Obstetrics and gynecology fellowship interview preferences

Consider This
Obstetrics and gynecology fellowship interview preferences


Emily P. Barnard, D.O.,a,b Jenifer N. Byrnes, D.O.,a,c and John A. Occhino, M.D.a

a Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; b currently: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Magee-Women’s Hospital, Pittsburgh, Pennsylvania; and c currently: Department of Obstetrics and Gynecology, University of Rochester–Strong Memorial Hospital, Rochester, New York


Objective: The number of applicants to obstetrics and gynecology subspecialty fellowships is projected to increase. The interview process is taxing for both applicants and their residency programs, with excessive time away from work, high cost, and lack of coordination between regional programs for shared interview dates. This study aimed to gather information about preferences for residents applying to fellowship in 2016.

Design: Survey study.

Materials and Method(s) : An e-mail link to a web-based survey was sent to all accredited obstetrics and gynecology residency program directors in the United States for distribution to 4th-year residents.

Result(s): A total of 192 4th-year residents responded, 140 of whom applied for fellowships in 2016. Applicants were predominantly female (73.8%), white (78.5%), married (76.9%), and childless (74.6%); 81.4% were in an academic program. The average number of interviews attended was 10.9; the most common reason to cancel was conflict with another interview (71.8%). Saturday was the most preferred interview day (47.2%). The majority of applicants preferred half-day interviews (93.3%) and interviews that began at 8 a.m. (60.5%). A preinterview dinner was favored (64.7%). Use of personal days for interviews varied by program from 0 (16.0%) to ≥11 days (24.8%). Vacation time was used by 56.8% of applicants, unpaid leave by 8.9%.

Conclusion(s): The fellowship interviewing process carries challenges for both residents and the interviewing program. Gathering further information from applicants and fellowship directors may lead to streamlining of the process and improving satisfaction for applicants and for the programs where they interview.

Consider This:


Applying to a subspecialty fellowship program in obstetrics and gynecology is increasingly competitive as the number of applicants steadily increases. Data from the National Resident Matching Program (NRMP) indicate that 464 applicants certified a rank-order list in 2016, compared with 430 in 2015. Specialties included were gynecologic oncology, minimally invasive gynecologic surgery, pediatric and adolescent gynecology, reproductive endocrinology and infertility (REI), maternal-fetal medicine (MFM), and female pelvic medicine and reconstructive surgery (FPMRS) (1). Two-thirds of applicants (63.6%) were matched with their chosen subspecialty, and 94.6% of programs were filled.

A survey of subspecialty fellows in 2014 showed that 51.5% of the 169 respondents spent at least 10 days away from their residency program for interviewing. For the resident, this time commitment creates challenges related to coordinating travel arrangements and scheduling rotations and clinical responsibilities. Applicants are pressured to apply to several programs and attend as many interviews as possible, because compared with candidates who are not matched to a program, successfully matched candidates apply to more programs, receive more invitations to interview, and attend more interviews (2).

A recent call to action proposed several changes to streamline the interview process (3). The main concern was that excessive time away from work detracted from clinical duties. In addition, the lack of coordination between regional programs for facilitating travel arrangements increases the cost of travel and fatigue related to multiple trips and different time zones. Overlapping dates may force residents to cancel an interview, affecting both the applicant’s chances to be selected for a program and the program coordinators’ planning for the interview day. This movement to improve the fellowship interview process has gained traction in the fields of gynecologic oncology and REI, with changes planned to address some of these concerns.

Although many of the shortcomings of the interview process are known, little is known from the applicant’s perspective. We aimed to collect demographic and preference data from obstetrics and gynecology residents applying for subspecialty fellowships in 2016.

Materials and Methods

Our survey was designed with the use of a web-based tool (Survey Monkey; www.surveymonkey.com; Fig. 1[ER1] ). A link to the survey was sent to all residency program directors for distribution to 4th-year residents in obstetrics and gynecology residency programs in the United States accredited by the Accreditation Council for Graduate Medical Education (ACGME). Program director names and e-mail addresses were gathered from FREIDA Online, the American Medical Association Residency and Fellowship Database that allows individuals to search for all programs accredited by the ACGME. Persons with limited English proficiency were excluded because the survey was distributed in English through an e-mail link. This study was approved by the Institutional Review Board of the Mayo Clinic, Rochester, Minnesota.

The survey became available on September 1, 2016, and an e-mail link was sent to all program directors for distribution on that date. A reminder e-mail was sent to program directors on September 15, 2016, to encourage participation. The last day the survey was available was October 1, 2016; match day was October 5.

