Roadmap for Applicants

Guide authored by: Dong-han Yao, MD, Vince Xiao, Johnny Lo, Adrian Romero, Kevin Smith

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SENIOR MEDICAL STUDENT

Congratulations on developing an early interest in clinical informatics as a medical student! This is a rapidly growing field at the intersection of clinical care, information technology, and data science that will prepare you for a fruitful career in an increasingly digital healthcare landscape. 

 

M3:

• Seeking out opportunities to participate in multidisciplinary projects: Collaborate on potential quality improvement (QI), AI or EHR-based projects with teams that include IT analysts, clinical researchers, or departmental leaders to improve patient care.

• Exploring national committees and conferences: Explore conferences, subcommittees, and workgroups in AMIA, ACEP, or SAEM. These organizations offer early exposure to the field and provide educational and networking opportunities.

• Shadowing a physician informaticist or seeking out an informatics mentor: Identify key faculty members or practicing clinical informaticists to gain insights into an informatics career as a practicing physician.

M4:

• Taking targeted coursework: Enroll in electives or online courses in data analytics, artificial intelligence/machine learning (AI/ML), business management, cybersecurity, programming, or health IT to build foundational knowledge of key informatics areas.

• Leadership and informatics rotations: Participate in rotations specifically focused on informatics leadership and governance in health IT to gain practical experience and executive insights to how to address clinical challenges through informatics solutions. 

• Away rotations for exposure and networking: If you do away rotations in your core specialty of choice, consider choosing institutions with strong clinical informatics programs to gain perspectives, as different enterprises have different challenges that require unique informatics approaches. 

• Tracking residencies with informatics focus: Research residencies that support informatics training, such as Epic certifications, resident informatics curriculums, and an established history of sending residents to clinical informatics fellowships. 

  • 3-year programs may provide a loose path/track for interested residents but have limited time for informatics electives/projects. 

  • 4-year programs may offer additional flexibility for informatics (projects, workshops, conferences, etc.), especially through additional elective time. This will likely be very helpful in increasing your informatics experience and portfolio for fellowship applications, and can also give you additional time to explore the specialty if you are not sure. 

 

Residency

PGY 1: Building Foundations

Your first year of residency will be busy. You should prioritize learning the health system and building clinical knowledge. As you navigate through your new role, you can consider the following to explore further in informatics: 

• Seek out a local/regional informatics mentor: Identify faculty members within your department or the hosting institution with informatics background to guide you on your informatics journey.

• Position yourself as the EHR/digital guru: Establish yourself as an expert in using your institution’s electronic health record (EHR) system and common applications (e.g. amion, dictation, etc.), help your colleagues troubleshoot common issues and suggest improvements. 

• Join national committees and listservs: If you have not already done so as a medical student, consider joining informatics-focused organizations like AMIA (or working groups/subcommittees in ACEP/SAEM) to network with peers and experts. Consider attending informatics-specific conferences to get a better idea for the informatics personality, as well as the type of healthcare problems being solved and scholarly work being done. 

 

PGY 2: Expanding Your Role

As you refine your clinical acumen, consider the following to expand beyond your typical resident role and venture further into clinical informatics:  

• Read: Develop foundational knowledge in key areas such as cybersecurity, clinical decision support (CDS), and interoperability through Journal of AMIA and introductory informatics textbooks.

• Noticing Problems: Reflect on challenges in your daily workflows and consider ways to address these issues through human-centered informatics solutions. Collect these pain points. Think about how processes ought to be done- your fresh perspective as a junior learner that may be uniquely valuable. Ask why inefficient processes are done the way they are- you’ll find that  frequent answers include “it’s always been done that way” or “nobody knows”- which is a perfect way to: 

• Participate in informatics-related projects: Engage in quality improvement (QI)/patient safety or operational projects that involve informatics tools/IT team.

  • You can also consider working with departmental leaders to develop dashboards, create residency reports, or improve existing analytics tools for clinical and operational metrics.

