Surgical Oncology

[cowboy1978]

Starting my application today...

Anyone else applying?

I know its pretty competitive, does anyone have the actual match statistics for last year?

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[DoctorCthulhu]

I'm not applying myself, but I'm curious.

I'm particularly intrigued with the "second tier" programs. Everybody knows (going by name alone here) that MSKCC in NY, and MDACC in Houston are the "first tier". But where do Fox Chase, Roswell Park, OSU, U. Pitt and USF/Moffitt (to name but a few) stand? What about traditional Ivy League departments who have recently opened up Surg Onc fellowship positions, like Harvard/Dana Farber and JHU?

Also, I know that research during residency is pretty much an unwritten requirement, but is 1 year enough, or should the prospective applicant go straight for 2 years?

 

[blaithnaid]

didn't hopkins just change their program last / this year? to a track on hbp and ?general surg onc? i thought the other track was specific, but idk... they've had surg onc fellowships for years though.

 

[Amgen1]

There were approximately 85-90 applicants for 53 spots. However, what is not clear is how many of those people were also applying to HPB which is a separate pool of applicants. Several of the people who did not match at SSO program may have ranked/ matched at HPB programs

This year was apparently a bit more competitive than the past couple, but who knows. Tough to gauge with the combined HPB match

approx 60-70% of applicants had taken time off for research. One year, as long as it is productive is probably reasonable. Clinical research is becoming much more common in the applicant pool

 

[MattD]

I don't have anything constructive to add, but as a rising PGY1 interested in surg onc and HPB, I'd love to hear about how the application process goes for you, what kind of advice and experiences you got from the mentors at your program, and impressions of the centers you interview at

 

[HNANAL]

I'm finishing my 3rd year gen surgery, and i'm thinking about surgical oncology right now. I wonder what factors important in matching. I know research is important, but where does absite, usmle and letters of rec fall in?

I seem to recall the unmatched rate is about 30%

 

[MattD]

I'm finishing my 3rd year gen surgery, and i'm thinking about surgical oncology right now. I wonder what factors important in matching. I know research is important, but where does absite, usmle and letters of rec fall in?

I seem to recall the unmatched rate is about 30%

geez usmle

Do you have plans to go to the lab, or have you already?

 

[HNANAL]

geez usmle

Do you have plans to go to the lab, or have you already?

I am going with the SSO website's description http://www.surgonc.org/default.aspx?id=459

i have plenty of research experience, and the papers to prove it. More research than I'd like to admit but my scores are not great. I would probably be a great fit in surg onc. I love research and love doing surgeries. Some people i talked to say that absites don't matter, but they must to some extent.

 

[surg]

Different programs care about different things, so there is no 1 size fits all. Having said that:

-Interviews
-LORs (quality of, and who from)
-Fit (are you interested in what they are good at training you in? Some programs tend to be be more tilted towards certain organs/diseases)
-ABSITEs matter within reason (very detrimental to have very low scores that put you at risk of failing the boards) but won't get you in anywhere.
-Research: there are more research oriented fellowships that really care. All of them care somewhat. Surg Onc attendings as a group tend to be more academic. Experience helps, but papers prove you can follow-through, an even more important trait.

USMLEs is a non-issue as a general rule (again unless they confirm that you are really bad at tests putting you at risk of failing)

 

[cowboy1978]

thanks for the info, will keep you guys updated once the process is over

 

[surgoncforya]

I am a surg onc fellow and I love it. Huge cases, lots of collaboration with medical oncology & radiation oncology. You get exposure to such a wide variety of cases, major HPB, breast, melanoma, upper GI, lower GI, thoracic, H&N, etc.

The applicaiton process was competitive, and I think research, letters, etc are the most important part. I didn't take dedicated time off from residency but did some research at MSK on post-call days, etc and got a nice paper out of it.

I think the big programs and only "first tier" programs are MSK and MDA. They are clearly superior to the other programs in terms of research, reputation, etc. They are also EXTREMELY competitive and I think a lot comes down to who you know. For example, I know someone who took 2 years in research, nature publication, excellent resident with the best credentials and didn't even get an interview at MSK.

