Internal medicine residents' assessment of the subspecialty fellowship application process

Purpose. The application process for fellowships in internal medicine subspecialties begins approximately 18 to 24 months before the start of training, requiring residents to decide on a career by the beginning of their second year of residency. The authors surveyed the internal medicine residents at Mount Sinai Hospital to assess their attitudes toward the fellowship application process. Method. A survey instrument was designed and given to all 121 residents in 1994-95. The instrument surveyed the residents' career plans and the timing of their decisions, inquired about the effect on their residency of applying for a fellowship, and asked the residents to assess and comment on the timing of the fellowship application process. Results. In all, 80% (97) of the residents responded. Nearly two-thirds intended to apply for fellowship training; however, 17% of the first-year residents had changed their minds about their fellowship plans, and 50% of the second- and third-year residents had changed career plans. Whereas 79% of the first-year residents intended to apply ''on time'' during their second year, only 29% of the second-year residents intended to do so; 25% of the third-year residents planned to delay entry into a fellowship. Nearly two-thirds of the first- and second-year residents felt uncomfortable making an informed fellowship decision in their second year. In all, 60% of the residents felt they had to do research in order to get a competitive fellowship, and 68% said they had to change their assigned residency schedule to ''get credentials'' for fellowship applications. The consensus of nearly all the residents was that the timing of fellowship applications was much too early and should be moved to the middle of the third year. Conclusion. As the current system of applying for medical fellowships is generally experienced negatively by residents, the authors recommend chat the process be moved to the middle of the third year and that medical schools, residency programs, and fellowship training programs reconsider the entire fellowship application process.