‘Mini Fellowships’

[AlvinKamara]

Greetings, many 4 year programs like offer clinical ‘mini fellowships’ in the 4th or 3rd&4th years such as administration, toxicology, ultrasound,EMS, etc. Did any of you do these? What was your experience like? Which of these are the most fruitful to pursue?

Appreciate the responses.

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[GonnaBeADoc2222]

Greetings, many 4 year programs like offer clinical ‘mini fellowships’ in the 4th or 3rd&4th years such as administration, toxicology, ultrasound,EMS, etc. Did any of you do these? What was your experience like? Which of these are the most fruitful to pursue?

Appreciate the responses.

Doesn't mean a thing if you want to pursue academics. Best route is 3 yr program plus fellowship. 4 yr programs are a scam.

 

[Tipsy McStagger]

Doesn't mean a thing if you want to pursue academics. Best route is 3 yr program plus fellowship. 4 yr programs are a scam.

They may be a scam, but from what I understand (I could be wrong though), many academic centers still prefer 4 year residencies. So if you really want to work in academics it may be best to do a 4 year residency + fellowship.

Please correct me if I’m wrong though.

 

[deleted109597]

They may be a scam, but from what I understand (I could be wrong though), many academic centers still prefer 4 year residencies. So if you really want to work in academics it may be best to do a 4 year residency + fellowship.

Please correct me if I’m wrong though.

The only academic places that prefer 4 years are the ones that have 4 year residencies. And even then, you can do a fellowship.
And it really only boils down to "we don't want 2 people to graduate med school and have one be the attending of the other during their last year"

 

[BoardingDoc]

They may be a scam, but from what I understand (I could be wrong though), many academic centers still prefer 4 year residencies. So if you really want to work in academics it may be best to do a 4 year residency + fellowship.

Please correct me if I’m wrong though.

What McNinja said above. You usually can't do a 3 year program and immediately go be an attending at a 4 year program. That said, I have never heard of an academic center with a 4 year program not hiring someone who did a 3 year residency + fellowship. Also, I applied to one place which had 4th year residents rotating in from a huge academic center straight out of my 3 year residency and got a job offer.

 

[Groove]

Greetings, many 4 year programs like offer clinical ‘mini fellowships’ in the 4th or 3rd&4th years such as administration, toxicology, ultrasound,EMS, etc. Did any of you do these? What was your experience like? Which of these are the most fruitful to pursue?

Appreciate the responses.

My residency was 4 years in length but has since changed to 3. We had "mini fellowships" the last year which was basically a glorified elective year to customize your elective time as you saw fit. Most "mini" fellowships are not in actuality a true full fellowship year but more of a marketing scheme to hopefully attract the type of candidate where heavily customized elective time in the final year would be desired. I did an ultrasound year for my last year and accumulated over 1000 scans that year alone and satisfied all the ARDMS requirements. I never actually went on to sit for ARDMS. In hindsight, I really think these mini fellowships are just ways to make you feel better about doing an extra year of residency. Personally, if you're interested in any sort of fellowship training followed by academics, you'd be better served to do a 3 year residency and then a year or two of formal fellowship.

Three years of training is all that's really required to attain proficiency in emergency medicine. Proponents of the 4 year programs will say that you are more polished and seasoned and while this may be true....you're more polished and seasoned at 5 years and then 10 years and so on. I certainly would have been fine after three. Most of us in our fourth year worked autonomously in the department with little oversight.

I'm not saying a fourth year of training is necessarily a bad thing. However, I'd focus more on the quality/location/personal valuation criteria of the specific program you are interested in and not worry so much about whether it's 3 or 4 years. Being happy where you are and receiving a quality education is the most important thing. I thought I received excellent training and so I didn't mind the 4 years. Plus, we got to moonlight a lot so it wasn't a completely waste of attending salary.

The only negative would be for slightly older residents like myself who were a few years older than my co-residents. 4 years of training was more than enough and although I would have possibly considered a fellowship year in a 3 year program, I was absolutely unwilling to consider it after 4 which took fellowships completely off the table for me. I was 38yo, 400K in debt and needed to start making some real money.

 

[Birdstrike]

Sounds like someone's trying to sell someone on a notta.

It's not a mini-fellowship it's notta fellowship.

