PICU Fellowship 2016

[doopdidoop]

hi everyone,

sorry if this information is posted elsewhere, I'm just having a hard time finding more current information. I'm a 2nd year at a medium-size academic peds program interested in applying for PICU this cycle. I've just now finally committed in my mind and am feeling a little overwhelmed! I would welcome any advice in the questions below.

Application timeline: So our program is quite busy clinically and finding time off for interviews has been challenging for folks going into onc this year - trying to plan ahead. If I have very flexible rotations and/or vacation from about August 23rd to about September 19/20th, and again from about October 18th-November 15th, would this be enough to complete enough interviews? I've been offered this amazing opportunity of a fully funded international rotation 9/20-10/17....but if this is going to jeopardize my chances I have the option of (grudgingly) giving up my spot. I plan to have my application totally complete on July 1st (ie working CV now and asking for letters now, etc). How flexible are PCs about working with your schedule to get interviews done?

Program information: Is there any information out there besides the rarely updated and quite sparse program websites for some of these programs? Or do we rely on through the grapevine? My interests are in global health, transport, and cardiac pathology. I would love to stay in the northeast/Midwest but am considering Texas and the West Coast as well. Anyone who recently applied want to offer their 2 cents? I know michigangirl posted a framework of evaluating programs based on unit size/composition, ECMO, etc, but sometimes that's not even posted on the website.

Number of interviews: I scored above a 240 for both steps and am at a fairly strong academic center with a large PICU with a mixed med-surg unit. I'm an OK writer and I've convinced a few attendings at my program that I'm not an idiot (ha) so I think I would be able to get good letters. I loved my PICU rotation here and I am strongly consider staying (if they'll have me!). I do also have this desire to "broaden my horizons" by diversifying my experiences at a new institution but am still thinking through it. I've heard anywhere from 5-12 interviews. What have other people done in the past?

Research: I completed a lot of bench research in undergrad, including published material not in a PICU field at all. I didn't do much in med school and in residency I've been working on a case report that hasn't been submitted yet. My (required) QI/safety project is PICU focused on facilitating better sign out between ED residents and PICU residents. Is there something else that I need to get involved in now? My interests are in transport of critically ill patients, PICU care in resource poor environments and global health, and I love the cardiac pathophysiology....but haven't identified more specific interests.

Letters: I've seen that most programs require 3 letters, sometimes from your program director. Do these have to be from PICU attendings? I just feel that I did not make that much of an impression during my (very early) second year PICU rotation on the attendings. I also did not interact much with the attendings....moreso with the fellows who I got along great with. Would it be ok to get letters from other "high acuity" fields like NICU or ER? And supplement with letters from people who know me very well (continuity clinic, etc)? Is it ok to have 4 or even 5? I am just worried that my program director one won't be that strong since I've never directly worked with her in a clinical setting.

sorry for the novella.....any help would be appreciated!!

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[BigRedBeta]

Timeline: interviews range from mid August to late October, with most programs moving quickly. While there were some that waited until all your letters were in, most would offer before that. Early November is a possibility for interviews, but you're probably better off trying to squeeze everything in before you go abroad. You should do whatever you can to set up your schedule around interviews.

Program Info: The FREIDA database is updated annually, and most programs have reasonable websites. You should talk to your PICU attendings, starting with the fellowship director at your program. Explain what you're looking for, and they should be able to help you narrow your list. The fellows that you already know are valuable resources as well. You'll need to decide how you want to process your heart kids - split units or mixed?

Interviews: 7-10 is usually fine if you're a typical candidate. If there are red flags to your application (doesn't sound like it) or visa issues or something else, you'll want to broaden your application strategy but if you're at a recognizable institution with good letters and can talk intelligently about why you want to be an intensivist, you should be fine with the normal advice of applying broadly and putting enough locations on your rank list. Remember that only 10% of personal statements are memorable...the top 5% and the bottom 5% so don't worry about that too much. Adding a new location to your CV is generally a positive thing and may give you a very different perspective...for example, the way that transport is handled is very different from place to place.

