- Email: [email protected]
Applying to subspecialty fellowship: clarifying the confusion and conflicts!
Call to Action
ajog.org
Applying to subspecialty fellowship: clarifying the confusion and conflicts! Gary N. Frishman, MD; Carrie L. Bell, MD; Sylvia Botros, MD, MSCI; Brian C. Brost, MD; Randal D. Robinson, MD; Jody Steinauer, MD; Jason D. Wright, MD; Karen E. Adams, MD
The problem Subspecialty fellowship programs have overlapping interview dates without coordination across programs for applicants. This creates challenges with multiple residents requesting absences from their residency program during the same time period. Furthermore, multiple trips are required to interview within the same geographic area. There is currently no clearly defined governing body coordinating fellowship interview season. A solution The fellowship interview season should be broken into discrete time periods and geographically close programs should coordinate their interview dates. This will minimize conflicts and facilitate scheduling. A governing body facilitating and overseeing this process will help coordinate and sustain this effort.
From the Departments of Obstetrics and Gynecology at Warren Alpert Medical School of Brown University, Providence, RI (Dr Frishman); University of Michigan Health System, Ann Arbor, MI (Dr Bell); Northshore University Health Systems, University of Chicago, Pritzker School of Medicine, Skokie, IL (Dr Botros); Wake Forest University School of Medicine, Winston-Salem, NC (Dr Brost); University of Texas Health Science Center-San Antonio, San Antonio, TX (Dr Robinson); University of California, San Francisco, School of Medicine, San Francisco, CA (Dr Steinauer); Columbia University College of Physicians and Surgeons, New York, NY (Dr Wright); and Oregon Health and Science University, Portland, OR (Dr Adams). Received Aug. 2, 2015; revised Oct. 13, 2015; accepted Oct. 26, 2015. The authors report no conflict of interest. Corresponding author: Gary N. Frishman, MD. [email protected] 0002-9378/$36.00 ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.2015.10.936
Of graduating obstetrics and gynecology residents, 40% apply for fellowship training and this percentage is likely to increase. The fellowship interview process creates a substantial financial burden on candidates as well as significant challenges in scheduling the multiple interviews for residents, residency programs, and fellowship programs. Coverage with relatively short lead time is needed for some resident rotations, multiple residents may request time off during overlapping time periods, and applicants may not be able to interview based on conflicting interview dates or the inability to find coverage from other residents for their clinical responsibilities. To address these issues, we propose that each subspecialty fellowship within obstetrics and gynecology be allocated a specified and limited time period to schedule their interviews with minimal overlap between subspecialties. Furthermore, programs in close geographic areas should attempt to coordinate their interview dates. This will allow residents to plan their residency rotation schedules far in advance to minimize the impact on rotations that are less amenable to time away from their associated clinical duties, and decrease the numbers of residents needing time off for interviews during any one time period. In addition, a series of formal discussions should take place between subspecialties related to these issues as well as within subspecialties to facilitate coordination. Key words: subspecialty fellowship interviews
The presentation Applying for subspecialty fellowship during residency in obstetrics and gynecology is expensive, stressful, and time-consuming for all parties involved. Applicants are spending a significant amount of time away from their program. A survey of obstetrics and gynecology subspecialty fellows in February 2014 found that over half (51.5%) of the 169 respondents spent at least 10 days away from residency interviewing with 16% missing >15 days (Figure).1 Fellowship candidates must juggle their clinical schedules and requirements while incurring the significant costs associated with traveling (potentially with multiple crosscountry flights). Many fellows surveyed emphasized the lack of coordination between programs in the same geographic area as a major challenge. One respondent noted “Programs should have to group their interviews by region. I flew out to California 3 separate times, Boston twice, etc,
because programs even in the same city interview on different days. Everyone I interviewed with had a similar issue. To compensate for this many applicants work for >24 hours at a time and then fly to their interviews, or come back from an interview and go straight to work.”1 Of 170 fellowship candidate respondents, 11.8% spent >$3000 on hotel rooms in addition to 44% stating that they spent >$3000 on airline tickets (with 16.5% spending >$5000 on airline tickets).1 In a different survey of fellowship applicants, Iqbal et al2 noted that matched candidates spent on average $5286 with applicants who matched spending more than those who did not ($5818 vs $3786, P < .001). This was believed to be likely due to the difference in the number of interviews between these 2 groups of applicants. Candidates must schedule their fellowship interviews based on the widely variable (and often last-minute) dates offered. Residency programs with a significant number, or percentage, of
FEBRUARY 2016 American Journal of Obstetrics & Gynecology
243
Call to Action
ajog.org
FIGURE
Number of fellowship programs applied to and time away from residency
Number of fellowship programs applied to and time away from residency.1 Frishman. Subspecialty fellowship interviews. Am J Obstet Gynecol 2016.
