A Guide to the Fellowship Match

Most radiology residents pursue a fellowship, ¹ and many would agree that the process truly could not be more confusing. Some subspecialties utilize the Electronic Residency Application Service, while some follow the National Residency Matching Program match system, and still other subspecialties employ their own “universal application.” And, of course, every fellowship program has its own application requirements. To add to the confusion, some programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME) while others are not (more on that later).

So the question becomes: where do you start? The first step is to visit the primary website for the sub-specialty you are pursuing and read its guidelines for application. For example, you can find the guidelines for breast imaging fellowships at the Society of Breast Imaging website, https://www.sbi-online.org/

In addition, the Society of Academic Chairs in Radiology recommends a specific timeline during which fellowship programs can accept applications, conduct interviews, and make offers.² They are only recommendations, however, and not all programs follow the them. Be sure to check when pursuing a fellowship in your chosen subspecialty.

Three Keys to Success

A key component of the application process — in my opinion, the most important — is your letters of recommendation. You may have heard that residency is one long job interview; I would agree. Securing three strong letters of recommendation from your mentors is a major key to a successful fellowship match.

I recommend obtaining at least one subspecialty letter, a letter from your program director, and a letter from someone of your choice who knows you well. In addition, the letter’s content is paramount. The letters should be personal and speak to your character, accomplishments, and what you will bring to radiology. Radiology is already a very small world, and its subspecialties are even smaller. These letters can often lead to personal phone calls between program directors and your mentors, especially if they are already familiar with each other.

I also strongly recommend focusing on your research and publishing experience. While not everyone desires to enter academia, completing at least one significant project during residency typically improves one’s chances of obtaining a fellowship match. Remember, most fellowships are in large academic centers, so demonstrating interest in contributing to the department can help you stand out from the pack.

Third, put thought into your personal statement, where you will explain why you are pursuing the fellowship. Many residents choose fellowships based on familiarity (home program), geography (nearby family and support system), specific research projects, and of course, job prospects at the institution and/or nearby. The personal statement is your opportunity to discuss these important points and potentially overcome any geographical biases if you are seeking a fellowship located far from your current medical school.

Frequently Asked Questions

Here is a brief list of questions that I am often asked about obtaining fellowships and answers based on my experience:

• Does core exam score matter?
  No. You will not receive your core exam score before rank lists are finalized.
• Do step scores or medical school grades matter?
  Yes and no. Neither were brought up at any of my interviews. Indeed, most fellowship applicants have already completed Step 3 of the US Medical Licensing Examination and there’s no way to go back and change medical school grades, so they are essentially out of your control. Focus on what you can improve and be ready to talk about any low scores in the event they are brought up in the interview.
• Does ACGME accreditation matter?
  It depends. Baker et al nicely outline what accreditation means for fellowships and what it could mean for you.¹ As far as job prospects, I have yet to see the issue come up in conversation, and I have not included it in my curriculum vitae.
• How many programs should I apply to?
  This is personal and depends largely on your desires for location and job preferences. Anecdotally, most residents I have spoken to have applied to between 15 and 20 programs.

A fellowship can be one of the most rewarding experiences of your career but obtaining one can be challenging. Carefully planning your steps and doing your due diligence can help make the process easier and more successful.

References

1. Baker S R, et al. The trouble with fellowships. J Am Coll Radiol. 2010; 7(6): 446-451. doi.org/10.1016/j.jacr.2010.01.020
2. Society of Abdominal Radiology. Fellowship timeline. abdominalradiology.org/sar-subpages/fellowship-timeline/. Accessed 1 July 2023.