Research: in general, it's okay to not have specific research ideas developed, even during the interview process. That said, there are some places that have a particular focus that if you don't feel the same way, your time could be better spent elsewhere. For example, if lung physiology/pulmonary hypertension/hypoxia research sounds terrible to you, don't expect the folks in Denver to bend over backwards to meet you. On the other hand, if you love the idea of exploring TBI or neurodevelopmental outcomes in various critically ill populations, you'll fit in really well with the people in Pittsburgh. Show your interests by getting involved with the people in your institution who are doing those things, and seeing if they have any projects you can tag along with. Ask the fellows which faculty member is the best at putting together projects that invariably get published - especially if they have a string of things that are actually pretty small projects (at my residency there was one prof who was constantly putting out papers about ECMO and specific infections, one paper was fungal sepsis, the next was HSV, the one after that serratia).

Letters: an LOR from someone who knows you is always better than one from someone who just fits a good category. It should be a given that your PD writes one for you as they can provide the best assessment of your total clinical skill. If the person that knows you best is a cardiologist or pulmonologist, use them. The behavioral pediatrician maybe doesn't carry as much weight, but a good letter is a good letter.

 

[doopdidoop]

Thank you so much BigRedBeta for your thoughtful response. When you were scheduling interviews, did you feel that program coordinators generally worked with you in scheduling? Especially with programs that are not always able to give everyone time away/flexible during peak interview season? If I'm able to get my letters in before the application goes out in July (I plan on asking for them in the next few weeks), do the invitations come out on a first come-first serve basis allowing me to get early invitations with my application ready early?

 

[BigRedBeta]

They'll try to work with you within reason. Scheduling practices vary widely with some programs doing more "group" interview days that felt more like residency interviews, and others scheduling only 1, maybe 2, candidates per day. If they do group days, expect to have fewer choices of interview dates

Don't discount the possibility of having your friends help you out by trading shifts so you can go on interviews (which you would payback). Obviously, talk with your chiefs, and your program director too. Taking care of patients is important, but to diminish your chances at the next step of your career runs against the "supportive" culture many programs want and advertise during recruitment. Even just saying "I'm not feeling supported in my career development" if you run into problems may help jumpstart the right people.

 

[bjackrian]

That said, there are some places that have a particular focus that if you don't feel the same way, your time could be better spent elsewhere. For example, if lung physiology/pulmonary hypertension/hypoxia research sounds terrible to you, don't expect the folks in Denver to bend over backwards to meet you.

I agree with most of your advice, but as a former Denver fellow now Denver attending, I think we've broadened our focus quite a bit the last few years. We seem to be averaging about one bench research, one clinical research, and one "other" (QI, Education, Ethics, etc.) person per year, though the exact mix varies year to year. The same is true of our faculty interests which have broadened a lot as a (I think deliberate) decision on the part of the institution.

Otherwise, agree with above.

 

[BigRedBeta]

I agree with most of your advice, but as a former Denver fellow now Denver attending, I think we've broadened our focus quite a bit the last few years. We seem to be averaging about one bench research, one clinical research, and one "other" (QI, Education, Ethics, etc.) person per year, though the exact mix varies year to year. The same is true of our faculty interests which have broadened a lot as a (I think deliberate) decision on the part of the institution.

Otherwise, agree with above.

Good to know. I know a lot of talented people out there who have stories about being pushed away from the program at various points throughout the recruitment process, whether by faculty members at their home institutions before even applying or by the program itself before, during, or after the interview process. While the group certainly excelled at the bench research component, glad to hear theyre expanding their skill set. That's good for our field to have a strong group exploring a lot of different problems.

 

[SurfingDoctor]

I agree with the above. Here is my general advice about fellowship.