• Develop technical skills: While not strictly necessary, building technical proficiency in applications, tools and programming languages such as SQL, R, or Python to analyze data and contribute meaningfully to projects can be helpful.

• Work with Epic/Cerner analysts: Collaborate on EHR optimization projects to address pain points in your specialty’s workflow.

• Plan to present at and attend conferences: Prepare to share your work at local, regional, or national conferences as a senior resident, as informatics projects often require significant lead time.

• Take on more active roles in committees: Increase your involvement in local, regional, or national committees to build your leadership skills and network with other professionals.

 

PGY 3-4: Deciding and Preparing to Apply

• Continue projects and exploration from before

• Research/Projects:

  • Try to finish up projects and ease up on starting new projects as you ramp up to application season

  • Remember that quality generally trumps quantity. It is generally better to be able to talk about a few completed projects in detail and demonstrated impact, rather than an exorbitant number of recently started or unfinished projects

  • Begin to weave a cohesive narrative for your interests in informatics, and tie them to projects and activities you’ve participated in the past. Use this to help decide what projects to take on in the last year(s) of residency. 

 

• Relevant Conferences: 

  • Epic Expert Group Meetings (XGM) 

  • AMIA Clinical Informatics Conference (CIC)

  • Epic User Group Meetings (UGM) 

  • AMIA Annual Symposium 

  • Healthcare Information and Management Systems Society (HIMSS)

  • Any regional or national conference for your home specialty! 

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Timeline of Fellowship Application Process: 

• Feb – April

  • If you are able to plan your final year’s block schedule, try to place easier rotations for interview season (September through November).

  • Identify your letter of recommendation authors to give them an early start.

  • If you have a specific program you want to be at, reach out to current fellows/program leadership to set up a meeting to discuss how you can maximize your chances to match there, or to explore the possibility of an away rotation. 

  • Start drafting your personal statement. 

• April – June

  • April/May:

    • Start to research programs and keep a running list or spreadsheet of pros/cons, salary, expected clinical time, etc.

    • Finalize and notify your letter of recommendation authors if you haven’t yet.

  • June:

    • Request for your ERAS Fellowship token for the July Application Cycle.

    • Register at MyERAS.

    • Finalize your personal statement.

    • Start submitting documents to the ERAS Fellowship Documents Office (EFDO) because they can take up to five (5) business days to process to ERAS after they are uploaded.

    • ERAS photos will usually update at midnight EST of the day you upload.

• July 

  • Early-mid July: 

    • Submit your ERAS application (programs will not be able to access your application and documents until mid July so you can submit any time before then- any submissions after that deadline will be time stamped)

  • Late July: 

    • Early interview invites will start to roll in.

• August – November

  • The bulk of interview invites will occur in late July through late September (with the final invites trickling in throughout October). Interviews will start in August but most will occur September through November.

  • As you go on your interviews, think about some important questions to consider (see end of section). 

  • During November, you should go on Second Looks (some programs offer help with setting up in-person site visits) and schedule additional interviews with other faculty/staff if you want more information.

  • Start to make multiple iterations of your rank list based on different factors that are important to you until you’re happy with your final list.

  • Sign up for an AMIA student membership so that you can participate in the match, w

• December

  • Early December:

    • Finalize your rank list and submit.

    • Send a letter of intent to your #1 program before the programs’ deadline if you want.

  •  Mid-December:

    • Congratulations on making it to the Match!

    • Start to compile licensing documents if you aren’t already licensed in the state you matched in.

 

Some questions and factors to consider when evaluating programs and interviewing:

1. What department is the program housed in? 

   1. CI is unique in that the fellowship training program can be housed in a variety of different specialty departments, ranging from pediatrics to pathology. While where fellowship is housed will certainly influence your experience, many of the best programs may be housed in a department outside of our clinical background, and this is perfectly fine. Your fellowship will work with you to ensure that you are practicing clinically in your clinical “home”, if this is not the same as the fellowship department. 

