What Factors stop an IM resident from getting a Fellowship?

[EMDO2018]

Med school and residency both rely on grades and standardized test to rank applicants, what do fellowship programs use? If a person went to a US MD school, did an academic IM residency, did not fail any step exams, and has a moderate amount of research, should they be ale to match somewhere no problem?

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[gutonc]

Fellowships still use all those things including reviewing your MSPE, looking at Step scores, AOA status, residency PD letter, etc.

There are 3 major things that will stop people from matching a fellowship:
1. Academic red flags - This is really no different than med school.
2. Bad application strategy - Aiming too high in terms of sub-specialty or programs, not enough programs, not enough interviews.
3. Personality issues - As in residency, a terrible interview can sink an otherwise good applicant.

But the short answer is that, yes, if you do everything right, you should be able to get a spot somewhere.

 

[ABatOutofHeck]

Tacking onto this thread, it sounds like fellowship applications consist of your residency application + a residency PD letter + any research you did in residency? Obviously, your rec letters will all be different, but it doesn't sound like there's all that much you can add during residency?

 

[gutonc]

Tacking onto this thread, it sounds like fellowship applications consist of your residency application + a residency PD letter + any research you did in residency? Obviously, your rec letters will all be different, but it doesn't sound like there's all that much you can add during residency?

That's pretty much it. Doing (and presenting/publishing) research and kicking ass on the wards and your relevant subspecialty rotations is about all you can do.

 

[DermViser]

Fellowships still use all those things including reviewing your MSPE, looking at Step scores, AOA status, residency PD letter, etc.

There are 3 major things that will stop people from matching a fellowship:
1. Academic red flags - This is really no different than med school.
2. Bad application strategy - Aiming too high in terms of sub-specialty or programs, not enough programs, not enough interviews.
3. Personality issues - As in residency, a terrible interview can sink an otherwise good applicant.

But the short answer is that, yes, if you do everything right, you should be able to get a spot somewhere.

Fellowships still look at your MSPE/Step scores/AOA from medical school? Why?

 

[visari]

Fellowships still look at your MSPE/Step scores/AOA from medical school? Why?

If you have a track record of being a star from early medical school years through USMLEs through residency then you will likely continue the same trend during your fellowship. I don't think it's unreasonable

 

[DermViser]

If you have a track record of being a star from early medical school years through USMLEs through residency then you will likely continue the same trend during your fellowship. I don't think it's unreasonable

Yes, but I would say it also gives an unneeded halo effect. Why not just look at Residency performance, USMLE Step 3, and ITE scores for fellowship consideration?

 

[visari]

Yes, but I would say it also gives an unneeded halo effect. Why not just look at Residency performance, USMLE Step 3, and ITE scores for fellowship consideration?

Because:
1-residency performance: there is no good measure for that. the IM PD LOR should reflect that somehow but this is still not a standardized measure. what if your PD is an a** who doesn't write good LORs ??
2-USMLE step 3: this is a stupid test that no one takes seriously. come on they test you on obgyn and peds on that thing do you really want it to be a major part of your fellowship app ?
3-ITE: this is a self-assessment test the result of which (ideally) should be kept between you and your PD. Making it part of the fellowship app defies its whole purpose.

Now I agree with you that MSPEs and USMLEs and even AOA aren't the best measures and don't guarantee getting awesome fellows, but programs have to use something to filter all those applications. IMGs get filtered if they need visa or even by what kind of visa they have which even makes less sense. There have to be filters and those are the best they've got unfortunately.

 

[DermViser]

Because:
1-residency performance: there is no good measure for that. the IM PD LOR should reflect that somehow but this is still not a standardized measure. what if your PD is an a** who doesn't write good LORs ??
2-USMLE step 3: this is a stupid test that no one takes seriously. come on they test you on obgyn and peds on that thing do you really want it to be a major part of your fellowship app ?
3-ITE: this is a self-assessment test the result of which (ideally) should be kept between you and your PD. Making it part of the fellowship app defies its whole purpose.

