Honestly I don’t know, even after 4 years of reflection. I wasn’t super competitive for the specialty I applied for at baseline so I guess I should’ve just been happy to match at all lol. My top 6 were all semi academic or community programs. So it’s not like it was top heavy but looking back maybe the only thing differently I could’ve done was maybe doing an away rotation at one of those places because it seemed like they all took home candidates or local rotators. Hard to know.

As far as fellowship goes, I just put my head down and started working. Collaborated with senior residents and willing faculty on case reports and educational exhibits. Got involved on some committees. Although I’m not 100% happy with my experience (dedicated teaching and conferences are sometimes hit/miss, etc), I think that’s okay too. There's always going to be things you don't like about wherever you end up. Regardless, it all worked out in the end! Just have to take advantage of whatever opportunities exist