I'm a current fellow, and I've always been terrible at asking the "correct" questions so I always panicked during interviews. Having done this for a few months now, I think there are a couple things that are important and to kind of delve into when speaking to faculty or fellows at places you're interviewing (no particular order):
1) What procedures you get exposure to and how many procedures you get to do: Some places I interviewed didn't get that as many procedures as I would have hoped. I'm at a place where we do a good amount of procedures, mostly injections. Some procedures are pretty easy and you get the hang of it within a few tries, but others do require more reps and you want to be sure that you get your reps in.
2) How involved you are in coverage: Coverage for major professional teams (NFL, NBA, NHL, MLB) or high level college teams is sometimes less hands-on than you would expect because of how high-profile the athletes are. A lot of times the attending is doing everything and you're kind of shadowing. At lower levels and especially the high school level, a lot of times you're the only doctor there and your attending is available by phone so you get to be "in charge". Your trainers will often be calling you or texting you for stuff and you're the one at the games.
3) Relationship with other department (especially orthopedic surgery): My program is very well-integrated with the orthopedic department and relationships are genuinely friendly the vast majority of the time. It just makes things run so much easier when there's no turf war. They refer non-operative stuff to us or things that require US injection and we refer things to them that require surgery or have failed conservative measures.
4) Ultrasound experience: I personally think US is extremely useful to help decisions and aid in examining the patient. The easy answer all the time is to get a CT or MRI, but those are costly and take time and often times require prior authorization. If you learn US really well, you can expedite care for your patient and really buy some time until they can get into CT or MRI. I definitely recommend taking into consideration how well you'll be taught US.
5) Balance of clinic time and coverage: You want to go to a place that gets you a good amount of time in clinic with good variety. It's cool to do sideline coverage and go to games and stuff, but in the future, your job will mostly be clinic so you want to make sure you have a strong clinic base. That being said, event coverage and knowing how to be a team physician is also important so you want to make sure that you get opportunities to cover different sports and get those types of experiences.
6) Pediatric exposure: Pediatrics is a whole different beast. Don't believe people when they say kids are just little adults. Their fracture and injury patterns are different and they have diseases/conditions that adults typically will not have. Almost every program I interviewed at admitted that this was one of their biggest weaknesses.
7) Acute fracture care: This one is +/-. I'm EM trained so I'm probably a bit more adept than most IM/FM/PM&R trained residents at reduction and splinting. Again, this was one of the things that most programs admitted as a weakness. It's not really the programs' fault because most patients will have gone to the ER where somebody already yanked on it and put it in a splint/cast. Typically the best you can hope for is clinic time dedicated to new fractures especially with an orthopedic surgeon because sometimes the surgeon may decide to reduce it more in their office at the first post-ER visit to get a better alignment. Furthermore, it would be nice to learn to cast because you may end up working somewhere without casting techs.
8) Primary care set-up: The ACGME requires that you do an average of 4 hours per week in your primary specialty (IM, FM, EM, PM&R, Peds). If you think about it, 4 hours on average is not much. Some places do 8 hours every other week so you might not even be getting exposure in your primary specialty every week. If you were already an attending for some time in your primary specialty, this is less important. If you're straight outta residency, this should weigh on you a bit because you're so fresh you don't want to lose the skills and training that you just completed. Just make sure that your setup is adequate.
There are other things that may be important to you, but they were less so to me. These topics may be related to research, funding to go to conferences, vacation time, maternity/paternity leave, etc.
Overall though, a lot of your decision making will be similar to how you made your rank list for residency. You'll gravitate to your desired region and towards people that you vibe with. The one thing that you should try to remember is that most fellowships are small. You might be the only fellow and if you don't get the opportunity to mingle with other residents or fellows and you end up far away from friends/family, you might get lonely.
This year has been a blast so far. I kind of wish it could go on forever haha. Best of luck in this process!
