Here is a transcript and brief notes on the discussions we held on the 11th of March pertaining to fellowships. Please note these are presented in notes format and are not a complete representation of each speaker's entire point. For a live discussion, ability to interact and ask questions, please join our fellowship rooms which are held on a weekly basis.
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Mr. Pranai Buddhdev (Paediatric Orthopaedic Consultant and Co-Founder of The Bone Club) was the host and moderator with Mr. Akib Khan (Orthopaedic Registrar in NW London and Co-Founder of The Bone Club) providing administrative support.
Ms Deepa Bose —> Trauma and Limb Reconstruction (infection) Consultant in Birmingham. Oxford fellowship then went to Bellevue in New York (had done the USMLE previously) for six months. Excellent experience.
Dr. Dhanur Damodar —> 5 years of ortho training in USA. In 4th year you match for the fellowship (16 months before graduation date from residency). Allows you to strategise where you want to go for fellowship. A lot of it is based on the faculty of where you train and who you know. Heavily based on your CV. Sports medicine is the new generalist. Applied for 30 sports med programmes. Interviewed for 14 of them. Made a list of what he desired and entered it into the matching system. He matched at Rush in Chicago.
Mr Jonathan Stevenson (Bone Tumour Surgeon, Royal Orthopaedic Hospital) —> He was in Oswestry and was given mixed advice from trainees and trainers. David Jeffery told him not to go to Australia but to go somewhere with a large population if you want to pursue oncology (go to China or India) as this will give you the highest caseload. The level of training would be better in the UK because the oncology centres are concentrated. In order to find a fellowship, used the people he knew in Oswestry and going to the right meetings (to get to know people socially). Had a fellowship in UK (Prof Jays) and an International one (BOA sponsored) in Mumbai, India. This has since become a well trodden path. He has also been sponsored (British Orthopaedic Oncology Society) for a travelling fellowship, but has not yet taken. His advice is to speak to everybody - consultants in the field and out of the field. Also speak to current fellows in the institutions. Also look at the fellowships on all of the national association websites. Then make a plan and stick to it - being organised is very important.
Hani Abdul-Jabar (Hip and Knee Surgeon, NW London) —> Advantages and disadvantages as to whether or not to stay or go abroad. Due to family commitments he did his ‘long fellowship’ at Guys and St Thomas’. He remained very keen to explore international fellowships so that he could compare to our system in the UK. He applied and received BOA/Zimmer travelling fellowship. He went to the Michigan, US (2 weeks) and Sunnybrook (Toronto), Canada (4 weeks). It was observations but was very useful. It was an eye-opener as to what the healthcare systems were like. Orthofix offerred a travelling fellowship to Pretoria in South Africa., 6 weeks there he learned more than in 6 years of orthopaedic training in the UK. The complexity and number of cases that came through the door. Overall, he feels where you do fellowship is very personal and has to match your circumstances.
Dr Vonda Wright (Board Certified Orthopedic Surgeon and Team Doctor, Chief of Sports Medicine and Orthopedics for Northside Health System in Atlanta) —> Variety of standpoints on fellowships. Trained for orthopedics at University of Pittsburgh (UPMC). Did a dedicated year in stem cell research. Spent a year doing trauma. Went to Hospital for Special Surgery (sports med and trauma). Then was chosen for a prestigious fellowship which allowed further specialisation within sports medicine. She also sat on the AOA leadership and fellowship committee where she actually chooses the travelling fellow. Returned from her HSS fellowship as faculty for UPMC. As a sports doctor, she also spends time as a ‘team doctor’ caring for division one sports people. When hiring a fellow, she is looking for two things. Number one: There is a baseline level of education that is required as to whether you will get an interview (including reference letters, relationships you’ve formed with attendings and your research experience). The second thing is, once you have an interview, the main thing is what you are like as a person. Interview tips —> the interview is about being a ‘real person’.
Mr Elliot Sorene (Hand Surgeon, London) —> Basic Orthopaedic training in Israel. Pulvertaft Hand Surgery (Derby) fellowship for one and a half years. Once you are in a place for fellowship, you will always be attached to that place. Make contacts internationally. If you have a chance to do it, you should do it. Suggests going to a country you have no ethnic bond with so you can learn a new way of thinking. Goes to India frequently.
Mr Tim Waters (Hip and Knee Surgeon, East Herts) —> Hip and Knee Surgeon. Sydney fellowship. Strongly recommends going away somewhere different. He did his fellowship in a private hospital. This meant that everything that left the hospital must be perfection - and that is how he learned it on his fellowship. He learned bit by bit to ensure perfection in each bit of the operation. He runs a fellowship at West Herts with two fellows 6 months each. Important for trainers to teach fellows how to become a consultant. Also suggests that you shouldn’t miss out on opportunities overseas (for example he is a part of “operation walk” where he goes out to Vietnam to do knee replacements. Happy for people to contact him about his fellowships. He also wants to remind people that people do drop out of fellowships for example if someone gets a consultant post that is more important. So keep your ear to the ground.
