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How to pursue a postgraduate fellowship

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Postgraduate fellowships are becoming a fact of life for junior doctors. A fellowship is a programme of intensive training in a chosen subspecialty, which is usually completed towards the end of postgraduate training. A medical trainee, for example, might consider a fellowship in stroke medicine or electrophysiology, whereas a surgical trainee might spend some time in minimally invasive surgery or mitral valve repair surgery.

Most fellowships are done in the penultimate year of training to allow for preparation afterwards for applying for a consultant job. It is possible to do fellowships at any time during higher specialty training, but most benefit will be obtained when you are close to receiving the certificate of completion of training. Most fellowships last for a year, although some can be for a shorter time.

Why do a postgraduate fellowship? A postgraduate fellowship, which is often regarded as the “icing on the cake” in a junior doctor’s career, is when a trainee acquires special skills and advances his or her knowledge, while maturing into a prospective consultant. Fellowships provide excellent opportunities for hands-on experience in techniques and procedures that may otherwise be difficult to learn during general training and can offer focused training with considerable exposure to the area of special interest. Devina Gogi, consultant at Huddersfield and Calderdale Hospitals NHS Trust, says that her fellowship “contributed significantly” to making her a confident ophthalmologist. “My fellowship in paediatric ophthalmology at Manchester Royal Eye Hospital gave me a comprehensive exposure, and I was able to develop my competencies further,” she explains. 

Other fellowships allow trainees to develop an area of personal interest, such as medical education or medical management, leading to a subspecialty qualification. Good fellowships also offer ample opportunities for high quality research and publication.

Furthermore, fellowships are rapidly becoming almost essential for getting a consultant post, particularly in competitive specialties. A survey of orthopaedic trainees found that nearly all had done at least one fellowship with the specific goal of helping them to compete for the limited number of consultant posts available in the United Kingdom.[1] In an increasingly competitive job market, a fellowship can be a deal maker, certainly in getting shortlisted and sometimes in getting the job when other factors are similar.

As a result, there is a risk that fellowships could become a “de facto” requirement for gaining a consultant job, says Ben Molyneux, chairman of the BMA’s Junior Doctors Committee. “This is already an emerging problem in orthopaedics, where trainees are reporting having to complete not just one but two fellowships to get a consultant job,” he says. “We already have very high quality training and relatively long training duration, relative to other nations, and there is a risk of pushing the bar even higher to get a consultant job.”

Fellowships undertaken overseas have further advantages: experience of working in a different healthcare system with people of different cultural background can go a long way in professional and personal development and exchange of knowledge. Doctors who have completed fellowships abroad bring back new ideas for improving practice and changing the way we work.

On the downside, fellowships often come with a financial challenge. Many UK fellowships do not have on-call commitments, which can result in a pay cut for some doctors. Stipends paid for overseas fellowships may be just enough to cover your basic expenses. 

Box 1: Examples of postgraduate fellowships Cambridge knee, foot, and ankle fellowship: Addenbrooke’s Hospital, Cambridge, UK

Hammersmith hepato-pancreato-biliary fellowship: Hammersmith Hospital, London, UK

Minimally invasive surgery fellowship: University of Toronto, Canada

Fellowship in cardiovascular diseases: Stanford School of Medicine, United States

Neuro-oncological surgery fellowship: University Hospital Southampton NHS Trust, Southampton, UK

Fellowship in paediatric ophthalmology: Manchester Royal Eye Hospital, Manchester, UK

Fellowship in medical education: London Deanery

Clinical leadership fellowship: Department of Health, London

Applying for a fellowship Before you start looking for a fellowship, you should define your objectives and what you hope to achieve from the experience. This could be improvement in a particular surgical skill (for example, laparoscopy or cardiac catheterisation), gaining teaching skills, or building international contacts. Occasionally, a single fellowship may not satisfy your requirements completely, in which case you may have to split the fellowship period into two or more parts.

You can get information on fellowship opportunities from several sources, such as professional contacts and mentors; websites of specialist units and societies (such as the Royal College of Surgeons of England, the British Cardiovascular Society, and the Hepato-pancreato-biliary Registry); advertisements on websites of specialty journals (such as the Journal of Bone and Joint Surgery); and job advertisements in BMJ Careers. Once you have identified a potential fellowship, a serious chat with a previous (or current) fellow of the unit you intend to join is by far the best and easiest way of getting a detailed account of what the fellowship entails.

