By Karun Neupane, MD, Muhammad Salman Faisal, MD, Zunairah Shah, MD, Mercy C. Anyanwu, MD, Sushmita Khadka, MD, Laercio DaSilva, MD, Pamela Contreras-Chavez, MD, Andrea Anampa-Guzmán, MD, and Aakash Desai, MD, MPH

To address the common questions that fellowship applicants have, especially those applying for a hematology-oncology fellowship, HemOncFellows Network (@HemOncFellows) organized a Twitter Spaces session on June 13, 2023. In the article that follows, session participants, organizers, and members of the HemOncFellows Network recap the discussion and share practical advice that you can use in preparing your fellowship application.

A note on roles and authorship: The session was hosted by Dr. Karun Neupane (KN) and co-hosted by Dr. Muhammad Salman Faisal. The speaker panel included current and incoming fellows Dr. Zunairah Shah (ZS; on a J-1 visa), Dr. Mercy C. Anyanwu (MA; on an H-1B visa), Dr. Sushmita Khadka (SK; J-1 visa), Dr. Laercio DaSilva (LD; J-1 visa), and Dr. Pamela Contreras-Chavez (PC; J-1 visa). Dr. Andrea Anampa- Guzmán and Dr. Aakash Desai helped in the preparation of this article. The discussions from the Twitter Spaces session have been edited for clarity and organization.

KN: How was your experience at this stage in mid-June the year you were applying for fellowship, and what suggestions do you have for the applicants at this stage?

MA: To ensure my fellowship application went smoothly, I researched program options thoroughly due to my H-1B visa limitations. I found that some program websites needed updated visa information on the FREIDA website, so I emailed program coordinators to confirm their visa sponsorship. I focused solely on programs supporting H-1B visas, while some friends opted for programs offering J-1 visas.

ZS: Requesting letters of recommendation should be done early to allow for processing time. Unfortunately, I experienced delays in uploading my letters, causing them to be released on the application deadline. I advise everyone to ask their letter writers to upload their letters as soon as possible to avoid last-minute anxiety and difficulties.

SK: I fully agree with Zunairah. It's a good idea to have backup letters in case your preferred ones are not uploaded on time. During the application season, applicants often create an Excel summary of the programs, which can help with program details. Start working on your ERAS CV early.

KN: Mercy, when you contacted programs listed as H-1B visa sponsors on FREIDA, did you encounter any discrepancies between the information on FREIDA and what the programs told you?

MA: Yes, there were discrepancies between FREIDA and the actual sponsorship status of some programs. Relying solely on FREIDA may not provide accurate information, and I came across around 10 to 15 programs with such discrepancies.

KN: Can you share your experience regarding the number of programs you applied to and the number of interviews you received?

PC: I didn't dedicate much attention to the fellowship application during my second year, which was a mistake. I recommend thoroughly researching every program you're applying to and contacting fellows from those programs for information. I received only four interviews after applying to around 80 programs. However, this can vary based on your profile and how well-prepared you are. I needed to prepare better and faced burnout due to COVID surges. I also applied to programs that didn't align well with my profile. Determining your goals for the fellowship and choosing programs accordingly is crucial.

MA: I applied to 45 to 50 programs and received approximately half the interviews. I felt nervous during the application season and extensively researched the programs, especially regarding visa sponsorship. Ultimately, I ranked 21 programs and decided not to rank one program I didn't want to attend. I advise avoiding applying to or ranking programs you don't want to join. Fellowship decisions carry significant weight, and even if you don't match, you'll still have opportunities, such as hospitalist jobs, instead of being in a fellowship program you dislike.

LD: It can be stressful selecting which programs to apply to given the hefty fees involved. The process can be worse for those coming from community hospitals and with visa requirements as, unfortunately, many competitive programs still filter out candidates without ever reading the application. In my case, I first determined how many applications I would submit, then created a rank considering my interest in each program, then attributed a value to what I thought was the likelihood of getting an interview from each. I spent most of the budget on programs I considered interesting and likely to invite me, but I also applied for those interesting yet unlikely programs. The total was around 100 applications. I was surprised to get several interviews from highly academic programs (which was my interest in the first place) while receiving fewer invitations from non-academic institutions. I shared this journey with several other visa-holder friends who also ended up in institutions they once dreamed of. The bottom line here is: If you are excited about a program, can afford the fees, and there is no hard rule disqualifying you, apply for it. That might be the year your dream program is finally changing the screening criteria.

KN: Returning to the topic of letters of recommendation, how did you approach ensuring timely uploads without feeling hesitant to bother your letter writers?

ZS: It varies, but one approach I took was asking the lab manager to remind my mentor instead of directly approaching him myself. Additionally, you can send polite reminders to the writers every week or so if the letter is not uploaded timely.

MA: Letter writers don't usually mind being reminded and appreciate the follow-up since they tend to be busy and might forget. If someone has offered to write a letter for you, they won't be irritated by a gentle reminder. Just remember to be kind and respectful when reaching out.

KN: Let's move on to the personal statement. How did you approach writing it, and what aspects did you focus on? Also, how did interviewers respond to your personal statements?

