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Fellowships
#1
Does the place you match at for residency have a huge effect on fellowships? If the place I matched has a certain fellowship am I more likely to match to that fellowship because of this?
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#2
(05-19-2017, 05:12 PM)Guest Wrote: Does the place you match at for residency have a huge effect on fellowships? If the place I matched has a certain fellowship am I more likely to match to that fellowship because of this?

Given that most fellowships are essentially handshake deals, it can have an effect on where you go.  As far as I know, pediatrics is the only fellowships that actually goes through a match process.  If your program director or chair is willing to vouch for you to a surgeon with whom they have a good relationship, it can go a long way.  Otherwise your application will be just another CV.  Doesn't mean you won't get a fellowship for which you have no relationship but it may be a little more challenging.  Certainly not impossible though.
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#3
As mentioned, fellowships tend to be based on recommendations. The place where you train can help with this. Moreover, there may be the possibility of doing it, or part of it, enfolded, if the fellowship exists at the program you attend.
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#4
Only pediatrics has a formal match process. As mentioned above, most fellowships are back-room handshake deals where a faculty member calls his buddy and recommends a particular resident for their fellowship.

Almost all the best fellowships fill many years in advance (3, even for 4 years!). PGY4 is a good time to start thinking about fellowships, but be aware that your interests and priorities may change in the intervening time. For example, you may want to do endovascular as a single PGY4, but then decide as a married-with-kids PGY7 that 24/7 stroke call is not for you.

Just like residencies, fellowships have different advantages. These can be grouped into 1.) clinical, 2.) research, and 3.) political

The best clinical fellowships may not be at programs with "name brand" residencies. They may be at hospitals that doesn't even have a residency at all. In general, the stronger/larger the residency, the weaker the fellowship experience because chief residents have official priority over fellows.

Research oriented fellowships may be divided with clinical. For example, 6 months research 6 months operative. Functional and Neuro-oncology fellowships may follow this pattern since post-graduate technical development is less important that research output in those fields when searching for an academic faculty position. Some fellowships may be 1 year clinical with an option to extend for a 2nd year of research.

One may also select a fellowship because of political reasons, to foster a mentor-mentee relationship with an influential and senior person in the field. These fellowships may be beneficial if seeking an academic job, but may not be high yield operatively or research wise. Often times, more famous fellowship directors may be frequently traveling, limiting the ability of the faculty closely mentor fellows.

It is therefore important to know why you are doing a fellowship.

Are you trying to a learn or refine techniques that you did not get adequate exposure to in residency?
Are you looking to climb the political ladder of organized neurosurgery?
Do you want to go to a place with the clinical and research infrastructure to do high powered research while also deepening your surgical focus?
Are you looking to have a prestigious institution or influential mentor vouch for you in your future career?

A side note: Enfolded fellowships are becoming increasingly popular. They save 1 or 2 years of training which is 100s of thousands of $s in opportunity cost. They do, however, have some disadvantages. First, part of the reason to do a fellowship is to see how other institutions practice. You lose that benefit if you stay at the same institution. Second, particularly for cerebrovascular/skull base (and perhaps also for complex spinal deformity), doing an enfolded fellowship as a mid-level resident will not be as high yield as doing a post residency following your chief year, since your technical starting point will be very different.

For programs with two full years of elective time, 2-year full-time enfolded endovascular fellowships or functional fellowships (1 year clinical, 1 year lab) make a lot of sense.
Enfolding one or even both years of endovascular training is becoming increasingly popular and is a recognized training pathway by CAST.

Final note: CAST accreditation

The SNS is developing a formalized accreditation system for fellowships. Realistically though, there are many excellent fellowships that are NOT CAST certified and many so-so CAST-certified fellowships. In truth, if you have solid residency training, you will be free to develop in any practice except endovascular/pediatrics without additional subspecialty training.

CAST certification of endovascular training will probably be more important than in other areas, since it is important to distinguish the training of an endovascular neurosurgeon from non-neurosurgeons who train at low quality community hospital "diploma mills" or even peripheral radiologists/cardiologists who want to do neuro catheter work.
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#5
(05-19-2017, 08:40 PM)Guest Wrote: Only pediatrics has a formal match process. As mentioned above, most fellowships are back-room handshake deals where a faculty member calls his buddy and recommends a particular resident for their fellowship.

Almost all the best fellowships fill many years in advance (3, even for 4 years!). PGY4 is a good time to start thinking about fellowships, but be aware that your interests and priorities may change in the intervening time. For example, you may want to do endovascular as a single PGY4, but then decide as a married-with-kids PGY7 that 24/7 stroke call is not for you.

Just like residencies, fellowships have different advantages. These can be grouped into 1.) clinical, 2.) research, and 3.) political

The best clinical fellowships may not be at programs with "name brand" residencies. They may be at hospitals that doesn't even have a residency at all. In general, the stronger/larger the residency, the weaker the fellowship experience because chief residents have official priority over fellows.

Research oriented fellowships may be divided with clinical. For example, 6 months research 6 months operative. Functional and Neuro-oncology fellowships may follow this pattern since post-graduate technical development is less important that research output in those fields when searching for an academic faculty position. Some fellowships may be 1 year clinical with an option to extend for a 2nd year of research.

One may also select a fellowship because of political reasons, to foster a mentor-mentee relationship with an influential and senior person in the field. These fellowships may be beneficial if seeking an academic job, but may not be high yield operatively or research wise. Often times, more famous fellowship directors may be frequently traveling, limiting the ability of the faculty closely mentor fellows.

It is therefore important to know why you are doing a fellowship.

Are you trying to a learn or refine techniques that you did not get adequate exposure to in residency?
Are you looking to climb the political ladder of organized neurosurgery?
Do you want to go to a place with the clinical and research infrastructure to do high powered research while also deepening your surgical focus?
Are you looking to have a prestigious institution or influential mentor vouch for you in your future career?

A side note:  Enfolded fellowships are becoming increasingly popular. They save 1 or 2 years of training which is 100s of thousands of $s in opportunity cost. They do, however, have some disadvantages. First, part of the reason to do a fellowship is to see how other institutions practice. You lose that benefit if you stay at the same institution. Second, particularly for cerebrovascular/skull base (and perhaps also for complex spinal deformity), doing an enfolded fellowship as a mid-level resident will not be as high yield as doing a post residency following your chief year, since your technical starting point will be very different.

For programs with two full years of elective time, 2-year full-time enfolded endovascular fellowships  or functional fellowships (1 year clinical, 1 year lab) make a lot of sense.
Enfolding one or even both years of endovascular training is becoming increasingly popular and is a recognized training pathway by CAST.

Final note: CAST accreditation

The SNS is developing a formalized accreditation system for fellowships. Realistically though, there are many excellent fellowships that are NOT CAST certified and many so-so CAST-certified fellowships. In truth, if you have solid residency training, you will be free to develop in any practice except endovascular/pediatrics without additional subspecialty training.

CAST certification of endovascular training will probably be more important than in other areas, since it is important to distinguish the training of an endovascular neurosurgeon from non-neurosurgeons who train at low quality community hospital "diploma mills" or even peripheral radiologists/cardiologists who want to do neuro catheter work.
^^nice post. Thank you.
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