Realities of Fellowships: UK and Overseas Perspectives

This episode of WENTS and Friends explores and discusses the lived realities of surgical fellowships, featuring open conversations with Ms Summy Bola and Ms Elinor Warner. Together, they share personal stories, practical advice, and honest perspectives on what it truly means to navigate a high-level fellowship balancing intense clinical learning, career ambitions, and the complexities of life outside the hospital.

Ms Summy Bola recounts her experience at the Royal Marsden Head and Neck Surgical Fellowship, offering a window into both the clinical breadth (including high-volume operating, complex neck dissections, and multidisciplinary teamwork) and the non-clinical realities of childcare, family planning, and household logistics. She emphasises that success in a fellowship depends on proactive communication, strong support systems at home, and the willingness to negotiate both professionally and personally. Summy's insights highlight the importance of arriving well-prepared, taking responsibility for self-development, and embracing the privilege of advanced surgical training. She also addresses the practicalities of managing on-call duties, integrating into new teams, and sustaining family life through flexibility and gratitude.

Ms Elinor Warner shares her perspective from an overseas fellowship in Auckland City Hospital, New Zealand. Her day-to-day schedule is a blend of ward rounds, specialist clinics, and a notably high number of complex theatre cases, including rare trans-labyrinthine and skull base procedures. Elinor explains how the healthcare setting in New Zealand, with less reliance on radiotherapy, provides greater operative exposure for trainees and expands the clinical experience well beyond what might be expected in the UK. She emphasises the importance of seeking out unique learning environments and reflects on the personal and professional growth that results from managing complex cases and adapting to a new system.

Both guests offer concrete, actionable advice: choose a fellowship that aligns with your goals, visit units in advance, speak with previous fellows, and embrace the mindset of a day-one consultant. The combined stories illuminate the dedication, resilience, and self-awareness required to thrive during this pivotal stage of a surgical career.

WENTS & Friends is the official podcast for Women in ENT Surgery UK.
Follow us on Instagram, LinkedIn and X

Email: wents@entuk.org  any questions or suggestions on topics you may have for future episodes.

Thank you to all of our guests for this season and to Karl Storz UK and the ENT UK Foundation for sponsoring season two of Went and Friends, the podcast of Women in ENT Surgery.

This season’s episodes are hosted by Alex Ashman. Produced and directed by Heather Pownall @heathershub of Heather's Media Hub Ltd. The podcast was created by Ekpemi Irune. The rest of the team includes Anna Slovick, Katherine Conroy, Marie Lyons, Tanya Ta, and Alex Ashman. 

Transcript

Alex Ashman:
Karl Storz are proud sponsors of this podcast. Discover why Karl Storz is the name synonymous with innovation, precision, and excellence in the world of surgical endoscopy.

This is WENTS and Friends, the podcast of Women in ENT Surgery UK. I'm your host, Alex Ashman. This season, we'll be looking at key career advice on returning to training, working less than full time, and applying for fellowships. And we'll be looking at factors that can make the working lives of women and minority individuals more challenging and what we can do about them. 

Today, we'll be talking to Ms. Elinor Warner, an Otologist currently undertaking the TWJ Fellowship in Auckland. And we'll also talk to Ms. Summy Bola, a head and neck consultant who undertook the Marsden Fellowship. But first, a brief word about our sponsors.

The WENTS and Friends podcast is sponsored by Karl Storz UK, who have kindly supported the podcast from the beginning and continue to do so for a second season. The podcast is also sponsored by the ENT UK Foundation, who have supported this season with an educational grant. Thank you to Karl Storz UK and ENT UK Foundation for their support. 

Ms. Elinor Warner is currently undertaking the TWJ Fellowship in Otology, Neuro-Otology and Cochlear Implants in Auckland, New Zealand.

She trained in London, including time working as part of the Royal National Advanced Otology and Cochlear Implant team, the Royal London and Great Ormond Street. Eli thanks so much for joining us. Hi. So first of all, tell us about your experience of your on an overseas fellowship at the moment.

Elinor Warner:

Yeah, I'm currently in Auckland, New Zealand. I'm the TWJ fellow here and the fellowship is in otology, implants and skull-based surgery. It's been a really amazing experience, both from a kind clinical perspective and also a life experience for myself and family. I've got two young kids and a husband who's come with me.

And yeah, it's something I don't think any of us will ever forget.