Respondents were asked whether they applied to a fellowship program for the 2016 application cycle. If an individual did not apply to a fellowship program in 2016, the survey concluded. Those who did apply were directed to complete the survey and provide demographic information, including age, gender, race, and family status. The survey gathered information on the size and location of their residency program, whether others in their class were applying to a fellowship program, to which subspecialty fellowship the applicant was applying, the number of interview invitations the applicant received, and the number of interviews the applicant attended. Applicants were asked about which days of the week were best for interviews, about the timing of interviews, about web-based interview alternatives, and about the cost to attend each interview. Descriptive statistics were used to evaluate survey responses.


A total of 192 4th-year residents completed the survey, and 140 respondents (72.9%) applied to a subspecialty fellowship program in 2016. Approximately 1,255 obstetrics and gynecology residents matriculate each year, so we estimate that our survey captured data from 15.3% of all 4th-year trainees. Of those who answered the specific questions, 73.8% were female (96 of 130) and 78.5% (102 of 130) were white. The majority were married or in a committed relationship (100 of 130; 76.9%), but most did not have children (97 of 130; 74.6%; Table 1).

Table 1. Demographic information, (n = 140).



Age, y


1 (0.7)


50 (35.7)


49 (35.0)


23 (16.4)


5 (3.6)

 Did not respond

12 (8.6)



96 (68.6)


33 (23.6)


1 (0.7)

 Did not respond

10 (7.1)



102 (72.9)


11 (7.9)


7 (5.0)


3 (2.1)


7 (5.0)

 Prefer not to say

6 (4.3)

 Did not respond

4 (2.9)

Married or committed relationship


100 (71.4)


30 (21.4)

 Did not respond

10 (7.1)



33 (23.6)


97 (69.3)

 Did not respond

10 (7.1)

Note: Data presented as n (%).

More applicants described the setting of their training program as “academic” (105 of 129; 81.4%) rather than “community” (24 of 129; 18.6%). Mean residency class number for those applying for fellowships was 7.5 per year. The structure of on-call duties during interview months varied by institution and the trainee’s rotation. The various types of reported on-call duties included night float (58 of 129; 45.0%), 24-hour in-house on-call shifts (77 of 129; 59.7%), and home call (19 of 129; 14.7%). Of those applying for a fellowship program, 88.3% (113 of 128) had classmates who were also participating in the match process. Those in a community program were significantly less likely to have coresidents applying to a fellowship program than those in an academic setting (66.7% vs. 93.3%; P<.001). Information on specific programs represented was not obtained, to keep responses anonymous and encourage participation.

Fellowship applications were distributed throughout the disciplines (Fig. 2). The largest number of respondents applied to an MFM program (45 of 127; 35.4%). NRMP data indicated that this specialty had the largest applicant pool, with 155 applicants certifying a rank list in 2016; therefore our survey captured data for 29.0% of all residents applying to an MFM program. The highest percentage of applicants surveyed was for REI, where 36% of the 75 who ranked this specialty participated in our survey. Only four respondents applied to fellowships outside the traditional match, including breast surgery (n = 1), palliative care (n = 1), reproductive infectious disease (n = 1), and unspecified (n = 1).

Time allotted away from residency was variable (Fig. 3): Of 125 residents who answered the question, 84% were allowed personal days to interview, ranging from 1 to 3 days (n = 6; 4.8%) to ≥11 days (n = 31; 24.8%). The largest percentage of applicants were allowed 6–10 personal days for interviews (n = 46; 36.8%). Vacation time was used for interviews by 56.8% of applicants (71 of 125), and 8.9% (11 of 123) were not receiving pay while they attended their interviews.

Applicants overall received invitations to an average of 15.1 interviews and attended a mean of 10.9 interviews. Applicants to FPMRS programs attended the largest mean number of interviews (12.8), and applicants to MFM programs attended the smallest mean number of interviews (9.8).

Of the 85 applicants who answered the question, 68% canceled at least one interview (Table 2). The most common reason for canceling was conflict with another interview (n = 61; 71.8%). About one-half of the residents who canceled interviews did so for financial (n = 44; 51.8%) or work-related reasons (e.g., on-call obligations [n = 43; 50.6%]). A novel web-based videoconferencing interview format was offered by some programs in 2016, with 14 residents being offered this opportunity and seven participating in this format.

