A visit from Istanbul
Dr Onur Oto, from Haydarpaşa Numune Training and Research Hospital in Istanbul, visited Dr Kenneth Cutbush and colleague Ashish Gupta. He had recently completed his orthopaedic residency.
We spent time together in clinic and in theatre discussing cases. Also pictured is Dr Praveen Vijaysegaran.
Thank you for visiting, and all the best. The fellowship programme benefits from visits of this kind as much as the visitors do.
What a fellowship is
A fellowship is the period of subspecialty training that follows the completion of general orthopaedic training. By that point a surgeon is fully qualified and able to practise independently, but a subspecialty such as shoulder surgery involves operations and decisions that a general training programme covers only in outline. A fellowship is typically six to twelve months spent in a unit that does little else, working alongside the surgeons there in clinic, in theatre and in research.
The arrangement suits both sides. The fellow sees a concentrated volume of one kind of work, including the uncommon and difficult cases that a general unit may meet only a few times a year. The unit gains a colleague who is already a competent surgeon and who arrives with the habits and assumptions of wherever they trained, which is a dependable way of having one's own habits questioned.
Why surgeons travel for subspecialty training
Subspecialty practice varies between countries, because case mix, health systems and implant availability all vary. A surgeon who trains in one country and completes a fellowship in another ends up with a wider repertoire than either place would have provided alone. In shoulder surgery the volume of arthroscopic instability work, the pattern of arthritis presenting for replacement and the usual approach to rotator cuff tears all differ from one region to the next. Individual results vary, and techniques a visiting surgeon takes home are applied case by case in their own practice rather than adopted wholesale.
Short visits and the teaching programme
Visits of days rather than months serve a different purpose from a full fellowship. A surgeon who has recently finished residency and is deciding what to subspecialise in can see what the work actually involves before committing a year to it. Hosting those visits also keeps a unit's teaching honest, since explaining why something is done a particular way, to someone who has never seen it done, is a reasonable test of whether there is a reason.
Related information
See our shoulder fellowship page for details of the programme, and our shoulder surgery page.