Navigating a Fellowship: My Experience

When considering selecting a fellowship, particularly in vitreoretinal surgery, numerous factors have to be considered. Foremost among these considerations is whether one has a particular subspecialty field of interest or whether one wishes to continue practicing as a general ophthalmologist. This decision sets the trajectory for one’s professional development and future career path. For individuals inclined toward subspecialization, the next decision involves determining whether to seek opportunities domestically or internationally. Reflecting on my journey, I was set on pursuing a fellowship during my registrar training. While I received good training in vitreoretinal surgery at my local hospital, it is always worthwhile to gain experience at another center. For me, this meant an international center in the UK, Australia, or Canada. The omission of the USA from my list stemmed from the barrier posed by the United States Medical Licensing Examination (USMLE) exam, which I perceived as too significant a financial, temporal, and non-vitreoretinal commitment. The fellowship application process is fiercely competitive, where well-qualified applicants hail from across the globe. To stand out in this environment requires meticulous preparation, strategic planning, and sometimes a bit of luck. Gary Player famously remarked, “…the harder I practice, the luckier I get” which underscores the link between diligence and fortuitous outcomes. A multifaceted approach is required when planning your fellowship. The three domains one needs to excel in are academic/research endeavors, clinical/surgical proficiency, and national/international engagement within the ophthalmology community. Most important of the three, in my view, are your clinical and surgical proficiency. These skills are required in the daily work of a clinical fellow. Mastery of foundational surgical skills, such as phacoemulsification, forms the bedrock of clinical competence. Additionally, substantial exposure to the chosen subspecialty, meticulously documented in a comprehensive logbook detailing outcomes and complication rates, signifies a commitment to excellence and patient safety. In the realm of research and academia, African ophthalmologists often perceive themselves at a disadvantage due to limitations in research infrastructure and funding. However, having the African spirit means that we see this as an opportunity for innovation and exploration. The dearth of extensive research projects on the continent translates into a wealth of untapped topics awaiting investigation, potentially with valuable contributions to the field. While local publications do hold merit, with hard work and diligence, international publications are inevitable. These elevate one’s scholarly work to the global stage and should be the goal. National/international presence is also important as it displays engagement with the broader ophthalmology community. An excellent place to start is the Young Ophthalmology Forum, as this displays commitment to continuous learning and professional development. Once the necessary experience/credentials have been achieved, one can begin searching for fellowship opportunities. Thankfully, a simple internet search is all, that is, required to view available opportunities. Some centers require you to go to center-specific websites to apply, while other countries place their application process on a single website (e.g., https://www.jobs.nhs.uk or https://sfmatch.org). Once a fellowship of interest has been identified, the online application process is straightforward. If eligible, you will be invited to an interview, either in-person or online. It is worth noting that even if one does not possess the relevant registration to practice in the host country, it is still worth applying as many hospitals have processes in place to assist international candidates with registration. There are also other avenues in place to assist with obtaining registration. A critical appraisal of fellowship opportunities is imperative as not all fellowships offer an equivalent level of immersion in the desired subspecialty. While one may not possess firsthand knowledge of the various fellowship programs in a specific country, it is worthwhile to speak to someone with firsthand experience. If this proves difficult, the program coordinator can direct you to one of the current fellows. Ideally, the majority of the fellowship period should be dedicated to hands-on experience and training in the chosen field. Occasional outside responsibilities (e.g., a weekly cataract list in a vitreoretinal fellowship) that complement rather than detract from the primary focus are acceptable. In no way, should the chosen subspecialty training account for the minority of the training time. I specifically recall looking through the job descriptions of various vitreoretinal fellowships in the UK. A fellowship in London advertised as vitreoretinal, mainly had medical retina duties as they were still busy setting up the vitreoretinal (VR) service. This was an example of an inadequate fellowship experience for my needs. The interview stage is the most crucial in the fellowship application process, offering an opportunity to convey one’s passion, competence, and suitability for the role. One should endeavor to attend in person if possible, however, if this is not the case an online interview will suffice. Authenticity and transparency are paramount, as interview panels possess a discerning eye for insincerity and embellishment. Prioritizing honesty and humility over grandiosity fosters a genuine connection with the panel, enhancing the likelihood of a favorable outcome. Post-interview, if unsuccessful in securing the post, soliciting feedback fosters a culture of continuous improvement and self-reflection. If successful, thorough planning and preparation are prerequisites before embarking on a fellowship abroad. This planning process usually occurs in parallel with the application process. Reflecting on my own experience, the overall planning took approximately 4 years. Firstly, successful candidates should capitalize on the opportunity to familiarize themselves with the prospective city and hospital before taking up the post. You will also get an idea of the facilities and machines that you will be using and will get time to ask any pertinent questions that you may have. Allowing one’s family to see the city aids them in planning for themselves during the fellowship year, when the working hours will be quite long. Secondly, a meticulous assessment of the fellowship country’s regulatory requirements for medical practice should be conducted. These are usually quite extensive, requiring proofs and letters from your local institutions, regulatory bodies, and police clearances. One then has to register with the fellowship country’s regulatory bodies. If the family is accompanying you, additional allowance should be made for obtaining their documentation, visas, etc. This process takes time, and, in my case, it took around 8 months to complete. Thirdly, financial planning is vitally important, more so if one has a family. There will be costs before leaving (which include the aforementioned documentation and registrations that are required). Knowledge of your expected salary is useful in planning a budget. The current fellows are of great assistance in ascertaining the cost of living and possible accommodation. Occasionally, one can take over the apartment of a fellow who has just finished. In addition, the regulations governing rental properties may be different in your home country. I was unfortunate to be informed of this while flying over central Africa en route to England, discovering that I did not have accommodation when I reached there. Emergency funds for unforeseen circumstances are essential. From my own experience, I had numerous family emergencies back home and was not paid my full salary in my first month. Once all is set, and you have your fellowship lined up, go and give it your best shot. When speaking and interacting with my co-fellows and consultants, the most important traits I have found are diligence, a good attitude, and then clinical acumen. During a fellowship, it is important to look after one’s physical and mental health. A good exercise routine and time off are important. While in England, we were able to see many parts of Scotland and Wales. Actively engaging in the learning experience is important, identifying which procedures/cases one would like to see/operate on and communicating this with the fellowship director enriches the experience. This will ensure an even spread of cases and the necessary experience required. During a fellowship, it is important to plan for the next step, which may mean returning to your home country or staying on. Ideally, this should be sorted out before finishing to ensure a smoother transition. In conclusion, the pursuit of a fellowship represents a transformative journey of personal and professional growth, characterized by challenges, triumphs, and invaluable learning experiences. A huge thank you to Manchester Royal Eye Hospital for making my fellowship experience worthwhile and enjoyable. Always remember, growth does not occur in one’s comfort zone and if it were easy, everybody would do it. Ethical statement Not applicable. Financial support and sponsorship Not applicable. Conflicts of interest There are no conflicts of interest.

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