A fellowship is designed to help you develop a certain set of skills (e.g. IBD, TEMs, pelvic floor, intestinal failure) that weren’t met by your higher surgical training and to develop expertise in an area, prior to developing it within your consultant practice.
Be careful of some ‘fellowships’ – they are merely an extension of normal higher surgical training and make you a jack of all trades and a master of none.
When?
The first thing to decide about your fellowship is when? Post CCT or as out of programme? It is probably easier to do as a post-CCT and count it as extra to training. Not all fellowships are approved for training by the GMC and to get all that paperwork completed can be extremely time consuming and difficult. It is difficult for your Deanery as they will need to keep your job open whilst you complete your Fellowship and for that reason also prefer as post CCT. Most fellowships will advertise as post- CCT as they require someone senior to do the role as an element of independent practice may be required. Once you have your CCT, it is far easier to leave your current Deanery to take up a fellowship. There is also the psychological element – doing a fellowship in specialised practice and progressing towards independent practice, to then go back to trainee job can be difficult.
If you do decide to do OOPE for your fellowship, plan early. The paperwork can take a while and it often takes a number of visits to your programme director. You also need a satisfactory outcome from your last ARCP to be allowed OOPE.
What?
The next thing to decide is what you want to develop your skills in. What is the area of training that you feel needs further development? It may also be time to get strategic. What would you like to concentrate on as a consultant? What will help you get a job? Where are the gaps?
Speak to people that have done fellowships, and see what they gained. Speak to consultants in the regions that you want to work and see where the gap is.
Good areas for fellowships include IBD, minimally invasive surgery (combining laparoscopic, TaTME and robotics), intestinal failure, pelvic floor and TEMS. Make sure it is something you are going to do as a consultant. It seems pointless spending a year learning HIPEC if you have no intention of working in a centre that does it, or you won’t be developing a unit yourself.
Where?
Home or abroad? Both have advantages and you may have seen Mr Kai Leong and Mr Oliver Warren thrash this out in the Big Debate at the Dukes’ Annual Educational Weekend.
It depends very much on you and your family circumstances. It’s not feasible for everyone to pack up their family for a year and leave a mortgage to go abroad. You have to pick what is right for you.
If you want to go abroad, it is normally to a specific centre. Planning for this takes much longer, with jobs often being offered years in advance. In which case, you need to start making email contact at no later than ST6 for the very popular centres. In this situation it really helps if you know someone who has worked there and can set up contact for you. There is also lots of paperwork involved to move abroad for a year, and this proves very stressful for those who do it.
For fellowships in the UK, you can leave things slightly later. Once you have decided what you want to do, make enquiries about good centres that run that fellowship and speak to people who have worked on those centres. You can also email the consultant in charge to make enquiries. Go down and visit the unit, and speak to any fellows currently in post. This has to be a good fit for you, and them. Once you have done this you can decide if the fellowship they are offering meets your objectives. Look at the job plan. Be careful of jobs where you are delivering a lot of service provision. Remember, this is an extra year of training that you are undergoing. You want specific things from that job. If it doesn’t meet your needs, look elsewhere. A really good opportunity for this is at the ACPGBI Conference or the Dukes’ weekend. You get a high number of colorectal surgeons in one area, who can point you in the right direction and even introduce you to people you need to know. Meet the consultants in that unit and express your interest.
Once you have made connection with the unit and expressed an interest they can normally let you know when the advert will be out so you can keep your eyes peeled. Most fellowships are put on NHS jobs, so set up an email alert. Some will be on the Dukes’ Club website. Jobs may be advertised well in advance, i.e. in April for an October start, or sometimes earlier, so you need to decide what you want to do well before the start of ST8 for a UK fellowship to really maximise your chances of getting the fellowship you want.
So, in conclusion, plan early. Plan very early if you want to go abroad. Watch out for service provision jobs and those that don’t offer anything extra to your HST.
Fellowships really are an amazing experience. You get pushed. Just when you think you know enough, you realise you still have so much to learn. Not only do you learn operative skills, you learn about patient management, about decision making and get more insight into being a consultant than you ever could get as a trainee.
You will grow as a doctor, mature in your thinking and approach to things, develop professional relationships that will be invaluable for the rest of your career.
But most importantly, you will probably have an amazing time!