Senior Resident

When deciding and preparing to apply for a fellowship, continue the projects and exploration from before. Try to finish up projects and ease up on starting new ones as you ramp up to application season. Remember that quality generally trumps quantity - it is generally better to be able to talk about a few completed projects in detail and demonstrated impact rather than an exorbitant number of recently started or unfinished projects. You should also begin to weave a cohesive narrative for your interests in clinical informatics (CI) and tie them to projects and activities you've participated in in the past. Use this to help decide what projects to take on in the last year(s) of residency. Some relevant conferences include:

• Society for Academic Emergency Medicine (SAEM)
• Epic Expert Group Meetings (XGM)
• American Medical Informatics Association (AMIA) Clinical Informatics Conference (CIC)
• Epic User Group Meetings (UGM)
• American College of Emergency Physicians (ACEP) Scientific Assembly
• AMIA Annual Symposium
• Healthcare Information and Management Systems Society (HIMSS)

Application Timeline

February-April

• If you are able to plan your final year's block schedule, try to place easier rotations for interview season (September-November).
• Identify your letter of recommendation authors to give them an early start.
• If you have a specific program you want to be at, reach out to current fellows/program leadership to set up a meeting to discuss how you can maximize your chances to match there or to explore the possibility of an away rotation.
• Start drafting your personal statement.

April-June

• Start to research programs and keep a running list or spreadsheet of pros/cons, salary, expected clinical time, etc.
• Finalize and notify your letter of recommendation authors if you haven't yet.
• Request your ERAS fellowship token for the July application cycle and register at MyERAS.
• Finalize your personal statement.
• Start submitting documents to the ERAS Fellowship Documents Office (EFDO) because they can take up to five business days to process to ERAS after they are uploaded (ERAS photos will usually update at midnight EST of the day you upload).

July

• Submit your ERAS application in early/mid-July. Programs will NOT be able to access your application and documents until mid-July, so you can submit any time before then - any submissions after that deadline will be timestamped.
• Early interview invites will start to roll in in late July.

August-November

• The bulk of interview invites will occur in late July through late September, with final invites trickling in throughout October. Interviews will start in August but most will occur September-November.
• As you go on your interviews, think about some important questions to consider (see below).
• In November, you should go on second looks (some programs offer help with setting up in-person site visits) and schedule additional interviews with other faculty/staff if you want more information.
• Start to make multiple iterations of your rank list based on different factors that are important to you until you're happy with your final list.
• Sign up for an AMIA student membership so that you can participate in the match.

December

• Finalize and submit your rank list in early December. You can send a letter of intent to your number one program before the program's deadline if you want.
• Start to compile licensing documents if you aren't already licensed in the state you matched in.

Questions and Factors to Consider when Evaluating Programs and Interviewing

•  What department is the program housed in? CI is unique in that the fellowship training program can be housed in a variety of different specialty departments, ranging from pediatrics to pathology. While this will certainly influence your experience, many of the best programs may be housed in a department outside of our clinical background, which is perfectly fine. Your fellowship will work with you to ensure that you are practicing clinically in your clinical "home" if this is not the same as the fellowship department.
• How important is traditional academic research? Not all programs have the same expectations or resources for academic research. There are many great programs that are not heavily focused on academic output - operational-first programs will have plenty of hands-on project experience as well as business, project management, and financial exposure, and may set you up well for a Chief Medical Information Officer (CMIO) role. Note that if you want a job in academic emergency medicine (EM) after fellowship graduation, having research experience will be important.
• How many fellows per year? What kind of fellows do you take? In addition to different total slots per year, some programs may have fluctuating support every year. Many programs can only support fellows from certain specialties, and some programs even have rotating specialty sots (e.g., taking surgery trainees on odd years and EM trainees on even years).
• Where is the program? Beyond choosing where you want to live for the next two years, the biggest factor influencing job offers after fellowship graduation is through your network and the kind of jobs available in your geographic area. A program in a larger metropolitan area tends to give you more flexibility and variety in job offers, but may also face a more saturated market.
• How old is the program? An older program has a larger existing network, which is important for getting job offers. A newer program may experience growing pains but potentially can allow for more freedom in "choosing your own experience."
• How many CI faculty are there? What is their clinical background? How senior are they? Having core CI faculty from a variety of clinical specialties (not just in EM) opens up more opportunities for projects and cross-collaboration. Having faculty across the seniority spectrum allows for a more relevant mentorship experience while preserving access to executive sponsorship when needed.
• How is the didactic curriculum designed? Some larger programs will manage and design their own didactic curriculum based on ACGME guidelines. Some smaller programs may not have the resources to support this, and many programs as a result use a standardized online curriculum which can also be highly effective.
• Does the program require a concomitant master's degree or have the option? Some programs require (or give the option) of a concomitant masters, often in biomedical informatics. While having more structured coursework can be helpful, others have felt that a masters degree takes time away from other opportunities such as informatics project work or clinical moonlighting. A master’s degree can, but doesn’t necessarily increase your competitiveness in the job market.
• What is the clinical time requirement? Most programs maintain a 20% clinical, 80% informatics split. If there is a higher clinical requirement, investigate the reason why, and find out how these “extra” shifts beyond 20% are paid (if at all). While additional clinical time so soon after residency graduation is not necessarily a bad thing, choosing a program that allows you to do this as additional moonlighting will give you more flexibility (often with higher attending-scale pay).
• Does the program allow moonlighting? Where do current fellows moonlight? Opportunities for moonlighting are highly desirable, as this will not only significantly increase your income during fellowship but also help upkeep the critical clinical skills you need to maintain as a brand-new attending.
• What is the salary scale? Some programs will pay you on a PGY-scale, while others may pay for some (or all) of your clinical time on an attending scale. While it may feel “impolite” to ask about this during interviews, this is an important question given significant variability between programs, sometimes even within the same program, and programs will not be taken aback if you ask about this.
• What are the average responsibilities and day-to-day of a fellow? Programs vary widely in the non-clinical expectations of a fellow, especially when it comes to project management and research. One of the best ways to get an unbiased look at the program is to ask a current fellow about what a typical day might look like for them.
• What is the department's institutional priority in the next two years? This is a very important question to ask that will give you insight into what kind of projects you will likely be involved in, ranging from “bread and butter” EHR implementation to billing and compliance to ambient AI dictation technology. An ideal fellowship should at least in part have shared alignment with your personal interests.
• What if I'm interested in another fellowship? You can still do CI fellowship if you’ve completed another fellowship, and there are actually ways to do a dual fellowship simultaneously - CI fits well into dedicated research or elective blocks of other fellowships! You can reach out to specific programs about this if you’re interested in pursuing a dual-fellowship.