Choose your own adventure, medical fellowship style

September 8, 2016 1:48 PM

I am finally almost done with residency, yay! I am planning to do a fellowship in a subspecialty of my (nonsurgical) field. For family reasons I will almost certainly be doing it at my current institution. Said institution has had only 1 fellow in the current (newly accredited) version of fellowship and that was a couple years ago, and in the interim there has been faculty turnover and also changes in funding sources, so there is not a good precedent for how my time will be structured. So, academic medicine types: any suggestions on how I should propose to fill my time, so that it is not filled for me in less than optimal ways? Snowflakes inside.

Snowflakes: the field is currently primarily an academic field, although there is a good chance there will be more community practice options in the next 5-10 years. I am not 100% committed to academic medicine, but also not ready to close that door (and if I decide to change course I can always practice my primary specialty). This is technically a clinical fellowship but is being envisioned as research-heavy by the fellowship director, and the option exists to stay for a second year if I want. I have some publications and background in research but am not a PhD.

So what should I do? Coursework in things like biostats? Maximize clinical exposure to rare diseases? Get involved in a clinical trial? Maximize publications by focusing on analyses of pre-existing datasets?

(for all that there have not been many fellows, the infrastructure is there for it to be awesome in terms of faculty, research support etc. My primary specialty tends to have a lot more fellowship spots than applicants across the board, for a variety of reasons.)

posted by ellebeejay to Education (7 answers total)

Coursework in things like biostats? Maximize clinical exposure to rare diseases? Get involved in a clinical trial? Maximize publications by focusing on analyses of pre-existing datasets?

The 2 year fellowship I'm most familiar with (as a medical student) requires all of the above of its fellows. It's typical for fellows in this field to complete an MPH, treat patients with rare diseases and complications, complete a capstone clinical trial, and publish as many papers as possible.
posted by i_am_a_fiesta at 2:22 PM on September 8, 2016

I work in a primary-care medical academic department (though I'm staff, not faculty) that has had a post-residency academic research fellowship for the past 2+ years (as in we just on-boarded our third this past month - we have one slot per year). Our fellows spend part of their time in-clinic (community medicine) and then work on an MSPH (a post-terminal masters that our University and many others offer for people in your position). The MSPH offers a lot more flexibility in building your own curriculum and finding your own way (as in they haven't had to take a lot of the fundamentals classes that folks in the MPH program do). Between our three fellows, we've had one skew pretty hard towards Epidemiology, one towards BioStats, and our newest is planning to focus on Behavioral Health (although they'll get exposure to all three to some extent).

In addition to their clinic work and studies, they do some/all of the following:
- mentor Medical Students that are interested in primary care research (and med student interest groups focused on primary care)
- original research (not necessarily with primary data, though) with the idea of getting published, presenting at conferences, etc.
- help teach MS1 courses in Epi/BioStats, etc. (these aren't full-semester courses, just 2-3 week modules)
- serve as preceptors for MS3s during their rotation through our field (during in-clinic time)
- serve as Co-Investigators on projects by other Faculty (the time commitment here varies wildly)
- organize several monthly research-focused meetings (we do a journal club, a senior faculty led advisement small group, and another small group that can be a bouncing ideas off of people/get feedback on a manuscript/general talk group once a month each - they get credit towards their program for these)

As you can probably tell, we're pretty research focused and it helps that we do have a full research division with non-clinical faculty (PhD's, not MD's) and staff (like me) that serve as advisors/support.

I'd be happy to answer any other questions you have about our fellowship via MeMail if you'd like.
posted by Ufez Jones at 3:36 PM on September 8, 2016

I would see if your academic institution or one nearby offers something like a Master's in Clinical Research or a clinical research MPH, which are typically 2 year programs that will have all the coursework already laid out for you in research design, biostats, etc, and where having a capstone project and articles ready to submit by the time you finish is the goal. A lot of fellowship programs have their fellows do a program like that, which eliminates the need to find individual instructors or assemble a program from scratch.

If you have good research mentors with good funding records available in your field, I would definitely try to piggyback on that opportunity.

Balancing clinical and research time will be a little specialty-specific and depend on whether you will need to be seeing inpatients as an attending or fellow as well as doing continuity clinic.
posted by The Elusive Architeuthis at 4:14 PM on September 8, 2016

Response by poster: Thanks everyone. Sorry to threadsit, but to clarify: The majority of time in this case will be in outpatient clinics. I am already very familiar with the _range_ of activities that can be included in a fellowship. I am asking for help prioritizing where to focus my unallocated, finite time and energy, so that I can propose it to my department, and not get too bogged down with miscellany that tends to get handed to trainees under the guise of it being "educational". A full masters is not going to be an option but my institution does have a semester-long clinical research training course that I am planning to take. My current research will yield at least a couple presentations but it uses previously collected datasets, so trying to figure out if I should be using time to learn new statistical methods, learn how to collect data, or what. I have excellent research mentors who are well known and funded in the field.
posted by ellebeejay at 5:18 PM on September 8, 2016

ellebeejay, I'm just not sure how any of us would be able to prioritize without knowing your interests, the strengths of your institution, or what field you're in.
posted by i_am_a_fiesta at 6:42 PM on September 8, 2016

I'm an ER physician/toxicologist at a major research hospital.

Seconding i_am_a_fiesta, it's very hard to know how to answer your question without knowing what your background is, and what your interests are.
posted by BadgerDoctor at 7:28 PM on September 8, 2016 [1 favorite]

Response by poster: I thought about posting anonymously so I could identify the field, since it's too small for me to feel comfortable identifying here, but it's also small enough that the odds of there being another mefite who is directly knowledgeable about it is quite low. So, to restate, I am interested in hearing from people in academic medicine about what they think are worthwhile and and not worthwhile uses of time during fellowship from either personal experience or other anecdata. (Example: it has been suggested to me that I do structured clinical encounters to enroll people in clinical trials to "learn how X type of study works". Since these visits are essentially what I do in clinic anyway, I am somewhat skeptical that this would be higher yield than, say, working on my current papers, but am trying to keep an open mind.) If I stay in academics it will be under a clinician scientist pathway with an eye to applying for a K award in a few years. Thanks! Shutting up now.
posted by ellebeejay at 8:33 PM on September 8, 2016