Online dating makes it sound like finding your soul-mate is only a click away. Smiling faces of beautiful, successful, and funny people are ready to make each other happy forever. So, how exactly do you know they are who they say they are? By meeting in person, asking questions, and getting to know the person behind the image.

Believe it or not, that same process applies to fellowships. Residents who choose a fellowship without a site visit and fellowship program directors who extend an offer to a resident without an in-person interview are basing their decisions on a smiling face. They’re skipping those important “getting to know you” steps, marrying a program without any kind of courtship.

The fellowship year affects a physician—and his or her family—for far longer than 12 months. The training, mentoring, and life experiences from that year influence the doctor’s future. Without visiting a fellowship program in person, the applicant misses out on key factors that will affect his or her experiences. For example, consider the following benefits of a site visit:

Examining the hospital, surgery centers, clinics, and administrative space tells an applicant more about the program than any pamphlet or website would show.

Meeting the faculty, watching them interact with each other and with support staff gives the prospective fellow a real window into how his or her experiences would be shaped day-to-day.

Seeing the program in action shows the applicant the reality of today, unencumbered by the historical prestige of a program, attractive though that might be to him or her.

Everyone can put on a similarly attractive face for a website; in person, an applicant can see the nuanced differences in each program. With a site visit, an applicant can get a clear picture as to whether or not he or she would be an appropriate fit, and vice versa.

Beyond the scope of training, visiting a program provides more information about the quality of life in a new community. Factors influencing an applicant’s decision may include access to affordable, quality housing; good schools for his or her children; and access to jobs for a spouse.

For most applicants, the choice of a fellowship program cannot be made in a vacuum. Having an on-site visit enables applicants to get a clear picture of the quality of life—both professional and personal—in each program and city.

The choice of fellowship is much like a marriage. The consequences of where physicians train follow them throughout their careers. It is not just 1 year; the decision forever links the physician, in name and experience, to his or her program and mentors. Without making a personal visit to each program under consideration, the applicant is choosing to marry before even going on a date.

Patrick B. Wright, MD, who completed his fellowship in pediatric orthopaedic surgery at Arnold Palmer Hospital for Children in Orlando, Fla., is assistant professor in pediatric orthopaedics at the University of Mississippi Medical Center, Jackson, Miss.

CON: Who needs site visits anymore?

Robert A. McGuire Jr, MD

Site interview trips are totally unnecessary in today’s resident education format. They are expensive and time-consuming, and they place stress on residents’ budgets, which are already spread thin.

We know that 90 percent of graduating residents proceed with a postresidency fellowship. We also know that no one wants to return to the days before the fellowship match, when candidates had to make a selection 3 or 4 years before completing their residency, with only a limited amount of time to decide on whether to accept the offer. Now, however, I think we have sent the pendulum a little too far in the other direction.

Why have we had to develop this need for an extra year of education, anyway? I know it is not because it presents an opportunity for cheap, educated labor to assist in a busy practice, so why then?

The mandated decline in work hours available for resident education may have compromised a resident’s ability and opportunity to develop appropriate expertise in specific philosophies. As a result, the resident may feel the need to acquire more training to attain the desired skill level.

Some residents may desire specific subspecialty training with an opportunity to develop a niche practice, filling a void in a group practice he or she may be joining.

Regardless of the reasons for desiring fellowship training, most residents know with whom they would like to train for the extra year, and site visits have nothing to do with that mentor selection. The same introductions and evaluation process that takes place at a site interview could instead take place on specific days at the AAOS Annual Meeting or at annual specialty society meetings. Each fellowship site would be able to showcase its educational opportunities, have a chance to get to know the candidates, and be able to make direct candidate comparison for the selection process. Fellowship candidates would be able to compare and contrast programs directly and make their selection.

We know from previous data analysis, interviews at seven or eight locations result in acquisition of a fellowship almost 100 percent of the time. That number of interviews could easily be accomplished during the AAOS Annual Meeting or specialty meetings. In this way, residents would incur minimum expense and time away from their parent programs.

Over the past 3 years, residents at the University of Mississippi Medical Center have averaged 10 days away for the interview process. It does not take a degree in rocket science to see the potential for educational compromise on training blocks that may be only 8 to 12 weeks long.

Yes, it would take significant coordination of the various sites to ensure that appropriate faculty attended for the interview day, and it would be more of an inconvenience to these faculty than it is when the residents travel to visit them. In the long run, however, this change would enable residents to maximize their education at their parent program with fewer days away for interviews and less expense for airline flights and hotel accommodations, while still giving them the chance to speak with their desired mentor.

Orthopaedic education is about training residents with minimum external distraction and stress, not adding on extra layers of turmoil for them to endure in a site interview. It is high time for us to reevaluate this process.

Robert A. McGuire Jr, MD, completed two fellowships—one at the University of Miami School of Medicine and the other at Miami Children’s Hospital—and is professor and M. Beckett Howorth Chair of Orthopedics at the University of Mississippi Medical Center, Jackson, Miss.

References

1. Ranawat AS, Dirschl DR, Wallach CJ, Harner CD: Symposium: Potential strategies for improving orthopaedic education. Strategic dialogue from the AOA Resident Leadership Forum Class of 2005. J Bone Joint Surg Am 2007;89(7):1633-1640.
2. Beaty JH, Beck TL, Bert TM, et al: Pursuing an orthopaedic fellowship. AAOS Now, September 2011.