Table 2. Fellowship applicant responses to the question, “For which reasons did you cancel interviews?,” (n = 85)



Conflict with another interview

61 (71.8)


44 (51.8)

Work (e.g., on-call or service obligations, lack of time)

43 (50.6)

Personal (e.g., family obligations)

20 (23.5)

Program (e.g., location, training focus)

52 (61.2)


3 (3.5)

Note: Data presented as n (%).

aMultiple answers were accepted.

When preferences for interview dates and timing were collected from respondents, the largest percentage indicated that Saturday interviews were preferred (n = 51; 47.2%); the least preferred day to interview was Wednesday. Half-day interviews were overwhelmingly preferred (n = 111; 93.3%) to full-day interviews. Most thought that starting an interview at 8 a.m. was optimal (n = 72; 60.5%), with few applicants preferring to start an interview in the afternoon (n = 3; 2.5%). A preinterview dinner was a favorable attribute for 64.7% of respondents. Those who did not prefer the dinner most commonly reported travel-related reasons (n = 36; 85.7%).

About one-half of the respondents were aware of grouping interview dates geographically, and 49.6% (59 of 119) reported that they did use regional coordination when scheduling interviews. The average cost per interview, including airfare, lodging, ground transportation, food, and clothing, was $859.50. With applicants attending an average of 10.9 interviews, the total cost of the process, not including application fees, averaged $9,368.55. 


Respondents to our survey confirmed that the subspecialty fellowship interview process is challenging, creating scheduling difficulties with coresidents and financial strain on families. Additional financial strain may arise when residents use vacation time or do not receive pay while they attend interviews. Many programs do not limit the number of interviews that residents may attend, so the only limitations would be budgetary or other concerns on the part of the applicant. Both time away from work and financial concerns may cause candidates to attend fewer interviews. Previous studies have shown that attending more interviews increases the chances of matching with a fellowship program (4), so more restrictive residencies may be limiting the opportunities for their residents to match with a competitive fellowship program.

The NRMP data suggest that 464 residents applied to subspecialty fellowship in 2016, including both the FPMRS August match and the traditional October match. A total of 140 applicants responded to our survey, for a response rate of 30.2%. Our target for the survey was 4th-year residents in ACGME-accredited programs in the United States. Nontraditional applicants applying to fellowships after working or participating in research or other clinical fellowship programs did not have access to this survey. One limitation of this study is that the NRMP does not distinguish between applicants in their 4th year of training and those already in practice; therefore, our response rate appeared lower overall, although it may be seen to have been more favorable if we consider that it captured data only from applicants still in residency training. NRMP does stratify match rates based on applicant medical school (i.e., U.S. graduate, foreign medical graduate, or osteopathic medical school graduate); these data were not collected in our survey but should be considered in future research.

The process of interviewing for fellowship positions may change in the future. The Committee on Fellowship Training in Obstetrics and Gynecology was established in 2011 (3). Potential solutions to some of the scheduling complications include allotting specific weeks or months to each subspecialty so that residents could anticipate absences. Web-based interviewing with the use of tools such as Skype (Microsoft) was also piloted by some programs in 2016. Previous studies in other disciplines have shown that candidates prefer in-person interviews to gain a more personal perception of the program (5), so it is uncertain whether these new strategies will become popular. Other proposed changes include conducting preliminary interviews at subspecialty meetings to help decrease the number of in-person interviews (6).

Our survey results show multiple areas for improvement in the interview process. Only 47.1% of applicants could schedule interviews with regional coordination. This cross-country travel leads to increased time away from residency obligations and family, and fatigues the applicant both during the interview and at work. Use of vacation days for interviewing means that residents who already have challenging work schedules have less vacation time to relax. Chief residents have multiple administrative, clinical, and educational duties, and completing those tasks in addition to interviewing for competitive fellowships can lead to burnout and interfere with their wellness. Also, the inefficiencies of the interview process contribute to the financial burden placed on trainees: In this study, the average total cost for interviewing exceeded $9,000.


Interviewing for a fellowship program is an expensive and time-consuming process for applicants that often inconveniences their coresidents and creates scheduling challenges for program directors. According to applicant preferences, the process could be improved by implementing regional coordination between neighboring programs, condensing interview days, and offering weekend interview dates.

Based on the results of our survey, we applaud the changes being made across fellowship disciplines, most recently in REI. These improvements should be instituted as permanent to streamline the process for both programs and applicants. A shared calendar with regional interview date coordination by neighboring programs would help to decrease cost and time away from work for future fellows. A common date for notification of interview invitations would allow applicants to schedule their travel further in advance, both cutting costs and easing scheduling with their coresidents. Gathering additional information from both applicants and fellowship directors would further streamline the fellowship interview process.


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