FOR THE LOVE OF LEARNING Exploring the role of post-CCT Fellowships in the UK

For the love of learning

Haroon Rehman on the role of post-CCT Fellowships in the UK and his own positive experience at Wrightington Hospital in north-west England

Fellowships are an extremely ill-defined and poorly understood part of a surgeon’s career. The best iteration, in my mind, is a sufficient period spent in a unit acquiring specialist skills and knowledge ahead of taking on a consultant post.

A Fellowship should not be a duplication of training. However, in an era of surgical training heavily disrupted by COVID-19, some surgeons may reasonably wish to advance their skills in index procedures.

Overseas Fellowships can provide exposure to alternative healthcare environments and an opportunity to visit a new country. A ‘good

Fellowship’ will make a candidate more competitive for consultant posts, but few are formally validated and reputation is often based on word of mouth.

TRAINING NIRVANA Throughout my training, I had always hoped to undertake a Fellowship in Australia, but this plan fell victim to the pandemic. Overseas Fellowships had become highly popular among local surgeons, who were unable to travel abroad for such training. It all worked out well for me, though, as I secured a post for one year at Wrightington Hospital in revision hip and knee arthroplasty in 2021.

Wrightington is a specialist orthopaedic hospital and surgical hub in north-west England. It was John Charnley’s unit – the English orthopaedic surgeon and pioneer of the hip-replacement operation – and was home to the first effective hip replacement.

The unit has an extremely rich history and delivers the highest levels of care to its patients. I was supervised by Professor Peter Kay, Professor Martyn Porter, Mr George Pavlou and Mr Bodo Purbach, who are some of the finest surgeons in this profession. The volume of training opportunities available in Wrightington, even with some lingering COVID-19 and winter restrictions, wildly exceeded pre-pandemic levels in most hospitals around the country. The hospital also offers several other themed Fellowships in orthopaedic subspecialties.

I was able to perform both low- and high-complexity elective procedures. Fellows operated on complex cases together with supervising consultants; independent practice is also heavily encouraged in preparation for your consultant post. TEACHING CULTURE The high volume of revision and complex surgery meant these procedures were a routine part of the day, enhancing the culture of teaching and learning. The great sense of responsibility and pride taken in teaching and training means that Fellows are highly protected in this centre. Academic opportunities were available to me, although admittedly I didn’t have the time to take them on.

The Fellowship provided me with essential exposure to a wide range of

pathology as well as the opportunity to learn from highly regarded and experienced surgeons in a centre of excellence. The surgeons offered a great deal of insight into issues that affect consultants, but are generally not encountered as a trainee. There Haroon was as much to learn about the Rehman management of consultant practice as Consultant there was orthopaedics. Trauma & My own supervisors supported Orthopaedic and encouraged professional Surgeon, development outwith routine Victoria scheduled activity. On many Hospital, occasions they facilitated my work Kirkcaldy with the College as Council member and Chair of the Trainees’ Committee. They made highly valuable contributions during our discussions on ongoing College campaigns. Without their help and understanding of this It’s important to have a clear idea of what you role, I think it would have been very difficult to do it alongside the Fellowship. It is worth noting that Fellowships can be financially challenging. Wrightington, want from a Fellowship '' Wigan and Leigh offer Fellows the chance to provide on-call trauma cover for an additional supplement. I didn’t take up this offer, but I did do the occasional locum shift. Not all Fellowships are the same; exposure and experience are supervisordependent. So it is important to have a clear idea of what you want from a Fellowship. l Haroon Rehman has a special interest in service recovery, patient safety and training.

Engage boosters

Thomas Williams encourages fellow aspiring surgeons to make the most of the College when seeking a mentor and identifying opportunities

Finding your feet as an aspiring surgeon is both daunting and confusing. Within the high-pressure environment of the operating theatre – filled with occupied, multi-tasking clinicians – it is easy to lose your confidence, suppress your queries and allow ‘imposter syndrome’ to seep in.

For medical students it can be overwhelming trying to step into the surgical world. Regardless of your specialty, identifying suitable mentors and role models may be a challenge. Luckily, the College can act as the ideal intermediary via the

Regional Surgical Ambassadors’ (RSA) network.