SK: The personal statement formatting is similar to the one you wrote for residency but focuses on why you want to pursue hematology and oncology. Keep it concise, within a page, and reflect on your journey. Start working on it early, as it requires refinement. Seek feedback from trusted mentors and proofread it carefully to avoid grammatical errors. Avoid reiterating achievements already mentioned in your CV, such as step scores. Instead, emphasize what influenced your decision to pursue hematology-oncology and outline your plans.

PC: I agree with Sushmita. In my statement, I shared an experience from my internship in surgical oncology during my last year of medical school in Peru. I started with that unique story, and during interviews, many interviewers mentioned how much they appreciated it. They found it distinct and engaging. I recommend writing about what sets you apart and staying true to yourself, as programs value authenticity.

KN: When deciding which experiences to include as meaningful experiences on the ERAS CV, what should applicants consider? Should experiences from before residency be included, or should the focus be solely on hematology-oncology experiences? And what about including hobbies?

SK: Prioritize experiences that significantly impacted your journey towards pursuing a hematology-oncology fellowship. These experiences can come from before or during residency, but they should align with your interviewer's interests. Include experiences that led you to choose hematology-oncology, such as electives or volunteering in the field. For example, if you have previous experience as a primary care physician, mentioning the hematology-oncology electives you completed during your residency is preferable. However, if you have any volunteering experiences related to hematology-oncology, you should include them.

ZS: I agree with emphasizing hematology-oncology experiences. Some interviewers may recognize the attending physicians you rotated with, which can lead to engaging conversations. Highlight experiences in the field of oncology, whether they are clinical or volunteer-based.

MA: Additionally, include activities or accomplishments that significantly influenced your career. For example, I won a grant to provide transportation for underserved populations to access mammogram screening and mentioned that. Personal stories that shaped you as a physician, such as living in a different country or adapting to a new health system, can also be impactful. Sharing your hobbies, like traveling or engaging in adventure activities, can make you memorable to interviewers and spark interesting conversations.

KN: Moving on to geographical preference in the ERAS application, what was your experience with questions about geographical preference during interviews?

SK: During interviews, programs often ask about how you heard about their program and if you have any personal connections to it. While this may not be a decisive factor, having a relationship to the program or being familiar with the area can be somewhat beneficial.

PC: I recall being asked about family ties to the area and how I came to know about the program. Though they may not directly ask about geographical preference, they often inquire about your ties to the location during interviews.

KN: One question from the audience is on the use of Twitter before, during, and after the interviews. What are your thoughts on that?

PC: While I wasn't very active on Twitter during my application process, I now recognize its importance. It can be valuable for networking and finding potential collaborations. Additionally, Twitter can be a powerful tool for self-promotion. I've witnessed its impact, as my friends and I have received interviews for jobs, residencies, and fellowships through connections made on Twitter. When used wisely, it can be a great resource.

KN: After submitting your application, did you wait for the interviews or did you actively email the program about your interest to get an interview?

PC: It's important to be patient after submitting your application as programs typically take 1 to 2 weeks to review applications. Refrain from rushing or panicking if you have yet to hear back within a few weeks. However, if there are programs you’re genuinely interested in, it’s worth reaching out to express your interest. Fellowship programs value candidates who demonstrate a strong interest in their program, and sometimes program directors or coordinators may reply and consider you for interviews.

ZS: Programs may review applications at different times, so interviews can come any time between August and late September. If you have a genuine interest in a program, it's recommended to reach out to them. Even without connections, contacting the program coordinator or director can yield a response. Programs are concerned about the quality of applicants who will match at their program, so they are likely to reply to inquiries as they want applicants who are genuinely interested.

SK: I applied broadly and received interviews from August until early November. I did reach out to programs I was interested in, and I regret not contacting programs I didn't have any connections with. I suggest contacting both connected and unconnected programs, as program coordinators or directors often respond. Remember that programs are also eager to find suitable applicants, so reaching out can be beneficial.

MA: My first interview arrived in mid-August, with more interviews coming through September. Don't hesitate to reach out to programs you're genuinely interested in. By reaching out, you open up the possibility of receiving an interview. Remember that programs review applications in waves, so there's still a chance your application is under review. It's generally advisable to wait until mid-September before contacting programs.

LD: I want to add that in the email to the programs, include how the program aligns with your career goals as an oncologist or hematologist. Demonstrating a clear connection between the program and your aspirations can strengthen your application.

KN: After applying, do you suggest updating the programs about your achievements, for instance, let's say you attended a conference or published a paper?

MA: If there are any significant achievements or additions to your CV after applying, it is advisable to update the programs. While it may not drastically impact your application, it can provide additional information and show your continued growth and dedication.

KN: I have a question from the audience. What's the best approach to stand out and try to get into a top-tier program in fellowship?

PC:  To stand out and have a better chance of getting into a top-tier program, I recommend pursuing an away elective, especially if you come from a smaller community program. Reach out to attendings at bigger academic centers and try to secure a rotation. This can help you make contacts, gain valuable experience, and strengthen your application. In my case, getting an away elective and obtaining letters of recommendation from that rotation significantly enhanced my application.

