Transcript ABIM Research Pathway - Stony Brook University

ABIM Research Pathway Applying for Residency
Ajit Janardhan
Washington University in St. Louis
Internal Medicine Residency – Cardiology Fellowship
Edward Kim
University of Michigan
Internal Medicine Residency – Medical Oncology Fellowship
Today’s topics
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The ABIM Research Pathway
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Residency application advice
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Traditional Pathway vs. Research Pathway
Differences in structure and application to the Research Pathway at
different institutions
Advantages and Disadvantages
Timeline: what you should do and when to do it
Selecting programs and who to ask for advice
Miscellaneous tidbits of advice
Open forum
The ABIM Research Pathway
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Designed by the American Board of Internal Medicine
(ABIM) for physicians who are devoted to a career in
clinical/basic research
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Who is this designed for?
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MD/PhD’s or those with significant research experience
Major features:
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Shortened length of clinical training
Protected research time with guaranteed salary
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Designed to allow physicians to develop research interests &
eventually apply for independent funding
“Traditional” Pathway:
Internal Medicine Residency-Subspecialty Fellowship
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Internal Medicine Residency – 3 years
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Apply for fellowship in 2nd year of residency
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Ph.D definitely helps competitiveness for fellowships–
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fellowship programs need fellows to do research (like your PI)
Subspecialty Fellowships - 2-3 years
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1-2 years of clinical training
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6-12 months of research time
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Variable degree of protection of research time
Fellowship Training Time Requirements
Area of Discipline
Minimum Months of
Training
Clinical Months
Required
Cardiovascular Disease
36
24
Endocrinology, Diabetes, and
Metabolism
24
12
Gastroenterology
36
18
Hematology
24
12
Infectious Disease
24
12
Medical Oncology
24
12
Nephrology
24
12
Pulmonary Disease
24
12
Rheumatology
24
12
“Traditional” Pathway:
Internal Medicine Residency-Subspecialty Fellowship
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Internal Medicine Residency – 3 years
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Apply for fellowship in 2nd year of residency
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Ph.D definitely helps competitiveness –
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fellowship programs need fellows to do research (like your PI)
Subspecialty Fellowships - 2-3 years
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1-2 years of clinical training
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6-12 months of research time
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Variable degree of protection of research time
Additional years of research time generally required to develop studies that will be
independently funded
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NIH K type awards, R01 awards
The ABIM Research Pathway
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AKA the “short-track” / Physician-Scientist Pathway / MedicalScientist Pathway
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The Basics
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Internal Medicine Residency shortened to 2 years
Fellowship training split:
Spend minimum time allowable in formal clinical training
 Research time extended:
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3 years mandatory research time (protected from clinical duties)
 Normal research time is 6-12 mo, not always protected
80% Research, 20% Clinical (to stay current)
Clinical time is outpatient subspecialty clinic – NOT Floors, O/N Call
These features apply to every program – guidelines are set
by the American Board of Internal Medicine
Sample comparison - Cardiology
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Traditional pathway
1
2
3
Medicine Resident
4
5
6
Cardiology Fellowship
7
8
Research (& Clinical…)
Research (& Clinical…)
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ABIM Research pathway
1
2
Medicine Resident
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3
4
5
Clinical fellow
6
7
8
7
8
Research
Alternate ABIM Research pathway
1
2
Medicine Resident
3
4
Research
5
6
Clinical fellow
Advantages of the Research Pathway
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Shortened length of general Internal Medicine clinical training
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Still do entire length of required CLINICAL fellowship training
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Begin research sooner
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Increased time to set up research projects, produce publishable data, write grants
Truly protected research time
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No overnight call, no backup, no consults
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20% clinical / 80% research split allows you to stay current clinically
Fellowship secured earlier
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Big deal if you’re trying to do experiments to know you won’t be disturbed
Stability allows better planning of personal life
Inside track to faculty positions
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Most institutions view this program as a means to develop faculty
Disadvantages of the Research Pathway
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Loss of 1 year of IM clinical training
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Must choose subspecialty 1 year early
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Waste of time if you ultimately choose a purely clinical
position
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“Another long *!&*!&%* program!!”