This initiative provides College members and affiliates with advisers in their local region, offering support and direction in our budding careers.

This can manifest in many ways, from expert advice on portfolio building to expanding our horizons, and helping us identify new opportunities for research, awards and clinical experience.

I contacted the RSA network as I struggled with the same issues as many of my peers: ambition and motivation coupled with a poor understanding of how best to channel it. Sadly, such knowledge isn’t well taught in a medical school curriculum, meaning we are left to find the answers ourselves.

So I reached out with a typical overly formal and pretentious medical student email to the Surgical

Ambassador for Yorkshire &

Humber. In truth, I wasn’t expecting much more than some generic, recycled advice. However, I promptly received a warm and understanding response from Mark Peter offering to discuss any questions I had over the phone.

On the back of just a few interactions, I had an entire summer elective placement organised, working alongside an incredible team in surgery – not even 15 minutes from my house. Better yet,

A fun montage from Huddersfield Royal Infirmary features the consultants who Thomas worked with during his elective. From left, consultants Mark Peter, Tamir Salih, Robert Adair, Brian Dobbins, William Ainslie and Arin Saha

Having someone within your intended position to contact is an invaluable resource ,,

Thomas Williams Fourth-year medical student, Hull York Medical School I was given opportunities to expand my portfolio and access to an entire department of people who had been through or were going through the same process.

Being from Huddersfield, I had unfairly assumed that my hometown was no epicentre of medical expertise. As such, I was astonished to realise the outstanding level of care being delivered and to learn it was a national exemplar site of emergency surgical care.

Alongside encouraging my interests and expanding my clinical competency, Mark and his colleagues ensured that I developed an appreciation of the ins and outs of a career in surgery, making sure not to simply provide a showcase of the glamorous aspects of being a consultant on which most of us fixate.

This became one of the more insightful aspects of my experience, providing an understanding of surgery at every level, from junior doctor to consultant – an honest blueprint of what it takes to pursue such a career, highlighting the many personal and clinical challenges we can expect to encounter.

Having someone within your intended position to contact is an invaluable resource of knowledge and support, particularly within a field as demanding and competitive as surgery. It is an immense comfort to have individuals with such prowess having genuine interest in your career, and offering their time and insight to help you along.

Engaging with the RSA network will enable you to nurture your surgical interests, become more aware of relevant opportunities and expand your network of mentors and influence. The more you engage with such individuals and services, the more your proclivity to do so will increase. From there your confidence, competency and accomplishments will compound, and you will accrue the attributes and expertise needed to propel you into your desired career.

Alongside the RSA network, the College has a broad array of resources available for Members to benefit from. From the RCSEd app you can access library services, innovative anatomy tools, a repository of webinars led by experts, along with information on upcoming courses, exams and a wealth of other opportunities.

See facing page for more information on the RSA Network

REGIONAL AMBASSADORS IN YOUR AREA

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The College’s support and advice network throughout the country

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Council Member with responsibility for RSAs

1 Replacement TBC

Director

2 Mike Silva, Churchill Hospital, Oxford

Deputy Director

3 Barnabas (Barney) Green, James Cook Hospital, Middlesbrough

SCOTLAND EAST

4 Jaiganesh Manickavasagam, Ninewells Hospital, Dundee 4 Andrew Martindale, Ninewells Hospital, Dundee 4 Stephen Jones, Ninewells Hospital, Dundee

NORTH

5 Malcolm Nicol, Raigmore Hospital, Inverness 6 Pragnesh Bhatt, Aberdeen Royal Infirmary, Aberdeen 6 Manoj Kumar, Aberdeen Royal Infirmary, Aberdeen 6 Bhaskar Ram, Aberdeen Royal Infirmary, Aberdeen

WEST

7 William Andrew Clement, South Glasgow University Hospitals, Glasgow 7 Maria Coats, Glasgow Royal Infirmary, Glasgow

SOUTH EAST

8 Robyn Webber, Victoria Hospital, Kirkcaldy 8 Peter Driscoll, Victoria Hospital, Kirkcaldy 1 Andrew Tambyraja, Royal Infirmary of Edinburgh