 

[gro2001]

There are definitely advantages to the fourth year if it's done right. Whether it's called a "mini fellowship" or not is beside the point. What really matters is understanding what your career goals are and how one can use the fourth year to help you develop professionally towards those goals. This does require good faculty advising, which is unfortunately almost non existent.

I doubt I would be as prepared to take on the academic role I did if it hadn't been the experiences I had during fourth year of residency. In my case this was not planned, and hypothetically might have been achievable with some advanced planning in a three year program, but I just haven't seen many people come out of three year programs with that level of (non clinical) career development (exceptions being non traditional grads). This is not a knock on those grads, this is more an aspect of lack of effective career advising, both at three and four year programs, which the four year programs have some room to make up for with elective opportunities and having PGY4s take on additional roles in the program and department (committees, QI, etc).

As to the utility of a 3 year program followed by fellowship, I think it depends heavily on the specifics of the fellowship. I haven't appreciated a lot of people developing as academics as a result of a 1 year ultrasound fellowship for example.

I fully acknowledge that there is a lot of motivated reasoning going on by grads of both three and four year programs to rationalize why our choice was superior. I am guilty of this too.

 

[Tenk]

My minifellowship came in the form of several hundred thousand dollars because I went to a three year program.

 

[Hercules]

There is no valid reason to do a 4 year program short of being nonnegotiably geographically tied to a place that only offers 4 years. The 4th year is a waste of your time. I say that as someone who did a 4 year that became a 3 year program.

 

[carbonizedeyesockets]

What McNinja said above. You usually can't do a 3 year program and immediately go be an attending at a 4 year program. That said, I have never heard of an academic center with a 4 year program not hiring someone who did a 3 year residency + fellowship. Also, I applied to one place which had 4th year residents rotating in from a huge academic center straight out of my 3 year residency and got a job offer.

Since most residencies staff more than one ED, they often have a process for taking grads from 3 year programs. Either you get scheduled shifts without PGY4s, or are put in pods or EDs where the PGY4s don't rotate. Some places just DGAF and just schedule as usual. I went to a 3 year program and work at a place with a 4 year program. I also interviewed at an "Ivy-league" 4 year program and they said they'd make it work if hired. I'm sure some places can afford to be choosier about hires, but there are plenty who are happy to have someone with academic interests and be willing to accept academic pay. The training length is not nearly the barrier that some make it out to be.

 

[SamtheWise]

Lol a mini-fellowship, aka 2 months of glorified elective mixed in with 10 months of free labor. All I'm going to say is it's not a coincidence that the most desirable cities to live in all have mostly 4 year programs.

 

[Fox800]

Echoing above. Do a three-year program and a one-year fellowship. Any four-year program that won't accept that is too stuck-up and inbred.

 

[GonnaBeADoc2222]

Echoing above. Do a three-year program and a one-year fellowship. Any four-year program that won't accept that is too stuck-up and inbred.

They just care about the labor, I promise you. When I was a pgy4 resident I had pgy4 attendings that graduated from pgy3 programs that were now doing a fellowship. It was a slap in the face. Go to a three year program. There is zero justification for four years of EM residency.

 

[cyanide12345678]

They may be a scam, but from what I understand (I could be wrong though), many academic centers still prefer 4 year residencies. So if you really want to work in academics it may be best to do a 4 year residency + fellowship.

Please correct me if I’m wrong though.

Yeah only the 4 year spots care and don't want to hire fresh out grads because their pgy4 is more or less at the same level as the attending then.

Only the places with brand name are able to pull people despite a 300k opportunity cost. These places have 6 months of elective!!!!! Sounds pretty useless lol

 

[TooMuchResearch]

Me too! And I worked much less. And had way more control.

My minifellowship came in the form of several hundred thousand dollars because I went to a three year program.

 

[SpacemanSpifff]

Greetings, many 4 year programs like offer clinical ‘mini fellowships’ in the 4th or 3rd&4th years such as administration, toxicology, ultrasound,EMS, etc. Did any of you do these? What was your experience like? Which of these are the most fruitful to pursue?

Appreciate the responses.

In an effort to actually touch on the OP's question... I know Hopkins and Kings in NY have a program like this, but I don't recall many other four year programs who do it. Most have some sort of longitudinal track that allows you to further your professional goals. These are unlikely to have a significant effect on your marketability, unless they lead to academic production or otherwise useful experiences (i.e. medical direction, operations positions, etc.). If you end up in a place that has these programs, pursue whichever one you find most interesting.