2. How important is traditional academic research? 

   1. Not all programs have the same expectations or resources for academic research. There are many great programs that are not heavily focused on academic output — operational-first programs will have plenty of hands-on project experience as well as business, project management, and financial exposure, and may set you up well for a CMIO role. Note that if you want a job in academic medicine after fellowship graduation, having research experience will be important. 

3. How many fellows per year? What kind of fellows do you take? 

   1. In addition to different total slots per year, some programs may have fluctuating support every year. Many programs can only support fellows from certain specialties, and some programs even have rotating specialty slots (e.g. taking surgery trainees on odd years, EM trainees on even years). 

4. Where is the program? 

   1. Beyond choosing where you want to live for the next 2 years, the biggest factor influencing job offers after fellowship graduation is through your network and the kind of jobs available in your geographic area. A program in a larger metropolitan area tends to give you more flexibility and variety in job offers, but may also face a more saturated market. 

5. How old is the program? 

   1. An older program has a larger existing network, which is important for getting job offers. A newer program may experience growing pains, but potentially can allow for more freedom in “choosing your own experience”. 

6. How many clinical informatics faculty are there, what is their clinical background, and how senior are they? 

   1. Having core informatics faculty from a variety of clinical specialties (not just in EM) opens up more opportunities for projects and cross-collaboration. Having faculty across the seniority spectrum allows for a more relevant mentorship experience while preserving access to executive sponsorship when needed. 

7. How is the didactic curriculum designed? 

   1. Some larger programs will manage and design their own didactic curriculum based on ACGME guidelines. Some smaller programs may not have the resources to support this, and many programs as a result use a standardized online curriculum (e.g. OHSU graduate certificate/masters program) which can also be highly effective. 

8. Does the program require a concomitant master’s degree or have the option?

   1. Some programs require (or give the option) of a concomitant masters, often in biomedical informatics. While having more structured coursework can be helpful, others have felt that a masters degree takes time away from other opportunities such as informatics project work or clinical moonlighting. A master’s degree can, but doesn’t necessarily increase your competitiveness in the job market.  

9. What is the clinical time requirement? 

   1. Most programs maintain a 20% clinical, 80% informatics split.  If there is a higher clinical requirement, investigate the reason why, and find out how these “extra” shifts beyond 20% are paid (if at all). While additional clinical time so soon after residency graduation is not necessarily a bad thing, choosing a program that allows you to do this as additional moonlighting will give you more flexibility (often with higher attending-scale pay). 

10. Does the program allow moonlighting? Where do current fellows moonlight?

    1. Opportunities for moonlighting are highly desirable, as this will not only significantly increase your income during fellowship but also help upkeep the critical clinical skills you need to maintain as a brand-new attending.

11. What is the salary scale? 

    1. Some programs will pay you on a PGY-scale, while others may pay for some (or all) of your clinical time on an attending scale. While it may feel “impolite” to ask about this during interviews, this is an important question given significant variability between programs (sometimes even within the same program), and programs will not be taken aback if you ask about this. 

12. What are the average responsibilities and day-to-day of a fellow? 

    1. Programs vary widely in the non-clinical expectations of a fellow, especially when it comes to project management and research. One of the best ways to get an unbiased look at the program is to ask a current fellow about what a typical day might look like for them. 

13. What is the department’s institutional priority in the next 2 years? 

    1. This is a very important question to ask that will give you insight into what kind of projects you will likely be involved in, ranging from “bread and butter” EHR implementation to billing and compliance to ambient AI dictation technology. An ideal fellowship should at least in part have shared alignment with your personal interests. 

 

FELLOWSHIP

This is your dedicated time to immerse yourself in the world of clinical informatics. You'll gain a strong foundation in core concepts and develop the practical skills needed to become a leader in the field. Maximize this opportunity by actively engaging in all aspects of your fellowship program.

