How Do I Earn the Best Fellowship?

Milton Little, MD, FAAOS | Daniel Osei, MD, MSc, FAAOS

July 28, 2021


Every year during the summer before the fourth year of residency, there’s a level of anxiety that rises among the fourth-year residents as they prepare to submit fellowship applications.  This is the next milestone in the seemingly endless journey to becoming an attending physician.  Fellowship applications are due in the fall, and everyone is gathering letters, completing research projects, and updating CVs to try and improve their applications.

The strongest candidates have been working towards this application cycle from the start of  residency, beginning with relationships developed from the outset of intern year.  While it’s difficult to know exactly what fellowship you will apply to at the start of residency, you can build a relationship with a mentor and work extremely hard on your rotations.  The attendings on your intern rotations all discuss your performances throughout the year.  Those interns who stand out early clinically can build a strong reputation that will help establish them well on orthopaedic rotations.

As you transition to orthopaedic rotations, keep your eyes open for the subspeciality that brings you the most joy.  In the interim, volunteer and say yes to research projects that pique your interest and learn to be a closer.  Even if you end up going into a different specialty, these projects will look great on your CV.  When you are given deadlines, finish the projects before the deadlines.  If you aren’t getting enough feedback on your rotations or your research, schedule time to meet with your attendings to discuss the projects and your rotation experiences.  Every attending wants to work with the residents who clearly demonstrate that they care about their rotation performance, their clinical skills and their performance on research projects.

 Once you have decided on a subspecialty, it is important to meet with the attendings in that subspecialty with whom you have previously developed rapport.  The earlier in your residency career that happens, the better the relationship you can develop with the attendings.  Remember – these mentors will be writing your recommendation letters and more importantly making personal phone calls on your behalf. Engulf yourself in the subspecialty by attending journal clubs, doing research, joining clinics, and even scrubbing cases whenever possible while not interfering with your other assigned rotations’ clinical responsibilities (and your co-resident’s rotations).  At this point, it is critical to streamline your research projects and complete the projects you sign up for in a timely fashion.  Completed, published projects, and presented research strengthen applications, while incomplete projects should be left off applications to avoid appearing disingenuous.

Building a well-rounded application is critical as well and often that comes from fulfilling standard rules of residency.

  1. Be honest.
  2. The hardest thing is usually the right thing.  Always do the hardest thing.
  3. Always put the patient first.

The people who do those things most consistently often receive awards from their colleagues and their attendings and more importantly become the best physicians. Those accolades are noticed by both application reviewers and  recommendation letter writers. Additionally, these are the residents asked to participate in committees and leadership activities. Follow your passions and be a closer for those activities as well. Consistent and thorough work on those extra-curricular activities is more important than scattershot involvement in numerous activities.

The fellowship application process is one of the final stepping-stones in your journey through medicine and, like all processes, it starts far earlier than the date the application is due. Be consistent. Be resilient. Be a closer. Be honest. Do the hardest thing. Put the patient first.  Build relationships early with mentors.  Stick to those same qualities that got you to this point in your career and you will earn the best fellowship.


DISCLOSURES: Dr. Little Consultant: Globus Medical, Consultant: Depuy Synthes, Committee Member: AO Fellowship Committee; OTA Membership Committee; OTA Diversity Committee; OTA Wellness Committee Dr. Osei has no active consultant relationships, Committees: ASSH Council, Member at Large; ASSH Publications and Products Advisory Committee; ASSH Diversity Committee; Co-Chair ASSH Research Management Committee; Associate Editor, Journal Hand Surgery.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.

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