First and foremost, I would suggest you decide up front if you want to be in private practice or in academics. And when I say academics, I don't mean "education" or "teaching" because everyone in academics has to do that to some degree, but I mean how are you going to contribute to the field as a whole. This can mean education, but also QI, policy, bench research or clinical research and typically that something that gives you local, national, international exposure as a leader in that field and something that provides financial support so you can spend your time on those endeavours and not only see patients. In other words, something that makes you an asset to have at an academic institute (which "teaching" is typically not considered to be a financial asset, again unless it is a leader position). Once you've decided that:

Pick the place that 1) you feel like you would fit in well, 2) a place you can bare living for 3+ years, and if you want to be an academic physician, 3) a place that will give you the best opportunity to gain experience you need for the next stage of your career. For instance, if you what to be a future director of transport, try to interview at places where the ICU is the control center for transports or is at least equally shared with other divisions (NICU, ER). Also you would want to see what administrative learning opportunities you could be exposed to developing administrative/leadership skills (business or management classes). If you are interested in CVICU, make sure you look at programs with robust CVICUs, possibly with later CVICU fellowship training, so you can get as much exposure as possible as well as good letters for CVICU fellowship training. As far as global health, that one is tough. I'm sure it is possible, but it is hard to be in PICU and be a leader in global health when most global health issues are related to sanitation, prevention and access to primary care... not really a PICU expertise, but I suppose it is possible.

As far as the application and interview goes, I'll be totally honest, I don't really pay attention to personal statements or letters except when they are not proofread or are overly brief (but other people put a lot of emphasis on them, so I'm not saying they are unimportant). But I do care about 1) what has an interviewee done beyond being a doctor; medical-related extra-curricular activities, any sort of research experience, involved in advocacy projects, whatever. Something that shows you are willing to go out and do something extra that gives you a unique outlook on something besides just being a resident. It doesn't have to be published, just a passion. 2) where do you see yourself going and what do you think you need to get there. Obviously you wouldn't have all the answers of how to get there, but you should have a general sense of what your career path is and what general things you think you need to get there. Again, for instance, if transport medicine is your passion, how do you see yourself as a leader in that field. Do you want to be director? What skills do you think you will need to be a director? How do you think you can obtain those skills? You should also assess if the program can provide those skills you need (like BigRedBeta suggested). Again, you wouldn't be expected to know all the answers to this, but if you walk into an interview with a 5-10 year plan and tell someone your 5-10 year plan and ask them how can they help you achieve it, I will tell you, at least in my experience, it goes a lot further than saying you don't know what you want and don't know what you need to learn. Additionally, I have seen fellows who've hit the ground running with a plan, achieve far more, in fellowship and beyond, than those who don't.

 

[doopdidoop]

Thank you so much everyone! Just submitted my application!!!

 

[DeadCactus]

How many people here are applying this year? For those interviewing, I'm sure any reviews/thoughts/information you can share from your interview days would be appreciated by others. I'm happy to post them anonymously if you message me them.

 

[doopdidoop]

How many people here are applying this year? For those interviewing, I'm sure any reviews/thoughts/information you can share from your interview days would be appreciated by others. I'm happy to post them anonymously if you message me them.

great idea! I am in...also just got my first interview invite today!

 

[habsMD]

How many people here are applying this year? For those interviewing, I'm sure any reviews/thoughts/information you can share from your interview days would be appreciated by others. I'm happy to post them anonymously if you message me them.

great idea! maybe start a seperate thread?

 

[DeadCactus]

I'll start a thread once I get a few responses.

 

[Linus van Pelt]

Hey all! I'm applying for a PICU fellowship this year. I'm just curious which programs others have been hearing from.

 

[DeadCactus]

Interview invites posted anonymously for someone else:

Montefiore
Rainbow Babies
U Buffalo
UCLA
U of Colorado

 

[doopdidoop]

Are invitations still supposed to be coming in? I've only heard from about 50% of the places I applied to. What's the thought on emailing program coordinators to ask? Would love to be able to lump together transcontinental travel if possible....travel is so expensive!!

 

[SurfingDoctor]

I would say yes, invites are still going out. I know the interview dates our program is offering, but I haven't seen a finalized list of applicants yet.

