The Continuing Fellowship Conundrum

Cytopathology fellowship match: Pros and cons

A cytopathology fellowship match would create an enforced and structured recruitment timeline for the benefit of applicants and programs. Major benefits would include delaying fellowship applications to allow residents to explore different subspecialty areas, a standardized application process for administrative ease, and optimization of matches between applicants and programs based on ranked preferences rather than use of time-limited "exploding offers." The overall gains in efficiency and achieving the primary goals of supporting trainees and recruiting in an equitable and inclusive manner outweigh any downsides to instituting a cytopathology fellowship match. We aim to review the major discussions around this ongoing debate, arriving at the same conclusion as others in the literature that a pan-pathology fellowship match is ideal and that leadership from the Association of Pathology Chairs will be essential in unifying the fractured fellowship recruitment process.

The pathology fellowship application crisis: The current state and suggestions for remediation

Problems within the Pathology fellowship application process in the US have been recognized and reported for years. Recently, members of the Graduate Medical Education Committee (GMEC) of the Association of Pathology Chairs (APC) and collaborators collected survey data from the residents themselves and the fellowship programs, as represented by both the fellowship program directors (members of the Fellowship Directors Ad Hoc Committee, FDAHC) and the program administrators (members of the Graduate Medical Education Administrators Section, GMEAS). These data are presented and discussed, and potential steps to resolve some of the problems around fellowship applications in pathology are presented.

The crisis in the pathology subspecialty fellowship application process: Historical background and setting the stage

The process whereby pathology residents apply for fellowships for subspecialty training after residency has long been fraught with multiple problems. This paper reviews the history of the creation of such fellowships, as tied to requirements for eligibility for certification by the American Board of Pathology, going back to the inception of the Board in 1948. The problems with fellowship applications began to appear in conjunction with changes in Board requirements for basic certification, revolving around the "fifth year" or "credentialing year" requirements, and have created a situation where now residents mostly apply for fellowships while still in the second of their 4-year AP/CP residency. The pressures to apply ever-earlier, to accept offers with short intervals between offer and expiration, and how this damages programs, as well as residents, are reviewed. This paper is a companion to a larger examination of the current status of this problem, which also explores some means to ameliorate or eliminate those problems.

How to Succeed in Fellowship Acquisition: A Survey of Pathology Residents

Medical school curricula limit students’ exposure to pathology practice while pathology subspecialty training programs require residents to apply for fellowships as early as the end of their first year of training. Thus, limited exposure to pathology practice creates significant confusion and anxiety, often making the fellowship application process premature. Additionally, early focus on subspecialty training in order to acquire a fellowship adds to the initial lack of emphasis on general pathology training. We prepared a voluntary online survey with questions developed through focus groups and advice from an expert in survey design to determine which fellowships are desired and how successful residents are in their pursuit of these fellowships. The survey was distributed through the Pathology Residency Program Directors' (PRODS) listserv. Answers were solicited from pathology trainees throughout the entire training cycle. There were 141 (4.6% response rate) total respondents with each postgraduate year represented. One hundred twenty-two (95%) of 129 residents plan on completing 1 or 2 fellowships after residency training. Encouragingly, 94 (75%) of 126 pathology residents attained their desired specialty fellowship. However, 32 (32%) of 99 residents who acquired at least one fellowship chose a general surgical pathology fellowship. Furthermore, 33 (24%) respondents had already decided to pursue a specific specialty while still in medical school. An additional 32 (23%) came to their decision during postgraduate year 1. Therefore, although most residents are successful in attaining their desired fellowship, further research is needed to understand the effect of early commitment to a subspecialty and its impact on pathology education.