ABIM Research Pathway -Applying for Residency

ABIM Research ABIM Research Pathway -Applying Pathway -Applying

for Residencyfor Residency

Ajit JanardhanAjit Janardhan Washington University in St. LouisWashington University in St. Louis

Internal Medicine Residency – Cardiology FellowshipInternal Medicine Residency – Cardiology Fellowship

Edward KimEdward KimUniversity of Michigan University of Michigan

Internal Medicine Residency – Medical Oncology FellowshipInternal Medicine Residency – Medical Oncology Fellowship

Today’s topicsToday’s topics

The ABIM Research PathwayThe ABIM Research Pathway Traditional Pathway vs. Research PathwayTraditional Pathway vs. Research Pathway Differences in structure and application to the Research Differences in structure and application to the Research

Pathway at different institutionsPathway at different institutions Advantages and DisadvantagesAdvantages and Disadvantages

Residency application adviceResidency application advice Timeline: what you should do and when to do itTimeline: what you should do and when to do it Selecting programs and who to ask for adviceSelecting programs and who to ask for advice Miscellaneous tidbits of adviceMiscellaneous tidbits of advice

Open forumOpen forum

The ABIM Research PathwayThe ABIM Research Pathway

Designed by the American Board of Designed by the American Board of Internal Medicine (ABIM) for physicians Internal Medicine (ABIM) for physicians who are devoted to a career in who are devoted to a career in clinical/basic researchclinical/basic research

Who is this designed for? Who is this designed for? MD/PhD’s or those with significant research MD/PhD’s or those with significant research

experienceexperience

Major features:Major features: Shortened length of clinical trainingShortened length of clinical training Protected research time with guaranteed salaryProtected research time with guaranteed salary

Designed to allow physicians to develop research Designed to allow physicians to develop research interests & eventually apply for independent fundinginterests & eventually apply for independent funding

““Traditional” Pathway:Traditional” Pathway:Internal Medicine Residency-Subspecialty Internal Medicine Residency-Subspecialty

FellowshipFellowship Internal Medicine Residency – 3 yearsInternal Medicine Residency – 3 years

Apply for fellowship in 2Apply for fellowship in 2ndnd year of residency year of residency Ph.D definitely helps competitiveness for fellowships– Ph.D definitely helps competitiveness for fellowships–

fellowship programs need fellows to do research (like your PI)fellowship programs need fellows to do research (like your PI)

Subspecialty Fellowships - 2-3 yearsSubspecialty Fellowships - 2-3 years 1-2 years of clinical training1-2 years of clinical training 6-12 months of research time6-12 months of research time Variable degree of protection of research time Variable degree of protection of research time

Fellowship Training Time Fellowship Training Time RequirementsRequirements

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:Traditional” Pathway:Internal Medicine Residency-Subspecialty Internal Medicine Residency-Subspecialty

FellowshipFellowship Internal Medicine Residency – 3 yearsInternal Medicine Residency – 3 years

Apply for fellowship in 2Apply for fellowship in 2ndnd year of residency year of residency Ph.D definitely helps competitiveness – Ph.D definitely helps competitiveness –

fellowship programs need fellows to do research (like your PI)fellowship programs need fellows to do research (like your PI)

Subspecialty Fellowships - 2-3 yearsSubspecialty Fellowships - 2-3 years 1-2 years of clinical training1-2 years of clinical training 6-12 months of research time6-12 months of research time Variable degree of protection of research timeVariable degree of protection of research time

Additional years of research time generally required to Additional years of research time generally required to develop studies that will be independently fundeddevelop studies that will be independently funded NIH K type awards, R01 awardsNIH K type awards, R01 awards

The ABIM Research PathwayThe ABIM Research Pathway

AKA the “short-track” / Physician-Scientist Pathway / AKA the “short-track” / Physician-Scientist Pathway / Medical-Scientist PathwayMedical-Scientist Pathway

The Basics The Basics Internal Medicine Residency shortened to 2 yearsInternal Medicine Residency shortened to 2 years Fellowship training split:Fellowship training split:

Spend minimum time allowable in formal clinical trainingSpend minimum time allowable in formal clinical training Research time extended:Research time extended:

3 years mandatory research time (protected from clinical duties)3 years mandatory research time (protected from clinical duties) Normal research time is 6-12 mo, not always protectedNormal research time is 6-12 mo, not always protected

80% Research, 20% Clinical (to stay current)80% Research, 20% Clinical (to stay current) Clinical time is outpatient subspecialty clinic – NOT Floors, O/N Clinical time is outpatient subspecialty clinic – NOT Floors, O/N

Call Call

These features apply to every program – These features apply to every program – guidelines are set by the American Board of guidelines are set by the American Board of Internal MedicineInternal Medicine

Sample comparison - CardiologySample comparison - Cardiology

Traditional pathwayTraditional pathway1 2 3 4 5 6 7 8

Medicine Resident

1 2 3 4 5 6 7 8

Medicine Resident Clinical fellow Research

ABIM Research pathwayABIM Research pathway

1 2 3 4 5 6 7 8

Medicine Resident Clinical fellowResearch

Alternate ABIM Research pathwayAlternate ABIM Research pathway

Cardiology Fellowship Research (& Clinical…)

Research (& Clinical…)

Advantages of the Research PathwayAdvantages of the Research Pathway Shortened length of general Internal Medicine clinical trainingShortened length of general Internal Medicine clinical training

Still do entire length of required CLINICAL fellowship training Still do entire length of required CLINICAL fellowship training

Begin research soonerBegin research sooner Increased time to set up research projects, produce publishable Increased time to set up research projects, produce publishable

data, write grantsdata, write grants

Truly protected research timeTruly protected research time No overnight call, no backup, no consultsNo overnight call, no backup, no consults

Big deal if you’re trying to do experiments to know you won’t be Big deal if you’re trying to do experiments to know you won’t be disturbeddisturbed

20% clinical / 80% research split allows you to stay current 20% clinical / 80% research split allows you to stay current clinicallyclinically

Fellowship secured earlierFellowship secured earlier Stability allows better planning of personal lifeStability allows better planning of personal life

Inside track to faculty positionsInside track to faculty positions Most institutions view this program as a means to develop facultyMost institutions view this program as a means to develop faculty

Disadvantages of the Research Disadvantages of the Research PathwayPathway

Loss of 1 year of IM clinical trainingLoss of 1 year of IM clinical training

Must choose subspecialty 1 year earlyMust choose subspecialty 1 year early

Waste of time if you ultimately choose a Waste of time if you ultimately choose a purely clinical positionpurely clinical position

““Another long *!&*!&%* program!!”Another long *!&*!&%* program!!”

Why do institutions participate in Why do institutions participate in these programs?these programs?

Nationally recognized need for physician-Nationally recognized need for physician-scientistsscientists Same justification as NIH-funded MSTPsSame justification as NIH-funded MSTPs

Much cheaper to hire future faculty from within Much cheaper to hire future faculty from within than from other institutionsthan from other institutions Average cost of recruiting faculty is greater than Average cost of recruiting faculty is greater than

$1,000,000$1,000,000

Fellowship programs get an early crack at people Fellowship programs get an early crack at people who have a proven ability to carry out research who have a proven ability to carry out research

Prestige Prestige looks good for the residency and fellowship programslooks good for the residency and fellowship programs

Major categories of programsMajor categories of programs

Match, then apply to Research Pathway in year 1 Match, then apply to Research Pathway in year 1 of IM Residencyof IM Residency No guarantees of acceptance to Research Pathway No guarantees of acceptance to Research Pathway

(limited slots)(limited slots) No guarantees of acceptance to particular fellowshipNo guarantees of acceptance to particular fellowship If accepted to Research Pathway, one can generally get If accepted to Research Pathway, one can generally get

a fellowship at same institutiona fellowship at same institution Allergy/Cards/GI vs. Oncology vs. ID/Rheum/EndoAllergy/Cards/GI vs. Oncology vs. ID/Rheum/Endo

Match directly to Research PathwayMatch directly to Research Pathway Program guarantees Research Pathway upfrontProgram guarantees Research Pathway upfront Must apply for specific fellowship in year 1 of IM Must apply for specific fellowship in year 1 of IM

residencyresidency Match directly to Research Pathway - FellowshipMatch directly to Research Pathway - Fellowship