I think the rest of the programs are all very good, the SSO only gives fellowship status to a limited number of high-quality programs, so the overall fellowship quality is excellent no matter where you go. I am at a "2nd tier" type program and I'll give you a brief run down on my experience from interviews. Note, this is highly biased, entirely subjective, and just based on limited experience and may in fact change from year to year.

MSK, MDA- highly selective, outstading training. Only possible downfall is perhaps limited experience as the surgeon, instead you will be 1st assist.

City of hope- very nice, tons of OR volume, very good laparoscopy (largest robotic rectal series out there). Lots of hours, not very cush but will come out with outstading training. Stand alone program with no residents

Ohio- among the best, very busy lots of volume not much MIS. Probably the best program for autonomy, they want to make sure they don't have to teach you to operate. Very dynamic faculty highly respected.

Fox Chase- huge in laparoscopy (lap major livers, HPB, robotic rectal/APR/TME, etc) get lots of H&N and thoracic (maybe too much if you don't want to do it in practice), Most cases are done directly with attending so probably middle of road in terms of autonomy. Stand-alone cancer center with no residents

Chicago- very well respected program big research center 3 year program with 1.5 clinical 1.5 research. Posner is boss and he is very well known. Good training

Moffitt- highly liked during interview trail, I didn't interview here

Toronto- very nice if you like Canada. They can adapt training according to your wishes, for example can make 2nd year a colorectal fellowship (HUGE!). Big HPB program but they have their own HPB fellowship. Lots of interaction/shared cases with residents

Roswell Park- part of the initial 3 programs in surg onc (MSK, MDA, Roswell) very good place, lots of research available. Dedicated center with minimal resident interaction.

Brigham/Dana Farber- among the worst programs for surg onc (excellent hospital of course) fellowship bad because residents are very strong, too much competition from residents for cases and you will as the fellow get 2nd dibs. Powerhouse for research/resources so may be the right place for someone who likes the research.

Hopkins- similar to Dana Farber, fellowship seems like 2nd class citizen

John Wayne- Santa Monica!! Huge melanoma (Morton) and breast program (Giuliano). Home of the sentinel node. Spread out across LA for colorectal, etc. Competitive place, and I liked it very much.

Virginia- smaller program and not as competitive on the trail

Providence (Roger Williams)- small program and not as competitive on the trail but Espat is great liver surgeon. Very dynamic guy exciting to be around I think you will get outstanding HPB here

Pittsburgh- Probably the best place in the SSO for HPB. They have several different tracks according to your interest- research, MIS, HPB... extremely competitive work very hard get very nice training. Also big HIPEC center.

Miami- smaller program, not much MIS but big proportion of very advanced disease huge cases. Lots of residents around to help with service but I didn't get the feeling they had much competition.



I am sure I'm probably forgetting a couple but these were my immediate thoughts. You need to get your own opinion and judge for yourself. Each place has different feel, strengths/weaknesses. For example- no residents means no competition for cases (good), but if chest tube needs to be put in at 3am you are the one to go in and do it (bad). Several of the stand-alone centers have NO ER!! How great is that! (MDA, MSK, Fox Chase, City of Hope, Moffitt)

Good luck!

 

[ts7766]

How are the interviews for Surgical Oncology? Are they more of a 'get to know you feel' or are do they ask you medical-surgical questions?

Has anyone applying this year heard from the big name programs? When do they usually send out invitations -- ie: rolling or a set date?

Any information provided will be much appreciated!

 

[angleoflouise]

If you take two years off to do research, does it have to be oncology related? Is it ok if you did research in another field and got multiple publications in it?

 

[surg]

It definitely does not need to be oncology related, although it does help since your lab mentors may be known to your interviewers. However, many institutions funnel their residents to certain labs that are more productive and productivity in such a lab is preferable to doing two years of oncology research with no publications to show for it. Also, at institutions that send their residents to the lab after year 2 it is very common to change your mind about fellowship choice once you get to finally do the bigger cases as a midlevel resident so people are pretty understanding so long as you can explain your decision.

