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Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
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The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
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by Philip Masters, MD, FACP
Director, Clinical Content Development
During the second year of residency training, most trainees
start to make a decision about whether to pursue a fellowship
immediately after their residency. This is an important decision
because whether you are considering fellowship application may
affect scheduling of rotations and other activities during the rest
of your residency, particularly to accommodate program visits and
interviews. Others may choose to defer this decision to a later
point in their residency, although this will mean that there will
be a gap between completing your residency training and the start
of a fellowship. Some individuals find this attractive as it
provides an opportunity for a year (or more) of practice experience
prior to starting more advanced training.
All internal medicine fellowships participate in the
subspecialty match offered through the National Residency Matching Program (NRMP). The
Match opens for submission of applications around the start of the
third year of residency with interviews occurring until
mid-November when rank lists must be submitted. Match day for
subspecialty fellowships is in early December of your third year,
approximately 6 months before the start of the fellowship
When considering whether to pursue fellowship training, it is
important to consider these questions:
Unfortunately, the decision about whether to pursue subspecialty
training occurs relatively early in residency training and is
therefore often made with limited information. Many residents make
a decision on a subspecialty career based primarily upon their
subspecialty hospital experience or association with an exciting
role model. Be sure to gain ambulatory or community experience in
the subspecialty that interests you before making a career decision
as this will better reflect what subspecialists in that area do
away from inpatient or academic settings. Also, try to have contact
with more than one role model before making career decisions;
looking at the subspecialty from many points of view can avoid
It is also important to not pursue subspecialty training
primarily because you do not find the practice options for general
internal medicine (such as ambulatory or primary care) appealing.
Pursuing subspecialty training is a major career and life decision,
and should therefore be based upon your overall personal and
professional goals and not primarily on excluding other career
options. Many trainees who are undecided choose to delay the
decision about subspecialty training and take the opportunity to
work in one or more areas of general internal medicine to clarify
whether they truly want to subspecialize.
Additionally, it is important to consider the practical
landscape of fellowship training. Some subspecialty areas are more
popular and therefore more competitive than others, and this may
influence your decision making. Practical information about the
number of fellowship training slots is available on the American Board of Internal Medicine website and from
individual subspecialty societies.
If you do choose to apply for fellowship training, it is
important for you to assess your qualifications and seek to
optimize your credentials for fellowship training. First and
foremost, it is critical that you do well in your general medicine
residency program. Your overall performance evaluation in your
residency and recommendations from your program director and
program leadership are one of the most influential parts of the
fellowship application. It is also important to find a mentor in
your institution in the subspecialty area in which you are
applying. Different fellowships have unique requirements and
expectations, and it is extremely valuable to have guidance from
someone who knows that particular system well. This person and
others within the subspecialty division at your institution will
likely be helpful in ensuring that your training and experience
during residency will position you well for fellowship application
in that area.
You may also wish to visit or perform an elective rotation in a
particular institution where you are interested in applying. While
not usually necessary, this may provide both you and the program
with additional information and perspective about your interest and
qualifications for training. Lastly, it is important that you
interview well (see the article in this series on Tips for the First
Interview). Factors such as performance on the USMLE, US
citizenship, and completing a residency program with a specific
institution are much less important to fellowship program
directors. If these are concerns for you, discuss them with your
residency program director and subspecialty mentor who may be
helpful in addressing them.