Completing the fellowship
Dr Naghman Choudhry finished a twelve-month shoulder fellowship in Australia in January 2020. He spent six months in Melbourne with Dr Greg Hoy and Dr Eugene Ek, and six months in Brisbane with Dr Kenneth Cutbush and Ashish Gupta.
He is pictured with his Australian Orthopaedic Association certificate for an accredited fellowship in shoulder arthroscopy and arthroplasty. He has since returned to England to take up a consultant post.
What an accredited fellowship means
The Australian Orthopaedic Association accredits post-training fellowship posts, which means a post has been assessed against standards for case volume, breadth of exposure, supervision and teaching in the subspecialty area named. Accreditation matters because a fellowship year is otherwise difficult to compare between centres: a certificate for an accredited fellowship records that the holder has worked in a post judged to provide the training it claims to provide. For a surgeon applying for a consultant appointment afterwards, that is the evidence an appointment committee can rely on.
Arthroscopy and arthroplasty
These are the two halves of shoulder surgical practice. Arthroscopy is keyhole surgery on the joint, used to repair torn rotator cuff tendons, to reattach the labrum and capsule in a shoulder that keeps dislocating, to release a stiff joint and to remove damaged tissue. Arthroplasty is joint replacement, either anatomic, which reproduces the normal arrangement of ball and socket, or reverse, which inverts it so the deltoid can raise the arm when the rotator cuff cannot. Replacement is used for arthritis, for arthritis occurring with an irreparable cuff tear, for some fractures and for revision of earlier surgery. A fellowship covering both is intended to produce a surgeon who can assess a shoulder and choose between the full range of options rather than offering only the ones they were trained in. Individual results vary.
Why a fellowship is split between centres
Two units in different cities have different case mixes, different referral patterns and often different preferences in technique. A fellow who spends six months in each sees the same problems handled two ways and has to form their own view about why, which is harder to do in a single unit where one approach is simply the way things are done. It also doubles the number of supervising surgeons whose judgement the fellow observes.