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Year 1: Building Your Foundation

• Didactics and Coursework:

  • Master Core Concepts: Immerse yourself in foundational topics, including:

    • Data standards and interoperability (HL7, FHIR, SNOMED CT, LOINC)

    • Clinical decision support systems (CDSS)

    • Electronic health record (EHR) systems and their functionalities

    • Data analytics and visualization

    • Database design and management

    • Project management methodologies (Agile, Waterfall)

    • Human factors and usability

    • Change management and implementation science

    • Healthcare policy and regulations (e.g., HIPAA, Meaningful Use/Promoting Interoperability)

    • Ethics and privacy in clinical informatics

    • Biomedical and Health Informatics

  • Formal Education: If not already obtained, consider pursuing a master's degree in biomedical or health informatics, or a related field (e.g., MPH, MBA with a healthcare focus). Many fellowships offer this as part of the curriculum.

  • Network: Attend lectures, seminars, and journal clubs. Engage with faculty, guest speakers, and your co-fellows. This is an opportunity to build strong professional relationships. The clinical informatics community is a relatively small and tight-knit one compared to most specialties, and you will likely run into familiar faces across multiple settings. 

• Rotations and Clinical Experiences:

  • Immerse Yourself: Participate in rotations across various informatics-related departments, such as:

    • Clinical decision support

    • EHR optimization and implementation

    • Quality improvement and patient safety

    • Data analytics and reporting

    • Telehealth and digital health

    • Research informatics

    • Pharmacy informatics

  • Gain Hands-On Experience: Participate in system design, implementation, and evaluation activities. Shadow informaticists, analysts, and other team members to observe their daily workflows.

  • Apply Your Knowledge: Start to connect the dots between your didactic learning and real-world informatics practice.

• Scholarly Activity:

  • Identify a Project: Begin exploring potential research or operational projects that align with your interests and the needs of your institution.

  • Develop a Proposal: Work with your faculty mentors to develop a well-defined project proposal, including aims, methods, and anticipated outcomes.

  • Data Collection/Initial Work: If possible, start preliminary data collection or project work.

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Year 2: Specialization and Leadership

• Advanced Training:

  • Deepen Expertise: Focus on areas of particular interest through advanced coursework, electives, or specialized rotations. Consider topics such as:

    • Natural language processing (NLP)

    • Machine learning and artificial intelligence (AI) in healthcare

    • Predictive modeling

    • Population health management

    • Consumer health informatics

  • Develop Leadership Skills: Seek out opportunities to lead project teams, mentor junior colleagues, or present your work at conferences.

• Capstone Project:

  • Execute Your Project: Conduct your research or operational project, applying the knowledge and skills you've acquired.

  • Analyze and Interpret: Analyze your data, draw meaningful conclusions, and develop recommendations for practice or further research.

  • Disseminate Your Findings: Prepare a manuscript for publication in a peer-reviewed journal and/or present your work at national conferences (e.g., AMIA, HIMSS).

• Professional Development:

  • Engage with Professional Societies: Become an active member of organizations like the American Medical Informatics Association (AMIA) and the Health Information and Management Systems Society (HIMSS).

  • Networking: Attend conferences, workshops, and networking events to connect with leaders in the field.

  • Board Certification: Prepare for and pass the Clinical Informatics board exam offered by the American Board of Preventive Medicine (ABPM) or the American Board of Pathology (ABP).

• Job Search:

  • Define Your Career Goals: Refine your career aspirations based on your fellowship experiences.

  • Prepare Your CV and Portfolio: Highlight your projects, publications, presentations, and relevant skills.

  • Network and Interview: Leverage your professional network to identify job opportunities and practice your interviewing skills.

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Throughout Your Fellowship

• Mentorship: Cultivate strong relationships with your faculty mentors. Seek their guidance on academic, research, and career matters.

• Self-Reflection: Regularly assess your progress, identify areas for improvement, and seek feedback from mentors and colleagues.

• Stay Current: The field of clinical informatics is constantly evolving. Stay up-to-date on the latest trends and technologies by reading journals, attending conferences, and participating in online forums.

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By the end of your fellowship, you should be well-equipped to embark on a successful career in clinical informatics, contributing to the improvement of healthcare delivery through the effective use of information and technology. Good luck! 

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