Mini-fellowships during Radiology Residency

[DrMasochist]

I have seen that some programs offer "mini-fellowships" in certain subspecialties like IR during R5, but are these programs few and far between? I know Kaiser LA offers something like this but wanted to know if there are other programs that do the same? What's the usual amount of time dedicated to electives, 5 months? Thanks.

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[shark2000]

I have seen that some programs offer "mini-fellowships" in certain subspecialties like IR during R5, but are these programs few and far between? I know Kaiser LA offers something like this but wanted to know if there are other programs that do the same? What's the usual amount of time dedicated to electives, 5 months? Thanks.

I did 8 months of body imaging in my 4th year. I did an MSK fellowship thereafter. My program was very liberal about number of elective months and how can you schedule them.
For IR probably it is not helpful unless you integrate it into a year of fellowship.

It helps you improve your skills, but depends on the set up. If you compete with the fellows, it is uselss. If you really act as a fellow, it can be helpful. The problem is in most programs there are fellows to compete with over high end cases. I was lucky because one of the fellows quit early in the year and I was acting as a fellow.

My experience helped me a lot in pp. Now I do a lot of body imaging and procedures in addition to my MSK work and general radiology work.

It is not marketable as a fellowship in current market. It is very useful but most pp jobs want you to have a separate one year fellowship in addition to residency. It is marketable to say you have a lot of for example high end body imaging experience.

 

[badasshairday]

It helps you improve your skills, but depends on the set up. If you compete with the fellows, it is uselss. If you really act as a fellow, it can be helpful. The problem is in most programs there is a fellows to compete with over high end cases. I was lucky because one of the fellows quit early in the year and I was acting as a fellow.

This is important.

 

[PushnElectrons]

I have seen that some programs offer "mini-fellowships" in certain subspecialties like IR during R5, but are these programs few and far between? I know Kaiser LA offers something like this but wanted to know if there are other programs that do the same? What's the usual amount of time dedicated to electives, 5 months? Thanks.

With the new boards structure it's becoming the standard to have mini-fellowships during the R4 year. The new boards structure isn't in full effect yet so neither are the mini-fellowships. We'll have to wait to see how they play out. In general, most programs are offering at least one 3 month mini-fellowship. Larger academic programs with more fellows tend to have more flexibility and allow more mini-fellowship time (multiple mini-fellowships or even a full fourth-year of elective/research time) because the residents aren't necessary in completing the day-to-day work and an additional resident on a service won't impact the learning of other residents to a large degree. Smaller programs without fellows tend to have less flexibility because the resident clinical rotations are necessary to getting the work done and there isn't enough work to have residents double up on a service so one can do a mini-fellowship. So if you want to end up a specialized academic radiologist and train at an academic institution, you'll probably do a mini-fellowship and associated research. If you want to end up in pp and train at a community hospital, you may not have the option to do a mini-fellowship or will have limited opportunity to do so. There is no way to say whether the mini-fellowship is a good or bad thing at this point in time and it seems to play little role in applicants' decision-making in terms of where to go for training.

 

[DrMasochist]

With the new boards structure it's becoming the standard to have mini-fellowships during the R4 year. The new boards structure isn't in full effect yet so neither are the mini-fellowships. We'll have to wait to see how they play out. In general, most programs are offering at least one 3 month mini-fellowship. Larger academic programs with more fellows tend to have more flexibility and allow more mini-fellowship time (multiple mini-fellowships or even a full fourth-year of elective/research time) because the residents aren't necessary in completing the day-to-day work and an additional resident on a service won't impact the learning of other residents to a large degree. Smaller programs without fellows tend to have less flexibility because the resident clinical rotations are necessary to getting the work done and there isn't enough work to have residents double up on a service so one can do a mini-fellowship. So if you want to end up a specialized academic radiologist and train at an academic institution, you'll probably do a mini-fellowship and associated research. If you want to end up in pp and train at a community hospital, you may not have the option to do a mini-fellowship or will have limited opportunity to do so. There is no way to say whether the mini-fellowship is a good or bad thing at this point in time and it seems to play little role in applicants' decision-making in terms of where to go for training.

Yea this was what I was referring to. I know some places give more elective time during 4th year, and like you said, it varies for each institution. Wondering if this will become "the norm" in a few years for most "big" institutions.

 

[PushnElectrons]

It's already becoming the norm - the question really is whether it will stay the norm once these first few classes pass through.

 

[shark2000]

Doing multiple so called mini-fellowships is non-sense. It is an extension of residency, i.e. it is the same schedule as residency.

But if you spend for example 8 months of your 4th year in the same field, you will obtain the skills equal to a fellowship trained.

Fellowship by itself is not something special. It is just one year focus on a special field. For example a second year resident also has MSK rotation and where I trained we read a lot of MRs. But you have one or two of those rotations. As a fellow you spend a year on that rotation.

I doubt small programs have the ability to provide fellowship level of training in your fourth year. Many of them do not have the variety (the have the volume, but not the referral). Also probably they can not provide you with subspecialty attending with different training background and enough time which can make you a true expert in the field.

 

[shark2000]

Overall, the job market is bad not because of turf issues or decreased volume, but mostly because of ABR mistakes. For example Neuroradiology which has pretty high volume has the worst job market. It is not because neurologists reading MRs or it is not because the volume is down.

 

[badasshairday]

Any plans of this changing in the future? In particular 1, 2, and 5?

Or is ABR going to continue the destruction of the specialty?

Some actions by academic radiology which really hurt our field and the only intention was to make life easier for academic attending:

1- Increase the number of residency spots. 1100 is a killer, while Derm has 400.

2- Designing alternative pathway: If you did rad residency in any part of the world, you can do 4 fellowship in US or one fellowship+ 3 years of junior faculty with low pay and become board certified. No other specialty is doing it. It adds to the number of trainees.

