PICU Fellowship Advice

[sparklystu]

Hi there,

I'm a current second year in Pediatrics and have happily decided to pursue a fellowship in Critical Care. Unfortunately, I haven't been successful obtaining much advice from the PICU attendings at my program, and it is a rather small, 10-bed PICU with a lot of heavier cases sent to larger centers, so I'm hoping folks currently in the process of applying or those with experience reviewing applications could answer some questions I have.

1. Does a doing chief year help chances of landing a choice fellowship? (Boston Children's/MGH/Cornell/Columbia/UNC, etc)

2. How much emphasis is based on research completed in residency? Is a publication required? Is a case report required? Is it more a nice "feather in the cap" or an absolute requirement?

3. Apart from general enthusiasm, good letters, any other types of activities which are important to be involved with as a resident?

4. Is there a strategy for applying to programs, particularly coming from a program that does not have it's own in-house fellowships?

5. A lot of attendings have been trying to talk me out of a career in the PICU. They tell me to consider my family, life-balance goals outside of medicine. However, it doesn't really intimidate me. I'm currently single, would like to stay on the East Coast although am flexible with that, and really just want to be at an academic institution where I can focus my efforts on clinical time and education. I'm not really that big into clinical research and am more into QI and potentially education-based stuff. Just curious what the experience of some others have been.

6. Should I be trying to do an away rotation in my third year at a place where I potentially want to go for fellowship? Is that useful, and should I try to do it as early as possible (i.e July/August)

7. Just any general advice for a second year who's a pretty decent resident but nothing extraordinary and who has her heart set on the PICU and is ready to make it happen at all costs.

Thanks a bunch!

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[Stitch]

Glad to hear of your interest!

1. Having a chief year on your resume is always a plus, but not a necessity. It's more of a question of whether you really want to do it for your program and whether you want to delay fellowship for a year. Go for it if you want to, but don't do it just because it would look good.

2. I'd say most programs don't expect you to have published. Most applicants have not published. Most residents have some involvement with research or QI stuff as part of their residencies, and that's adequate. If you find something that particularly interests you, it never hurts to pursue that. Poster presentations count too!

3. Most of what you mention is sufficient.

4. Don't worry so much about what your program does and does not do or see. The key here is to find a program that's going to fit you and your personality. There are small fellowships and very large ones. I do think it's useful to see how a big academic hospital works if you're coming from a smaller program, but big academic medical centers all have different 'feels' and personalities to them. You will get fine training at a smaller fellowship, so don't let that deter you. Pick 8-10 places that might fit, and interview at a variety of setups if you can to see how each feels to you. Don't overdo the interviews. They will start to blend together and you'll be tired

5. Burnout can be an issue in PICU, but I there are definitely ways to mitigate that. It's really up to you to make sure there are enough life/work boundaries to survive. Some people dive into research in order to step away from the bedside. Some get into administration, some just work at lower acuity units. There are lots of options. Be willing to explore them and start down those roads early. There are plenty of places that would value your interest in QI.

6. I don't generally recommend away rotations as a resident. It's too hard to learn a new system in a short amount of time, and you are unlikely to truly shine in comparison with the home residents. It's also unlikely to help you application. Just my opinion.

7. Also talk to your cardiologists. You'll need good cardiac exposure during residency and you'll be working closely with the cards fellows. A LoR from a cardiologist or a willingness for them to make a phone call can help you. Also don't be afraid to ask your current attendings to reach out to programs they know on your behalf. A nice email or phone call can get you in the door someplace that otherwise might be a stretch.

 

[SurfingDoctor]

Hi there,

I'm a current second year in Pediatrics and have happily decided to pursue a fellowship in Critical Care. Unfortunately, I haven't been successful obtaining much advice from the PICU attendings at my program, and it is a rather small, 10-bed PICU with a lot of heavier cases sent to larger centers, so I'm hoping folks currently in the process of applying or those with experience reviewing applications could answer some questions I have.