residents applying for fellowship have the challenge of scheduling absences from clinical rotations at unpredictable times. Multiple residents may all request to be away for interviews at the same time, placing significant demands on the coverage system and rotation schedule. There is minimal communication concerning the application process between most fellowship programs within each subspecialty, and even less between the different subspecialties, within obstetrics and gynecology. Candidates who might wish to interview at
a specific fellowship program may not be able to, based on conflicting interview dates or the inability to find coverage for their clinical duties within their residency. The Committee on Fellowship Training in Obstetrics and Gynecology (COFTOG) was established in 2011 to serve as a forum for discussion of issues common to all fellowships. A COFTOGsponsored panel discussion took place at the March 2015 annual meeting of the Association of Professors of Gynecology and Obstetrics and the Council on
Resident Education in Obstetrics and Gynecology (CREOG), and included representatives from 6 different obstetrics and gynecology fellowships. The panel reviewed barriers and opportunities to decrease the burden associated with the fellowship application process. The wide variation in number of applicants, match rate, and outcomes from the 2014 through 2015 match year between different subspecialties and fellowships were acknowledged (Table 1). Different ideas and strategies for improving the system were discussed and debated among the panelists and audience members, which included residency program directors, fellowship directors, program coordinators, fellows, and residents. Discussants agreed that the earlier interview season and match date for candidates applying in female pelvic medicine and reconstructive surgery was helpful in that it decompressed the interview season. Discussants also agreed that family planning’s practice of coordinating interviews between programs in the same geographic area was a best practice that should be emulated across subspecialties. Despite fellowship directors agreeing that having programs in the same geographic region coordinate their interview schedules was ideal there was no consensus on how to go about this or who would oversee this process. Similarly, fellowship directors uniformly acknowledged the challenges for both
TABLE 1
Interview season data for different subspecialties from 2014 through 2015 match year FPMRS
MFM
MIGS
REI
GYN ONC
FFP
Interviews
April through June
July through September
July through September
July through September
May through September
July through September
Match day
Aug 5
Oct 8
Oct 8
Oct 8
Oct 8
Oct 8
No. of applicants
77
144
80
63
85
30
Applicants matched
74%
65%
40%
65%
50%
93%
Filled
98%
97%
100%
100%
100%
100%
53
70
44
43
46
28
No. of spots
a
FFP, fellowship in family planning; FPMRS, female pelvic medicine and reconstructive surgery; GYN ONC, gynecologic oncology; MFM, maternal-fetal medicine; MIGS, minimally invasive gynecologic surgery; REI, reproductive endocrinology and infertility. a
Not all fellowships take candidate each year.
Frishman. Subspecialty fellowship interviews. Am J Obstet Gynecol 2016.
