Organising and doing a fellowship is an exciting, rewarding, and sometimes exhausting time. Jobs are often more senior than we have done before, for long hours, and sometimes in a new system if we have chosen to go overseas. It can be the time to consolidate knowledge in an interest area in paediatric critical care, to do research, or to develop the clinical and non clinical skills necessary to work as a specialist rather than a registrar.
There are a number of factors to consider when organising a fellowship(s). There are many different and equally valid motivations for doing a specific period of training in a particular place, however it pays to think through these motivations prior to signing up for the fellowship.
These motivations include
- To work in a certain unit / with a certain specialist
- To gain skills / experience in a certain area, or to work in an expert centre on a certain topic (e.g. ECMO, transplant, burns)
- To do research in a certain area
- To experience work and life in another country and culture
- Because other factors in your life dictate a move to a different place (e.g. partner’s employment)
Other factors to consider, which are often not explicit until you have signed up include
- What exactly the job will entail (clinical / research / teaching)
- How much / whether you will be paid
- Whether there is any funding that you could apply for either in your home country or at the institution you will be working for
- How long the working hours will be
- Prospects for attending courses and conferences
- Holiday / education leave
- Time for research / teaching
In terms of moving to another country, additional considerations may include
- What is required in terms of work permit, professional registration, indemnity insurance
- Is the unit you wish to work in already accredited by the CICM for training
- Allow plenty of time to achieve this, it takes at least several months
- What is the maximal time that the CICM will accredit in this unit?
- Whether additional exams are required to do clinical work
- In general the USMLE is required to work in the US
- What level will you be employed at (registrar, senior registrar, research fellow)
- Language – what is spoken in the workplace, and what level is required
- Whether your partner may come with you / work
- Ease of putting children into schooling etc
Long term employment prospects
Many units have a preference for employing new specialists who have done a fellowship in a certain overseas unit or country/system. If you have long term goals to work in a certain unit, it would be wise to find out what these unspoken expectations are early in your advanced training. Acquiring specific skills or experience in an area which is in demand can be helpful to find future employment.
Working outside of Australasia
It is very variable how easy/hard it is to arrange a fellowship in a different country/system. Even once you have found a job (which may well be for two years from the time you apply), it can take quite a long time to ensure that you will be paid, that the CICM will accredit your training etc. Start thinking about your fellowship well in advance!
Many hospitals have established exchange programs with hospitals in other countries. This is often at the registrar level, but can open doors. The next easiest way of arranging a fellowship is by personal contacts. This can be through asking consultants in your unit whether they know anyone in a certain unit that they could contact on your behalf (or give you their contact details), or by contacts made at conferences. In general, Australasian trainees are very well thought of, and given a certain tenacity, and a personal reference, fellowships can usually be arranged.
There are many advantages in working in a different system – either a richer / poorer / better / worse system – for a period of time during advanced training
- To see alternative ways of doing the same thing
- To get out of the role of ‘registrar’ and take on a more senior role in a new environment where no-one knows that two years ago you didn’t know how to put in a CVL
- Experience and learn another culture and or language
- Learn about other styles of health systems, their advantages, and disadvantages
- To learn to look more objectively at our own system
- To bring back new knowledge to your unit / Australasia
- To have a great time!