MA: I also emphasize the importance of doing away electives in academic centers. I spent time doing electives in multiple academic centers, which ultimately resulted in interview invitations from those programs. Building connections with fellows and attendings during these electives can make a difference.

LD: Even if you come from a small community program without exposure to every subspecialty within hematology-oncology, you can showcase your dedication and determination. Highlight how you overcame obstacles and emphasize your commitment to the field. In my case, I didn't have hematology/oncology rotations or the opportunity for away electives due to COVID. Instead, I focused on learning how to do remote research and emphasized this during my interviews. Highlighting the positives and showcasing your efforts can make a favorable impression on the programs.

KN: What are your dos and don'ts for applicants while approaching the interviews, and how did you decide how to select the programs for ranking given the interviews are virtual and you can't really get an in-person feel for the program?

SK: Once you get the interview, the most important thing to do is research the program. Ideally, you should know about the program at the time of application itself. Try to know your interviewers well. The difficult part of the interviews was towards the end when I was asked if I had any questions. You should ask unique questions; knowing the program and interviewer would make this easier. Framing those questions nicely is important as that's usually the closing part of the interview and interviewers will remember that part. In terms of ranking the programs, I made an Excel sheet including things that were important to me and talked to the fellows from the programs. In the end, every program is different and you try to find your best fit. There is no single best program for everyone.

PC: Yes, definitely, doing good research on programs is important. Also, try to find a friend of a friend in the program. Consider requesting the program for an in-person visit to get an in-person feel. Not all programs offer that, but showing your genuine interest in the program might be a good idea.

MA: Programs will sometimes try to match you with an interviewer from the same field as your research, so use that opportunity to connect with them. You can make notes of the interesting things about your interviewers and refer to them during the interviews.

Be mindful of the difference in the time zone and set alarms not to be late. Keep your virtual background clean and free of clutter.

I would say a big don’t is sending first-choice letters to every program. Send a first-choice letter only to your first-choice program. One thing to be mindful of is that it is still possible to match in a program where you didn't send any post-interview communication or didn't hear from the program before the rank order list.

Lastly, don't read from the screen during the interview. It is obvious and it won't look good.

ZS: Additionally, while scheduling your interviews, try to space them over several days because scheduling them back-to-back is tiresome. Try to schedule light rotations or vacation during the interview season. Prepare a lot of questions, because you will be asked to ask a lot of questions, and asking insightful questions will show your interest in the program.

LD: To add to that, programs really want to get to know you during the interview. So don't feel shy to show who you really are and ask about the things that you value. Please be mindful of the light settings, make your room bright, and do mock interviews with your friends.

KN: Any closing remarks?

PC: Remember that each one of you is amazing, and congratulations on choosing the beautiful field of hematology-oncology. Stay confident and take the interviews seriously.

MA: Let's be kind to one another throughout this journey online and offline. Best wishes to everyone!

Dr. Neupane is a third-year internal medicine resident at Albert Einstein College of Medicine/Jacobi Medical Center and a co-host of @HemOncFellows Network. He is applying for hematology-oncology fellowship this year. Follow him on Twitter @KarunNeupaneMD. Disclosure.

Dr. Faisal is a hematology-oncology fellow at Roswell Park Comprehensive Cancer Center and a co-host of @HemOncFellows Network. Follow him on Twitter @msalmanfaisal. Disclosure.

Dr. Shah is a hematology-oncology fellow at Roswell Park Comprehensive Cancer. Prior to her current position, she served as the Internal Medicine Chief Resident at Weiss Hospital. Her areas of special interest include Hematological Malignancies and Precision Oncology. Follow her on Twitter @ZunairahShah. Disclosure.

Dr. Anyanwu is a hematology-oncology fellow at Mt. Sinai NYC. Follow her on Twitter @MercyCAnyanwu. Disclosure.

Dr. Khadka is a hematology-oncology fellow at Moffitt Cancer Center. Follow her on Twitter @Sushmit51456595. Disclosure.

Dr. DaSilva is a medical oncology fellow at the National Cancer Institute, focusing on early-phase clinical trials, immunotherapy, and thoracic tumors including thymomas and mesotheliomas. He is currently leading diversity, equity, and inclusion and wellness quality improvement projects within his fellowship program. Follow him on Twitter @laerciolopesMD. Disclosure.

Dr. Contreras-Chavez is a hematology-oncology fellow at St. Elizabeth's Medical Center. Follow her on Twitter @PamChMD. Disclosure.

Dr. Anampa-Guzmán is a medical student at Universidad Nacional Mayor de San Marcos in Lima, Peru, a researcher at the lymphoma section of Roswell Park Comprehensive Cancer Center, and a co-host of @HemOncFellows Network. Follow her on Twitter @AndreaAnampaG. Disclosure.

Dr. Desai graduated from hematology/oncology fellowship from Mayo Clinic-MN and is starting as an assistant professor at the University of Alabama, Birmingham. He is a co-host of @HemOncFellows Network. Follow him on Twitter @ADesaiMD. Disclosure.