Alex Ashman:
That sounds amazing. From the clinical point of view, I mean heard in the fellowship you're on at the moment you get about sort of six theatre lists a week, which sounds absolutely amazing. What sort of, do you get a good range of experience in terms of otology? Or is there something specific that you sort of narrowed it in on, you know, is it sort of customized to what you want to

Elinor Warner:
Yeah, it's really great because there is a lot of operating, which I think when you're on fellowship is what I was really wanting to do a lot of time kind of cutting. There's what's been interesting is you have experience of both the public and private systems. I kind of follow the fellowship lead, Mitchell Neaf. He operates in private and public and the cochlear implants here are publicly funded but provided for in the private hospitals. So generally, they're kind of ASA one or two patients, that all the cochlear implants are done in the private hospitals, because it's essentially been outsourced. So for those patients, I get to do all of the operating for them as far as even in the private hospitals. So that's been an interesting experience, kind of seeing the public-private partnership as it were, and also just, you know, a new experience of cochlear implants from what I had had before, because the boss here prefers to use a slightly different implant from what I was using back at home. So I've had to learn that. I said, most commonly they use the cochlear devices and the Cochlear 632 device is the most common one that they use here. So it's a kind of a perimodular array rather than a lateral one. Anyway, yeah.

So that's been really interesting, but mainly it's just been the opportunity to be doing lots of operating and also be doing a lot of independent operating. So I have quite a few, you know, fellow lists or whether, you know, supervising consultant is, you know, available, but not necessarily in the theatre. And that's given me a lot of really good experience getting me ready for, I suppose, a consultant life back home and also the experience of training, you know, juniors, registrars or registrars and medical students and taking them through cases as well.

Alex Ashman:
So it sounds like you're getting experiences, skills that you can bring back home with you that you wouldn't necessarily get if you did a fellowship domestically. And also you're just getting that independent operating that wouldn't necessarily get as a senior registrar as well.

Elinor Warner:
Yeah, absolutely. I start each week by or each day by going around the main ward in Auckland City Hospital where they have all of the inpatients and rounding on any otology or skull-based patients there with the team. And then my time travel kind of varies week to week. There's an average of kind of six half-day lists a week. So for example, Monday morning I go and operate in private, do cochlear implants. Afternoon it's a clinic. Alternate Tuesdays it's a skull-based list where we do the major trans lab cases and middle cornea fossa approaches for things like CSF leaks or repair of superior canal dehiscences. And then Wednesdays can vary between theatre and clinics, similar with Thursdays and then all day operating on Friday as well. Yeah, it's been really great kind of skull-based exposure because they tend to do essentially majority trans-lab cases. And also there isn't much use of stereotactic radiotherapy here, which means there's a lot of more surgical cases than maybe we would see back home for even sort of slightly smaller tumors. So that's been a really great operative experience and really interesting, you know, getting to manage those patients and manage the complications that inevitably sometimes happen as well.

Alex Ashman:
How has the experience been for you from a sort of family and non-clinical point of view?

Elinor Warner:
Yeah, it's been really great. initially I've got two kids, the older one's now four and the other one's two. The older one was very apprehensive about going to nursery over here. It turned out to be because she still on holidays with us before where she'd been in kids clubs where they didn't speak English, for example and I think she made the same assumption that New Zealand as a foreign country, no one was going to speak English to her and she was worried about that. But no, it's been great and they've loved it and they've made a lot of friends and I think it's going to be quite a transition moving back home. we've done lots of so many outdoor stuff, so many trips. BG is only a short hop away from New Zealand, which is a beautiful Pacific Island, which has been great to visit as well as the beautiful areas in New Zealand, which we've really enjoyed. One of the things that was interesting, I think I found interesting here, is kind of the experience of working with kind of marginalised groups, for example, the Maori and Pacific Island population, who have, you know, much worse sort of health outcomes. And it's really interesting the way in which they are trying to approach that, and the amount of support that they try and give those groups to sort of create essentially justice in the system. So they have additional support workers who can attend appointments with them or to remind them of appointments or even just advocate for them, not even from a cultural perspective as well as from a sort of not even a language perspective and also just an understanding that the family dynamics are very different. you can have your whole extended family coming to visit you preoperatively, being consented with you, coming into recovery with you with a lot of different grandparents. There's, I suppose, different attitudes to even things like consent that unofficially, the wider family can play a role in terms of consenting for you or for a child even. So it's very interesting how they approach things differently and it's been really eye-opening. So that was one thing I've also really enjoyed. Also just kind of having trained, I suppose, in one region for a long period of time, a lot of the people I came across did things quite similarly. For example, most people doing staphys surgery were using a particular prosthesis and laser, et cetera. And so it's been really, really interesting to see that actually there's many different ways of doing it and coming across completely different techniques and different prostheses and even down to grommets that they're using. Everything's quite different. But I suppose overall, there are also lots of similarities like the healthcare system here, I suppose, broadly similar in that it's a public system and the training system is, again, broadly similar and lots of things that made it easy to fit in and understand what was going on.