244 American Journal of Obstetrics & Gynecology FEBRUARY 2016
Call to Action
ajog.org residents and residencies associated with the current lack of coordination (if not actual chaos) of interview season and the lack of predictability of when residents would need to be away to interview. However, without central coordination and oversight there were no realistic solutions. As a result of the discussion, a consensus proposal was agreed upon that provides a potential solution. Specifically, the interview season could be organized into distinct time periods (blocks) with each subspecialty attempting to restrict their interview sessions to that given block. Although blocking out specific months for each subspecialty (eg, July being dedicated to gynecologic oncology interviews and August to maternal-fetal medicine ones) would allow residents to be assured that certain months would be interview free (allowing them to, eg, schedule rotations that do not allow time away or plan their wedding), large blocks of rotations would be compromised by the interview process. As such, we propose that weeks within each month be designated to the different subspecialties with the weekends (being a popular time for fellowship interviews) overlapping (Table 2). Based on their smaller fellowships, minimally invasive gynecologic surgery and family planning would share their weeks. Applicants in female pelvic medicine and reconstructive surgery would not be affected. The last 2 weeks in May and the first 2 weeks in September would be open to all subspecialties as an overflow period. Of note, if this schedule does not allow for enough interview slots then expansion into May would be instituted (similar to what some gynecologic oncology programs are already doing) alongside taking into account existing interview season patterns (eg, family planning, which does not open their interview season until July). Annual meetings would be an ideal time to draw multiple candidates and program faculty in a very compressed time frame and an attempt could be made to overlap these meeting within the fellowship’s interview weeks. However, many programs and candidates
prefer “boots on the ground” to have the best sense of a fellowship, including their facilities and staff. As such, the interview blocks were specifically chosen to not overlap with national meetings. This schedule could be initiated with the 2017 academic year to allow individual programs time to adjust their timetables for clinical activities and personal and professional travel accordingly, as well as communicate with other neighboring programs about specific interview dates. The goal would be to maintain the current match dates but “backload” the interview season to accommodate these new demands. Importantly, continued efforts should be made to have programs within the same geographic region schedule interviews in close temporal proximity to facilitate travel plans while attempting to limit conflicting dates as is done with family planning’s programs in Boston, New York, and elsewhere. Furthermore, the overall master block schedule would be reviewed yearly to allow adjustments based on changes in the number of interview sessions within the different subspecialties or other factors. Such a system would necessitate interspecialty coordination, which could be facilitated through COFTOG, CREOG, or a similar organization. Our proposed plan would limit the number of residents requesting time off during any specific time period with minimal overlap between subspecialties. Especially important is the predictability of this approach, allowing for rotation schedules to be made well in advance while taking into account which rotations a resident would most and least like to, or be able to, be pulled from. Residents on rotations such as clinic gynecology could prospectively schedule their own patients for surgery without worrying about interview conflicts. As a result of this improved coordination, residents may be able to more effectively use the 6 weeks in postgraduate year 4 and the 8 weeks in postgraduate year 3 allowed by the American Board of Obstetrics and Gynecology as time away from residency.3
TABLE 2
Proposed interview schedule for obstetrics and gynecology fellow applicants May 20 through 29
Open
May 27 through June 5
Open
June 3 through 12
GYN ONC
June 10 through 19
MFM
June 17 through 26
REI
June 24 through July 3
MIGS/Open
July 1 through 10
GYN ONC
July 8 through 17
MFM
July 15 through 24
REI
July 22 through 31
MIGS/FFP
July 29 through August 7
Gyn Onc
August 5 through 14
MFM
August 12 through 21
REI
August 19 through 28
MIGS/FFP
August 26 through September 4
Open
September 2 through 12
Open/FFP
FFP, fellowship in family planning; GYN ONC, gynecologic oncology; MFM, maternal-fetal medicine; MIGS, minimally invasive gynecologic surgery; REI, reproductive endocronology and infertility. Frishman. Subspecialty fellowship interviews. Am J Obstet Gynecol 2016.
