UK and international IR fellowships

Created - 01.11.2022

Following 6 years of radiology training in the UK I decided to take the plunge and spend a year with our friendly neighbours across the pond in Canada doing an IR fellowship. Armed with not much more than my surgical clogs, lead specs and a pair of skis I jumped on a plane to Vancouver in June 2021. What unfolded was a fantastic experience working with trainees from all over the world, learning some high end IR techniques and exploring the beautiful country of Canada.

Why did I choose an international fellowship?

I had really enjoyed my radiology and IR training thus far but felt the opportunity to see a di®erent way of working and experience living in a different country was too good an opportunity to turn down. Whist my UK training had fully prepared me for consultancy I also felt that further exposure to areas such as interventional oncology (IO) would be beneficial when deciding on IR jobs back home. 

Being an untalented monolinguist and not wanting to do the USMLEs my location for an international fellowship was limited to Canada and Australasia. Consistently ranked as one of the top three liveable cities in the world, and receiving great feedback from previous IR Fellows, Vancouver seemed like an obvious choice.

Organising the fellowship

Canadian and Australasian fellowships do take some organising. Often the post will be advertised 2 years in advance of the start date. So you should start doing your planning in ST3 or ST4. 

Following a competitive application and interview process there is a significant amount of paperwork involved before you get started. This should not be underestimated but with some reasonable time management and help from friendly administrators this is totally doable. It’s also important to budget for the cost of visas, medical licensing and relocation fees for you and your family which can run up to several thousand pounds.

Comparison to UK training

In Canada healthcare is devolved to a provincial level. However, all the provinces have a broadly similar socialised health care system that, like the NHS, is free at the point of use. Most Attendings (Consultants) are self-employed contractors within the hospital. Therefore, their income is based on e¦ciency and case numbers. So Canadian IR departments run smoother than silk on shoeshine. From a trainee perspective this translates to a large case volume. Over a 12 month fellowship you can expect to do > 1500 cases which is relatively unheard of in the UK. Days are long and tiring (starting at 6.30 am and often leaving after 8pm) but the experience is very rewarding at the end.

Case mix will vary from hospital to hospital but is broadly similar to the UK Vancouver has a large IO practice with lots of TACE, SIRT and ablation. There was minimal vascular work but plenty of GI, GU, HPB, lines, fistulas, elective and emergency emblotherapy.

Canadian trainees usually only do one year of fellowship following 5 years of general radiology residency. I found that UK IR trainees had significantly more experience at the beginning of the year than their peers. The fellowship is an intense experience designed to take you from a relative novice to an independent practitioner. By then end of the year all the fellows were of a similar standard. There is a big focus on education within North American training schemes. This is apparent in every facet from morning rounds, performing cases, reporting and in MDTs. The quality of training is very high as is the expectation by your supervisors. I found I was pushed to improve and hone my skills. Practical hurdles to be aware of Canada pay their fellows significantly less than the UK (equivalent to a FY2 salary). This is important to bear in mind if you’re coming with dependants and have plans for travel during the year. However, the salary is still totally liveable on and with a bit of budgeting can go a long way. If you’re coming with family it’s also important to think about how they will spend their year as you will spend the majority of your waking hours in the hospital and annual leave is minimal (4 weeks/year in Canada).

Main advice for those considering an overseas fellowship:

 - If you’re thinking about it do it! An overseas fellowship is a fantastic opportunity to broaden your horizons (professionally and socially), enhance your CV and increase your exposure to di®erent ways of working. Very few people regret doing it.

 - Ensure you speak to people who have done the fellowship before you. n Start planning early and look into your desired position to find out what the financial and hours of work you’re committing to.

 - If you are coming overseas with a partner or family, you need to consider what their year will look like as well.

 - Ultimately it’s not as di¦cult to organise as it might seem. The benefits of an overseas fellowship far exceeded the challenges.

Ben Thompson, Guy’s and St Thomas’ NHS Foundation Trust