To explore neurology residency program directors' (PDs) perspectives on fellowship career counseling.

While most neurology residents pursue fellowship training, many report feeling underinformed about this decision. PDs are directly or indirectly involved in fellowship career counseling, yet how intentional they are about this counseling role varies. PDs may face barriers to optimally supporting residents’ choices. Understanding their perspectives would help inform strategies to improve residents’ experiences during this process.

We conducted semi-structured interviews with seven neurology PDs from diverse academic, community, adult, and pediatric programs, spanning various career stages. Template analysis was used to analyze interview transcripts. Initial coding was informed by existing literature, and the template was refined iteratively based on the first three interviews. We identified themes by reviewing excerpts of coded data.

We identified three preliminary themes:

(1) PDs prioritize strategic mentorship guidance: Several PDs highlighted the importance of actively connecting residents with appropriate subspecialty mentors early in training. These connections, more than subspecialty exposure alone, were seen as pivotal in shaping residents' fellowship decisions. PDs felt it is important to help residents distinguish mentors’ enthusiasm from the realities of field.

(2) PDs address residents’ wellness priorities: PDs noted that current residents place a higher value on work-life balance and job satisfaction when choosing fellowship. They felt responsible for making sure residents had a realistic preview of the subspecialty work experience to ensure residents were well-informed.