Why do institutions participate in these programs?
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Nationally recognized need for physician-scientists
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Same justification as NIH-funded MSTPs
Much cheaper to hire future faculty from within than
from other institutions
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Average cost of recruiting faculty is greater than $1,000,000
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Fellowship programs get an early crack at people who
have a proven ability to carry out research
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Prestige
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looks good for the residency and fellowship programs
Major categories of programs
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Match, then apply to Research Pathway in year 1 of IM
Residency
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No guarantees of acceptance to Research Pathway (limited slots)
No guarantees of acceptance to particular fellowship
If accepted to Research Pathway, one can generally get a
fellowship at same institution
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Match directly to Research Pathway
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Allergy/Cards/GI vs. Oncology vs. ID/Rheum/Endo
Program guarantees Research Pathway upfront
Must apply for specific fellowship in year 1 of IM residency
Match directly to Research Pathway - Fellowship
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Program guarantees Research Pathway AND Fellowship upfront
Major categories of programs
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Match, then apply to Research Pathway in year 1 of IM
Residency
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No guarantees of acceptance to Research Pathway (limited slots)
No guarantees of acceptance to particular fellowship
If accepted to Research Pathway, one can generally get a
fellowship at same institution
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Match directly to Research Pathway
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Allergy/Cards/GI vs. Oncology vs. ID/Rheum/Endo
Program guarantees Research Pathway upfront
Must apply for specific fellowship in year 1 of IM residency
Match directly to Research Pathway - Fellowship
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Program guarantees Research Pathway AND Fellowship upfront
Major differences between institutions
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Number of positions earmarked for ABIM Research Pathway
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Accepting a (ABIM Research Pathway) Participant means sacrificing one
3rd yr IM Resident in the residency program
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Participants spend less time overall in fellowship training
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This means fellowship must hire more fellows to account for your absence
from clinical service
Each Participant is guaranteed a salary for 3 yrs of funded research
Thus, it is advantageous to go to a well-funded Dept. of Medicine
Talking the talk vs. Walking the walk
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Participants only do 2 yrs IM residency
Actual number of people who do join the Research Pathway each year?
Incentives
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Money for supplies and salary supplement
Costs of attending meetings & conferences
Other important points
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Who offers it?
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Organization and Funding
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University-Based Teaching Hospitals that draw large amounts of research
funding
Some are well organized, formal programs with budgets, others are put
together on an ad-hoc basis (less desirable)
Some have a program director & committee that guide your career
Support
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Research-committed vs Research-supportive vs Research-permissive
Some programs have the support of the chair & faculty
What’s the Bottom line?
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This program is designed with MD/PhD’s in mind to
facilitate their entry into academic medicine
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If you are considering an academic medical career –
you WILL need to do substantive research beyond the
Ph.D.
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The ABIM research pathway gets you into the lab more
quickly and protects & funds your research time
How do you know if this is right for you?
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Determine your goals and priorities
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Are you interested in a career consisting of Research only,
Research & Patient Care, or Patient Care only?
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Do you have an interest in a particular field of medicine?
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Your thesis topic need not relate to your fellowship field
Perfectly acceptable to not know your field of interest
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Do you want the guarantee of the Research Track or
Research Track - Fellowhip?
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Would you prefer the stability of knowing where you’ll be
located for residency and fellowship?
What to do if you’re interested
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Incorporate your interest in research into your personal statement
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Letter writers should know you’re interested in academic medicine
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Be as specific as possible: disease, areas of investigation, etc.
Especially true for your PI
Contact Research Pathway directors – let them know you’re INTERESTED!
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Email addresses are usually listed on websites – end of 3rd year
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IM Residency director and Research Pathway director are rarely the same
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Do this before you complete your application (ERAS)
Don’t assume that they communicate with each other
When you get interview invitations - make sure they know you’re also applying for Research
Track – some have supplemental interview days
Confirm that your interview is for the Research Pathway
Do your homework
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Look up faculty and ongoing research (PubMed)
Determine strengths of institutions based on research being conducted, number and
funding of researchers
Ask as many people as many questions as possible!