Additional changes are suggested to further facilitate interview season and decrease the burden on all parties. As the paper or electronic applications for fellowship have become increasingly similar, it has become more challenging to able to know and truly distinguish between candidates solely on the basis of their application. Many faculty acknowledge that a percentage of applicants offered interview slots are essentially eliminated immediately upon meeting them on interview day based on the additional information obtained. However, the applicants’ travel with cost and time away from their program is already incurred at that point and the fellowship program has, similarly, given away that interview slot. Consideration for virtual interviews, interviews conducted at national meetings, or similar first-round interviews to help reduce the actual number of physical trips needed is
FEBRUARY 2016 American Journal of Obstetrics & Gynecology
245
Call to Action recommended. This could be initially done principally for borderline candidates with the decision made to then offer the formal face-to-face interview based on this screening tool. Residents could block out an afternoon or other time period for virtual interviews, thereby eliminating the need to be away from their program. Fellowship programs could have a group video chat interview with multiple faculty present similar to their interview days. At national meetings, there could be a form of “speed dating” with multiple interviews being able to be completed in a timely fashion. If successful, these interviews could be expanded as a way to decrease the travel costs for candidates. We also propose the expansion of communication between candidates within the same fellowship application process as exists in gynecologic oncology. This communication process, through a collective social media web page, helps to decrease costs through shared expenses of, eg, rides and hotel rooms. As an extra benefit, the networking and relationships developed by this supplementary contact and communication during interview season
ajog.org among future subspecialists provides a jump start to forming relationships that would normally not begin developing until national meetings or the conclusion of fellowship. In summary, the large percentage of residents applying for fellowships alongside a lack of coordination among applicants, fellowships, and subspecialties has led to challenges and costs for all involved. Practical and achievable steps can and should be taken to improve the application and interview process. The authors, which include representatives from major subspecialties and COFTOG, propose that each subspecialty place this issue prominently on their meeting agendas and provide reactions and suggestions to COFTOG and/or CREOG leadership to move this issue forward. Specific recommendations include allocating weeks of each month for the different subspecialties to conduct their interviews, consideration for a supplemental complimentary interview process such as video chat meetings or utilization of national meetings, increased coordination of regional interviews within each subspecialty, and expansion of social
246 American Journal of Obstetrics & Gynecology FEBRUARY 2016
networking between applicants during interview season to share expenses and develop relationships. In addition to discussions and collaborations within subspecialties there must be similar communication and cooperation between subspecialties and it is logical that a body such as COFTOG or CREOG can help coordinate these efforts. ACKNOWLEDGMENT The authors wish to acknowledge the vision and leadership of Timothy R. B. Johnson, Committee on Fellowship Training in Obstetrics and Gynecology founder, for articulating many of the ideas contained herein
REFERENCES 1. Bell CL. Ob/Gyn subspecialty fellowship survey. Presented at: COFTOG Business Meeting at the APGO/CREOG Annual Meeting; Feb 27, 2014; Atlanta, GA. 2. Iqbal IJ, Sareen P, Shoup B, et al. Attributes of successfully matched versus unmatched obstetrics and gynecology fellowship applicants. Am J Obstet Gynecol 2014;210:567.e1-8. 3. American Board of Obstetrics and Gynecology. 2016 Bulletin for the Written Examination for Basic Certification in Obstetrics and Gynecolgy. Available at: https://www.abog. org/bulletins/basic.written.bulletin.2016.pdf. Accessed January 8, 2016.
ajog.org
Applying to subspecialty fellowship: clarifying the confusion and conflicts! Gary N. Frishman, MD; Carrie L. Bell, MD; Sylvia Botros, MD, MSCI; Brian C. Brost, MD; Randal D. Robinson, MD; Jody Steinauer, MD; Jason D. Wright, MD; Karen E. Adams, MD
The problem Subspecialty fellowship programs have overlapping interview dates without coordination across programs for applicants. This creates challenges with multiple residents requesting absences from their residency program during the same time period. Furthermore, multiple trips are required to interview within the same geographic area. There is currently no clearly defined governing body coordinating fellowship interview season. A solution The fellowship interview season should be broken into discrete time periods and geographically close programs should coordinate their interview dates. This will minimize conflicts and facilitate scheduling. A governing body facilitating and overseeing this process will help coordinate and sustain this effort.
