So as you think about fellowship, you know, an extra year can be worth it, but it can also be a waste of time. It needs to have real purpose, either to increase expertise in a specific area of research, to solidify a claim of special expertise in a clinical subspecialty, to have something truly unique to offer and on your CV, to develop connections with important individuals in your academic subspecialty. It can be clinical or research-oriented. In this presentation, we'll review many of the types and various fellowships available and how and when to apply. First, a little history. Post-graduate subspecialty experience in neurosurgery prior to launching an academic career is not a new phenomenon. Upon the recommendation of Dr. William Osler and Dr. William Welch, Harvey Cushing himself studied abroad with these two individuals, Charles Sherrington and Theodor Kohler, performing significant work in the laboratory of Hugo Kronecker. Later on, Harvey Cushing mentored his own neurosurgical protégé, Dr. William P. Van Wagenen, whom he also recommended to embark on such an experience. And ultimately, Harvey Cushing financially supported him to go to Europe and study with Walter Spielmeier in Munich and Ottfried Förster in Breslau. This experience resulted in Van Wagenen later on developing a fellowship through the AANS upon his death in 1961, with the first Van Wagenen Fellowship awarded in 1968 to Richard Berglund, who went to Oxford. The Van Wagenen Fellowship was the first post-graduate fellowship in neurosurgery and was specifically designed to encourage graduates to pursue an academic career. There was then very little further development in the realm of postgraduate fellowships until the late 1980s. These changes were primarily driven at first by a possible loss of spine practice due to the expansion of instrumentation. With the need to preserve and advance neurosurgery as a specialty, managing the entire nervous system, including its supporting structures, fellowships gradually became commonplace. However, with significant variability in quality of fellowship training, and with expansion into every facet of neurosurgery over time, there became a need to develop fellowship standards of training. This resulted in the development of the Committee for Accreditation of Subspecialty Training, first started in 1999, now called the Committee on Advanced Subspecialty Training, which has fellowship review committees involving members of the various joint sections of the AANS-CNS responsible for developing guidelines for subspecialty training, for subspecialty certification of individuals, and for reviewing applications of programs and individuals. Fellowships can be done either postgraduate or enfolded. When considering which to do, enfolded fellowships by definition occur during residency, although most must occur following chief year if they are CAST-accredited. There are some advantages of enfolded fellowships. Some of these advantages include shortening the total training time before entering practice, meaning residency and fellowship are complete at all during residency. One can learn about a subspecialty area of neurosurgery early to help develop career goals before graduation, and it can improve one's CV with significant subspecialty publications and experience early on. However, there are some disadvantages to this as well. Often it's not allowed to occur outside of your primary institution, losing the opportunity to make additional political connections and see how subspecialty cases are managed elsewhere. You're also more prepared for the experience if it's done later in training, and you have limited autonomy while still a resident. Postgraduate fellowships, on the other hand, they tend to be set up during the fifth or sixth year of residency, and many are competitive in nature. There are some advantages of postgraduate fellowships. Some of these include the following. They typically occur at another institution, allowing you to learn ways of working in your chosen subspecialty different than how it's done at your primary institution. It helps you develop connections with other leaders in your subspecialty nationally or internationally. It gives you additional political connections to find an academic job, since most jobs are filled before a job is posted, simply via word of mouth. It allows you to improve your CV with significant subspecialty publications and experience early on. You often are credentialed as an attending neurosurgeon, so you can have additional autonomy while still having more available help and supervision for tough cases. Of course, there's some disadvantages as well. Extending training length with prolonged supervision. And if you don't mesh well with your mentors, it may actually hurt opportunities for a job hunt later on, and it delays a bigger paycheck one or more years. So the next question is, do you choose an accredited fellowship program or not? Some subspecialties in North America, accreditation is required. For example, pediatrics, neurocritical care, or endovascular training. CAST accreditation, just as an example, ensures an achievement of training standards across sites. If a site is not accredited, there may be more flexibility, but also less peer review of the experience. Despite this, there are excellent postgraduate fellowships with good reputations that remain unaccredited. And international fellowships are not CAST accredited, but also may include important experience for your future. So the next question is do you choose a domestic or international fellowship? North American fellowships are typically well-structured, often are cast accredited, and may be independently funded. International experiences tend to be more variable in quality, more frequently require you to provide your own funding, and may be more dependent on the international reputation of your mentor. A fellowship decision, however, should be based on the quality of the experience for your future career, not on location. So if it will significantly enhance your career, it's likely worth doing, whether domestic or international. The Van Wagenen Fellowship is a specific case example where for over 50 years the Van Wagenen Fellowship has provided financial support for foreign travel for scientific enrichment. The Van Wagenen Fellowship was designed to give freedom and scientific development without the restrictive limitations usually imposed by many research grants and fellowships. It can be clinical or bench research focused and is designed to be very flexible and for those in pursuit of an academic career. Applications are due in the fall every other year for senior residents to pursue a one-year postgraduate experience. Details can be found at the following website. Fellowships can be sub-specially focused but can also be multidisciplinary and these opportunities can fill gaps in your training from residency or provide an opportunity to develop experience in novel research techniques to launch an academic career. Are there funding opportunities for fellowships? Well, domestic fellowships are often funded by the sponsoring institution. NREF also funds enfolded research experiences during residency. Details can be found at the following website. Industry fellowship funding opportunities also exist with applications specific to each company, which can be found on their websites. The Van Wagenen Fellowship, we've already mentioned, funds international postgraduate fellowships. And information is found at the following website. In conclusion, fellowships can focus your research experience, they can improve your subspecialty clinical training, they can help you develop important connections with individuals in your field, they can help in your job search for your first academic appointment, and ultimately, if organized well, fellowships are important career-changing experiences helping to prepare you for a successful academic career.

fellowships

neurosurgery

career development

specialization

accreditation