2/24/2021 | BY Dan Miller, MD

5 Tips for Putting Together Your Fellowship Rank List

Congratulations! You have made it through all your fellowship interviews.  

Hopefully, you were able to get a good feel for different programs and are more excited than ever to pursue your dream specialty. Now comes the very exciting (and difficult) task of putting your rank-list together.   

Here are 5 tips to consider when you are putting together your rank list for fellowship.  

1. Unhappy spouse = Unhappy Fellowship   

If you have a spouse or significant other, have an open and frank discussion with them about their thoughts, desires, and wishes for the year.   

• Are you willing to spend the year apart?  
• Is he/she willing to travel with you for the year?  If so, are there work opportunities for them in each location?   
• If you are planning on long distance, how far apart are you willing to be (Should that distance be drive-able? Accessible via a 2–3-hour plane ride? Does it require a cross country flight?)   

This distance has a lot of implications for how often you would be able to see each other on weekends (and how expensive those trips would be).   

Some couples cannot imagine spending a year apart. Everyone’s situation is unique and there is no right or wrong answer. A key is having open and HONEST communication about the rank list.  Consider giving your significant other veto power for programs that they think will not work.  

2. What are your needs to develop as a surgeon/physician (and can this program meet them)? 

Everyone’s residency training is different. Be very honest with yourself in terms of critically assessing your strengths and weaknesses in terms of knowledge and surgical skills. When ranking a program, think about whether it will provide adequate opportunities to round out your deficiencies?  Does a given program provide some freedom for you to tailor your case load to your needs? Be cognizant about what sort of procedures or subspecialties you may have a particular interest in and be open to the notion that these passions/interests may change or evolve with further exposure.   

3. What is your day-to-day life going to be like?   

Think critically about what a normal day, week, or weekend will be like as a fellow at different programs (and the implications of that for your education).   

• Are you expected to act as the primary “point person” for inpatients in terms of rounding and orders?   
• How often are you taking call?   
• Are you competing with other fellows (or other subspecialty fellows) for cases?  
• Where do residents play into the hierarchy at a given program?   
• What sort of responsibilities will be required of you outside of clinical care (e.g., research, volunteering, conferences etc.)? Do you view those outside activities as a positive or negative?   

It is important to know these nitty gritty details will affect your day-to-day productivity, development, and happiness. Remember that time spent in the ED reducing a fracture is time not spent preparing for the next day’s case. 

4. Team sport or individual athlete?  

Fellowships vary in size and there are advantages and disadvantages to smaller and larger programs. In general, larger programs tend to provide more collegiality, a larger group of training staff, and more diversity in terms of case load. Additionally, co-fellows present the opportunity for lifelong friends (or “frenemies”). Smaller programs may offer more direct and intimate opportunities for mentorship and less competition for cases among trainees. Think hard about which situation suits you and in what environment you are more likely to thrive.  

5.  Think outside the OR 

While it is easy to stress about case volumes and operative experience, remember that your surgical skill only dictates a portion of your success as a physician. Your knowledge base and clinical acumen in the outpatient setting will be critical to developing a successful practice early on in your career. A well-rounded fellowship experience cannot be 365 days in the OR. You will need ample opportunities to develop your clinical skills while developing a solid understanding of the indications for surgery. Understanding what a normal (and abnormal) recovery from surgery is very important to your career early on as a young surgeon.   

Time in clinic as a trainee can be thought of like eating your vegetables…it is not always exciting, but deep down you know it is good for you. 

Be sure to take this aspect of your education into account when evaluating programs.   

Remember that there is no perfect fellowship, but hopefully there is one that is perfect for you. The paradox of choice when putting together a rank-list can be crippling at times. Take solstice in the fact that nearly all fellowships will provide an amazing opportunity that will likely represent the apex of your surgical training.   

Feel free to reach out to me directly if I can provide any assistance along the way. 

• Dan Miller Pediatric Orthopaedic Surgeon, Gillette Children's Specialty Healthcare  
• Chair, POSNA Resident Communications Committee 
• danmiller@Gillettechildrens.com