“Congratulations! You have matched!” With Match Day in the rearview mirror and residency nearing an end, incoming fellows prepare for the next road trip on their journey to becoming a rheumatologist.
Residency molds new graduates into competent physicians by providing an overview of general medicine and teaching them the clinical and professional skills necessary to be independent practitioners. The exposure to subspecialties is often limited. Although residents are comfortable requesting a consult, they wake up in July and suddenly they are the consultant.
Subspecialty knowledge and experience can be limited during the first several months of fellowship, not unlike residency. Coupled with other life dynamics (e.g., relocation, a new institution, family changes, board exams), a whirlwind of anxiety overcomes many who transition into subspecialty training. Moreover, success in fellowship relies heavily on personal time management and accountability while maximizing opportunities specific to the development of future career goals. Following are five key categories to focus on:
1. Decide Early: Research or Clinical
There are two main tracks—research and clinical. A significant portion of pediatric specialty training is dedicated to research, hence the three-year duration. Many programs for adult specialties, on the other hand, focus predominantly on clinical training. To gain adequate research experience, a research track often requires an extra fellowship year, which requires additional funding. This may make it necessary for fellows to decide early if research is their intended direction.
An early decision allows for identification of a supportive mentor who can help secure funding and provide career guidance in addition to research training. Early development of a longitudinal project provides an opportunity to learn research methods, present data and, ultimately, publish. Fellows on a research trajectory should explore advanced degree options, such as a Master of Science in Public Health or a Master of Science in Clinical and Translational Research, to learn about epidemiology and biostatistics.
Finally, it’s important to plan for post-fellowship career development by applying for early investigator funding. Ideally, a successful clinical researcher will have a grant in place prior to fellowship completion; however, don’t be discouraged from a research path if funding is limited.
Fellows pursuing a clinical career must maximize clinical exposure during training while experts are easily accessible. This may involve adding more outpatient clinic time or spending more time on the inpatient consult service. Additional opportunities outside the training program, such as a musculoskeletal ultrasound course, may prove beneficial for future practice and make a fellow-in-training more marketable in the post-fellowship job search.
Fellows and program directors should work together to develop each fellow’s unique interests and incorporate them into the fellow’s training plan. And as their fellowship progresses, fellows should think about their preferred practice setting—private practice or academic. If interested in medical education, it is important to seek opportunities for medical student and resident teaching. Creating PowerPoint decks and preparing presentations can save time and make it easier when you’re asked to give a talk.
Identifying a career direction early allows fellows to individualize their specialty training, better preparing them for independent practice.
