LAUSR

Gastroenterology (GI) fellowships continue to be highly sought after by internal medicine residents interested in pursuing subspecialty training. Indeed, a recent study published in Digestive Diseases and Sciences reported that GI fellowships had the highest number of applicants per available position among the major subspecialties within internal medicine (IM) [1]. Despite its popularity, applicant characteristics that may influence one’s candidacy for a GI fellowship position are not well described in the literature. From the late 1990s–early 2000s, during which the GI fellowship match was abandoned, studies noted a geographical association between an applicant’s site of IM residency and his or her GI fellowship training. For example, Niederle et al. [2] found that during this era, fellowship programs increasingly relied on internal applicants (e.g., candidates from the same institution’s IM residency program) to fill GI fellowship positions. Following the reinstatement of the match in the US, little is known about how geography influences the application process from the perspective of the applicant and the fellowship program. Of note, a recent study of Canadian residents who matched in a GI fellowship program did find that applicants ranked a suitable location as the most important factor when choosing a training site [3]. Research from other disciplines of medicine has also identified location as an important consideration in the application process—notably from the perspective of program leadership [4, 5]. In a survey study of the pediatric otolaryngology fellowship application process, program directors ranked “prior knowledge of an applicant” as a top consideration in determining an applicant’s candidacy—a factor that would preferentially benefit internal candidates [5]. And thus, the question for GI fellowship applicants and program directors remains—how does the applicant’s site of IM residency training actually impact the application process? In this issue of Digestive Diseases and Sciences, Atsawarungruangkit et al. [6] investigated the potential influence of the geographical location of a US applicant’s residency training program on the results of the GI fellowship match. The authors searched the medical professional network database Doximity for gastroenterologists who graduated from fellowship between 2010 and 2019 and also listed their respective fellowship and IM residency programs. GI physicians were then categorized as internal applicants if they graduated from the same institution for both IM residency and GI fellowship versus external applicants if the two programs differed. The authors also compared the location of a GI physician’s IM residency and GI fellowship in terms of state as well as US Census Bureau-defined division (e.g., Pacific) and region (e.g., West). A total of 1489 GI physicians were included in the study, with nearly 40% identified as internal applicants who matched at the same institution for both IM residency training and GI fellowship. The authors also found that 53% of applicants matched in the same state, 61% matched in the same division, and 72% matched in the same region. The distribution of internal, in-state, in-division, and in-region applicants varied in different locations of the US. The study authors state that an applicant’s geographical site of IM training is a major factor influencing a GI fellowship program’s decision to interview and rank applicants. The findings of this study provide new data regarding the potential influence that the location of an applicant’s IM residency program has in determining his or her GI fellowship program candidacy. The authors successfully gathered data over ten successive fellowship matches on a large sample of GI physicians using a publicly available medical professional network. The study results also intuitively make sense, for many of the reasons outlined in the study. Internal applicants may rotate on the GI service or pursue research projects within the same institution as residents, thereby increasing the familiarity between both applicant and fellowship program. There is also likely increased communication * Navin L. Kumar [email protected]