Uninspiring aspiring fellows (UNAFs): an emerging infectious disease.

I vividly remember my own experience applying for residency and fellowship in the middle 1980s. There was a significant amount of uncertainty and apprehension , not unexpected, since this process would determine where I would spend the next 5 years of my life. Sitting now on the other side of the desk, as a Program Director and interviewer for a 5-fellow Infectious Diseases (ID) training program, I try to remember those concerns and anxieties, and I try to treat the aspiring fellows fairly, honestly, and truthfully. Of course, I expect no less in return. My experience has led me to conclude , however, that my expectations are far too high. Since becoming an ID Program Director in 1992, I have become slightly jaded. During these past 8 years, 5 of our fellow applicants who signed con-tracts—definitively and unequivocally stating that they would begin their training with us—subsequently broke their word (and legally binding contract) and did not start their fellowship with us. One of the 5 applicants never even bothered to inform me that he had taken an ID fellowship position elsewhere; he just did not show up. This was despite the fact that I had spoken with him at least monthly and had corresponded with him on numerous occasions preceding the time he was supposed to enter our program. He actually enrolled several months before that date in another fellowship program, but apparently " neglected " to tell that program that he was already under contract at mine. The other program (unknowingly) took the applicant, and to my knowledge they allowed him to successfully complete his fellowship. Two other aspiring fellows also somehow neglected to inform me on their own that they would be unable to honor their contractual obligations. Having been forewarned by my experience with the first such case, I should not have been so easily misled and duped. Yet, despite repeated conversations with these applicants , I found out only subsequently that both were also going to be " no shows. " At least in these latter 2 cases I had an entire month prior to the start of the fellowships to scramble and find other applicants. A fourth aspiring fellow also did not volunteer the information that she would not honor her commitment, but I discovered it several months prior to the start of her fellowship. Only 1 of the 5 informed me on her …