Program guarantees Research Pathway AND Fellowship Program guarantees Research Pathway AND Fellowship upfrontupfront

Major differences between institutionsMajor differences between institutions

Number of positions earmarked for ABIM Research Number of positions earmarked for ABIM Research PathwayPathway Accepting a (ABIM Research Pathway) Participant means Accepting a (ABIM Research Pathway) Participant means

sacrificing one 3sacrificing one 3rdrd yr IM Resident in the residency program yr IM Resident in the residency program Participants only do 2 yrs IM residencyParticipants only do 2 yrs IM residency

Participants spend less time overall in fellowship trainingParticipants spend less time overall in fellowship training This means fellowship must hire more fellows to account for your This means fellowship must hire more fellows to account for your

absence from clinical serviceabsence from clinical service Each Participant is guaranteed a salary for 3 yrs of funded Each Participant is guaranteed a salary for 3 yrs of funded

research research Thus, it is advantageous to go to a well-funded Dept. of Thus, it is advantageous to go to a well-funded Dept. of

MedicineMedicine

Talking the talk vs. Talking the talk vs. Walking the walkWalking the walk Actual number of people who do join the Research Pathway Actual number of people who do join the Research Pathway

each year?each year?

Incentives Incentives Money for supplies and salary supplementMoney for supplies and salary supplement Costs of attending meetings & conferencesCosts of attending meetings & conferences

Other important pointsOther important points

Who offers it? Who offers it? University-Based Teaching Hospitals that draw large University-Based Teaching Hospitals that draw large

amounts of research fundingamounts of research funding

Organization and FundingOrganization and Funding Some are well organized, formal programs with budgets, Some are well organized, formal programs with budgets,

others are put together on an ad-hoc basis (less desirable)others are put together on an ad-hoc basis (less desirable) Some have a program director & committee that guide Some have a program director & committee that guide

your careeryour career

SupportSupport Research-committed vs Research-supportive vs Research-Research-committed vs Research-supportive vs Research-

permissivepermissive Some programs have the support of the chair & facultySome programs have the support of the chair & faculty

What’s the Bottom line?What’s the Bottom line?

This program is designed with MD/PhD’s This program is designed with MD/PhD’s in mind to facilitate their entry into in mind to facilitate their entry into academic medicineacademic medicine

If you are considering an academic If you are considering an academic medical career – you WILL need to do medical career – you WILL need to do substantive research beyond the Ph.D.substantive research beyond the Ph.D.

The ABIM research pathway gets you into The ABIM research pathway gets you into the lab more quickly and protects & funds the lab more quickly and protects & funds your research timeyour research time

How do you know if this is right How do you know if this is right for you?for you?

Determine your goals and prioritiesDetermine your goals and priorities Are you interested in a career consisting of Are you interested in a career consisting of

Research only, Research & Patient Care, or Patient Research only, Research & Patient Care, or Patient Care only?Care only?

Do you have an interest in a particular field of Do you have an interest in a particular field of medicine?medicine?

Your thesis topic need not relate to your fellowship field Your thesis topic need not relate to your fellowship field Perfectly acceptable to not know your field of interestPerfectly acceptable to not know your field of interest

Do you want the guarantee of the Research Track Do you want the guarantee of the Research Track or Research Track - Fellowhip?or Research Track - Fellowhip?

Would you prefer the stability of knowing where Would you prefer the stability of knowing where you’ll be located for residency and fellowship?you’ll be located for residency and fellowship?

What to do if you’re interestedWhat to do if you’re interested

Incorporate your interest in research into your personal statementIncorporate your interest in research into your personal statement Be as specific as possible: disease, areas of investigation, etc.Be as specific as possible: disease, areas of investigation, etc.