Bottom line, whatever lab you choose, make sure you show the ability to produce and also understand your research. It is a big negative for me when I ask someone about their research and they can't explain it.

 

[ram006]

Bottom line, whatever lab you choose, make sure you show the ability to produce and also understand your research. It is a big negative for me when I ask someone about their research and they can't explain it.

Here's a question I have for an attending level person. I took a year off to do research and was sort of verbally promised a first author on a project and got bumped to 2nd author. Rather than shoot myself in the foot and make a big deal out of it I went with the flow. The maunscript is submitted to a fairly prominent journal and the abstract was accepted for podium presentation at two national meetings. I'm hopeful I'll get two first authorships on other projects but since I'm back in clinical duty, I can't be certain they'll get finished.

My question is this: If no first authorships come out of my research year, how bad will that look? Is there any way to tastefully say that I should have been the first author on a paper?

In retrospect, I have sort of mixed emotions about that project. During discussion, one of the more senior authors felt it would be better for the research if we put their name first. I can see how that might be the case and it may have been the right choice. It is difficult, however, to do all the work, get bumped for authorship and not get a little irritated. There are more details that I'll intentionally leave out, but I think you can read between the lines.

I'm not all that worried about long term consequences of getting a second author but I am concerned it's going to have a significant negative short-term impact on my CV and fellowship application. Maybe I'm just new to the whole research thing and over thinking it... .

 

[surg]

This is why I encourage my lab residents to have multiple projects. Some should be small enough that they are clearly yours. My residents shoot to finish 6 projects. You are justified in feeling irritated about being bumped, but ultimately it is the corresponding author's decision on authorship roles short of you making an academic honesty case of it, which I would not recommend since you need a letter from this person. You are right to not worry about the long term. The short term perception though is that your time was not particularly productive if you don't finish the other projects. Hopefully your research mentor's letter will alleviate that issue, but I would do everything in my power to get those other papers done.

 

[thedrjojo]

This is why I encourage my lab residents to have multiple projects. Some should be small enough that they are clearly yours. My residents shoot to finish 6 projects. You are justified in feeling irritated about being bumped, but ultimately it is the corresponding author's decision on authorship roles short of you making an academic honesty case of it, which I would not recommend since you need a letter from this person. You are right to not worry about the long term. The short term perception though is that your time was not particularly productive if you don't finish the other projects. Hopefully your research mentor's letter will alleviate that issue, but I would do everything in my power to get those other papers done.

Are you considering projects = enough for a manuscript, and are these 6 independent of each other (like, if two residents are working together, do you count that as 1 project each, or does the primary resident only count it). I guess it's also different basic science vs clinical. With my clinical research, I'd think it'd be hard to have 6 projects on my own with the one pi. Between the 3 other surgeons I'm working with, I could claim 6 projects that will hopefully net me first authorship, and with my pi at least 3 first author papers, plus hopefully a few second authors /maybe some first author from the huge rct that payed the bills for my 2 years (which we just closed enrollment on... 323 brain death organ donors, might be the largest rct in organ donors) so hopefully we can get that rolling. I feel bad for my coresident who ran that rct and will unlikely have major publications from it before applying for fellowship this winter, but I should benefit 1.5 years from now when I apply

 

[surg]

I suppose it is a little of you know it when you see it. In general though I would define a project as an individual line of research that can lead to a publication of some sort. Hopefully they will mostly be first author, but for a more significant finding, a middle is fine. I encourage my folks to use more than 1 PI so long as they are clear on timelines with each one so they don't disappoint others. Many projects will be small one-offs such as a case series or analysis of local experience, but hopefully some will spin off more projects.

My reasoning for always having at least 6 active projects is that it gives you the ability to cut a floundering project without flushing the year down the drain or trying to force it to work. It also gives you the chance to work on some higher risk projects that may not pan out or may not complete in time for your application to fellowship or job hunt. Your RCT is a prime example of that. This is a great project to be a part of, but should not be the only project of a year. RCTs notoriously take longer to accrue than projected, and sometimes shut down for reasons completely out of your control. Because of this, without other projects as you did, you could spend 1 or 2 years in the lab with no papers to show for it.