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The Recipe for Becoming a Rheumatology Fellow
by Katarzyna J. Gilek, MD
In less than two months, I am beginning the next leg of my educational odyssey, starting my rheumatology fellowship at Southwestern University in Dallas. It has been nine years since I left Poland and five since completing my residency. Currently, I practice primary care and, until a month ago, I supervised medical residents in a Massachusetts community clinic. Resuming my education after spending a few years as an attending physician, and becoming accustomed to the financial perks of practice, presents a few challenges, particularly while moving to a very different part of the country. I’ve been informed that “it is all different in Texas”—everything is bigger: beef, oil, everything. But, for me, so far, the grandeur of the Lone Star State comes from one primary aspect: its university accepted me into its fellowship program, despite a prevailing view that “old graduates” without formal research experience are less desirable choices for fellowship programs.1,2
Choosing a Path
I came to the US from a country the size of Texas on a student exchange visa and was blissfully unfamiliar with the fellowship application process. I knew long ago that I wanted to subspecialize, but my field of choice was a little more elusive.
It is often considered detrimental for an applicant to be undecided, and residents fear that being keen on more than one field renders them dishonest and undedicated, but in my opinion, going into internal medicine was a declaration of having multiple interests. I tested waters and tried different flavors before I decided to pursue rheumatology.
I developed research projects with an endocrinologist, a hematologist, a pathologist, a dermatologist, and a generalist and, even if these endeavors did not get me closer to securing a fellowship position, they allowed me to sample and curb my enthusiasm for some areas of medicine.
When it came to the fellowship application process, I first consulted with specialists in the field. My program director suggested that we practice the interview process in the doctors’ lounge, nervous and exposed to the quizzical gaze of grazing attendings. He criticized me, even told me to go home, regroup, and practice in front of the mirror. It made me uncomfortable, but, with the benefit of hindsight, I think his plan had merit because, as I learned shortly after, the interviews basically are medical Hunger Games. What mattered most was that he truly believed in me.
I have to say that the application process was more complicated while practicing at a community clinic, without the support and exposure often provided in academia. For me, simply being invited to the interview was a success. And here they came, the interviews—the prelude to success, or disaster waiting to happen.
During interviews, first for residency and then for fellowship, I made a few observations of the absurdities of the process and the subjective quirks of the interviewers. I once was asked to pray before the interview started and, on one particular occasion, I was almost pinned to the wall to reveal my research interest.
I have been informed that, because I am from Europe, “it all comes easy to me.” I likewise was told that, because I have a family, I would most likely not relocate so my application was not to be treated seriously. (Who would have guessed that I was just kidding around after having invested about $10,000 into the process?)
I dreaded the obligatory “describe your weakness” question and never could quite come up with the optimal answer. The interview preparation websites suggest that you try to find a “weakness” that could be interpreted as a professional strength, i.e. “I often sacrifice my personal time because I adore working long hours.” It seems to me that this is a pretty standard question for many professional interviews, so it is not a bad idea to practice being creative in that regard. I was puzzled when well-meaning coaches kept harping that I must just “be myself.” I really believe that no one—other than, perhaps, our mothers—really would like to see our true selves at an interview. So, I developed my own take on it: we should strive to present our best self, the self that we try to perfect from birth, the self that we strived to improve in the wake of poor evaluations during residency’s clinical rotations.
During several of my interviews, it seemed that clinical practice was often viewed as being far less important than research experience. While considering myself to be a clinical fellow, I look forward to the research aspect of both my training specifically and the field in general. I do not presume that treating patients must deprive the physician of professional development and intellectual discovery. Since becoming an attending, I continued several writing projects with my residents, remained an active observer of patient behaviors, and became an astute student of more medical, sociological, and psychiatric illnesses than I ever intended to recognize.
A Choice of Rheumatology
And, of course, without support from my family, praise from some patients, and observations of random strangers, I would not be where I am today. At some point during the interview process, I was waiting at a train station near a gentleman who was sitting and reading his paper. We started chatting. When he found out the specialty for which I was interviewing, he said, “It is an obscure, but at the same time very important, field.” I paused, because that was probably the last thing I wanted to hear after a stressful day, running on coffee and adrenaline, and facing a tiring six hours of travel before I could get back home. Obscure? Initially I was taken aback. But, upon further reflection, I realized that he was very kind and his observation was not at all demeaning. Yes, rheumatology treats rare and uncommon conditions. But, while most doctors know how to recognize a heart attack, not many know how to recognize RS3PE or multicentric reticulohistiocytosis.
In the end, I am astonished at having been given the opportunity to become an expert in recognizing, naming, and treating obscure conditions. While having no delusion that my next two years will be easy, I know that, for me, the rheumatology fellowship is the way to go. The fact is, my general internal medicine knowledge and experience shall be used to my advantage in the near, and hopefully far, future.
In recent weeks, my internal medicine residents have asked about my interview experience. I hesitate to give them detailed advice, as I saw how complex the process is and how it is impossible to pin down exactly what led to my match. They all inquire whether I knew when I left the interview, whether I was liked. This amuses me because, 1) I truly had no idea, and 2) I was often in a rush; I had a plane to catch. I know that I was laughing a lot on the day of my Texas interview. I was more relaxed than at other interviews and that, although it was March, in Texas it felt like summer in Massachusetts. So, my advice to prospective fellowship applicants? Be yourself. Whatever that means...
Dr. Gilek is a rheumatology fellow at Southwestern University in Dallas.
- Gibson KS, Muffly TM, Penick E, Barber MD. Factors used by program directors to select obstetrics and gynecology fellows. Obstet Gynecol. 2012;119:119-124.
- Poirier MP, Pruitt CW. Factors used by pediatric emergency medicine program directors to select their fellows. Pediatr Emerg Care. 2003;19:157-161.