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Fellowship serves as milestone opportunity for young doctors
Physicians seek out specialized training to expand their clinical and surgical skills.
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This month Jorge Alió del Barrio gives us his take on the importance of fellowship training and the current state of play across Europe. He highlights an exciting new resource developed by SOE YO for European trainees looking to undertake a fellowship in another European country.
Anthony Khawaja, PhD, FRCOphthOutgoing Chair of the SOE Young Ophthalmologists committee
Fellowship is defined as the medical training a physician may undertake after completing a specialty training program. During this time, usually more than 1 year, the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the generalist field in which they were trained. After completing a fellowship in the relevant subspecialty, the physician is permitted to practice without direct supervision by other physicians in that subspecialty.
Fellowship programs are well established in English-speaking countries, where completion is almost obligatory in order to obtain a consultant job. However, in the rest of Europe, there are only a few centers, mostly private, that offer fellowship programs, and these positions are frequently exclusively clinical or research fellowships without real surgical exposure.
We should work toward a unified residency program in the European Union. Nowadays we are lucky to have the opportunity to easily work in any country in the EU without having to complete long and time-consuming paperwork to validate our titles, but even in this unified Europe, there still exists tremendous country-to-country differences between residency programs. In many countries, trainees are not exposed at all to surgery, which means that they finish their residency without some basic skills such as cataract surgery. This leaves them in an unfair position to get a fellowship job compared with trainees from other countries with residency programs that include surgical training. In my opinion, this scenario does not make any sense in the 21st century with a unified Europe. Politicians should address this problem to ensure equality and the same access to education for all doctors and to end some unfair systems in which the real underlying motivation is economical by the strict control of “who” and “when” someone becomes a surgeon by arbitrary selection.
A fellowship lets you expand your clinical and surgical skills in a particular area within your specialty, allowing you to become a consultant without the need for supervision and providing your patients with the best possible care. Just after finishing residency, even if you have been exposed to surgery, you are used to doing everything in one manner (same theaters, same instruments, same environment, same technique), but during the fellowship you are exposed to a completely different environment, which enhances your versatility and capability of adaptation. A fellowship is not only an excellent professional opportunity, but also a unique personal experience due to living abroad, learning different organization systems and becoming connected with professionals all over the world who you will connect with at international meetings.
Practical advice
When applying for a fellowship program, the curriculum vitae (CV) becomes critical, with a PhD and published international peer-reviewed papers the most important landmarks that may differentiate your CV from others. Previous completed observership programs in the service you are applying for may be useful as well.
The European Society of Ophthalmology Young Ophthalmologists committee is making great effort by contacting all centers in Europe in order to provide trainees with a reliable list of available European fellowships, including surgical, clinical and pure research ones, as well as relevant contact details. This list, http://soevision.org/fellowship-platform, is still not complete and it will need constant updating, but it is probably the best tool for new doctors to start searching.
In conclusion, subspecialization in ophthalmology is critical, as residency provides only general and basic training in the specialty, making a final period of specialized training necessary before becoming a consultant. Fellowship programs are likely to become obligatory in the near future across Europe, although in view of this, it is first necessary to homogenize and equalize the different residency programs from EU countries in order to avoid the limitations that many trainees still have as a consequence of unfair and restrictive training systems. In addition, a fellowship provides a unique opportunity to become connected with colleagues from all over the world, something that is currently very important in our globalized world.
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- Jorge L. Alió del Barrio, MD, PhD, is an OSN Europe Edition Board Member and professor ad honorem at the Universidad Miguel Hernández, Alicante (Spain). He can be reached at the Cornea, Cataract and Refractive Surgery Unit, Vissum Instituto Oftalmológico de Alicante, Spain; email: jorge_alio@hotmail.com.
Disclosure: Alió del Barrio reports no relevant financial disclosures.