From the Departments of Obstetrics and Gynecology at Warren Alpert Medical School of Brown University, Providence, RI (Dr Frishman); University of Michigan Health System, Ann Arbor, MI (Dr Bell); Northshore University Health Systems, University of Chicago, Pritzker School of Medicine, Skokie, IL (Dr Botros); Wake Forest University School of Medicine, Winston-Salem, NC (Dr Brost); University of Texas Health Science Center-San Antonio, San Antonio, TX (Dr Robinson); University of California, San Francisco, School of Medicine, San Francisco, CA (Dr Steinauer); Columbia University College of Physicians and Surgeons, New York, NY (Dr Wright); and Oregon Health and Science University, Portland, OR (Dr Adams). Received Aug. 2, 2015; revised Oct. 13, 2015; accepted Oct. 26, 2015. The authors report no conflict of interest. Corresponding author: Gary N. Frishman, MD. [email protected] 0002-9378/$36.00 ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.2015.10.936
Of graduating obstetrics and gynecology residents, 40% apply for fellowship training and this percentage is likely to increase. The fellowship interview process creates a substantial financial burden on candidates as well as significant challenges in scheduling the multiple interviews for residents, residency programs, and fellowship programs. Coverage with relatively short lead time is needed for some resident rotations, multiple residents may request time off during overlapping time periods, and applicants may not be able to interview based on conflicting interview dates or the inability to find coverage from other residents for their clinical responsibilities. To address these issues, we propose that each subspecialty fellowship within obstetrics and gynecology be allocated a specified and limited time period to schedule their interviews with minimal overlap between subspecialties. Furthermore, programs in close geographic areas should attempt to coordinate their interview dates. This will allow residents to plan their residency rotation schedules far in advance to minimize the impact on rotations that are less amenable to time away from their associated clinical duties, and decrease the numbers of residents needing time off for interviews during any one time period. In addition, a series of formal discussions should take place between subspecialties related to these issues as well as within subspecialties to facilitate coordination. Key words: subspecialty fellowship interviews
The presentation Applying for subspecialty fellowship during residency in obstetrics and gynecology is expensive, stressful, and time-consuming for all parties involved. Applicants are spending a significant amount of time away from their program. A survey of obstetrics and gynecology subspecialty fellows in February 2014 found that over half (51.5%) of the 169 respondents spent at least 10 days away from residency interviewing with 16% missing >15 days (Figure).1 Fellowship candidates must juggle their clinical schedules and requirements while incurring the significant costs associated with traveling (potentially with multiple crosscountry flights). Many fellows surveyed emphasized the lack of coordination between programs in the same geographic area as a major challenge. One respondent noted “Programs should have to group their interviews by region. I flew out to California 3 separate times, Boston twice, etc,
because programs even in the same city interview on different days. Everyone I interviewed with had a similar issue. To compensate for this many applicants work for >24 hours at a time and then fly to their interviews, or come back from an interview and go straight to work.”1 Of 170 fellowship candidate respondents, 11.8% spent >$3000 on hotel rooms in addition to 44% stating that they spent >$3000 on airline tickets (with 16.5% spending >$5000 on airline tickets).1 In a different survey of fellowship applicants, Iqbal et al2 noted that matched candidates spent on average $5286 with applicants who matched spending more than those who did not ($5818 vs $3786, P < .001). This was believed to be likely due to the difference in the number of interviews between these 2 groups of applicants. Candidates must schedule their fellowship interviews based on the widely variable (and often last-minute) dates offered. Residency programs with a significant number, or percentage, of
FEBRUARY 2016 American Journal of Obstetrics & Gynecology
243
Call to Action
ajog.org
FIGURE
Number of fellowship programs applied to and time away from residency
Number of fellowship programs applied to and time away from residency.1 Frishman. Subspecialty fellowship interviews. Am J Obstet Gynecol 2016.
residents applying for fellowship have the challenge of scheduling absences from clinical rotations at unpredictable times. Multiple residents may all request to be away for interviews at the same time, placing significant demands on the coverage system and rotation schedule. There is minimal communication concerning the application process between most fellowship programs within each subspecialty, and even less between the different subspecialties, within obstetrics and gynecology. Candidates who might wish to interview at
a specific fellowship program may not be able to, based on conflicting interview dates or the inability to find coverage for their clinical duties within their residency. The Committee on Fellowship Training in Obstetrics and Gynecology (COFTOG) was established in 2011 to serve as a forum for discussion of issues common to all fellowships. A COFTOGsponsored panel discussion took place at the March 2015 annual meeting of the Association of Professors of Gynecology and Obstetrics and the Council on
Resident Education in Obstetrics and Gynecology (CREOG), and included representatives from 6 different obstetrics and gynecology fellowships. The panel reviewed barriers and opportunities to decrease the burden associated with the fellowship application process. The wide variation in number of applicants, match rate, and outcomes from the 2014 through 2015 match year between different subspecialties and fellowships were acknowledged (Table 1). Different ideas and strategies for improving the system were discussed and debated among the panelists and audience members, which included residency program directors, fellowship directors, program coordinators, fellows, and residents. Discussants agreed that the earlier interview season and match date for candidates applying in female pelvic medicine and reconstructive surgery was helpful in that it decompressed the interview season. Discussants also agreed that family planning’s practice of coordinating interviews between programs in the same geographic area was a best practice that should be emulated across subspecialties. Despite fellowship directors agreeing that having programs in the same geographic region coordinate their interview schedules was ideal there was no consensus on how to go about this or who would oversee this process. Similarly, fellowship directors uniformly acknowledged the challenges for both
TABLE 1
Interview season data for different subspecialties from 2014 through 2015 match year FPMRS
MFM
MIGS
REI
GYN ONC
FFP
Interviews
April through June
July through September
July through September
July through September
May through September
July through September
Match day
Aug 5
Oct 8
Oct 8
Oct 8
Oct 8
Oct 8
No. of applicants
77
144
80
63
85
30
Applicants matched
74%
65%
40%
65%
50%
93%
Filled
98%
97%
100%
100%
100%
100%
53
70
44
43
46
28
No. of spots
a
FFP, fellowship in family planning; FPMRS, female pelvic medicine and reconstructive surgery; GYN ONC, gynecologic oncology; MFM, maternal-fetal medicine; MIGS, minimally invasive gynecologic surgery; REI, reproductive endocrinology and infertility. a
Not all fellowships take candidate each year.
