I was curious about how this scenario would work. Let's say you do a 3 year FM residency. You follow this with one year of a OB fellowship and then another year of Geriatric/Palliative Care fellowship. During those 2 post residency years how do you keep up your other clincal skills so that you are still sharp in the end?
Skill Atrophy During Fellowship
- Thread starter Dotsero
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What skills are you worried about losing?
What I am thinking is that when you are doing an OB fellowship you probably are not doing much in the way of peds, or adult in/outpatient medicine, ER work/procedures etc... While on a palliative care fellowship you probably are not going to be doing peds, OB, ER type work. I might be wrong.
Is there enough overlap in this areas where you wouldn't be rusty at the end of 2 years of fellowship should you want to practice full scope FM in a rural setting?
Is there enough overlap in this areas where you wouldn't be rusty at the end of 2 years of fellowship should you want to practice full scope FM in a rural setting?
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You're going to lose skills you don't keep up with during your fellowship year and you will definitely lose skills after 2 fellowships. All ACGME fellowships require that you spend 1 half-day in your primary specialty (FM), which for most programs, you do a half-day of clinic. The problem is OB fellowships are not accredited, thus governed, by ACGME, so it's up to the program to design their curriculum. When you're not under ACGME, you're not protected by ACGME work rules or any of their requirements unless your program chooses to. Your Geri or Hospice fellowship will require you to keep up with FM if they're ACGME accredited, which most are, because they lead to the CAQ.
You're going to lose the skills unless you find a way to practice. How are you going to do C-sections while you're doing your geriatric fellowship? Do you think your fellowship director will let you do that? Maybe you can talk to them about structuring something where you can keep up with peds, EM, etc., during your OB fellowship or during your Geri or Hospice fellowship, but I'd be hard pressed to think you're going to do enough OB during your Geri or Hospice fellowship *and* keep up with FM to keep your OB skills fresh.
If it were me, and this is just me, I'd pick OB. Why? Well, there's a huge variation between fellowships in terms of how much you do, but if I were to do OB, I would pick the one that gives me the most complex, emergent, diverse pathologies that get lots of training in procedures. I would do OB while I am young, have flexibility, energy, and dexterity to do it. Remember, OB fellowship is outside of ACGME's work rules and if you pick a program that works you like a dog, you need to be able to handle it.
If it were me, if I really wanted to do 2 fellowships, I would do geriatrics later if given a choice between geri or OB to do first. Why? Because geriatrics is mostly cognitive and your demands aren't going to be 24/7. Most rural medicine job positions are looking for OB trained FM docs. You'll see a few that want geriatrics fellowship training, but there's way more that want OB capable FM docs. So go for that first. Then work.
If after working a few years in rural area, if you feel like you want to pick up the geri fellowship, if you feel like you need to do a geri fellowship, or if you get burned out of OB and want to renew yourself as a geri specialist, do the fellowship then.
The other way of looking at it is, IMO, a large number of FM docs will give up OB after they graduate, but almost ALL FM docs will practice geriatrics in one form or another. So, if you want to do OB because you believe you will fill a niche then do it. Or, if you want ADVANCED training in OB, then do it. Or, if you feel like you will be seeing lots of older patients, and want ADVANCED training in geriatrics, then do it.
It's not easy to do 2 fellowships and it's not easy to stay current in 3 specialties... keep that in mind.
You're going to lose the skills unless you find a way to practice. How are you going to do C-sections while you're doing your geriatric fellowship? Do you think your fellowship director will let you do that? Maybe you can talk to them about structuring something where you can keep up with peds, EM, etc., during your OB fellowship or during your Geri or Hospice fellowship, but I'd be hard pressed to think you're going to do enough OB during your Geri or Hospice fellowship *and* keep up with FM to keep your OB skills fresh.
If it were me, and this is just me, I'd pick OB. Why? Well, there's a huge variation between fellowships in terms of how much you do, but if I were to do OB, I would pick the one that gives me the most complex, emergent, diverse pathologies that get lots of training in procedures. I would do OB while I am young, have flexibility, energy, and dexterity to do it. Remember, OB fellowship is outside of ACGME's work rules and if you pick a program that works you like a dog, you need to be able to handle it.
If it were me, if I really wanted to do 2 fellowships, I would do geriatrics later if given a choice between geri or OB to do first. Why? Because geriatrics is mostly cognitive and your demands aren't going to be 24/7. Most rural medicine job positions are looking for OB trained FM docs. You'll see a few that want geriatrics fellowship training, but there's way more that want OB capable FM docs. So go for that first. Then work.
If after working a few years in rural area, if you feel like you want to pick up the geri fellowship, if you feel like you need to do a geri fellowship, or if you get burned out of OB and want to renew yourself as a geri specialist, do the fellowship then.
The other way of looking at it is, IMO, a large number of FM docs will give up OB after they graduate, but almost ALL FM docs will practice geriatrics in one form or another. So, if you want to do OB because you believe you will fill a niche then do it. Or, if you want ADVANCED training in OB, then do it. Or, if you feel like you will be seeing lots of older patients, and want ADVANCED training in geriatrics, then do it.
It's not easy to do 2 fellowships and it's not easy to stay current in 3 specialties... keep that in mind.
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Geriatrics seems like a waste to me. Whenever we have geriatrics lectures I never seem to get anything out of it. Seriously, everything goes south when you age. What is it about that that requires a freaking fellowship? It's not like old people are a different species. Beers list and osteoperosis and dementia don't require a freaking fellowship. It's not like we never see any old people.
