The leap from residency to fellowship: How to apply and interview

By Naveed Saleh, MD, MS
Published March 25, 2022

Key Takeaways

  • Residents interested in a fellowship should start preparing a year before applying and perform at least one rotation in their subspecialty field of choice. 

  • Letters of recommendation (LORs) should expand on why you are a good candidate and not rehash your CV. Remember to request LORs early—attendings are busy people!

  • Prepare for your interview by understanding the program, formulating answers regarding your strengths and difficulties, and dressing impeccably. 

An increasing number of residents are applying for fellowships. According to the National Resident Matching Program (NRMP) Specialties Matching Service[] (SMS), the 2022 cohort was the largest in history, with 11,078 positions filled across all specialties included. In total, 4,407 programs (81.1%) filled all of their available slots, with 11,078 of 13,586 active applicants matching.

For those thinking about making the leap from residency to fellowship, we’ve gleaned some tips from various sources to help you on your journey.

Plan early

Applying to fellowship is a process that begins the year before you apply, according to NEJM Resident 360.[] Important steps include deciding on a subspecialty and doing at least one rotation in your desired subspecialty.

If you’re unsure what subspecialty you want to pursue, there are ways to help you find out.

Good resources to consult are advisors and mentors in your residency program. You can also do a few rotations in fields of interest, with a possible balance between ambulatory and inpatient settings, to see what best suits you.

Contribute to research

Research projects can be key when applying to research-oriented fellowship programs.

Doing research during residency is particularly important if you want to become a clinician researcher yourself.

You can also author case reports or case series to boost your prospects, especially if you are leaning toward a career in nonclinical areas such as health policy or hospital administration.

Consider taking a year off from training

It’s possible that taking a year off from your training path can enhance your prospects of garnering a residency position. Good choices for this year off include becoming a chief resident, doing a year of research, or becoming a hospitalist. Beware, however, of taking too much time off, which can be viewed as possibly diminishing your clinical skills. If you do decide to take time off, be prepared to discuss this decision in your personal statement and during the interview.

Gauge your programs of interest

Most fellowship programs utilize the Electronic Residency Application Service (ERAS). It’s a good idea to review the ERAS site in detail, along with fellowship program websites, to familiarize yourself with the components of the application (eg, CV, personal statement, LORs). Plan to gather and work on these materials in the months before application.

Choosing which programs to apply to depends on various factors, including your competitiveness, type of training (academic vs community), and your career goals. If you experienced certain academic struggles in medical school or residency, it may be a good idea to apply broadly.

Hone your application materials

With regard to application materials, you’ll want to start requesting LORs early on, because attendings are busy people and need time to craft a good letter. When requesting an LOR writer, think of who can meaningfully present your abilities and positive qualities. Avoid LORs that merely rehash your CV. 

In addition to an LOR from your residency program director, try to secure at least three additional LORs. At least one letter should be from a subspecialist in your field of choice, with others coming from research project supervisors, primary care physicians, and other specialists.

Although the CV and LORs may be the most important when applying, the personal statement is important, too. It can infuse your application with your own personal voice and pull all of your experience and personal characteristics together.

Make sure to have others take a look at your application to make sure it is free of errors.

Faculty at your program are highly skilled at editing personal statements.

When writing a personal statement, try to highlight why you are a strong candidate for the program and why you are prepared to have a successful career based on your experiences and achievements.  explanations of gaps or struggles that could be negatively construed unless they are satisfactorily explained.

Knock the interview out of the park

As the maxim goes, you only get one chance to make a first impression. Infectious disease faculty at the University of Nebraska Medical Center offer some good advice[] on acing the fellowship interview: 

  • Relax and be yourself.

  • Be truthful and don’t provide pat or contrived answers to please your interviewer.

  • Understand the program, and ask relevant questions about its educational practices.

  • Research the faculty who are interviewing you.

  • Prepare yourself to discuss your strengths/weaknesses, interests, and career plans.

  • Be prepared to explain academic struggles.

  • Treat everyone you encounter during the interview with kindness and respect.

Keep in mind that not only are you being interviewed by the fellowship program, but you also are screening the program itself to decide whether it is the right destination on your career journey.

Ask yourself whether this program will prepare you for your career goals and whether you will be happy there.

Dress to impress

In addition to preparing your answers and ideas for the interview itself, experts[]recommend dressing neatly in a clean, pressed dark suit, even if you know that the residents in that program dress casually. It is often better to be overdressed than to be underdressed.

The interview is essentially a business meeting, and should be treated as such. The idea is that you should be memorable, not your clothes.

What this means for you

Fellowship is the last stop on your accomplished academic journey. As with anything worth the effort, preparation is key. Leverage the support of your colleagues, attendings, and mentors to make the most of the application process. With proper preparation, success is attainable.

Read Next: Post-residency transitions: Choosing your next steps
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