Choosing the “right” fellowship (for you)

Dr. James Town, Fellow, Division of Pulmonary and Critical Care, University of Washington

June 23, 2015

This post is a part of our Life as a Fellow blog post series. This series includes "fellow life lessons" from members of the Training and Transitions Committee Trainee Work group, who are current trainees in leadership with CHEST.

Fellowship is an important time of career development and, because of this gravitas, the selection process can seem complicated and stressful. Fellowship training will come with increased autonomy, both in your day-to-day work, as well as the course you choose for yourself. Each fellow’s unique trajectory is a function of their choices, opportunities, and desires… some would say their luck too.

Instead of making a broad sweeping, generalizable “Guide to Fellowship Selection,” I’ll tell you how I went about my own process, and maybe it will help you in yours.

First, Look Within

Early in residency, I thought I would be looking for a research-based training pathway that would help me acquire skills for outcomes research while giving me the best clinical training possible. As I progressed through residency and chief residency, I realized that what I truly wanted was a career as a clinician-educator with the opportunity to do medical education research. In deciding this about myself, I was able to narrow my choices down to fellowship programs that had the right combination of opportunities and track record for my aspirations. It was helpful for me to be introspective as much as it was to scour the usual information sources in researching the many possible programs out there.

What you need to answer for yourself is: What do you want at the end of fellowship (and beyond)? Do the programs you’re looking at have the opportunities to get you there? What if circumstances (or your plans) change, for example, your ideal mentor moves to a new institution? How malleable is your vision? The more specific (and honest) you can be, the better informed your decision will be.

Along with a critical look at my career aspirations (and myself), I was wisely advised to think about “Fellowship Plus …” – that is, how does the fellowship training parlay into a career either at the same location or elsewhere? And, in addition to my career, how would that package suit my lifestyle and plans for my future?

"You’ll be offered a lot of advice along the way from friends, interviewers, mentors, and people you meet along the way… keep in mind that everyone has their own perspective.

Put more bluntly, trust no one!"

I was coming into the match with my significant other, so we needed a dual match in a location that brought us near family, things that we enjoyed and the chance to start our own family. It wasn’t until one day off midway through my first year when I was out hiking in the woods and realized how valuable it had been to incorporate lifestyle into my choice. While everyone has different things they enjoy doing in their spare time (when you can find it!), I would highly advise factoring that into your decision.

Clinical Environment

In comparing our fellowship choices, many of my colleagues who went into pulmonary and critical care (as well as me) were worried that we might miss out on some particular experience by virtue of our selection, be it a specific procedure or some other clinical exposure. In my experience, none of those things were as important as I thought they would be. It is true that my friends in other programs are having different experiences than I am, but I also believe that within each of our paths, we can help direct our own course – seek out electives and opportunities and, ultimately, decide what we need to develop the career we want.

I think autonomy and feedback are important for growth, so I sought a clinical environment that offers those things, but I have also tried to find opportunities to pick up skills that will help me as I progress. In the end, I want to be as clinically adept as possible, but I also want to be able to continue improving throughout my career— being able to envision and set my own course is part of that process for me.

Process and Decide

You’ll be offered a lot of advice along the way from friends, interviewers, mentors, and people you meet along the way… keep in mind that everyone has their own perspective. Put more bluntly, trust no one!

All kidding aside, every piece of information you collect during your selection process is subject to bias, so take everything with a grain of salt. After you’ve absorbed all the information that you’ll collect along the notorious “interview trail,” take time to digest it. Make notes about your experience during downtimes, and keep some space for your thoughts.

I found that I evolved as an applicant in the process of self-reflection. I also found it helpful to talk about the decision-making process with people who are important to me, as well as those who supported me and would be impacted by my decision. In the end, you should feel pretty comfortable with your rank list. It’s unlikely that you’ll feel perfectly at ease, but, hopefully, you will have learned enough to make a good decision and grown enough to know how to make your career aspirations a reality wherever you end up.

Good luck with your decision, and enjoy the process!

Dr. James Town is a second year Pulmonary & Critical Care Fellow at the University of Washington. He did his medical school at Brown University and residency and chief residency at the University of Chicago. He is interested in resident and fellow education as well as e-learning technologies.