Pediatric EM, Pediatric Fellowships, COVID-19

The Road to PEM Fellowship During a Pandemic: A Conversation about Applying Virtually

While applying to fellowship in the best of times can be stressful, the 2020 application cycle was uniquely different in that all interviews were held virtually. Navigating this uncharted territory was stressful for both applicants and programs alike.

At the moment, it appears likely the 2021 cycle will also be virtual for most programs. To help PEM fellowship applicants embarking on this journey, we sat down with recently matched PEM fellows from 2020 to discuss the process of applying for fellowship virtually. Dr. Cindy Chang (CC) completed her EM residency at Los Angeles County Harbor-UCLA and recently matched at Cincinnati Children’s Hospital for PEM Fellowship. Dr. Michelle Davis (MSD) completed her EM residency at Rutgers New Jersey Medical and recently matched for PEM fellowship at Maimonides Medical Center. Both interviewed at programs throughout the country and were excited to share their experiences with this unprecedented application cycle. 

Q: Did you end up applying to more places than you originally intended due to covid? Do you wish you had applied to more or less?CC: I did apply to a few more programs than I originally planned to - part of it was the uncertainty with COVID, and unsure of how difficult it would be to match as an EM applicant. In retrospect, I wish I had applied to a few less. You do meet amazing people/future colleagues on the interview trail, but interviews are exhausting (or maybe I’m just getting old compared to when applying for residency!).

MSD: I applied to more programs than I originally intended, not because of the pandemic, but due to the competitive nature of matching into PEM. Originally, I intended to limit my application pool to certain geographic regions and ended up applying across the country to ensure that I would match into a fellowship program.  I’m glad that I did because the program that was my best fit, and ultimately where I matched, was not located back home.

Q: How did you get a feel for the programs since you couldn’t go see them in person?
CC: I asked a lot of questions to EM/PEM and Peds/PEM mentors, and current fellows. There are a lot of EM-trained specific questions that you should ask and have answered at each program you interview at. Any program that is seriously considering training you will make the time to answer any questions you may have that are specific to you. Even though the interview was virtual this past season, you still get a good feel for the culture of the program through interacting with the faculty and fellows on interview day. I also connected with some current fellows and alumni outside of the interview day, everyone was very kind to phone/Zoom chat, answer questions, and offer advice! 

MSD: Despite all the online research and reaching out to my PEM faculty, mentors, and networks, I found that the best way to get a feel for programs was meeting the PD, faculty, and fellows virtually.  Getting to know the people and program’s culture were the most important factors for me since each program’s clinical experiences and academic expectations are universally the same thanks to ACGME standardization.

Q: What do you think is the best way for programs to get a sense of an applicant without meeting them in person?
CC: I think it’s important to present the best paper application possible, it should convey your story, no one else’s. Update your CV throughout residency so that it’s easier to fill in ERAS when the time comes. Make things easy to read, I like using bullet points for each activity on ERAS. Write a thoughtful, strong personal statement - have many people read it and give you feedback. Get strong letters of recommendations from PEM people, letters probably carry the strongest weight. And then in the interview, just be you :). It’s very conversational, anticipate what you will be asked and have thoughtful questions. No one should know your application better than you. 

MSD: Reflecting on my experience, I think my letters of recommendation, personal statement, and CV conveyed a unified story of who I am, why I want to pursue a career in PEM, and what I can contribute to the field.  Many interviewers commented on how they appreciated the honesty, conciseness, and vision that came forth in my application, which helped them to get to know me.  It gave my interviewers a baseline familiarity with me during our virtual conversations, which helped take the edge off the stress of interviewing on a novel platform.

Q: What are some tips for acing a virtual interview?
CC: Just be you. Make sure the lighting is good, otherwise I didn’t do much else besides having a white background. Do wear a full suit. You can probably invest in having a nicer looking background to make it unique!

MSD: Spend the money on a good webcam, microphone, and light stand - interviewers notice those details! I also recommend doing some research on how to stage a professional setting either at home or at your residency’s academic offices because the aesthetics of your webcam setting will definitely be a conversation starter during your interviews. Wear a full suit, including a belt and dress pants, just try to relax and be yourself as is appropriate. Interviewers want to get to know you and hear about your professional as well as personal activities, like that new bread baking hobby you developed during quarantine.  

Q: Looking back, would you have done anything differently?
CC: No, I'm just sad you only get to match at one place - there are so many wonderful people at each program that would be lovely to work with and learn from. Honestly, no matter where the algorithm would have thrown me, professionally I’m sure I would have been happy at any of the places I ranked. 

MSD: No, I would not have done anything differently. I’m very happy that I matched at a place where I will fit in comfortably, and I look forward to professionally growing with them in the next few years. I’m especially grateful that the match worked out well for me considering how incredibly competitive and unusual this past application cycle was.

Q: With the match being more competitive this past year and Children’s hospitals seeing lower volumes, would you consider delaying fellowship until after the pandemic? 
CC: No, just try to match at a place that sees a large volume of children and variety in pathology.

MSD: I think the conventional wisdom of doing fellowship right after residency still stands.  It becomes really difficult to secure letters of recommendations the farther away you are from training. I can also see how hard it must be to give up an attending salary to go back to a resident salary if you delay fellowship. In light of the pandemic, doing a fellowship sooner rather than later may be necessary to give job seekers the competitive edge they need now that the EP job market is going through some painful economic downsizing and reconfigurations across the country.

Q: What most surprised you about this past application cycle?
CC: Initially, I was concerned that the virtual interviews would make it difficult to truly grasp the culture of a program, but it actually wasn’t. I think as emergency physicians, we are used to meeting people and forming relationships quickly, while building trust all at the same time. I was surprised that it wasn’t that difficult figuring out which places would be a better fit for me.

MSD: I was most surprised by how flexible and transparent program leadership was during this past application cycle. They were literally reinventing the wheel with the virtual-only format, which I think attributed to this sense of being more flexible and transparent than they may have been in a more traditional format. I also was very surprised by the great career advice and mentorship offered by my interviewers during this past cycle. Through that experience, I could tell how connected and supportive the PEM community was, which very much validated my decision to pursue fellowship training and join this community.

Q: Did you/were you able to do an away rotation? Would you recommend it?
CC: No. I think it depends on your situation. If you don’t have a PEM program/faculty at your residency program, then you probably should do an away rotation. 

MSD: I did not do an away rotation since my residency program has a dedicated pediatric ED and a robust NICU rotation in our curriculum. I would not recommend doing one since it does not add much to your application or chances of matching. Doing an away rotation is only necessary if your residency does not have a pediatric ED or PEM faculty to write you letters of recommendation.

Q: If you could pass on one piece of advice to a 2021 applicant what would it be?
CC: Just be you, share who you are, what drives you, why you love PEM and why you want it to be a significant part of your career. Remember too that the purpose of the interview is also for you to figure out if you like them, their culture, and if you will be supported and valued as an EM-trained fellow. It goes both ways and everyone wants a win-win situation in the end. 

MSD: Take a deep breath, try to relax, and have fun on the interview trail. Be proud of all of your accomplishments and hard work, and let that shine in your application and interviews. You have made an excellent decision to join the kind, close-knit, and exciting world of pediatric emergency medicine so enjoy!

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