I wouldn't personally (nor did I when I applied way back) email people for the lack of a response. I know is it frustrating, but I they have to look through 80-100 applicants to decide who to invite for half the number of interview spots and that takes time. They will let you know if you have a spot or not either way. You won't be forgotten.

And yes, it is terribly expensive and a pain in the posterior. Some places will reimburse for flights/hotels, but it is rare. Definitely not as fun as interviewing for residency as a medical student. Fortunately, you don't have to interview at quite as many and will end up canceling some toward the end to save on money and time.

 

[DeadCactus]

An anonymous interview report:

Children's National
Colorado
Northwestern
Stanford
Seattle
Texas Children's
Wash U

Awaiting answers from: Boston, CHLA, CHOP, Cincinnati, Duke, Emory, Hopkins, Pitt

 

[DeadCactus]

Boston, CHOP, Cincinnati, Duke, Emory, Hopkins, Pitt

 

[Obnoxious Dad]

What is the job market like for graduating PICU fellows who did not train at elite programs? Do they end up in private practice PICUs? Are they employed as pediatric hospitalists? Are some relegated to general pediatrics which would of course make the whole fellowship a complete waste of time?

 

[SurfingDoctor]

I don't remember the specific number off the top of my head, but I want to say about 20% of graduating fellows from our program go into private practice which is in line with the national average. That being said, the number going into private practice is increasing over time simply because academic centers don't expand as fast as private groups have the ability to and the academic market is becoming harder to get into. 15 to 20 years ago, pretty much all pediatric intensivists were at academic center because there were plenty of jobs. If you graduated from PCCM fellowship and had a pulse, you were hired. Nowadays, for academics, you need a niche that makes you marketable. I don't think the specific program you trained at makes you a more marketable applicant than another program. There are plenty of other characteristics that make an applicant desirable besides they trained at program "X". When I was looking for jobs several years ago, there were often several applicants being interviewed for 1 spot (this doesn't account for the others than never got an interview invite and got the "thank you for your interest, we will keep in touch" letter). There is also a lot of luck/timing in getting specific jobs (ie you may be graduating now but the job in your ideal city/place isn't staffing up for another year or so, or your ideal job has an opening now, but you are another year out from graduating). Networking also has a lot to do with the job you get. I only got interviews at places where I knew people or had someone make a phone call for me and talk me up. Pediatric critical care is a pretty small world and networking helps. Likewise a specific academic center may have specific needs, ie they are building up their research enterprise, they need a expert in QI, they are building a satellite hospital that needs a director, etc that may limit the applicant pool. Anyway, long story short, yes there are jobs, but the academic ones are getting harder to get and you need the right academic skill set at the right place/time. That being said, I've never seen an intensivist go into general pediatrics, not unless they wanted to.

 

[S1S2]

I'm a PICU fellowship applicant as well. I did apply to 20 programs but I have only heard back from 9 programs - 2 rejections and 7 interviews. Should I expect to hear from more, since it's September already or is it time to panic ?

 

[SurfingDoctor]

I know our program offered interviews to people just recently after others had dropped their interview dates, so you never know, but most of the interviews have probably been offered at this point. I admit, I'm not really involved in the application process, but I get the sense there is an applicant "wait list", but the applicants aren't notified. That being said, 7 interviews is probably the right number to go on. Anymore and you'd probably be canceling them at the later dates. I think I went on 6 or so when I interviewed. It just ends up being too expensive and difficult to schedule around residency rotations.

 

[doopdidoop]

I'm a PICU fellowship applicant as well. I did apply to 20 programs but I have only heard back from 9 programs - 2 rejections and 7 interviews. Should I expect to hear from more, since it's September already or is it time to panic ?

I spoke to a friend who is a first year fellow this year. She said she was still receiving interview invitations into the second week of September. There are still 2 programs I have heard nothing from but likely won't worry about it as I've scheduled enough. 7 is a great number though! I do agree the silence can be kind of frustrating

 

[nibzbelle]

Has anyone heard from

CHLA
Seattle
Loma Linda yet?