Now I agree with you that MSPEs and USMLEs and even AOA aren't the best measures and don't guarantee getting awesome fellows, but programs have to use something to filter all those applications. IMGs get filtered if they need visa or even by what kind of visa they have which even makes less sense. There have to be filters and those are the best they've got unfortunately.

If your PD is an a** who writes a bad LORs, you won't be getting a fellowship in all likelihood, regardless. ITE score also demonstrate knowledge. They may be "self-assessments" but you know this isn't true, if you do badly, you're dragged in by your PD to explain yourself.

 

[gutonc]

ITE score also demonstrate knowledge. They may be "self-assessments" but you know this isn't true, if you do badly, you're dragged in by your PD to explain yourself.

ABIM forbids the use or release of the ITE score in relation to fellowship and other job applications. The PD letter typically uses some sort of code to describe where in the class, the ITE results put the applicant but can't explicitly use the number/percentile rank.

 

[Raryn]

Yes, but I would say it also gives an unneeded halo effect. Why not just look at Residency performance, USMLE Step 3, and ITE scores for fellowship consideration?

The ACP absolutely forbids PDs from sharing the ITE results of individual residents with anyone except the program administration and the resident himself. It also strongly discourages the program from using the ITE as a criterium for advancement, though it obviously can't know if a program does that.

Surgery does pretty much the exact opposite with their ITE, but the medicine test is (by design) a low stakes exam.

 

[ThoracicGuy]

The ACP absolutely forbids PDs from sharing the ITE results of individual residents with anyone except the program administration and the resident himself. It also strongly discourages the program from using the ITE as a criterium for advancement, though it obviously can't know if a program does that.

Surgery does pretty much the exact opposite with their ITE, but the medicine test is (by design) a low stakes exam.

Indeed. Our ITE scores are requested for all fellowship applications. Programs are not allowed to use this for advancement purposes, though.

 

[Bostonredsox]

In my humble option in what stops a medicine resident from getting/taking a fellowship most often is themselves and their own choice. A hospitalist paycheck that gets thrown in your face after three long years of residency and it's associated burnout....ie: man I love cardio but I'm so tired, wait you'll pay me $250k to work half a year....hmm maybe cardio isn't all that appealing...screw it let's take the $ and run.

Not saying this is a smart move, but when I first read the thread title this is immediately what came to mind

 

[intmed2014]

I have posted this on another thread but a Step 2 CS attempt may be a large red flag for fellowship PD. In my case, hopefully I'll be able to make up for it second time around and perform strong clinically.

 

[DermViser]

I have posted this on another thread but a Step 2 CS attempt may be a large red flag for fellowship PD. In my case, hopefully I'll be able to make up for it second time around and perform strong clinically.

And how do u know this?

 

[intmed2014]

I definitely do not know for certain. Some of the upper levels at my IM program had been screened out from in house fellowships due to step 2 ck failures. I am not sure how much CS plays a role in the grand scheme but every program and specialty seems to have its own algorithm for weeding out candidates with blemishes on their record.

 

[IM2GI]

I definitely do not know for certain. Some of the upper levels at my IM program had been screened out from in house fellowships due to step 2 ck failures. I am not sure how much CS plays a role in the grand scheme but every program and specialty seems to have its own algorithm for weeding out candidates with blemishes on their record.

Failure is a totally different animal. Failing anything will be a huge red flag at this point in your career.

 

[intmed2014]

Failure is a totally different animal. Failing anything will be a huge red flag at this point in your career.

Yes, that's what I was afraid of. Different people have mentioned different things due to the very subjective nature of the exam and lack of feedback. Other than pass it on second time, would you recommend anything else on this matter?

 

[IM2GI]

Yes, that's what I was afraid of. Different people have mentioned different things due to the very subjective nature of the exam and lack of feedback. Other than pass it on second time, would you recommend anything else on this matter?