Letter writers should know you’re interested in academic medicine Letter writers should know you’re interested in academic medicine Especially true for your PIEspecially true for your PI

Contact Research Pathway directors – let them know you’re Contact Research Pathway directors – let them know you’re INTERESTED!INTERESTED! Email addresses are usually listed on websites – end of 3Email addresses are usually listed on websites – end of 3rdrd year year

Do this before you complete your application (ERAS)Do this before you complete your application (ERAS) IM Residency director and Research Pathway director are rarely the IM Residency director and Research Pathway director are rarely the

samesame Don’t assume that they communicate with each otherDon’t assume that they communicate with each other When you get interview invitations - make sure they know you’re also When you get interview invitations - make sure they know you’re also

applying for Research Track – some have supplemental interview daysapplying for Research Track – some have supplemental interview days Confirm that your interview is for the Research PathwayConfirm that your interview is for the Research Pathway

Do your homeworkDo your homework Look up faculty and ongoing research (PubMed)Look up faculty and ongoing research (PubMed) Determine strengths of institutions based on research being Determine strengths of institutions based on research being

conducted, number and funding of researchersconducted, number and funding of researchers Ask as many people as many questions as possible!Ask as many people as many questions as possible!

Applying for Applying for residencyresidency

What to think about if you’re in…What to think about if you’re in…

11stst/2/2ndnd year medical school year medical school Two most important thingsTwo most important things

Find a good lab with a good PIFind a good lab with a good PI Step 1 scoreStep 1 score

Don’t slack off just because you’re MD/PhDDon’t slack off just because you’re MD/PhD Document your activities – (esp. leadership roles)Document your activities – (esp. leadership roles)

Graduate schoolGraduate school Form a thesis committee and defend your thesis proposal Form a thesis committee and defend your thesis proposal

earlyearly meet frequently – ideally every 6 monthsmeet frequently – ideally every 6 months

Let Dr. Frohman how things are going on a routine basis – Let Dr. Frohman how things are going on a routine basis – especially if they are going poorly or are stagnatingespecially if they are going poorly or are stagnating

He is your biggest advocate and supporterHe is your biggest advocate and supporter Inform Carron and Dr. Frohman of your plans to return to Inform Carron and Dr. Frohman of your plans to return to

medical school as soon as you are seriously considering medical school as soon as you are seriously considering defendingdefending

What to think about if you’re in…What to think about if you’re in…

33rdrd/4/4thth year medical school year medical school 33rdrd year scheduling year scheduling

Your first rotation will be your worstYour first rotation will be your worst Complete the rotation in field of interest before September of Complete the rotation in field of interest before September of

application year application year All rotation sites are not created equalAll rotation sites are not created equal

Expect to work longer and have less time to study at SBUHExpect to work longer and have less time to study at SBUH

Learn what you can on the wards but focus on finding time Learn what you can on the wards but focus on finding time to study for the shelfto study for the shelf

44thth year scheduling year scheduling Completion of a subinternship (sub-I) is a major part of your Completion of a subinternship (sub-I) is a major part of your

candidacycandidacy Complete your sub-I before November of application yearComplete your sub-I before November of application year

If you did not do your clerkship at SBUH, you should do sub-I at SBUHIf you did not do your clerkship at SBUH, you should do sub-I at SBUH Schedule “away” electives if you have the timeSchedule “away” electives if you have the time

Letters of recommendationLetters of recommendation

Minimum of 4 needed for residency applicationMinimum of 4 needed for residency application One from your PIOne from your PI One departmental letterOne departmental letter Two from attendingsTwo from attendings

Preferably from established faculty Preferably from established faculty One from sub-I attendingOne from sub-I attending Remaining should be from clerkship attendingsRemaining should be from clerkship attendings

Ask anyone you worked with regardless of duration of contactAsk anyone you worked with regardless of duration of contact Ask for letters during/immediately after contactAsk for letters during/immediately after contact

Be safe and ask early for more letters than you will Be safe and ask early for more letters than you will needneed

No upper limit to number you can keep on fileNo upper limit to number you can keep on file You choose which letters to use for applicationYou choose which letters to use for application

Research TrackResearch Track Additional supplemental letters from PI’s familiar with your Additional supplemental letters from PI’s familiar with your

researchresearch Committee members are idealCommittee members are ideal

Applying for residencyApplying for residency

Selecting programs to consider for Selecting programs to consider for residencyresidency University hospitalsUniversity hospitals

vs. university-affiliated vs. communityvs. university-affiliated vs. community Research opportunitiesResearch opportunities ReputationReputation LocationLocation

Whom to ask for advice?Whom to ask for advice? MSTP alumniMSTP alumni

Eager to help and best suited to understand your Eager to help and best suited to understand your situationsituation

