The decision to pursue a subspecialty is one that is likely part of the path that led a resident to their residency program. The plan, however, can evolve based on your path in residency.
A sixth-year neurosurgery resident in Chicago, James Mossner, MD, MS, is familiar with the dynamic of finding your footing as a resident while trying to plan the next phase of your career. As he prepares to begin a fellowship in stereotactic and functional neurosurgery in Oregon in July 2027, he offered these tips about how residents can use their residency training experiences to inform physician fellowship decisions and their postresidency options.
Plans can change
Like the initial decision to pursue a certain specialty as a medical student, the choice to pursue a subspecialty fellowship is one that evolves during your time in training.
“I kind of had an idea of what I was going to do subspecialty-wise, but I definitely questioned it earlier on in residency,” he said.
Early inclinations have a way of evolving, Dr. Mossner noted.
“You think you know what you want to do as a med student, then you’re actually in the throes of being in the OR in the clinic seeing these patients.”
The AMA’s Specialty Guide simplifies residents’ subspecialty-selection process, details training information and provides access to related association information. The guide is produced by FREIDA™, the AMA Residency & Fellowship Database®, which offers a streamlined experience and includes information on thousands of fellowship programs accredited by the Accreditation Council for Graduate Medical Education.
Vary your experiences
Dr. Mossner’s residency program is structured around distinct rotational blocks, rather than assigning residents to random cases. For example, he would spend four months almost exclusively working on tumor cases, then rotate to other clinical areas such as spine or vascular. This format allowed him to deeply immerse himself in each clinical area of neurosurgery for an extended period.
Whether the mechanisms for variety are built into your curriculum or you must seek them out, it’s important to vary your experiences, he advised.
“As you go through different cases, ask yourself: If I was going to be doing this for the rest of my life, would I be happy?” said Dr. Mossner, an AMA member who serves as an alternate delegate for the AMA Resident and Fellow Section. “Is this the thing that makes me want to get out of bed in the morning and come and operate? For me, that was functional neurosurgery.”
Have outcomes in mind
As you go through residency, it’s important to identify mentors in your desired subspecialty and seek their guidance. Because subspecialty decisions can get granular.
The exploration process, Dr. Mossner said, begins with asking your mentors how they went about picking their own fellowship. Then, when you are narrowing down your fellowship considerations they can help guide you with detailed, behind-the-scenes knowledge about what makes each fellowship unique and how it might fit in with your ambitions.
To get all the information, it’s important to “talk to people in the field and understand what each program offers,” Dr. Mossner said. “You can go on to their websites, but sometimes the websites aren't that informative. For me, having a mentor who is well connected in the subspecialty and could provide a lot of that knowledge was extremely helpful.”
Identify your knowledge gaps
The goals of pursuing fellowship vary widely depending on both the program and the applicant. For Dr. Mossner, a central motivation was gaining broad exposure to techniques and approaches within an emerging technology, rather than training in a program narrowly focused on a single skill set.
“Everyone’s reasons for pursuing fellowship are different,” he said. “For me, it was important to train in a place with a wide-ranging technical focus—one that complemented the skills I developed during residency and expanded the scope of techniques I could offer as a surgeon. I wanted exposure to a diverse set of approaches rather than being defined by one specific technique.”