Failing CS, as long as you are an AMG, is something that you can probably recover from. Most people roll their eyes at the CS exam. Don't fail it twice.

 

[DermViser]

I definitely do not know for certain. Some of the upper levels at my IM program had been screened out from in house fellowships due to step 2 ck failures. I am not sure how much CS plays a role in the grand scheme but every program and specialty seems to have its own algorithm for weeding out candidates with blemishes on their record.

A Step 2 CK failure is different from Step 2 CS failure (most PDs consider this exam to be a joke, so failing it once can be overlooked - failing it twice won't be).

 

[RaiImposs]

Fellowships still use all those things including reviewing your MSPE, looking at Step scores, AOA status, residency PD letter, etc.

There are 3 major things that will stop people from matching a fellowship:
1. Academic red flags - This is really no different than med school.
2. Bad application strategy - Aiming too high in terms of sub-specialty or programs, not enough programs, not enough interviews.
3. Personality issues - As in residency, a terrible interview can sink an otherwise good applicant.

But the short answer is that, yes, if you do everything right, you should be able to get a spot somewhere.

Hey @gutonc i just can across this thread. Thanks for the above info.

Just wished to ask, does AOA help in anyway for fellowship for those who attain it during residency?

Thank you for your time!

 

[gutonc]

Hey @gutonc i just can across this thread. Thanks for the above info.

Just wished to ask, does AOA help in anyway for fellowship for those who attain it during residency?

Thank you for your time!

It doesn't hurt.

 

[hotsaws]

My experience in reviewing and interviewing fellowship applicants showed me that the screening process is largely similar to that used for residency. Our interviewees were generally USMDs with high USMLE scores, +/- AOA, solid letters of rec and varying research experience. Someone who consistently performed well is more likely to continue to do so. You don't really get high USMLEs without hard work. Sure, some people are brilliant and it may come easier but pretty much everyone has to put in quite a bit of work to score say 240+ on step 1. Step 3 scores can drop significantly because the stakes are lower and you are (rightfully so) more worried about learning how to actually take care of patients and probably pulling a ton of hours in the hospital. PD letters are probably taken with a grain of salt because they are biased. PDs want all of their residents to match as well as possible, so there is a bias to present applicants in the best light possible unless there are serious concerns or on-the-record conduct issues for that particular resident. Agree that ITE performance and overall residency performance is presented in code talk in those letters. Residency achievements are a plus too but similarly biased and fluffy. Departments often hand out awards to residents interested in their field, ie "outstanding Allergy and immunology resident of the year" or some BS.

I do think fellowship considers research and letters of rec from respective subspecialists more strongly than residency does. I also would add that many fellowships are considerably smaller than residency programs so the interview, overall personality, and career goals can be important. A/I fellowships have 1 to 3 fellows per class depending on the program and probably a proportional amount of attendings, say maybe 4-15. So an awkward or malignant personality can really make for a tough couple years. Assuming you meet the general criteria as other good applicants, I would say research or a connection to a particular program is the best way to set yourself above the rest.

 

[hotsaws]

oh wow just realized I wrote a mouthful to an old thread...

 

[porkyqkr]

Our interviewees were generally USMDs with high USMLE scores, +/- AOA, solid letters of rec and varying research experience.

Is there anything a USMD with low STEP scores can do to overcome the filtering process? (196/216, no fails). I like to think people generally find me personable and enjoyable to work with once I get the chance to speak, but I literally only had one interview for the residency match.

 

[AlbinoHawk DO]

Is there anything a USMD with low STEP scores can do to overcome the filtering process? (196/216, no fails). I like to think people generally find me personable and enjoyable to work with once I get the chance to speak, but I literally only had one interview for the residency match.