Frishman. Subspecialty fellowship interviews. Am J Obstet Gynecol 2016.
244 American Journal of Obstetrics & Gynecology FEBRUARY 2016
Call to Action
ajog.org residents and residencies associated with the current lack of coordination (if not actual chaos) of interview season and the lack of predictability of when residents would need to be away to interview. However, without central coordination and oversight there were no realistic solutions. As a result of the discussion, a consensus proposal was agreed upon that provides a potential solution. Specifically, the interview season could be organized into distinct time periods (blocks) with each subspecialty attempting to restrict their interview sessions to that given block. Although blocking out specific months for each subspecialty (eg, July being dedicated to gynecologic oncology interviews and August to maternal-fetal medicine ones) would allow residents to be assured that certain months would be interview free (allowing them to, eg, schedule rotations that do not allow time away or plan their wedding), large blocks of rotations would be compromised by the interview process. As such, we propose that weeks within each month be designated to the different subspecialties with the weekends (being a popular time for fellowship interviews) overlapping (Table 2). Based on their smaller fellowships, minimally invasive gynecologic surgery and family planning would share their weeks. Applicants in female pelvic medicine and reconstructive surgery would not be affected. The last 2 weeks in May and the first 2 weeks in September would be open to all subspecialties as an overflow period. Of note, if this schedule does not allow for enough interview slots then expansion into May would be instituted (similar to what some gynecologic oncology programs are already doing) alongside taking into account existing interview season patterns (eg, family planning, which does not open their interview season until July). Annual meetings would be an ideal time to draw multiple candidates and program faculty in a very compressed time frame and an attempt could be made to overlap these meeting within the fellowship’s interview weeks. However, many programs and candidates
prefer “boots on the ground” to have the best sense of a fellowship, including their facilities and staff. As such, the interview blocks were specifically chosen to not overlap with national meetings. This schedule could be initiated with the 2017 academic year to allow individual programs time to adjust their timetables for clinical activities and personal and professional travel accordingly, as well as communicate with other neighboring programs about specific interview dates. The goal would be to maintain the current match dates but “backload” the interview season to accommodate these new demands. Importantly, continued efforts should be made to have programs within the same geographic region schedule interviews in close temporal proximity to facilitate travel plans while attempting to limit conflicting dates as is done with family planning’s programs in Boston, New York, and elsewhere. Furthermore, the overall master block schedule would be reviewed yearly to allow adjustments based on changes in the number of interview sessions within the different subspecialties or other factors. Such a system would necessitate interspecialty coordination, which could be facilitated through COFTOG, CREOG, or a similar organization. Our proposed plan would limit the number of residents requesting time off during any specific time period with minimal overlap between subspecialties. Especially important is the predictability of this approach, allowing for rotation schedules to be made well in advance while taking into account which rotations a resident would most and least like to, or be able to, be pulled from. Residents on rotations such as clinic gynecology could prospectively schedule their own patients for surgery without worrying about interview conflicts. As a result of this improved coordination, residents may be able to more effectively use the 6 weeks in postgraduate year 4 and the 8 weeks in postgraduate year 3 allowed by the American Board of Obstetrics and Gynecology as time away from residency.3
TABLE 2
Proposed interview schedule for obstetrics and gynecology fellow applicants May 20 through 29
Open
May 27 through June 5
Open
June 3 through 12
GYN ONC
June 10 through 19
MFM
June 17 through 26
REI
June 24 through July 3
MIGS/Open
July 1 through 10
GYN ONC
July 8 through 17
MFM
July 15 through 24
REI
July 22 through 31
MIGS/FFP
July 29 through August 7
Gyn Onc
August 5 through 14
MFM
August 12 through 21
REI
August 19 through 28
MIGS/FFP
August 26 through September 4
Open
September 2 through 12
Open/FFP
FFP, fellowship in family planning; GYN ONC, gynecologic oncology; MFM, maternal-fetal medicine; MIGS, minimally invasive gynecologic surgery; REI, reproductive endocronology and infertility. Frishman. Subspecialty fellowship interviews. Am J Obstet Gynecol 2016.
