Applying for Fellowship: What You Need to Know

Applying for fellowships is a stressful process. It not only involves making major decisions that will impact your life but it also requires creating a competitive application and preparing for high-stakes interviews, all while you are still fulfilling your responsibilities as a resident. NEJM Resident 360 hosted a discussion with a panel of experts on preparing for fellowship to explore many of these issues. In this blog post, I share some personal tips and useful advice from our panel experts on how to be a successful fellowship candidate.

Be the Early Bird

Creating a successful application for fellowship does not start one or two months before applications are due. Starting the process a year before you apply can ensure that you are ahead of the game.

Here are some things to think about during the year before applying:

• Decide on your subspecialty:

You may be someone who knew you wanted to be a cardiologist when you applied to medical school or you may still be undecided about specialties. If you are in the second category, try to find clinical experiences in the subspecialty during your elective period, ambulatory block (for outpatient-focused specialties), or inpatient rotations in specialties that you are considering (for specialties with a heavy inpatient load, such as cardiology and oncology). Talk to fellows and faculty in the specialty to learn what their life is like. Discuss your choices with advisors (e.g., your residency program director) or mentors. You might also find the NEJM Resident 360 blog post Family Medicine, Rad Onc, or OB? How to Choose a Specialty helpful.

• Invest in at least one rotation in your chosen subspecialty:

Most fellowships want at least one letter from a faculty member in the subspecialty that you are applying for. As you set up your schedule for the year, ensure that you have at least one rotation that will give you time with a subspecialty faculty member who can write a letter of recommendation for you.

• Take part in research projects to enhance your application:

Depending on your subspecialty and career plans, consider working on a project that either has a research or educational focus or on a case report or case series during the year before you apply. This is particularly important if you plan to have a career that includes nonclinical or nontraditional activities such as research, medical education, health policy, global health, hospital administration, and medical writing. Participating in such activities in addition to patient care will demonstrate your commitment and set you apart from other applicants.

• Take time out of the training path:

Many residents are interested in taking a year off to do research, work as a hospitalist, or act as a chief medical resident. In many cases, this may strengthen your application. However, being away from clinical medicine for too long might elicit concern about your clinical skills when you return to practice. Make sure to address your decision to take time out in your personal statement and be prepared during your interview to explain why you decided to take that path, how you spent this time, and how the experience will help you during fellowship and your career. If you were a hospitalist and practiced independently for an extended period, you may be asked about the challenges of being a trainee again and required to run your plans by someone else.

Assembling Your Application

As the application submission deadlines loom closer (within 6 months), start collecting all the documents that you need to create your application. Some components depend only on you (e.g., the personal statement and resume) while other parts require input from busy people (e.g., letters of recommendation). The earlier you start, the better!

Here are the steps required to assemble your application:

• Familiarize yourself with the application requirements:

Most subspecialties use the Electronic Residency Application Service (ERAS). Some programs and subspecialties have specific requirements, so you will want to review the ERAS website in detail as well as the relevant fellowship program websites.

• Request letters of recommendation (LoR):
  • How many? Aim for four letters if the number is not specified. Check program requirements on the ERAS and program websites.
  • Who should write the letters? After you review the letter requirements for your programs, think about who can write a meaningful LoR about your abilities as a doctor rather than someone who will rehash your CV. Usually, one of the letters is from your residency program director. Others can be written by clinicians in general medicine or subspecialties with whom you have worked. If you have been involved in research or education projects, get LoRs from your project supervisor. Include at least one letter from a subspecialist in the specialty that you are applying for.
  • When should I ask for the letter? Asking for a letter while you are still working with a faculty member is best — and the earlier the better — as this allows them to pay more attention to your performance in real time and perhaps take note of specific strengths or examples. You can provide additional instructions on how to submit the LoR closer to the due date.
  • How do I ask for the letter? First, don’t be afraid to ask! All faculty members at institutions with residency programs are accustomed to writing LoRs. You can email your request, but also offer to meet in person to discuss your career plans. Writers based outside of the U.S. may require more guidance. An international faculty member may be brief about your abilities, and this could be perceived more negatively than intended. Providing sample LoRs could be helpful.

  Here are some more helpful tips:

  • Ask if they feel they know you well enough to write a positive letter on your behalf
  • Provide an updated copy of your CV and your personal statement to frame the LoR
  • Consider noting specific areas on your CV that you would like highlighted
  • Always remember to thank your letter writers, especially after you match, because they will be curious about the outcome!
  • How are the letters submitted? Letters are submitted electronically via ERAS. Make sure you review the ERAS procedure carefully and instruct your letter writers on how to submit their LoRs.
  • Write your personal statement:

  Your CV and LoR may be prioritized over your personal statement, but programs use your personal statement to learn more about you. The personal statement is the only place in your application where you can add your voice and bring together all of the pieces of your application. Send your personal statement to friends and mentors to ensure that it is error-free. Keep it brief — no more than one page.