Depends on your field. Geri, hospice, ID, endo, rheum, or nephrology? No problem. Others will be an uphill battle

 

[rokshana]

Depends on your field. Geri, hospice, ID, endo, rheum, or nephrology? No problem. Others will be an uphill battle

Eh… rheum is more competitive these days… not GI competitive, but rheum and endo fill up fairly decently compared to the others.

 

[AlbinoHawk DO]

Eh… rheum is more competitive these days… not GI competitive, but rheum and endo fill up fairly decently compared to the others.

They fill, but a substantial amount of spots go to IMG. I wouldn't stress applying to either specialty if you apply with a US MD

 

[collegestud2013]

Is there anything a USMD with low STEP scores can do to overcome the filtering process? (196/216, no fails). I like to think people generally find me personable and enjoyable to work with once I get the chance to speak, but I literally only had one interview for the residency match.

Have connections. Hopefully your home program has an in-house fellowship in the subspecialty you want, and you're okay with staying there for fellowship. Doing a chief year in nearly always guarantees matching to any in-house fellowship of your choice. If no in house fellowship and your app is mediocre (Eg low step scores, DO or IMG, from community IM program), it will be much harder but doing an outside rotation is another institution is a possibility if it can be arranged.

 

[hotsaws]

Strongly agree with the above post regarding connections. If you make a great impression at your home program, people are likely to take a known entity that they work well with. This is especially true in small fellowships such as A/I. Good letters from PD and relevant subspecialty attendings are helpful. Setting up away rotations even for a couple weeks at a program that you really see yourself attending can be helpful as well. Chief year is for sure helpful. If you are worried you got overlooked on the filter process, it certainly can't hurt to email the PD or program coordinator directly and express interest and ask if they've looked at your app -- this is an effective way to get a PD to actually pull your app and comb through it with a bit more detail rather than throwing directly in the reject pile.

Realistically, you should be prepared to explain your step scores if asked...that step 1 is a near fail if my memory is correct (depending on the year). It would be helpful if you had a solid step 3 or solid ITEs. PDs don't technically share this, but there is code talk in PD letters. I imagine if you had good ITEs, the PD may even comment directly along the lines of "so and so showed remarkable improvement in his/her standardized test scores since starting residency" or something like that (maybe that's not true, totally conjecture). The bottom line is that fellowship PDs absolutely DO NOT want a fellowship grad failing boards on the first try. I would want to see that you busted your butt for step 3 and ITEs. Otherwise, the data suggests that you don't do well on standardized tests (regardless of the reason...no judgement on your intelligence or clinical acumen) and that's higher risk than an IMG or DO that can comfortably score top quartile or higher on standardized tests.

 

[dozitgetchahi]

They fill, but a substantial amount of spots go to IMG. I wouldn't stress applying to either specialty if you apply with a US MD

At this point, rheum and endo are in a different tier from the “if you can fog a mirror, you’re good” specialties. Rheum was actually surprisingly competitive the year I applied, with almost 30% of applicants going unmatched.

 

[porkyqkr]

Have connections. Hopefully your home program has an in-house fellowship in the subspecialty you want, and you're okay with staying there for fellowship. Doing a chief year in nearly always guarantees matching to any in-house fellowship of your choice. If no in house fellowship and your app is mediocre (Eg low step scores, DO or IMG, from community IM program), it will be much harder but doing an outside rotation is another institution is a possibility if it can be arranged.

My program unfortunately does not have many in-house fellowships, no PCCM like I hope to pursue. I plan to do an away rotation at an academic center that is known to accept people from my residency and hope to impress them while I'm there. Do you think it'd be inappropriate for me to reach out to that 3rd-year fellow now, who has never met me, to see if he can set me up with some connections or even some research projects?

It would be helpful if you had a solid step 3 or solid ITEs

That's the plan! Studying for Step 3 now. I unfortunately had some bad advice from the seniors at my program who basically told me to not study at all for my 1st year ITE so that it looks like I improve a lot more on my 2nd/3rd year ITEs...

