By Anand Venkatraman and Alexis Steinberg
Applying for your fellowship can be one of the most stressful times during residency. If it weren’t hard enough to have to navigate a busy program, family life and keeping up with your reading, now you have to send out emails, set up interviews and book flights around the country.
The process of fellowship applications has certainly become easier since NCC joined SF Match. A match provides structure, while also taking out the stress of deciding when to accept an offer. That said, it is still a process that each class of residents must learn to navigate anew, with the same degree of anxiety and confusion.
To help provide insight to this process and guide you through the fellowship application season, we interviewed Dr. Kristine O’Phelan, chief of neurocritical care at the University of Miami Medical Center, for her advice.
The mark of a good applicant, Dr. O’Phelan says, is: “Fund of knowledge and sincere intellectual curiosity are essential. The willingness to work hard and the humility to realize that there will be a steep learning curve and handle that transition gracefully are also highly valued.”
This is where your letters of recommendation need to highlight both your clinical acumen and how well you work and interact with colleagues in the clinical setting. It is unlikely that an interviewer will directly probe your knowledge base, but they may get a sense of it when you describe your experiences in neurocritical care through patient cases or research interests. Your personal statement should be used to express your curiosity and motivation for going into neurocritical care and what your future career vision holds.
We then asked Dr. O’Phelan what factors she considered concerning in an applicant. She said: “I call the nursing staff on the floors where residents work. If I don’t hear that they are helpful, caring and responsive, I am concerned.”
Neurocritical care is a multidisciplinary field requiring the collaboration of colleagues at all levels. Thus, attracting a fellow that exemplifies those characteristics is very important to programs. When you interview for fellowship, many programs have you meet with nursing and other ancillary staff. Make sure to take these interviews just as seriously as the ones with the attendings. You will be interacting with the staff a lot, and they need to come away with the impression that you are going to be respectful and easy to work with.
There are dozens of programs out there. How is a resident to know how to pick a good one? To that end, Dr. O’Phelan listed out some characteristics of a strong program: “1) Diversity in the patient population; 2) exposure to multiple attendings with different backgrounds allows fellows to see a variety of perspectives; and 3) acuity that is high enough to assure they will acquire excellent critical care skills during their training.”
When considering the clinical strengths of a program, Dr. O’Phelan’s advice is very important. A diversity of patients means you learn to take care of a variety of diseases. Multiple attendings at an institution helps you to see both consistencies and variations in practice to help you form your own decision-making style for the future. Neurocritical care fellowship should most importantly prepare you to feel comfortable dealing with emergencies, so that when you are faced with very ill patients, you are ready to handle those situations in practice with ease. On the other hand, you should be cautious about choosing a program solely based on specific attendings since they may move institutions.
Another very important thing to remember is that you are evaluating the program just as much as the program is evaluating you. So, you need to watch out for concerning signs in a program too. Dr. O’Phelan states: “If there is any hesitation about giving you access to the current or recently graduated fellows to ask questions, that is a red flag.”
In a parting bit of advice, Dr. O’Phelan counsels applicants to: “Take time to learn about the aspects of the program that are unique, and think about how you would take advantage of them to make your training fit your ultimate career goals. It is important to be able to think three to five years out and make sure you are going in the right direction.”
It’s important to think deeply about what you want for yourself in the future, see where the program’s previous fellows currently practice, and assess how the program can help you meet your personal and professional goals. Every program is very different, and each program can offer something unique to an applicant. So, it is important to investigate the distinctive features of a program, especially before you go interview there. For instance, some programs focus more on general critical care, whereas other programs focus more specifically on neurocritical care or even vascular neurology.
The involvement of the fellow in different types of procedures also varies among programs. There are variations in the amount of “out of ICU” time and opportunities available to fellows to develop other skills beyond clinical neurocritical care. For example, some programs have specific research tracks or provide quality improvement, teaching opportunities or master’s training during fellowship. Understanding your career goals is imperative in choosing your perfect program.
Finally, in preparing for interviews, it can be helpful to create a list of questions that you want to ask attendings and fellows. This can help with deciding if the program will provide you with the training you are looking for. Current fellows may be the most informative, so don’t miss out on asking them, as well. On average, applicants interview at five to 12 programs. If you are really interested in a program, we recommend sending follow-up emails and maybe even phone calls to express your interest and thank them for interviewing you.
Winter is coming, friends. And that means interview season is coming, too. Good luck!#NCSRoundup #LeadingInsights #CareerAdviceSeries #ResidentandFellow #AnandVenkatraman #AlexisSteinberg #June2018