Additional changes are suggested to further facilitate interview season and decrease the burden on all parties. As the paper or electronic applications for fellowship have become increasingly similar, it has become more challenging to able to know and truly distinguish between candidates solely on the basis of their application. Many faculty acknowledge that a percentage of applicants offered interview slots are essentially eliminated immediately upon meeting them on interview day based on the additional information obtained. However, the applicants’ travel with cost and time away from their program is already incurred at that point and the fellowship program has, similarly, given away that interview slot. Consideration for virtual interviews, interviews conducted at national meetings, or similar first-round interviews to help reduce the actual number of physical trips needed is
FEBRUARY 2016 American Journal of Obstetrics & Gynecology
245
Call to Action recommended. This could be initially done principally for borderline candidates with the decision made to then offer the formal face-to-face interview based on this screening tool. Residents could block out an afternoon or other time period for virtual interviews, thereby eliminating the need to be away from their program. Fellowship programs could have a group video chat interview with multiple faculty present similar to their interview days. At national meetings, there could be a form of “speed dating” with multiple interviews being able to be completed in a timely fashion. If successful, these interviews could be expanded as a way to decrease the travel costs for candidates. We also propose the expansion of communication between candidates within the same fellowship application process as exists in gynecologic oncology. This communication process, through a collective social media web page, helps to decrease costs through shared expenses of, eg, rides and hotel rooms. As an extra benefit, the networking and relationships developed by this supplementary contact and communication during interview season
ajog.org among future subspecialists provides a jump start to forming relationships that would normally not begin developing until national meetings or the conclusion of fellowship. In summary, the large percentage of residents applying for fellowships alongside a lack of coordination among applicants, fellowships, and subspecialties has led to challenges and costs for all involved. Practical and achievable steps can and should be taken to improve the application and interview process. The authors, which include representatives from major subspecialties and COFTOG, propose that each subspecialty place this issue prominently on their meeting agendas and provide reactions and suggestions to COFTOG and/or CREOG leadership to move this issue forward. Specific recommendations include allocating weeks of each month for the different subspecialties to conduct their interviews, consideration for a supplemental complimentary interview process such as video chat meetings or utilization of national meetings, increased coordination of regional interviews within each subspecialty, and expansion of social
246 American Journal of Obstetrics & Gynecology FEBRUARY 2016
networking between applicants during interview season to share expenses and develop relationships. In addition to discussions and collaborations within subspecialties there must be similar communication and cooperation between subspecialties and it is logical that a body such as COFTOG or CREOG can help coordinate these efforts. ACKNOWLEDGMENT The authors wish to acknowledge the vision and leadership of Timothy R. B. Johnson, Committee on Fellowship Training in Obstetrics and Gynecology founder, for articulating many of the ideas contained herein
REFERENCES 1. Bell CL. Ob/Gyn subspecialty fellowship survey. Presented at: COFTOG Business Meeting at the APGO/CREOG Annual Meeting; Feb 27, 2014; Atlanta, GA. 2. Iqbal IJ, Sareen P, Shoup B, et al. Attributes of successfully matched versus unmatched obstetrics and gynecology fellowship applicants. Am J Obstet Gynecol 2014;210:567.e1-8. 3. American Board of Obstetrics and Gynecology. 2016 Bulletin for the Written Examination for Basic Certification in Obstetrics and Gynecolgy. Available at: https://www.abog. org/bulletins/basic.written.bulletin.2016.pdf. Accessed January 8, 2016.