Many centres insist that fellowship candidates complete application forms to be considered for a post. However, a carefully drafted email (or letter) to the fellowship supervisor along with an updated copy of your CV is perhaps a good idea to initiate the process. Most UK fellowships are offered only after success in a formal face to face interview, whereas overseas positions may entail either an informal telephone chat or nothing at all.

In preparing an application, it is important to remember that being in a training programme does not guarantee a fellowship position. The best fellowships are in high demand and attract trainees from all over the world. Although your references and contacts can help, having a robust CV in terms of publications and presentations is perhaps the most important factor that can tip the balance in your favour. 

Fellowship experience is generally viewed positively by deaneries and training programmes. The time spent in doing an approved or accredited fellowship can count towards training, so that training extension is not necessary. However, prospective approval from the deanery and the General Medical Council must be sought before you proceed with a fellowship. This approval can take a few months. 

Careful financial planning is essential, especially if you want to go abroad. You should have a reasonable amount of money available to cover initial and future costs: as a rough guide, £15 000 or so should be enough for initial settlement expenses in Canada, Australia, and the United States, which seem to be the most popular fellowship destinations for UK trainees.

Box 2: Potential costs entailed in overseas fellowships Initial expenses Overseas medical registration fee

Overseas royal college assessment fee

Immigration and visa charges

Legal verification of documents

Private health assessments

Flights

Miscellaneous (such as police certificate)

Future expenses Medical indemnity

Accommodation—at least two months’ rent in advance

Car—needed in most situations

Children’s schools—not free for foreigners in most countries

Private health insurance 

Recurring UK expenses—mortgage, essential bills, loan repayments, and so on 

Miscellaneous: furniture, holidays, and so on

Making the most of your fellowship Once you are on a fellowship programme, you can do several things to make sure you get the most out of the experience. On joining, the first thing to do is set up a formal meeting with your supervisor. 

You should seek early involvement in research projects, and publish, present, and teach throughout your fellowship. A fellowship is also a good time to expand your professional network. 

Remember, however, that clinical exposure should always be your top priority on a fellowship. If the fellowship entails training in specific techniques, such as cardiac catheterisation and endoscopy, you should aim to either do them yourself or actively participate in them all the time.

A fellowship shouldn’t be all work and no play, though. In the words of a Canadian fellow who recently spent time in Australia for research purposes, “Fellowships are a great way to explore a new country, and I am glad I did so in Australia.”

Depending on the stage of your training, you may or may not have a training job to go back to once you have completed your fellowship. Alternatively, you might be in a position to apply for a consultant post to start on completion of your fellowship. In the past, a single fellowship was enough to help a doctor secure a consultant position. However, because of the changing demands of the job market this is no longer the case, and many trainees end up doing another fellowship after completion of the first one. Doing several fellowships of a similar nature can be counterproductive and is best avoided; locum consultant jobs would be better in this scenario.

Taking the plunge Fellowships can act as a stepping stone to a consultant position. When wisely chosen and carefully planned, they can play an important part in enhancing a trainee’s professional profile throughout his or her career. No matter how expensive it might prove to be, few people who have been abroad have regretted their fellowship experience, professionally and personally.

Find out more about fellowships in the BMJ Could a passage to India be the way to get more surgical experience? BMJ 2012;345:e6637, doi:10.1136/bmj.e6637.

Rej Bhumbra, a surgical trainee in orthopaedic oncology, explains in a BMJ podcast how his time in India fast tracked his learning. www.bmj.com/podcast/2012/10/12/treating-masses-overtreating-few.

Competing interests: None declared.

References Billingsley M. Most orthopaedic trainees undertake fellowships to land a consultant post. BMJ Careers  2012; http://careers.bmj.com/careers/advice/view-article.html?id=20007962. Rahij Anwar hip and knee fellow  Sydney Private Hospital, Ashfield, Sydney, Australia Zameer Shah consultant orthopaedic surgeon  Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

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