The perfect fellowship

For those of you finishing up your residency training, it’s natural for your thoughts to turn to your subspecialty training and your future career. So how do you pick a fellowship? And once you find your dream job, how do you best the competition and secure that precious spot? Know before you go There is a lot a variation in the amount of exposure to surgical training you can expect to get during your residency. For all attempts at harmonisation, Europe is still a patchwork of different training schemes. Some countries like the Netherlands and Ireland will offer a lot of residency training, while other countries like Belgium and Germany offer far less. When you apply for your fellowship, ask those who went before you about what the opportunities are. Are they prepared to teach from zero? If you arrive with little experience, will you be sidelined or supported? There is nothing more deflating than uprooting your life and moving to another country, only to be left sidelined. Applying for a fellowship Polish up your CV and get it ready to go out. We all want to make our CVs look as nice a possible but avoid the temptation to overestimate your surgical skills. One complaint I heard recently from an eminent teaching professor was that he was tired of international fellows representing themselves as more experienced than they are. You need to be honest. The best approach is to log all of your surgeries into a surgical logbook. Printing a summary of your surgical experience from your logbook is an excellent addendum to your CV and is a way to reassure your potential trainer. Even if your numbers are not that high, the effort and diligence will be respected. Having a logbook report will also allow a potential trainer to determine where you fit best and how much support you may need. You may have been required to maintain a logbook as part of your residency training – and this is when it becomes really useful. In the UK and Ireland, trainees are required to log all of their surgeries into www.elogbook.org. If your country does not require you to log your surgeries, you should do it yourself. Log your cataract surgeries into the EUREQUO database and maintain a personal surgical log. Remember though, logbooks must not contain any identifying patient information. For the interview itself – just be you. Your best you, that is. You probably already know why you want to train in that particular centre, so show your interviewers that you have done your homework. Show them that you know what their main research lines are. Read their most recent articles. If they ask why you want a fellowship with them, “because you teach cataract surgery” is the worst response! Get your documents into the cloud The best practical tip I can give is to scan every piece of documentation you have, and load it up to a place that is always accessible. Dropbox, iCloud or Google drive are all great places to store this – it can be really helpful to have them on hand at all times. This online repository should include copies of your basic medical and ophthalmology diplomas, relevant translations, certificates of good standing, police vetting certificates, language exam certificates – everything you can think of, just scan it in and add it to your files. You will likely need to provide the originals (or officially notarised copies) to the local authority but having electronic backups, particularly your CV, can be a real lifesaver. Applying in Europe The process of securing a local accreditation can be a long one. I would advise to start the process at least one year in advance. These things always take longer than you would expect. If your basic medical training was in an EU country, there is a system of automatic recognition of professional qualifications for seven “sectorial” professions – this includes doctors. The regulations are outlined in Annex V, points 5.1.1 and 5.1.4 of the Directive 2005/36/EC. More information can be found of the website of the European Commission: 
http://bit.ly/ET-EC-Annex-V. Automatic recognition of your basic qualifications is not as “automatic” as it sounds, however. While the EU directive supports mobility, every country has its own regulatory authority to determine if you can work there. These bodies typically impose additional requirements, such as language competencies, to ensure that you can work safely in the country you choose. From my own experience, I have obtained accreditation from Ireland, Belgium and the Netherlands and all three countries had their own additional requirements. Securing your basic medical accreditation may be enough for your fellowship but if you choose to stay longer, you may wish to have your specialist degree accredited. Specialist degrees awarded in the EU that are eligible for automatic recognition are outlined in Annexes V, point 5.1 of the Directive on recognition of professional qualifications. Think about the financing Fellowships are, in general, poorly paid. Some fellowships are not paid at all. Many fellows not only have to pay rent in the fellowship country but also maintain a mortgage at home – so build up your reserves. The ESCRS now offers fellowship funding of up to €60,000 if you can submit a strong application. Fellowships can be great experiences but are also typically gruelling jobs with long hours. Stay focused and you will be able make the most out of your experience. Remember to stay in touch with the colleagues, contacts and friends you make along the way – these will be your lifelines when you are looking for advice on complex cases later in your career. Sorcha Ní Dhubhghaill is Professor of Anterior Segment Surgery at Antwerp University Hospital (UZA) and a Consultant Surgeon at the Netherlands Institute for Innovative Ocular Surgery (NIIOS). The NIIOS offers fellowships in corneal surgery and research in Rotterdam

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