to compensate for this liability. This is
especially relevant in less traditional subspecial-
ties, such as fertility.
Currently, there is increasing pressure to
standardize subspecialty educational pro-
grams and create a matching process in this
area, as for residencies. This effort is geared
to enhance the overall quality control of
fellowship offerings. It already exists in some
of the internal medicine subspecialties and is
now impacting on other areas, such as
radiology and pediatrics. Gradually, the number
of free-standing programs will be
reduced as accreditation of fellowship programs
increases.
Obtaining a Fellowship
To obtain an attractive fellowship requires
careful strategic planning. Standards for fel-
lowship applicants vary. Program directors are
quite selective and competition for an
appointment is keen. Completing a residency at
an institution where the fellowship is
offered can usually give the applicant an edge.
The disadvantage in continuing at the
same institution is that the fellow receives
rather narrow training, since the fellow is in
contact with the same attending as in the
residency, and the opportunity to expand con-
tacts is limited. If one anticipates ultimately
seeking a fellowship, the residency training
should at least be at an institution that has a
good track record of its residents securing
fellowships. Thus, the site of one's residency
training is one major critical factor in the
process of finding suitable subspecialty
training.
A second strategic consideration is selecting
appropriate faculty to provide letters of
recommendation. The goal is to receive these
from the people you worked with and who
are prepared to write as strongly as possible
in your behalf. The impact of a favorable
letter is significantly influenced by the
stature of the author of the letter. Obviously, a
department chair's letter has greater
credibility than one from a junior faculty member.
Similarly, a positive impact can be made by a
letter from a prominent person in the spe-
cialty or a known acquaintance of the
fellowship program director. Completing an elec-
tive in the prospective area of
subspecialization can facilitate obtaining helpful letters
of
recommendation.
Of special importance is the interview and
interpersonal and communication skills that
the candidate demonstrates. Showing that you
are open-minded, flexible, and enthusiastic,
and that you are amenable to open discussion of
issues will enhance your chances to secure
a fellowship.
IMPROVING POSTGRADUATE TRAINING
The long-established system of clinical
education is one in which senior physicians
serve as instructors to their junior
colleagues. This apprentice system may be flawed by
the fact that mentor physicians often lack
formal training as educators. This weakness
impacts directly on the atmosphere and ultimate
success of the learning process. As a
result of the increased awareness that many
physicians are deficient in teaching skills, a
few medical schools, residency programs, and
continuing education seminars are pro-
viding opportunities to remedy this situation.
Physicians are learning the basics of good
teaching, such as how to create a positive
learning climate, how to enhance learner
retention, and how to evaluate learner
performance.
There are many skeptics, especially among older
physicians, who question the need
and value of teaching physicians how to teach.
Some of the younger doctors believe that
clinical teaching is a basic medical skill that
is as valuable as physical diagnosis or his-
tory taking.
Providing teaching skills to physicians is
hampered by the fact that it is not a grant-
funded area and does not generate patient
revenue. In addition, it is not formally encour-
aged by the medical establishment but is the
driving force of some individual medical
school faculty members. While not yet
widespread, support for their efforts is gaining
momentum.
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