Abstract
Junior perspective: Triana Lobatón
Today the ways of learning medicine are numerous. We study and see patients, we use new media and new technologies that help us tremendously, yet one ways of learning remains the interaction between colleagues. This is why a fellowship or moving abroad to work is an excellent way to learn more about your speciality. Not everything is written up in our guidelines. One realizes that there are other ways of managing the same problem. After all, we know that the combination of evidence and experience is what help us best to achieve an optimal clinical practice. Here I go through the added-value of moving abroad as well as some tips to take the maximal advantage of this experience. This means you need to think carefully before go what-where, when and how.
First, what do you exactly want to do? This may be an obvious question but is the most important one before you think of all the rest. Where you go will depend on your project, professional and personal situation.
Of course you will contact the institution you are interested in via email in order to present yourself, explain the purpose of your stage and ask for information. But actually, what I highly recommend is to have a meeting before you go in order to discuss everything face to face. This allows you to know better your host, the hospital and the surrounding environment and city where the hospital is located. In addition, it is always very useful to talk to a fellow who has been there before you and who has already gone through a similar experience.
The most important issue, both for yourself and the person/centre that will receive you, is your role during this stay. For instance, if you are a physician focused on basic research and you are interested in doing a fellowship to complete your PhD involving fundamental research, then you have to decide if you want to stop doing clinical work. Depending on the project and the duration of your stay, focusing only on lab work might be the best option. However, if you are willing to do research but also clinical work, then you have to talk this through carefully with your host. In conclusion, and both for lab or clinical work, you need to define very accurately your specific tasks with your host institution. Both your role and the role of your host needs to be clear. For instance, it is very useful to agree on a formal week schedule ahead of your stay in order to know specifically what to do and where to go every day. This will avoid a waste of your time. In addition, it is very important to know when and how you can receive feedback from your mentor, as they will be probably very busy. This helps to avoid frustrations later on as you know what to expect and what not and accordingly set your goals.
Another important aspect of a fellowship is at what point of your career you go abroad. Sometimes you can decide this and plan when to go but sometimes you have not much choice and you have to adapt to the possibilities that your hospital and/or funders offer you. A good moment to go is before completing your specialization and/or during your PhD. This is probably one of the best ways to complete your specialization and/or enriching your PhD by taking in different points of view. Moreover, at this point you will probably have still no family and therefore it might be easier to plan your stay, you will be able to make the most out of your time there. On the other hand, if you go later in your professional career you have more knowledge and experience and therefore you can specialize even deeper throughout your stay. In sum, what I would therefore recommend is to actually go abroad as much as possible during your professional career as it has benefits in the early stages of your career but as well as later on.
Finally, you need to face this experience as unique in your life and therefore enjoy it and take full advantage of your time from the very beginning. This applies to your professional attitude but also for your personal way of experiencing this. From the professional point of view, this is the best moment to ask and absorb as much as possible. Do not hesitate to ask every single doubt you might have! Do not be afraid of giving your opinion, try to interact as much as possible with your colleagues every single day. Do not forget that one of the main objectives of your fellowship is to create a network which will only grow in the future. In addition, as a personal experience, you will learn from other cultures, maybe learn other languages and you will probably make friends forever.
In conclusion, a fellowship abroad is probably one of the most amazing experiences you can have both as physician and as person. But it is absolutely up to you how amazing and enriching this can be. It is a question of good organization and planning, but mainly of attitude. Live is short, but your live as gastroenterologist is even shorter, so think thoroughly what you really want to do during your professional career and then go for it.
Senior perspective: Alessandro Armuzzi
The field of Gastroenterology encompasses a broad range of organs within its setting coupled with a multiplicity of pathologies represented, an abundance of available procedures, and, finally, a huge clinical demand for practitioners. Moreover, the variety of research disciplines offers continuous opportunity to achieve advances in the field, to further understand the pathogenesis and mechanisms of multiple diseases, to refine diagnostics and treatment of different gastrointestinal conditions, and to ultimately improve patient care.
