Why It Pays To Pursue A Fellowship

This author discusses her experience in a diabetic limb salvage research fellowship and the rewards residents can gain if they choose a fellowship.

As I approached the end of my residency, I was at a career crossroads. Would I start the job search process or perhaps continue in academia?

   Although I was confident in my podiatric training and abilities, I wanted to focus on a special interest and truly dive into a niche. I had taken a liking to wound care as I was heavily exposed to it during my training at Boston University Medical Center. Additionally, I had always felt a strong desire to partake in research. However, I found it challenging to commit to given scholastic obligations and arduous residency schedules.

   With much thought and consideration, I had made up my mind to continue in academia and explore the world of fellowships.

   Fellowships are quite common in other fields of medicine and have recently started to pick up momentum in podiatry as well. The title “Fellow,” as used in health professions, denotes focused training in a medical specialty. Although they are not a mandatory step in our podiatric training and are not required in order to obtain a license, fellowships in podiatric subspecialties are an increasing trend. Choosing a fellowship is a personal endeavor. You make this decision after years of exposure to various aspects of podiatric medicine and surgery.

   Podiatric fellowships can run the gamut from research to sports medicine and surgery, among other areas. Fellowships allow the clinician to focus on a particular area of interest in our vast field. These one or two years of focused study aim to instill expansive knowledge and strong mentorship, and ideally build confidence to set the newly practicing physician apart.

   The Diabetic Limb Salvage (DLS) Research Fellowship at MedStar Georgetown University Hospital is a recognized fellowship of the American College of Foot and Ankle Surgeons (ACFAS). This recognition fosters high-quality training and requires certain criteria to be upheld by the college’s standards. With its esteemed reputation and superior training, Georgetown’s DLS Fellowship was the perfect fit for me. It combines my dual interests of wound care and research in a highly regarded and challenging academic atmosphere.

Why Choose A Research Fellowship?

Having always wanted to take the time to really leap into the research world, this was a unique opportunity to do so. The MedStar Georgetown University Hospital’s DLS Research Fellowship is through the Department of Plastic Surgery and based out of the hospital’s Center for Wound Healing. This “team approach” allows for exposure to podiatric medicine and surgery in conjunction with plastic surgery, vascular surgery, hyperbaric oxygen (HBOT), prosthetics, etc. This unique fellowship allocates a hands-on application of research. I like the idea of seeing a hypothesis go from the paper to the person. Research provides an opportunity to be at the forefront of innovative treatment modalities, products, methods, etc.

   Having read numerous journal articles throughout my training, I was always fascinated (and perhaps a little intimidated) with the research process. This fellowship enables me to enhance my research skill set by intricately learning the systematic research process. This experience has placed me in the center of all the steps of research (i.e., institutional review board applications, consenting and enrolling patients, analyzing data, writing, etc.). It is captivating to partake in the transformation from reading a protocol to applying a test article in a research clinic. To see the conversion of your idea become a tangible study is astounding. Research often provides patients with the “hope” of a new modality. It is wonderful to provide a novel service and share in the possibility of a patient’s success. I feel lucky to be a part of the process.

   Being the DLS Research Fellow at Georgetown has encouraged me to take on leadership roles. I work closely with both podiatry and plastic surgery residents and often join them in the OR, at lectures, journal club, surgical workshops and the like. Even though my focus is research, I am encouraged to sharpen my clinical skills and surgical techniques by staying involved in all facets of podiatry and surgery. The idea that I am not taking any time off from surgery and patient care greatly appeals to me.

What My Typical Week Is Like

The MedStar Georgetown University Hospital’s DLS Research Fellowship is a well-balanced experience. The Center for Wound Healing is set on the strong foundation of a “team approach” and thus my training is multidisciplinary.

   When you break my workweek down into percentages, I would say about 40 percent of my week is spent doing research. This encompasses reading protocols, writing abstracts, working with the research team, constructing poster presentations, etc. Furthermore, this includes a research clinic where we see patients enrolled in prospective trials. This incorporates the entire systematic research process of consenting, enrolling and randomizing patients, and following them in their subsequent clinic visits.

   Additionally, I spend about 20 percent of my week in the operating room and scrubbing in to various podiatric and plastic surgery cases. Another 25 percent of my week consists of seeing patients in clinic at the Center for Wound Healing.

   This leaves the remaining 15 percent devoted to academics. I am encouraged to take on leadership roles and work closely with the residents. I attend a variety of lectures, grand rounds, journal clubs and workshops, as well as rounding a couple of nights a week with the residents on in-house patients. This well-formed week keeps me busy, intellectually stimulated and allows me to be involved in all aspects of podiatric medicine. Most importantly, this experience is providing me the tools to become a well-rounded physician.

Why My Career Mentors Are Indispensable

It is no surprise a fellowship provides career-building mentorship opportunities. There is no better way to get to know and learn from the best and highly respected experts in a subspecialty than to work closely with them. I am fortunate to spend one year learning from truly respected, intelligent, and talented physicians in the world of wound care: John S. Steinberg, DPM, Paul J. Kim, DPM, Christopher E. Attinger, MD, Karen K. Kim, MD, and Roy C. Monsour, MD.

   What I have learned from them surpasses any chapter I might read in a book or any class I could have taken in medical school. Their altruistic teaching and passionate guidance are beyond measure and confirms my decision to take on this fellowship year.

Final Notes

The field of podiatry continues to evolve as medical knowledge and technological advancements grow exponentially. Our post-graduate training simultaneously tailors its requirements as the profession grows. Residency programs enrich their curriculum to reflect our expanding field. We have seen residency programs transform from one-year postgraduate training to a two-year program and, just recently, to a three-year requirement. With this growing trend, one can see the necessity of a fellowship being the evident next step.

   The podiatric field calls for the development of fellowships to fill the need of its growing discipline. Although podiatry is a specialty unto itself, there are many subspecialties within our field that merit close attention. Graduating podiatric residents are highly skilled and vastly knowledgeable. A fellowship may be a practicable option to bridge the gap between residency and the workforce. Whether the personal endeavor is to find a niche, learn one-on-one from a mentor, build confidence or hone in on a special interest, I strongly encourage graduating podiatric physicians to consider the immense rewards a fellowship can offer.

   If I have piqued your interest, a fellowship might be the logical next step in your podiatric career. I encourage you to contact the ACFAS and the Council on Podiatric Medical Education (CPME) for a complete list of recognized fellowships and their subsequent contact information. According to their websites, the current list of ACFAS recognized fellowships consist of 24 programs and the CPME recognizes 11 approved fellowships.

   My experience has been advantageous in every way. My subspecialized training is a rewarding balance of academia, clinical and surgical training. A research fellowship encompasses so many aspects of hands-on education and application, but ultimately I will come away from this experience knowing that in some capacity, I have made a contribution to our field of podiatric medicine.

   Dr. Powers is a Fellow in Diabetic Limb Salvage Research at MedStar Georgetown University Hospital in Washington, D.C.