Geriatricians without borders: A guide to planning an overseas fellowship

By Dr Rajni Lal

Years of training, exams and night shifts are coming to an end, and now you are at a crossroads, where you can choose to take your journey to an overseas fellowship. There are multiple factors to consider prior to applying, and given the current COVID situation, it can be a challenge.

I spent 12 months overseas and in this article I will share my pre-COVID fellowship experience in Perioperative care for Older People undergoing Surgery (POPS), London, UK.

Planning ahead
Firstly, it is important to identify your area of interest and research accordingly. For me, I commenced looking at my options as a year one Advance Trainee (AT) and took the opportunity to visit Dr Jugdeep Dhesi and Dr Judith Partridge, who later became my mentors. It also provided me with an opportunity to explore the hospital and assess the team culture. These visits can now be partially replaced via teleconferencing, keeping in mind the different time zones.

My area of interest was in Perioperative Care (POC), whatever your area of interest in geriatrics may be, I recommend asking yourself these questions:

Does this role suit my area of interest and career goals?
Is this fellowship only available overseas (consider interstate as well)?
Does this job come with high recommendations?
Will I gain any additional skills? (Discuss this with employees beforehand).
Are 12 months sufficient to gain additional skills?
Do I qualify for the job?
Can I support myself (and my family)?

If you have answered yes to the majority of the above questions, then I suggest starting the application process early. The whole process can take anywhere between 12–18 months. See here for a step-by-step guide written by Dr Rachel Aitken and myself.

The experience
Once overseas, get out of your comfort zone and immerse yourself in your new role by adjusting and adapting to new settings and with your team. But equally important is to show your ability to work independently. As a POPS fellow, I was involved in weekly clinics, multi-disciplinary team meetings and daily ward service on surgical wards. These were three-month rotations in vascular, colorectal, urology and orthopedics.

I would strongly recommend having a discussion with your mentor early about your goals.

I was encouraged to participate in various projects, and quite a range of committees. By being open to opportunities, I was fortunate to gain multiple unexpected skills and prospects, including:

Education: London Geriatric Trainee Day, King’s Medical School teaching; developed SDM teaching sessions for junior POPS clinicians.
Research: Supervising Quality Improvement Project (QiP) and audits for junior doctors; completed own QIP within POPS team.
Publications: gained systematic review skills.
Multiple national and international conference and poster presentations, whilst having an opportunity to travel to France, Poland, and other UKUK cities including Birmingham and Leicester.

The overall National Health Service (NHD) experience
I was exposed to generally unfavourable misconceptions about the “tough” NHS system, but was pleasantly surprised and encouraged when I saw for myself just how supportive, well-structured and well-run it was. In Australia, we are proud to say that we have one of the top health care systems in the world. However, the geriatrics infrastructure within NHS London has allowed me to imagine outside the Australian health infrastructure. It has provided me with an opportunity to bring ideas home on how to further enhance geriatric service for our community, clinics, geriatric service within emergency department, and most importantly, perioperative care for older people in both elective and non-elective patients.

The return home
Gaining experience overseas indicates to employees that you are motivated and keen to understand overseas advances and to bring this knowledge home.. It also has a knock-on effect.

In my case, following my return; I became involved in national committees, including Choosing Wisely, Australia; I co-founded ANZSGM Perioperative Care, Special Interest Group (SIG), and

I will be convening ANZCA Perioperative Medicine, SIG 2021. At a state level, I am on the committee for NSW Agency of Clinical Innovation (ACI) Frailty taskforce; and ACI Prehabilitation as well as ACI Low Value Care Working Groups.

Fortunately, having immersed myself in SDM during my fellowship year, I am now involved in developing SDM workshops directed towards all healthcare workers.

This experience and the skills and knowledge I have gained from it have helped shape my CV. The lifelong friendships with colleagues and associates has made an incalculable difference to my life as I continue, with them, to foster collaborative research and education. This has openly been welcomed in my current job, to advance patient care within the district.

Reflection
So, should you consider going? Well, getting out of your comfort zone will help you gain unforeseen skills, and widen your vision by providing you with excellent clinical and leadership skills. Most importantly, you will be able to travel (within COVID restrictions) and make genuine, life-long friendships.

There is no doubt that applying and relocating does come at a considerable cost, time and effort. You may lose out on local job opportunities, and it may well impact your long-service leave, mortgage and superannuation. Even so, it is an invaluable experience that can only be gained overseas.

With an eye to the future, supervisors should encourage trainees to consider opening up to different experiences, and our universities, colleges and hospitals should consider bi-directional international and interstate fellowship programs, with a focus on education, research and providing financial support to our fellows, benefitting both countries and states.

We cannot predict what is around the corner, and the only way to discover is if you take that flight and go beyond the borders!

Teachers open the door, but you must enter by yourself. – Chinese proverb

Image courtesy Rajni Lal: Myself (in the middle) with colleagues at Guy’s and St Thomas Hospital, London, UK