  Some questions you may want to ask yourself as you write your personal statement include:

  • What experiences make you a strong candidate for this program?
  • What parts of your application suggest that you will have a successful career?
  • How can you draw the reader’s focus on your unique achievements?
  • What relevant information is not included elsewhere on the application (e.g., unexplained absences from clinical work or a failed exam)?
  • Create your application/CV:

  ERAS will prompt you to input all the information that fellowship program directors are looking for, such as education, academic projects, publications, etc. Include all achievements, including ongoing projects. Be prepared to address anything that is on your application during the interview.

  • Select programs to apply to and submit your application:

  Once you have created your application, you will submit it to programs (usually via ERAS). Deciding how many and which programs to apply to will depend on personal preferences, your competitiveness as an applicant, and the type of training you seek. For example, if you are planning a career as a clinician-investigator, focus on academically oriented programs. If you had some struggles during medical school or residency and therefore do not have a very strong application, you may need to apply more broadly. Your residency program director can help you decide how many and what programs to apply to. Look at the fellowship program website to find out the career paths of prior fellows.

  Acing the Interview

  Fellowship interviews are often a bit more involved than residency interviews. The number of faculty members and trainees is much smaller in the fellowship program, and some fellows may stay on faculty after their fellowship. Therefore, faculty will be considering you as a potential future colleague and want to determine in the interview whether you will be a good fit.

  Tips for acing the interview include:

  • Be engaged: Show your best side during the interview day. Make sure you are rested. Do not schedule interviews when you are post-call! Be social, put your phone away, and get to know the faculty, fellows, and other applicants.
  • Practice and prepare: Many residency programs will offer mock interviews with experienced fellowship interviewers. Even if you do not have the opportunity to do a mock interview, prepare answers to commonly asked questions and practice delivering these answers out loud.

  Some interview topics to prepare for include:

  • talking about yourself
  • your strengths/weaknesses
  • describe a challenging patient interaction and how you resolved it
  • where you want to be in 5 to 10 years (You don’t have to be specific but you should have some sense of what you would like to do and how you will get there.)

  Make sure you know what questions interviewers are not allowed to ask (e.g., what other programs you applied to, age, gender, religion, sexual orientation, and family status). If any of these questions come up, try to make light of it and take the conversation in a different direction. Let your residency program director know if you are concerned about questions asked during your interview.

  • Know your interviewers: Many fellowships will give you the interview schedule ahead of time; make sure you read about the interviewers and their interests. If you know the program has a faculty member that might make a good mentor, make sure to contact the program well ahead of time to see if they can schedule an interview with that person. In addition to the division’s website, you can find useful information about interviewers on PubMed, LinkedIn, Doximity, Google, etc. This information will allow you to find some common points for discussion during the interview.
  • Ask questions: You should have read the program’s website in detail before the interview. Reviewing the website of the medical school or the medical center might also be helpful. You may find information on a relevant grant or multidisciplinary initiative. Prepare honest questions to help get to the essence of the type of curriculum the program offers (including clinical experiences you would like to learn more about, research mentorship, or non-clinical training opportunities).
  • Interact with current fellows: They are on the front lines and can tell you more about call schedules, work hours, and other day-to-day questions than any of the faculty members. In addition, current fellows can give you the inside scoop on the program, the program director, and mentorship.
  • Send thank you notes: Sending a thank-you note (via email or snail mail) is not required and may not be reciprocated. If your post-interview feelings are genuine, you can choose to send a quick note to express your ongoing interest in the program and you can include specific points, but do not cut and paste a generic thank you note. If there are been major updates to your application, let the program know.
  • Post-interview communication: The official match policy is to discourage any communication from the program to the applicant after the day of the interview. Therefore, if you do not hear from the program, it does not necessarily indicate a lack of interest in you. However, fellowship programs are not prohibited from contacting you so you may get a call or an email, usually just to check if you have any additional questions. Programs cannot ask you how you are going to rank them. If you have concerns about a post-interview communication, discuss it with your residency program director who can help resolve the situation.

  Once you are done with the interview season, you will need to submit your rank list and wait for match day! Good luck!

  Dr. Hamnvik is an endocrinologist and educator at Brigham and Women’s Hospital and Harvard Medical School in Boston. He is a core faculty in the HMS endocrine course; an advisor for HMS medical students during their clinical years; an assistant program director for the internal medicine residency program and an associate program director for the endocrinology fellowship program at Brigham and Women’s Hospital; and also involved in several continuing medical education courses.