As for other areas of Medicine in recent years, the field of Gastroenterology has gone through a remarkable number of significant developments that have stimulated the specialty to a revolutionary growth. However, while these achievements ultimately yield benefit to patient community, implementing such massive scientific progress in daily patient care can represent a significant challenge. While a “standard” Gastroenterology residency prepares young physicians to manage what is most frequently faced in day-by-day clinical practice, the continuous progress in many areas of the field necessitates the development of focused Gastroenterology “subspecialties” (e.g. Inflammatory Bowel Disease, nutrition, Neurogastroenterology, advanced endoscopy, transplant hepatology, metabolic liver disease, pancreatic and biliary disease, gastrointestinal cancer, etc). Therefore, for emerging young gastroenterologists who have worked in their hospital university system for some years, the option of applying for any form of fellowship programme or a PhD abroad should be particularly appealing. This is probably the best circumstance on when to apply, but this career path can be pursued also later in professional careers. In any case, it will definitively enable them to open their minds and to immerse themselves in a new and different culture, while also being able to dedicate more time to focus on their research and/or to enhance their clinical skills. Before beginning the application process, however, there are different issues that need to be considered, and some of which are listed below.
1. Where to go and what to do
This is a very important decision before starting to consider moving abroad. It is advisable to make the choice based on personal projects and situation, that firstly means whether the career will be clinically or research oriented. If there are reliable senior colleagues working in the same university hospital or outside, asking specific advice and guidance will be extremely useful to clarify and start to properly plan. Programs will differ with regard to the balance of clinical service and dedicated research time and the length of the fellowship will depend on previous personal experience and on what it will be planned to achieve (e.g. clinical training, focused clinical training, clinical or basic research methods training, focused clinical or basic research project to develop abroad). Once identified location and program, a simple suggestion is to clarify in advance what will be both the fellow and the host roles.
2. The funding
Funding is potentially one of the biggest issues to face when considering a fellowship abroad. There are several options available in terms of applying for external funding. Some fellowship are paid, providing financial support in the form of a salary or grant. Almost all the non-profit international Scientific associations, and sometimes also the national ones, assign funding for different levels of fellowship programmes (e.g. visiting, research, grant). Other possibilities may come from local institutional grants, governmental funding, industries, philantrophy, etc. It is worth to remember, however, that the competition is usually extremely tough, and the achievement rate for applicants is notoriously rather low. This may reflects the reality of a sector where there is a chronic lack of funds and many applicants for them. Because of this, it might be advisable to plan for the possibility to explore to raise funding from other sources (e.g. local employer, patient’s associations, charities, etc).
3. The mentors
The choice of a (or more than one, indeed) mentor is one of the most important step that everyone should make, regardless of desired clinical or research career setting. Ideally, a faculty mentor in the personal specific field of interest inside the department/institution and another one outside are equally important. Mentorship will be the personal fellowship and career compass along different path. Therefore, a mentor-mentee relationship will require concrete personal connection and commitment to ensure that expectations and objectives will progress over time. The role of the mentor is something more than acting as a “simple” supervisor (e.g. someone that is only devoted on achieving specific goals). A mentor typically support the mentee in a comprehensive manner and not only as clinical or scientific advisor. Detailed and flexible recommendations on how to arrive at desired destination, help for networking at various levels, social support, suggestion for a correct work-life balance are some of the requirements that make the role of the mentor more as a friend than a simple colleague. Therefore, while the mentor-mentee association is often viewed as a one-to-one relationship, several individuals may cover the role of mentors to a single applicant. In conclusion, identifying the appropriate mentor or mentors is an essential step. It is important to identify either those within and those outside the department or institution, all with expertise in the same field of interest and, finally, to be in touch with them regularly.
An international fellowship will ultimately provide the fellow with many other opportunities. The professional network will be enhanced through discussion with other colleagues, primary sources will be accessed, a different culture will be experienced, personal horizons will be broaden and many different opportunities will be explored. In conclusion, a fellowship abroad can be a landmark experience that will enrich both the personal and professional trajectory in an unparalleled way.
This was my personal experience years ago and nowadays I am use to divide my professional memories into two distinct chapters – pre-fellowship and post-fellowship.