Clerkship directors / SB Residency directors Clerkship directors / SB Residency directors MentorsMentors ResidentsResidents

Last few tidbits of adviceLast few tidbits of advice ““Dean’s letter” – Medical Student Performance EvaluationDean’s letter” – Medical Student Performance Evaluation

You write it, Dean Schiavone edits it, and Dr. Frohman embellishes You write it, Dean Schiavone edits it, and Dr. Frohman embellishes itit

What to look for and expect on interviewsWhat to look for and expect on interviews Be prepared to talk about your research and ANYTHING in your Be prepared to talk about your research and ANYTHING in your

personal statement and applicationpersonal statement and application Fellowship matching success: a good indicator of how program is Fellowship matching success: a good indicator of how program is

perceivedperceived Attending Teaching vs. Private Attendings (& private patients)Attending Teaching vs. Private Attendings (& private patients) Resident satisfaction – take the time to talk to them Resident satisfaction – take the time to talk to them Get a feel for the residency program directorGet a feel for the residency program director

They play a major role in your daily residency experience and fellowship They play a major role in your daily residency experience and fellowship hunthunt

Thank you lettersThank you letters Get business cards from your interviewers AND program directorsGet business cards from your interviewers AND program directors Send a thank you letter immediately after your interview Send a thank you letter immediately after your interview

Make them personal and avoid form lettersMake them personal and avoid form letters Near the end of interview season, send a second letter to directors Near the end of interview season, send a second letter to directors

of your top programs to show your interestof your top programs to show your interest Let your number one program know that they are your number Let your number one program know that they are your number

one!one!

Web ResourcesWeb Resources

ABIM website – research pathwayABIM website – research pathway http://www.abim.org/cert/respath.shtmhttp://www.abim.org/cert/respath.shtm

Sample program websitesSample program websites Wash U.Wash U. http://http://meded.im.wustl.edu/application/PSTPFlier.htmlmeded.im.wustl.edu/application/PSTPFlier.html Vanderbilt Vanderbilt

http://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfmhttp://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfm UCSD UCSD http://pstp.ucsd.edu/http://pstp.ucsd.edu/ Stanford Stanford http://medicine.stanford.edu/education/scip.htmlhttp://medicine.stanford.edu/education/scip.html Columbia Columbia http://http://

www.cumc.columbia.edu/dept/medicine/residency/tracks.htmwww.cumc.columbia.edu/dept/medicine/residency/tracks.htm Einstein Einstein

http://www.medicine-residency.org/special_programs/msp/index.htmlhttp://www.medicine-residency.org/special_programs/msp/index.html

Residency databaseResidency database www.ama-assn.org/go/www.ama-assn.org/go/freidafreida

Ajit JanardhanAjit Janardhan [email protected]@gmail.com Edward KimEdward Kim [email protected]@gmail.com

Web ResourcesWeb Resources

ABIM website – research pathwayABIM website – research pathway http://www.abim.org/cert/respath.shtmhttp://www.abim.org/cert/respath.shtm

Sample program websitesSample program websites Wash U.Wash U. http://meded.im.wustl.edu/application/PSTPFlier.htmlhttp://meded.im.wustl.edu/application/PSTPFlier.html Vanderbilt Vanderbilt

http://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfmhttp://medicine.mc.vanderbilt.edu/harrison/q4paharrison.cfm UCSD UCSD http://pstp.ucsd.edu/http://pstp.ucsd.edu/ Stanford Stanford http://medicine.stanford.edu/education/scip.htmlhttp://medicine.stanford.edu/education/scip.html Columbia Columbia

http://www.cumc.columbia.edu/dept/medicine/residency/tracks.htmhttp://www.cumc.columbia.edu/dept/medicine/residency/tracks.htm Einstein Einstein

http://www.medicine-residency.org/special_programs/msp/index.htmlhttp://www.medicine-residency.org/special_programs/msp/index.html

Residency databaseResidency database www.ama-assn.org/go/www.ama-assn.org/go/freidafreida

Ajit JanardhanAjit Janardhan [email protected]@gmail.com Edward KimEdward Kim [email protected]@gmail.com

ABIM Research Pathway -Applying for Residency

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