Program structure

[Guest]

Which programs can allow you to do a CAST accredited fellowship as a chief, and how important is this to look for in a program?

[Guest]

(05-09-2019, 10:05 PM)Guest Wrote: Which programs can allow you to do a CAST accredited fellowship as a chief, and how important is this to look for in a program?

Duke does. I think UF, Barrow, Pitt.

[Guest]

You mean as a 7th year. You have to have a "chief" year to graduate. In this case, the programs (like the ones mentioned above) allow you to have your chief year as a PGY6, and dedicate your enfolded CAST-approved fellowship as a PGY7. In this way, it is a post-Chief fellowship. Not sure how much weight programs give to that compared to post-graduate fellowships when hiring us in the future.

[Guest]

Not sure about CAST accreditation, but I think assessing available additional training options is very important when deciding on a residency program.  An enfolded fellowship can save you a year of tough training in exchange for a year of the practice you want.  Regardless of what you want to do as a medical student, your interests will likely change during residency.  Good to go to a program that will support your career plans, whatever they might be.  More importantly, what a program will allow you to do to achieve your career goals is a good metric of their respect for you as a person.  Denying a career opportunity like an enfolded fellowships is a red flag in my opinion.

[Guest]

(05-10-2019, 02:12 PM)Guest Wrote: Not sure about CAST accreditation, but I think assessing available additional training options is very important when deciding on a residency program.  An enfolded fellowship can save you a year of tough training in exchange for a year of the practice you want.  Regardless of what you want to do as a medical student, your interests will likely change during residency.  Good to go to a program that will support your career plans, whatever they might be.  More importantly, what a program will allow you to do to achieve your career goals is a good metric of their respect for you as a person.  Denying a career opportunity like an enfolded fellowships is a red flag in my opinion.

I specifically ordered my rank list to match at a program that has the chief year in PGY6.  This way I can do a fellowship at an away institution where I want to be hired as faculty. It also means the hard chief year is done one year sooner and I can focus on my subspecialty in my PGY7 fellowship year. 

It’s too bad that several programs had the opportunity to switch into this PGY6 chief model when the program extended into 7 year programs but failed to do so: Rush, UNC, etc. 

PGY6 chief followed by fellowship is the better model

[Guest]

Senior resident, agree with the above. For most applicants, this should be a serious priority when making you match list.

[Guest]

(05-18-2019, 02:33 PM)Guest Wrote:

(05-10-2019, 02:12 PM)Guest Wrote: Not sure about CAST accreditation, but I think assessing available additional training options is very important when deciding on a residency program.  An enfolded fellowship can save you a year of tough training in exchange for a year of the practice you want.  Regardless of what you want to do as a medical student, your interests will likely change during residency.  Good to go to a program that will support your career plans, whatever they might be.  More importantly, what a program will allow you to do to achieve your career goals is a good metric of their respect for you as a person.  Denying a career opportunity like an enfolded fellowships is a red flag in my opinion.

I specifically ordered my rank list to match at a program that has the chief year in PGY6.  This way I can do a fellowship at an away institution where I want to be hired as faculty. It also means the hard chief year is done one year sooner and I can focus on my subspecialty in my PGY7 fellowship year. 

It’s too bad that several programs had the opportunity to switch into this PGY6 chief model when the program extended into 7 year programs but failed to do so: Rush, UNC, etc. 

PGY6 chief followed by fellowship is the better model

I agree with this. Not a deal breaker but it a) can potentially save you a year of training and b) offer a lot more career flexibility. For example, you'd have adequate surgical skills to do skull base as a PGY-7 and depending on your interests you could go into practice or do another fellowship after graduation (like open vascular).

[Guest]

Along this same topic, is there any info on which programs will take you on as an outside resident to do an enfolded fellowship there? My program has a super flexible 7th year and said we can go extramural but it's a ways off and I didn't know how many places will take you as a fellow while still a resident.

[Guest]

(05-18-2019, 03:22 PM)Guest Wrote: Along this same topic, is there any info on which programs will take you on as an outside resident to do an enfolded fellowship there? My program has a super flexible 7th year and said we can go extramural but it's a ways off and I didn't know how many places will take you as a fellow while still a resident.

I think it's obviously very institutionally/faculty dependent. I think as long as your own program lets you leave you should be able to find a spot somewhere else. I've heard of people spending 3-6 months doing oncology, spine, peripheral nerve at extramural insitutions.

[Guest]

While sure it is great to be able to specialize to your interest at the PGY6/7 year, you also have to account for several factors:
- Your institution has to be cool with their resident being gone for a year. Why would they pay their resident to work for someone else?
- An outside institution has to be okay taking an outside resident (not fellow). This can be a tough sell as PGY8 fellows can be 'attendings' to help with call stuff, they can bill, etc
- There is a difference in many people's eyes about an enfolded fellowship and PGY8 fellowship; I think that saying a PGY6/7 enfolded spine fellowship is not 'as legit' as a PGY8 fellowship is stupid but have certainly heard that argument made
- If you do an enfolded at an outside institution, do you really think that the residents at the new place will get bumped for someone not even belonging to their program?
- Aside from spine and endovascular, I don't know of too many opportunities for enfolded away fellowships in open vascular, skull base, etc. If there are, I would highly suspect they are essentially observer years where you don't actually improve surgically

I realize there are some exceptions, and we would all love to be able to do an enfolded PGY7 fellowship that is seen as legit and beneficial to all, but I don't think it should be the priority of a rank list. I think having a PGY6/7 year that gives you a chance to subspecialize in some form is def optimal, but I would argue having that PGY7 year as a mini attending year where you call the shots for the most part and run your own service, have extreme autonomy at your home institution where the attendings know you and you can call to help with advanced cases while doing the bread and butter by yourself is the way to go. Just my two cents