what's really important to you when you are applying.
     
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  4. Global Disrobal

    Global Disrobal Along for the ride
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    Great post. Thanks to all of you for sharing.

    With respect to the OP, there are several of us that have tried to stay active and "give back" to the community at-large, but I must say that I could not agree with you any more in that it is profoundly disappointing to see the large turn-outs for residency interviews, start of fellowship applications, and nothing beyond that. Hopefully this will eventually change.

    Nevertheless, good luck to everyone applying to residency or fellowship.
     
  5. VivaLaVida

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    Current third year medical student strongly considering Ob/Gyn (but not sure about fellowship...it's early!) What is the best way to find out about a program's fellowship match record? Some programs have a "Resident Alumni" webpage that shows who went on to fellowship and in what, but short of that is there any database that has this information? Or is this a question I just have to wait and ask at residency interviews about?
     
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  6. anonperson

    Physician 10+ Year Member

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    You can find this out at the interview if it's not listed on the residency website. There is no central database regarding this. Overall, most OB GYN residents stay as generalists. On average, usually residents from academic/university programs pursue fellowship.
     
  7. Gypsy04

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    anonperson, thanks for starting this forum. it is very informative. I would like to ask you your opnion in my situation, I am very ambitious doctor. After i finished my residency in obgyn in my home country i fond my self little bed limitted of scope of our specialty. I was in University degree and was appointed as assisted professor. I was preparing myself to come to the state to continue my career. I finished the USMLE in one yr. I have been applying without any interviews or any hope. I need your kind advice. My husband was supportive but now after three yrs he choose to divorce me because these difficulties have rewened our relation. I am in a middle of shaking cruise and i need some jenerous advice what to do.
     
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  8. Diane L. Evans

    Diane L. Evans SDN Moderator
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    The failure rate of ABOG increases if you procrastinate taking your exam. I am a strong advocate of the accelerated process. So good luck with fellowship but remember board certification is key!
     
  9. obgyny

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    What is the timeline for getting ABOG board certified if you start fellowship after residency?
     
  10. jvlop

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    I have a question, how realistic or how easy or hard is it to do a fellowship years after being a general obgyn??
     
  11. anonperson

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    It happens. Depends on the fellowship and where you did your residency.
     
  12. Airport Playaobgyn

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    Hey,
    Thanks for your post it is very informative..
     
  13. obgyny

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    Such a helpful thread!!

    I just wanted to add, I think CREOG scores are starting to have a little more emphasis in MFM.

    I applied to MFM this year and about 40% of the programs I applied to asked for my CREOG scores. A few of my interviews also commented on my CREOG scores.

    And as anonperson mentioned, I think it helped coming from a community residency program to have done well on my CREOGs.


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  14. marcozecca

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    what is the the application day for MFM fellowships? is it always December 1st? How many MFM fellowships are out of ERAS? Usually ppl apply during third year of residency?
     
  15. obgyny

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    If you want to start MFM fellowship right after residency, then you can apply in your 3rd year of residency (and you can submit ERAS from Dec 1 to May 31st of your 3rd year). But some people apply later with gap years in between.

    So I applied the 2017-2018 cycle to start fellowship in July 2019. It’s an early process.

    I think there are something like 85 MFM programs on ERAS. The year before I applied, there were 107 available spots. Most programs have 1 spot each, some have 2-3.


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  16. marcozecca

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    Thank you for your answer! Is it like the residency application process, that opens in July but everybody apply on September 15th? I mean when do the programs actually see your application, in the time frame from Dec 1 to May 31?? When do they give out interviews?
     
  17. obgyny

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    Yes it is. I don’t remember when it opens beforehand but you can submit starting Dec 1st (meaning programs can start receiving your app Dec 1st). It’s a very long application window... I have no idea why...

    I didn’t submit my ERAS app until March, and I began receiving interviews in April, but mostly in May/June/July. Not sure if they send them earlier since I applied mid-cycle. The interviews are primarily in July/Aug/Sept, but I had one as early as June.



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