How to choose the perfect GI Fellowship program

This September, our program has been interviewing candidates to fill two positions for the July 2019 academic year.  In a way, it’s really mind-blowing how quickly I’ve found myself on the other side of the coin.  Its been an honor to meet these (very qualified) individuals vying for a spot.  It surely does not feel like a year has elapsed since I was in their position — I vividly recall being anxious, excited, and hopeful.

Much like last year’s Match cycle, I find that every applicant is a high-scorer on the USMLE exams, well-published, and often a fourth-year chief resident.  Others (rightfully) boast about Hepatology fellowship prior to applying for Gastroenterology fellowship.  It’s amazing to see that there are many different pathways to securing an interview for GI fellowship.

November 28th marks the sub-specialties Match Day; prior to that, every Gastroenterology applicant will attempt to rank their programs.  Here is my best and unfiltered advice to everyone participating in the Match.

How to Rank Clinical GI Fellowship Programs:

#1:  What will your long-term career focus be?  Clinical or research?

Every Gastroenterology fellowship program has its strengths and weaknesses.  Similarly, each program aims to select own “brand” of applicants.  Research-predominant institutions prioritize applicants who demonstrate research productivity (e.g. many original research publications).  Generally, community-based programs prioritize personality over publication volume.

You likely have interviews at both big name nationally recognized academic institutions as well as regionally recognized community programs.  As a three-year clinical GI Fellow, your job is to become a competent Gastroenterologist.  Therefore, prioritize your needs when ranking programs.  Because every GI program is strong in some areas and weak in others (clinical procedures vs. research productivity), try to align your needs with their capabilities.  Do you see yourself practicing in a private practice or academic setting?  Do you plan to focus on bread-and-butter endoscopic procedures, or push the boundaries with advanced endoscopic techniques (ERCP with stenting, suturing, ESD, bariatric surgery, POEMs, etc.)?  If your future career endeavors require research publications, like an appointment to an academic GI position, be sure you rank programs with research capabilities accordingly.

Do you want to complete an additional year of advanced endoscopy after the three years are up?  Consider programs that have a fourth-year advanced fellow:  this may help get your foot in the door when it comes time for you to apply for that advanced year.  Interestingly, some programs WITHOUT an advanced fellow are able to teach/certify general GI fellows in advanced techniques like ERCP and EUS by the end of their third year.

#2:  People, people, people

Analyzing the secretary, program director, associate PD, faculty, fellows, and endoscopy nurses during your interview day is a daunting task.  Remember, you are evaluating the program as much as they are evaluating you!  You already have the credentials that are required of a modern Gastroenterologist.  Most programs want PEOPLE that are likable, approachable, and teachable.  No one wants to spend 50-60 hours/week (on average) with machines devoid of personality.  Conversely, YOU (the applicant) should rank programs that have palpable signs of personality and camaraderie.  If you don’t meet any of the first year fellows on interview day, consider that a warning sign.

#3:  Impact on Lifestyle

Consider your lifestyle when choosing your career path.  Academic advanced endoscopists have different responsibilities compared to private practice doctors.  The range of procedures performed may dictate call hours.  Furthermore, consider job availability when choosing general versus advanced GI.  Talk to your GI mentor(s) and ask their opinion; I guarantee you they’ll be happy to share their thoughts!

Add these questions to your interview-day question bank:

  • When on consult service, who places orders?  Are orders primarily resident-driven or fellow-driven?
  • What does the typical consult list look like?  How are follow-ups handled?
  • In the hospital, who acts as the primary team?  Does GI act as the primary team in any capacity?
  • Will I scope patients I see on the floor?
  • What is the culture of the program regarding overnight consults?  Is call taken at home?  If yes, are the fellows expected to come in for everything or emergencies only?

Remember, fellowship training is the start of YOUR CAREER in Gastroenterology.  Prior to ranking programs, ask your mentors questions.  Find approachable GI Fellows and ask them questions.  GOOD LUCK to all of the applicants!!

Photo by Tamara Menzi.

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