 

[hotsaws]

So you're an intern, correct? I guess I took step 3 very early in intern year, so it was similar time frame for ITE. Studying for step 3 is basically same as ITE. Normally I wouldn't advise people to study for the ITE (i mean, maybe the last one if you want to use it as a surrogate for board prep). In your situation, doing anything to impress your current PD is important. The PDs and APDs all know who scores well and who scores poorly. I think you would be smart to reach out to pulm crit fellows if you know them, certainly doesn't hurt. Fellows should be kind and helpful ...and hopefully offer honest insight into their program and you as an applicant.

One of the best things you can do for now is be an awesome intern and resident. Get a reputation for being a competent doctor with a good personality. You never know who knows who. Might be some doctor/nurse/RT/NP/whatever on a random rotation who is low key married to some PCCM attending or whatever. If you don't have good scores, you're pretty much dead in the water if you are a bad doctor or a difficult/awkward personality.

 

[AlbinoHawk DO]

At this point, rheum and endo are in a different tier from the “if you can fog a mirror, you’re good” specialties. Rheum was actually surprisingly competitive the year I applied, with almost 30% of applicants going unmatched.

Reviewing the data, endo seems to have about 1.1 ratio between applicants and positions. Rheum does seem to be a little bit more competitive at 1.4

 

[dozitgetchahi]

Reviewing the data, endo seems to have about 1.1 ratio between applicants and positions. Rheum does seem to be a little bit more competitive at 1.4

Everyone obsesses over these numbers on SDN. In the real world… things are different. Rheum programs fill and sometimes applicants aren’t matching anywhere (same for endo). Renal and ID, not so much.

 

[AlbinoHawk DO]

Everyone obsesses over these numbers on SDN. In the real world… things are different. Rheum programs fill and sometimes applicants aren’t matching anywhere (same for endo). Renal and ID, not so much.

It's simply not the same for endocrinology. Almost everyone matches, and if you see most fellow lists, it's full of IMGs. I haven't kept track of rheum, so I'll give that the benefit of the doubt

 

[rokshana]

It's simply not the same for endocrinology. Almost everyone matches, and if you see most fellow lists, it's full of IMGs. I haven't kept track of rheum, so I'll give that the benefit of the doubt

Funny how you keep arguing with an endocrinologist and a rheumatologist about their fields..what exactly is your expertise here?

 

[AlbinoHawk DO]

Funny how you keep arguing with an endocrinologist and a rheumatologist about their fields..what exactly is your expertise here?

I didn't argue with the rheumatologist after the data was presented. I was also not aware that being an endocrinologist made you an expert on admissions too.

 

[rambocharlie21]

I didn't argue with the rheumatologist after the data was presented. I was also not aware that being an endocrinologist made you an expert on admissions too.

Non US IMG
I had attempt in step 1
Step 2 270
Step 3 244
Had 5 publications in impact journals as 1st author
My father had MI attack just 2 weeks before my exam
Currently matched in a University IM program in DC .
I am targeting fellowship post my MD .
I am working hard for my CV .
Any chances to land in a fellowship spot with my credentials.

 

[mszzeta]

Med school and residency both rely on grades and standardized test to rank applicants, what do fellowship programs use? If a person went to a US MD school, did an academic IM residency, did not fail any step exams, and has a moderate amount of research, should they be ale to match somewhere no problem?

My personal experience:
1. most important: residency program. The more prestigious the residency program (similar to medical school rank), the bigger the advantage.
2. 2nd most important: US citizenship or green card...
3. then being chief resident, research, and being a star resident (in clinical performance)......Could be program and specialty dependent.

 

[NotAProgDirector]

My personal experience:
1. most important: residency program. The more prestigious the residency program (similar to medical school rank), the bigger the advantage.
2. 2nd most important: US citizenship or green card...
3. then being chief resident, research, and being a star resident (in clinical performance)......Could be program and specialty dependent.