3- Training other groups: Thoracic radiologists took cardiologists for fellowship. IR trained vascular surgery just to have someone do scut work for them in the days that IR was not popular. Neuro-IR trained NS.

4- Moving the board to 15 months after residency: to have 4th years free so they can do more. Thanks god I am done with this. This board design is horrible.

5- High number of some fellowship spots: For example Neuro. Because they don't want to cover nights and evenings, they have increased Neuroradiology spots. Now there is a glut of neuroradiologists.

6- Making Neuroradiology a 2 year fellowship: This does not benefit applicants at all. It only provides department cheap labor. One year is enough. In most places 2nd year Neuro fellows act as junior faculty.

Overall, the job market is bad not because of turf issues or decreased volume, but mostly because of ABR huge mistakes. For example Neuroradiology which has pretty high volume has the worst job market, only because of the ABR. It is not because neurologists reading MRs or it is not because the volume is down.

 

[shark2000]

Any plans of this changing in the future? In particular 1, 2, and 5?

Or is ABR going to continue the destruction of the specialty?

I think we will kiss private practice goodbye in a few years down the road in the whole medical system. The only thing administrators do not understand is the fact that I kill myself and read 150 studies day and night in pp, mostly because of financial incentive. The same for the surgeon who is doing 3 surgeries in a row. This will not happen if we become hospital employees with less financial interest. In fact, the whole cost of the system will go up as the efficacy will go down substantially. Have you ever worked in a VA system or even Kaiser?

 

[meister]

How are these holding up among programs out there? Seems like it is still very variable, with some getting nothing like a mini-fellowship and others having half the year of whatever they want.

 

[Radiologyreviews2015]

How are these holding up among programs out there? Seems like it is still very variable, with some getting nothing like a mini-fellowship and others having half the year of whatever they want.

Most of the places I've seen seem to now have that mini-fellowship structure in place with the new board exam.

What are people's thoughts on what to do during the mini-fellowship/R5 year? I figure these are probably some common choices:
1) focusing on what you'll be doing for fellowship (maybe for people doing academics?)
2) focusing on something totally different (better for private practice?)
3) focusing on a smattering of modalities or just doing what you feel like doing

Anyone else have any thoughts on it?

 

[shark2000]

Most of the places I've seen seem to now have that mini-fellowship structure in place with the new board exam.

What are people's thoughts on what to do during the mini-fellowship/R5 year? I figure these are probably some common choices:
1) focusing on what you'll be doing for fellowship (maybe for people doing academics?)
2) focusing on something totally different (better for private practice?)
3) focusing on a smattering of modalities or just doing what you feel like doing

Anyone else have any thoughts on it?

Depends on your career goals for the future.

 

[Radiologyreviews2015]

Depends on your career goals for the future.

I see. Do you mind expanding on that? For career goals, do you mean pp vs academics or something else?

 

[shark2000]

I see. Do you mind expanding on that? For career goals, do you mean pp vs academics or something else?

You will figure it out once you are a third year resident. For now, try to go to the best academic program in the location that you want to settle eventually.

 

[maxxor]

You will figure it out once you are a third year resident. For now, try to go to the best academic program in the location that you want to settle eventually.

At my program, the combinations for PGY5 and PGY6 are

Private Practice:
MSK + Abdomen
MSK + Breast (for procedure training)
IR

Academia:
Research + anything
Neuro (we have 2 year neuro program)
Nucs + Abdomen
Thoracic + Cardiac

 

[shark2000]

At my program, the combinations for PGY4 and PGY5 are

Private Practice:
MSK + Abdomen
MSK + Breast (for procedure training)
IR

Academia:
Research + anything
Neuro (we have 2 year neuro program)
Nucs + Abdomen
Thoracic + Cardiac

I am not sure how much a few months of IR during fourth year can help.

For academics, it depends on the fellowship that the applicant wants to do. What is the point of doing Nucs + abdomen elective for a person who wants to do MSK fellowship and get an academic MSK job?

Overall, as a person who is recruiting for his group, I can tell you that the value of mini fellowship is not clear and private practices don't care that much about it. Obviously I can not talk about all private practices, but in most practices that I know of nobody considers mini fellowship seriously.

However, if you feel weak in a certain area, it is good to do a mini fellowship in that area.

 

[maxxor]

I am not sure how much a few months of IR during fourth year can help.

For academics, it depends on the fellowship that the applicant wants to do. What is the point of doing Nucs + abdomen elective for a person who wants to do MSK fellowship and get an academic MSK job?

Overall, as a person who is recruiting for his group, I can tell you that the value of mini fellowship is not clear and private practices don't care that much about it. Obviously I can not talk about all private practices, but in most practices that I know of nobody considers mini fellowship seriously.

However, if you feel weak in a certain area, it is good to do a mini fellowship in that area.

These are year long.

R4 is one, "R5" / Fellowship is the other. We are a true 3+1+1 or 3+2.

 

[meister]

That seems really valuable.

 

[RadInterest]

Apologies again for bumping an old topic but: how do we find out which programs offer mini-fellowships? Can this information be found on their websites or mostly do we have to contact them to find out? And how long do mini-fellowships last typically?

 

[meister]

Mini-fellowships are completely program/program director dependent. I doubt many programs have formal information about them online because they are by definition informal. You should ask residents at programs you're interested in about any mini-fellowship opportunities at their programs. Some places don't have them.

In general, huge programs with mountains of fellows that do much of the clinical work are much more likely to have the ability for their R4s to spend an entire year on pediatric brain PET or whatever than smaller programs.

 

[Light at end of tunnel]

I think current residents are the best source of information in this regard. Resi fellowships are moving targets. Not sure the ACGME knows what to do with them either.