The Nuts and Bolts of Getting into an Oncology Fellowship

Oncology continues to be one of the most sought-after specialties. Because of a shortage of oncologists and the accelerating pace of developments in the diagnosis and treatment of cancer, oncology has become an increasingly competitive field. Accreditation Council for Graduate Medical Education (ACGME)-accredited training in oncology can be pursued in 2-year oncology-only programs or, more commonly, in 3-year combined hematology-oncology programs.

Starting this year, the application cycle for oncology fellowships began in July, when the post office of the electronic residency application service (ERAS) opened. Over subsequent months, programs review applications and invite selected applicants for interviews. Both interviewees and programs then rank each other in certified lists submitted to the National Residency Match Program. The match occurs in mid-December, and fellowships begin on the first of July.

The competitive nature of the match process makes it crucial for applicants to identify factors that would make them stand out. The main elements of fellowship application include a curriculum vitae, letters of recommendation, and a personal statement. The CV should be inclusive within reasonable limits. It is important not to neglect hobbies or areas of interest, especially those that help the applicant show consistent dedication, perseverance, and discipline. A demonstrated interest in research naturally strengthens an application but is not the most important selection factor. Publications, research projects, national presentations, and advanced degrees in research could all serve as evidence of such interest and are likely to be viewed favorably.

Letters of Recommendation

The importance of letters of recommendation from oncologists cannot be overstated. In a study examining selection factors for subspecialty training, the importance of recommendation letters was ranked by fellowship program directors only second to the importance of the fellowship interview.¹ Oncologists naturally trust other oncologists because they share a unique perspective.

In general, letters of recommendation should reflect personal knowledge of the applicant and an honest evaluation of the applicant’s residency performance and suitability for fellowship training. A letter from a nationally known oncologist who marginally knows the applicant will be almost uniformly weaker than a letter from a lesser-known oncologist with intimate knowledge of the applicant’s qualifications. Applicants should always waive rights to view the letter; anything else makes applicants appear untrusting.

“Be certain that your program director has your back by reviewing the letters of recommendation before they are uploaded. I routinely reject faculty letters that are poorly composed or show no commitment to the applicant. This is part of the job description of your program director, even if you have graduated, so do not hesitate to ask” said Paul L. Bernstein, MD, former internal medicine residency Program Director at Rochester General Hospital, Rochester, New York and coauthor of a study on selection criteria for fellowships.¹

According to the study, the third most important factor is the letter of recommendation from the internal medicine program director. The program director’s letter should reflect personal knowledge of the applicant as well as specific examples of his or her performance. “When writing a letter of recommendation, I usually review all of the applicant’s evaluations and include quotes about his most impressive qualities. I conclude with a detailed summative evaluation with my own assessment of the applicant’s personality, performance, and academic potential,” said Dr. Bernstein.

A well-written personal statement is an integral part of the fellowship application despite its relative unimportance compared to the CV or letters of recommendation. The key to a strong personal statement is to have a theme, a common thread that ties together the applicant’s background and formative experiences to show that she would be a “good fit” for oncology training. Applicants should be careful not to be overly influenced by personal statements of colleagues. Program directors do Google lines of text from personal statements; any plagiarism is grounds for immediate rejection and worse.

Program Goals

Applicants are advised to do some soul-searching before applying for a fellowship and to review aspirations and expectations with the residency program director and other mentors. Applicants should also be mindful of the different goals of different programs to which they apply. Programs typically come in three different flavors: community-based, university-based, or university-affiliated. University programs typically aspire to train academic oncologists who will become leaders in the field. Programs that aim to train physician-scientists offer both clinical and basic science research training.

“In our program, the second year of training is typically dedicated to a translational research project of the fellow’s choosing, with intensive faculty mentorship and support. Up to 18 months of training may be devoted to this project, while the fellow also continues seeing patients in a weekly continuity clinic. The fellowship applicants we favor are the ones most likely to thrive in this type of research environment ” said Ronald Scheff, MD, fellowship Program Director at the Weill Cornell Medical College hematology-oncology program.

First-hand Knowledge

An “away” elective at the fellowship site can offer the applicant and the program a valuable opportunity to gain first-hand knowledge of one another. It can also help the applicant obtain letters of recommendation from faculty at the program. However, an away elective can also be a double-edged sword if the applicant underperforms, so the risks and benefits of such an undertaking should be weighed carefully beforehand.

The interview is consistently ranked as the most important fellowship selection factor.¹ Program directors trust their instincts and reach conclusions rapidly. The interview is also an opportunity for applicants to learn about the relative strengths and weaknesses of each program and its educational philosophy. At the end of the day, the best possible outcome of the match is producing a good fit that achieves both the applicant’s and the program’s goals. ■

Disclosure: Dr. Faltas reported no potential conflicts of interest.

Reference

1. Mikhail S, Bernstein P: Selection criteria for fellowships: Are we all on the same page? Academic Internal Medicine Insight. 5(1), 2007.