1. Does a doing chief year help chances of landing a choice fellowship? (Boston Children's/MGH/Cornell/Columbia/UNC, etc)

2. How much emphasis is based on research completed in residency? Is a publication required? Is a case report required? Is it more a nice "feather in the cap" or an absolute requirement?

3. Apart from general enthusiasm, good letters, any other types of activities which are important to be involved with as a resident?

4. Is there a strategy for applying to programs, particularly coming from a program that does not have it's own in-house fellowships?

5. A lot of attendings have been trying to talk me out of a career in the PICU. They tell me to consider my family, life-balance goals outside of medicine. However, it doesn't really intimidate me. I'm currently single, would like to stay on the East Coast although am flexible with that, and really just want to be at an academic institution where I can focus my efforts on clinical time and education. I'm not really that big into clinical research and am more into QI and potentially education-based stuff. Just curious what the experience of some others have been.

6. Should I be trying to do an away rotation in my third year at a place where I potentially want to go for fellowship? Is that useful, and should I try to do it as early as possible (i.e July/August)

7. Just any general advice for a second year who's a pretty decent resident but nothing extraordinary and who has her heart set on the PICU and is ready to make it happen at all costs.

Thanks a bunch!

1. Maybe it'll get you interviews... personally, I dismiss it when rating applicants though.

2. Quite a bit. Nothing is required... but the more you can add that demonstrates in a peer-reviewed manner that you did more than the required patient-care, the better.

3. Board scores are important. We use them to judge success at 1) passing the pediatric boards 2) passing the critical care boards. There isn't a hard and fast number, but a low number, we typically knock down the list at rankings time. Also, like number 2, anything you can do to differentiate yourself from the other applicants. Papers, poster, presentations, small grants, whatever.

4. No, it's personal... and in the end, makes no difference in my opinion.

5. I don't know what they mean. Talk you out of PICU into what? They sound burned out, which is a real issue. As far as career, you need a path that buys time out of the PICU to maintain longevity, in my opinion. Whatever that is. QI is fine, but you need a real sense of QI, not PSDA cycles. Handing large datasets, obtaining specialty buy in. Most useful QI projects involve multiple parts of the hospital and multiple divisions. It is fine to start local (ie. the PICU), but most issues that require QI are system-related. And don't say "education" without having a plan of what that means. Everyone has to teach and provide education. Being told to do something that is part of a job isn't a skill. You mean like curriculum development because you want to be residency program director? Teaching physiology to medical students that actually requires major effort (considering you'd be competing against Ph.D professors in physiology). There are a good number of people also clamoring for those jobs, so you need to set yourself apart from an educational leadership standpoint. Whenever some says, "I want to teach medical student and residents" without having any concept beyond bedside teaching... I have immediate disinterest because it shows they put zero thought into it.

6. No. Don't. Ever.

7. Get involved in as many extracurricular activities as you can. Start to figure out a passion beside patient care. Everyone who goes into and graduates from fellowship wants to take care of patients and can do the job. That doesn't make you unique. Its the passion that you have related to the field of medicine and the skills you obtain to make the most of that passion that makes you unique (and desirable from a job application standpoint).

 

[sparklystu]

Thanks very much for the advice! I appreciate the time it took to formulate your thoughtful responses.

 

[BigRedBeta]

Regarding point 4. I'd probably apply very broadly given you are coming from a smaller unit. Interview at 8-10 places, as stitch said, that hopefully give you a good range of options.

To just add to the chorus: DO. NOT. DO. AWAY. ROTATIONS.

Regarding burnout...it's a there for sure. Knowing it exists is helpful...money helps too, which unfortunately is not in line with most pediatric subspecialty academic salaries. Your attendings, particularly in a small unit that probably runs lean and also lacks fellow coverage, is totally ripe for burnout to the Nth degree. Not only do they have lots of clinical time but they are pushed to be on all the administrative stuff that in a bigger group gets spread out across more bodies. And it's one thing if you feel like you are being adequately compensated for your time, but if you aren't, even if you can contextualize it, can make all the effort seem like a waste.