Applying for residency
What to think about if you’re in…
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1st/2nd year medical school
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Two most important things
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Find a good lab with a good PI
Step 1 score
Don’t slack off just because you’re MD/PhD
Document your activities – (esp. leadership roles)
Graduate school
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Form a thesis committee and defend your thesis proposal early
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Let Dr. Frohman how things are going on a routine basis – especially if
they are going poorly or are stagnating
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meet frequently – ideally every 6 months
He is your biggest advocate and supporter
Inform Carron and Dr. Frohman of your plans to return to medical
school as soon as you are seriously considering defending
What to think about if you’re in…
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3rd/4th year medical school
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3rd year scheduling
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Your first rotation will be your worst
Complete the rotation in field of interest before September of application year
All rotation sites are not created equal
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Expect to work longer and have less time to study at SBUH
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Learn what you can on the wards but focus on finding time to study
for the shelf
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4th year scheduling
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Completion of a subinternship (sub-I) is a major part of your candidacy
Complete your sub-I before November of application year
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If you did not do your clerkship at SBUH, you should do sub-I at SBUH
Schedule “away” electives if you have the time
Letters of recommendation
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Minimum of 4 needed for residency application
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One from your PI
One departmental letter
Two from attendings
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Preferably from established faculty
One from sub-I attending
Remaining should be from clerkship attendings
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Be safe and ask early for more letters than you will need
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Ask anyone you worked with regardless of duration of contact
Ask for letters during/immediately after contact
No upper limit to number you can keep on file
You choose which letters to use for application
Research Track
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Additional supplemental letters from PI’s familiar with your research
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Committee members are ideal
Applying for residency
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Selecting programs to consider for residency
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University hospitals
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vs. university-affiliated vs. community
Research opportunities
Reputation
Location
Whom to ask for advice?
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MSTP alumni
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Eager to help and best suited to understand your situation
Clerkship directors / SB Residency directors
Mentors
Residents
Last few tidbits of advice
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“Dean’s letter” – Medical Student Performance Evaluation
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You write it, Dean Schiavone edits it, and Dr. Frohman embellishes it
What to look for and expect on interviews
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Be prepared to talk about your research and ANYTHING in your personal
statement and application
Fellowship matching success: a good indicator of how program is perceived
Attending Teaching vs. Private Attendings (& private patients)
Resident satisfaction – take the time to talk to them
Get a feel for the residency program director
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They play a major role in your daily residency experience and fellowship hunt
Thank you letters
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Get business cards from your interviewers AND program directors
Send a thank you letter immediately after your interview
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Make them personal and avoid form letters
Near the end of interview season, send a second letter to directors of your
top programs to show your interest
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Let your number one program know that they are your number one!
Web Resources
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ABIM website – research pathway
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Sample program websites
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Wash U.
Vanderbilt
UCSD
Stanford
Columbia
Einstein
http://meded.im.wustl.edu/application/PSTPFlier.html
http://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfm
http://pstp.ucsd.edu/
http://medicine.stanford.edu/education/scip.html
http://www.cumc.columbia.edu/dept/medicine/residency/tracks.htm
http://www.medicine-residency.org/special_programs/msp/index.html
Residency database
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http://www.abim.org/cert/respath.shtm
www.ama-assn.org/go/freida
Ajit Janardhan
Edward Kim
[email protected]
[email protected]
Web Resources

ABIM website – research pathway
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Sample program websites
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Wash U.
Vanderbilt
UCSD
Stanford
Columbia
Einstein
http://meded.im.wustl.edu/application/PSTPFlier.html
http://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfm
http://pstp.ucsd.edu/
http://medicine.stanford.edu/education/scip.html
http://www.cumc.columbia.edu/dept/medicine/residency/tracks.htm
http://www.medicine-residency.org/special_programs/msp/index.html
Residency database
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http://www.abim.org/cert/respath.shtm
www.ama-assn.org/go/freida
Ajit Janardhan
Edward Kim
[email protected]
[email protected]