 

[Frazier]

There are a few 3 year programs that have this sort of offering. They are, as alluded to above, often longitudinal across all years.

They serve more for personal/professional enrichment (ie protected time to study XYZ) than for promised career advancement.

 

[namethatsmell]

Close your eyes and imagine the next 5, 10 and 20 years from now and what you want your work life to look like.

Do you see doing a few months of a niche area in residency realistically giving yourself some major career advantage? Will doing a 4th year of residency to get a few extra months to focus on something --but probably not achieve expertise in it-- afford you protected research/teaching/admin time as an attending in the future? Will it allow you to cut down your clinical work load? Will it allow you to diversify your practice in a setting outside of the ED? Will it give you an edge to get a job in an sought-after ED you otherwise couldn't break into? Will it increase your pay?

Almost certainly, the answer to all these questions will be no. Perhaps 10-15 years ago it would be "maybe." But not now. In this day and age there's a fellowship for almost every type of EM niche and the people who do those will have a major advantage in those spaces over the 4 year grad with a "focus" in residency. There are also more EM grads now and thus more people actually doing those fellowships.

EMS? There's a fellowship.

Informatics/Tech? There's a fellowship.

Crit Care? There's a fellowship.

Sports? There's a fellowship.

Sono? There's a fellowship.

Pain? There's a fellowship

HPM? There's a fellowship.

Tox? There's a fellowship.

Simulation? There's a fellowship.

Research? There's a fellowship.

Health Policy? There's a fellowship.

Peds EM? There's a fellowship.

Wilderness medicine? There's a fellowship.

Hyperbarics? There's a fellowship.

International EM? There's a fellowship.

Administrative/Safety/Quality? Three's a fellowship.

Disaster medicine? There's a fellowship.

Education? There's a fellowship.

And I'm sure there are several other examples I'm missing.

If you have to be in a geographic area for family or spousal purposes that only has a 4 year program then sure go for it and don't look back. Otherwise, I'm not sure there's any good argument left for picking a 4 year program. Your future self will thank you for picking a 3 year one.

 

[alpinism]

Close your eyes and imagine the next 5, 10 and 20 years from now and what you want your work life to look like.

Do you see doing a few months of a niche area in residency realistically giving yourself some major career advantage? Will doing a 4th year of residency to get a few extra months to focus on something --but probably not achieve expertise in it-- afford you protected research/teaching/admin time as an attending in the future? Will it allow you to cut down your clinical work load? Will it allow you to diversify your practice in a setting outside of the ED? Will it give you an edge to get a job in an sought-after ED you otherwise couldn't break into? Will it increase your pay?

Almost certainly, the answer to all these questions will be no. Perhaps 10-15 years ago it would be "maybe." But not now. In this day and age there's a fellowship for almost every type of EM niche and the people who do those will have a major advantage in those spaces over the 4 year grad with a "focus" in residency. There are also more EM grads now and thus more people actually doing those fellowships.

EMS? There's a fellowship.

Informatics/Tech? There's a fellowship.

Crit Care? There's a fellowship.

Sports? There's a fellowship.

Sono? There's a fellowship.

Pain? There's a fellowship

HPM? There's a fellowship.

Tox? There's a fellowship.

Simulation? There's a fellowship.

Research? There's a fellowship.

Health Policy? There's a fellowship.

Peds EM? There's a fellowship.

Wilderness medicine? There's a fellowship.

Hyperbarics? There's a fellowship.

International EM? There's a fellowship.

Administrative/Safety/Quality? Three's a fellowship.

Disaster medicine? There's a fellowship.

Education? There's a fellowship.

And I'm sure there are several other examples I'm missing.

If you have to be in a geographic area for family or spousal purposes that only has a 4 year program then sure go for it and don't look back. Otherwise, I'm not sure there's any good argument left for picking a 4 year program. Your future self will thank you for picking a 3 year one.

Denver offers a “climate and health science policy” fellowship to add to your list.

 

[RuralEDDoc]

“Mini-fellowship” is four year program marketing. Programs needs to find something to set them apart and justify the 4th year to students who may be skeptical of the value of a fourth year. I certainly wouldn’t chose a program based on this feature alone. I think the 3+1 model makes more sense to those set on academics (3 year program plus one year fellowship). 2 year fellowships only make sense to me if they significantly expand your opportunities or skill set, such as a critical care fellowship.