Agree wholeheartedly. USMLE/COMLEX scores may have a floor effect -- too low and your application doesn't get reviewed.
This is all focused on the competitive fields. In Endo or Neph, none of those things matter unless you're looking at a top program.

Non US IMG
I had attempt in step 1
Step 2 270
Step 3 244
Had 5 publications in impact journals as 1st author
My father had MI attack just 2 weeks before my exam
Currently matched in a University IM program in DC .
I am targeting fellowship post my MD .
I am working hard for my CV .
Any chances to land in a fellowship spot with my credentials.

This is a WAN issue. That's Worried About Nothing.

You're at a Univ program. Your S2 score is amazing. No one is likely to care about your S1 failure anymore. You have multiple pubs. You need to have research during reidency -- if all of those pubs come from beforehand that's nice, but fellowships will be looking for research productivity during residency. Assuming your program has a fellowship in the field you want and you can get supportive letters from faculty, you should be fine. Visa will limit options -- especially if it's an H.

 

[AlbinoHawk DO]

Non US IMG
I had attempt in step 1
Step 2 270
Step 3 244
Had 5 publications in impact journals as 1st author
My father had MI attack just 2 weeks before my exam
Currently matched in a University IM program in DC .
I am targeting fellowship post my MD .
I am working hard for my CV .
Any chances to land in a fellowship spot with my credentials.

What field are you applying to?

 

[rambocharlie21]

What field are you applying to?

Endocrinology

 

[AlbinoHawk DO]

Endocrinology

Cakewalk. You'll match

 

[holystonemag]

Med school and residency both rely on grades and standardized test to rank applicants, what do fellowship programs use? If a person went to a US MD school, did an academic IM residency, did not fail any step exams, and has a moderate amount of research, should they be ale to match somewhere no problem?

Hello, When it comes to fellowship programs, they're not just fixated on grades and test scores like med school and residency. They care about other stuff too! They wanna know about your clinical skills, research experience, and if you'll be a good fit for their program.

So, if you went to a US MD school, did an academic IM residency without flunking any Step exams, and you've got some research under your belt, you should have a pretty good shot at matching somewhere. But keep in mind, it also depends on the specialty you're going for and how popular it is.

Fellowship programs will also check out your letters of recommendation, your personal statement, and how well you do during the interviews. They wanna see if you've got the right attitude and if you're passionate about what they're offering.

It's always a good idea to apply to a bunch of different programs, just to cover your bases. And don't forget to show off your strengths in your application. Be proud of your accomplishments and let 'em know why you're the right fit for their fellowship. There are no guarantees in life and the competition can be tough.

 

[HemeOncHopeful19]

Endocrinology

You got nothing to worry about (as long as you’re a normal human)

 

[NotAProgDirector]

Endocrinology

With this extra bit of information, you'll get interviews at top programs with that application. Shoot for the moon, if that's what you want.

 

[rokshana]

Non US IMG
I had attempt in step 1
Step 2 270
Step 3 244
Had 5 publications in impact journals as 1st author
My father had MI attack just 2 weeks before my exam
Currently matched in a University IM program in DC .
I am targeting fellowship post my MD .
I am working hard for my CV .
Any chances to land in a fellowship spot with my credentials.

Are you j1 or h1b? Visa is probably your only real issue… failure on step 1 is basically negated by your great CK and 3 scores.
There are great endocrine leaders at Georgetown Dr Jonklass, Dr Wartofsky, Dr.Berman…contact one of the and let them know of your interest.

ATA is having their centennial meeting in DC this year…see if you can attend… the have trainees track that can be helpful and it’s a small meeting ( 900-1000) and everyone is very approachable.

Next year AACE is in New Orleans and Endo society is in Boston… work on a poster and present… gives you a chance to meeting PDs.

As noted, you probably have a chance to match at a top program… but programs like Mayo, the Brigham, UCSF, will be weighted with US grads, but they are still accessible to the FMG.