ENGLAND EAST OF ENGLAND

9 Anita Balakrishnan, Cambridge University Hospitals, NHS Foundation Trust, Cambridge 10 Stuart Irving, Norfolk and Norwich University Hospital, Norwich 24 Niteen Tapuira, Milton Keynes University Hospital, Milton Keynes 11 Roshan Lal, James Paget University Hospital NHS Trust, Great Yarmouth SEVERN 25 Jamshed Shabbir, University Hospitals, Bristol EAST MIDLANDS 12 Hazem Khout, City Hospital, Nottingham 13 Paul Lee, Grantham and District Hospital, Grantham SOUTH EAST 26 Jeremy Rodriguez, Stoke Mandeville Hospital, Buckinghamshire 14 Aravind Desi Syamarao, Diana, Princess of Wales Hospital, Grimsby SOUTH WEST PENINSULA KENT, SURREY AND SUSSEX 27 Ashok Sridhara Subramanian, Musgrove Park Hospital, Somerset 15 Mike Williams, Eastbourne District General Hospital, Eastbourne WESSEX LONDON 16 Cynthia-Michelle Borg, University Hospital, Lewisham 16 Jihene El Kafsi, Frimley Park Hospital, Wexham 16 Nagarajan Muthialu, Great Ormond Street Hospital 28 29 29 29 Hunter MacLean, Queen Alexandra Hospital, Portsmouth Aiman Alzetani, University Hospital Southampton, Southampton Arjun Takhar, University Hospital Southampton, Southampton Nandita Pal, Southampton General Hospital, Southampton 16 Michael Saunders, The Royal Free London (NHS Foundation Trust)

WEST MIDLANDS

MERSEY 17 Ravi Pydisetty, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston 18 Janardhan Rao, Countess of Chester Hospital, Chester 19 John Taylor, University Hospital, Aintree 30 Yuvraj Agrawal, The Royal Orthopaedic Hospital NHS Trust, Birmingham 31 Sriram Rajagopalan, Royal Stoke University Hospital, Stoke-on-Trent 31 Vittal Rao, Royal Stoke University Hospital, Stoke-on-Trent 32 Ramadan Vadivelu, Royal Wolverhampton Hospital NHS Trust, Wolverhampton NORTH WESTERN 33 Devaraj Srinivasamurthy, University Hospital, Coventry 20 Richard Graham, North Manchester General Hospital, Manchester 20 Aiman Khunda, Salford Royal Hospital, Manchester 20 Nadeem Khwaja, Wythenshawe Hospital, Manchester 20 Emma Stapleton, Manchester Royal Infirmary and Salford Royal Hospital, Manchester 21 Jayadeep Jayachandran Saraswathy, Cumberland Infirmary, Carlisle YORKSHIRE AND HUMBER 34 Nathan Chidambaram, Northern General Hospital (Sheffield Teaching Hospitals NHS Foundation Trust), Sheffield 35 Amaran Krishnan, York Teaching Hospital, NHS Foundation Trust, York 36 Mark Peter, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield NORTHERN 36 Shireen McKenzie, Leeds Teaching Hospital, Leeds 22 Paul Gallagher, Northumbria Healthcare NHS Foundation Trust 23 Sanjay Pandanoboyana, Newcastle Freeman Hospital, Newcastle upon Tyne 23 Alex Phillips, Royal Victoria Infirmary, Newcastle upon Tyne 23 Dan Saleh, Royal Victoria Infirmary, Newcastle upon Tyne NORTHERN IRELAND 37 Mano Shanmuganathan, Royal Victoria Hospital, Belfast 37 Andrew Diver, Royal London Hospital 3 3 Peng Wong, James Cook Hospital, Middlesbrough Sarah Healy, James Cook University Hospital, Middlesbrough WALES 38 Raymond Delicata, Nevill Hall Hospital, Abergavenny OXFORD 39 Keshav Swarnkar,Royal Gwent Hospital, Newport 2 Giles Bond-Smith, Oxford University Hospitals NHS Trust, Oxford 40 David Owens, University Hospital of Wales, Cardiff 2 Stephen Boyce, Oxford University Hospitals NHS Trust, Oxford 41 Konstantinos Serafeimidis, Singleton Hospital, Swansea

If you are interested in applying for a Regional Adviser role please email outreach@ rcsed.ac.uk

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