Ms Sara Shelton (Paediatric Orthopaedic Surgeon) —> Wen to Cambodia for fellowship. Moved entire family out including their 2 year old! Plastics with nerve reconstructions, paeds ortho, limb reconstruction - lots of complex and rare pathology in high volumes. Learned how to ‘stand on her own two feet’ as went from being very supervised to being quite unsupervised. Had residents following her around, how to deal with complications.
Mr Angelos Assiotis (Upper Limb Consultant, Lister Hospital (Stevenage)) —> Two national fellowship. Bristol Royal Infirmary and Lister (Stevenage) fellowship. Important to choose fellowship, high volume. Points: 1. Expensive time in life (paid less than you’re used to) so make sure you save before. 2. Never get your fellowship time back (can enjoy, relax and have fun —> apply what you have and know. Enjoy your time and don’t rush into a job. 3. Abroad vs Local—> It’s great to go abroad if family circumstances allow. Take opportunities even if for a short amount of time.
Mr James Shelton (Lower Limb Fellow) —> Cambodia fellowship. Cavendish revision hip fellow. Speak to previous fellows and arrange a visit to the unit. It’s a great time, get all the operating and have someone to bail you out. Build your management credentials.
What are the top things to look out for when looking for a fellowship?
Ms Deepa Bose—> Know the kind of thing you are looking for. Want to look for a position when you are almost like a consultant.
Mr Jonathan Stevenson —> Depends what you want. It’s about the research or experience then go for that.
Mr Hani Abdul-Jabar—> From an arthroplasty point of view, it’s not about number of joints you need to do. In a fellowship, it’s about fine-tuning the skills you’ve accumulated during your years of training. It’s about knowing how to get out trouble.
Dr Vonda Wright —> Get two in one. It will always matter when looking for jobs, where you come from. Find people who will present the most complex things and ask them how they are thinking.
Mr Elliot Sorene —> In hand surgery, number of cases and be exposed to everything. Mentors and who you’re with. When you’re a consultant, you’ll be ringing up your mentors. Also where the other fellows are from (i.e. from all over the world) it’ll make your life more interesting.
Ms Sara Shelton —> Depends on what is to be gained. It’s about getting the bits of experience from each place. Location is up for negotiation with family. It should be a different surgical experience or a different way of thinking.
Angelos Assiotis —> Combination of numbers and case mix of what the unit offers.
James Shelton —> Mentorship is the key one. Prestige does matter as well.
What about private sector operating fellowships in the UK?
Mr Elliot Sorene —> It’s an observational experience. Doesn’t approve of fellowships in private practice in the UK as a good thing. Doesn’t know if it can be formalised. He’s is, however, happy to have trainees in his private lists.
What makes a good fellowship trainer?
Ms. Deepa Bose—> Someone who was willing to share the complexity of what they are doing and let you into their brain. Know what it is you are trying to achieve. Keep that in your mind and be honest about your aims with your fellowship trainer.
Mr Jonathan Stevenson—> He will tailor the fellowship programme to meet the fellow. You won’t be able to get what you want out of it unless you set expectations and your goals.
Mr Hani Abdul-Jabar —> Be in constant dialog with your mentor. Use every opportunity. Question why it is they do it the way that they do it.
Dr Vonda Wright —> It’s a give and take. To trust the fellow, she must know that the fellow has been listening to her and they have read for the case. If you want the trainer to trust you, you must do things the way she does things. It’s a symbiotic trust relationship. See everything, do everything, know everything. Use your fellowship, eat it up (even if you’re exhausted). It’s a unique time.
Mr Elliot Sorene—> It’s a dance between fellow and mentor. Let the fellow do the case and not interfere too much.
Mr Angelos Assiotis —> Give your fellow the confidence that they do the case and that they can bail you out. Having the calm and composed mindset. To get the most of your fellowship, go ballistic. Go and be there.
Mr James Shelton—> Open, honest and unflappable (the trainer should be). A good fellow needs to realise operating is a privilege and not a right. “Can I do that please?”, ask as many dumb questions as you can in clinic.
How long is long enough?
Ms Deepa Bose —> 12 months in any specialty is the minimum to get the full benefit
Mr Jonathan Stevenson—> Depends on the orthopaedic specialty.
Mr Hani Abdul-Jabar—> It depends on the trainee and how much you’ve done. 9-12 months is the minimum before you can step up to be a consultant. Do a shorter fellowship elsewhere… to gain experience from elsewhere and a different way of thinking
How much do you think your fellowship affected where your job is:
Mr Pranai Buddhdev—> Depends where the jobs are
Ms Deepa Bose —> Depends what you plan to do, for example with limb reconstruction (i.e. small subspecialty)
Mr Jonathan Stevenson —> Pick the one where there is likely to be someone retiring
Mr Elliot Sorene —> In hand surgery, well respected institute.
Mr Hani Abdul-Jabar—> You only get trained once, so don’t restrict your options. Maximize your chances and maximize your opportunities.
Regarding trauma fellowships, would it be useful even if you want to specialise to hip and knee?
Mr Hani Abdul-Jabar —> you need to know how to manage trauma
Mr Elliot Sorene —> Trauma is the key. Trauma principles are the building blocks
Mr Hani Abdul-Jabar— Start shopping early. Explore the market and what’s available. Must secure a formal fellowship training programme. Apply for funding though all the smaller programmes.
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