Yeah, I think mainly it's just sort of the distance being so far away from friends and family has been challenging, especially, you know, with the time difference. It's got a little bit easier now, but certain times of the year it became a little bit tricky to sort of talk to people in the morning or the evening and, you know, missing out on major sort of life events for those people. And also for my husband, mean, this has been very much kind of my choice of experience and he has been extremely supportive. He's a GP, but he's kind of had to take a little bit of a pause on his own career progression. He was keen to kind of work as a partner or get a role as a partner in a GP practice. And he's had to that slightly on the back burner to come to New Zealand, which he has loved. But there's definitely compromise and he's been very supportive. And also, I suppose, just the upheaval for the kids. Although again, I think they've had an amazing experience. as I said, my daughter was finding it difficult initially, I felt bad about that. And also knowing that we've come so far away, you know, that the hours are long and I do want to make the most out of the work experience. You know, I haven't seen as much as the kids would like to longer term. And I guess the final thing is just, you know, there are expenses involved in this type of thing getting visas and medical checks and flying. So you have to be prepared for that sort of thing.

Alex Ashman:
In terms of, guess, I mean, you've had a wonderful time and it's all gone sort of swimmingly in terms of this. Did you have any backup plans or, know, sort of plan Bs if you didn't get this fellow?

Elinor Warner:
Yeah, I mean, I was really keen to go overseas because I wanted to of combine the life experience of living abroad, which I'd never done before, with kind of a new training experience. So I think my plan B was also going to be another potential overseas fellowship. And I'd spoken to a few different places in Sydney and in Perth, for example. But I think failing that, would have applied for...

some places in the UK. think I may have tried to go somewhere away from the area that I trained in just to get a slightly different experience. Because I do think that, yeah, I do think that's beneficial just to kind of broaden your horizons and, you know, see how other people do things and hopefully bring something new back to the unit that you're going to ultimately end up working in has been helpful.

Alex Ashman:
I imagine you had to start planning a couple of years ahead of time for this, whereas I've noticed some domestic fellowships, you start planning a little bit nearer at the time. So that makes sense. You can always go for the overseas fellowship and then obviously you still have a backup plan.

Elinor Warner:
There's a degree of luck in terms of when the applications kind of come out. I sort of was thinking about the Sydney endoscopic ear surgery fellowship because I felt like that would be interesting, although I wasn't particularly experienced. But actually, I mean, this was, fortunately, my first choice of fellowship happened to be that application was earliest in the year and then the next application, the Sydney one, was after that because I got this, then I wasn't going to apply for anything else. But what I'm saying is that I suppose if you really do want something, it's probably not advisable to necessarily apply for something else beforehand.

 I mean, it depends how confident you feel about negotiating yourself out of it.

Alex Ashman:
Yeah. I think you're right. Generally, it's a good practice to not be applying for something you really want to be applying for your backup plan at the same time, because it kind of suggests you're not taking things seriously. I think you're everybody, everyone's in a different situation. So I guess it's take advice from your senior colleagues who've done this before and everything. But on that matter, do you have any advice for trainees who are looking at, you know, potentially an overseas fellowship?

Elinor Warner:
Yeah, I mean, think mainly it's sort of do your research, try and speak to the people that have done the fellowship before and ask them all the questions that you want. How many like theatre lists are they getting a week? What's the supervision like? What are the people like to work with? Are they letting you actually do what you want to do? Ask to see their logbook, ask what they're actually doing in each operation and all the things that you're interested in. Just try and ask as many of the people that have previously done the fellowship the information. You will gain information by speaking to them. It will be really useful and you'll be able to then build up a picture of these different fellowships and match yourself with the one that's most aligned with what your goals are.

I think that's one. As you've mentioned, Alex, the overseas fellowships do have a long lead-up time generally. You need to be thinking about it several years ahead of time. I was actually just coming back from maternity leave and I actually missed the application for the TWJ the year before. I thought I might want to go on it. Then I missed it and actually in the end, it didn't matter because I ended up having a second kid.

in sync in the end, but you have to kind of be aware that the deadlines are quite well ahead of time and be organized about it and don't miss them if that is what you really want.

Alex Ashman:
When you visit it, I have to assume you visited beforehand.

Elinor Warner:
I actually didn't. I didn't visit, but I think generally it's because it was through the TWJ fellowships. The fellowships are given out through the TWJ committee who interview you and there's often several fellowships that then interview for in one go. So when I did mine, there was actually four different fellowships on offer. Bridge one in Vancouver, one in New Zealand and one in Sydney. So those fellowship locations essentially hand over responsibility for choosing the fellow to the TWJ committee for that year. don't do it every year. But I think if I was applying not through the TWJ system, which they do alternate years to Auckland, then yes, it would be very important to visit because that makes a big difference in terms of whether they're going to give the fellowship to

Alex Ashman:
And in terms of funding, did you apply for any grants or how does that work?

Elinor Warner:
Yeah, I did apply for grants and I think that's a really good thing to do. So I got the TWJ, which basically funds your salary for half the year. And I also applied for another grant, Lionel College, which I got as well. And I also applied for funding from Cochlear, who paid for some of my flight costs and also from the Royal College, I got a grant from them as well. So overall, that was all been really helpful and to kind of lessen the sort of financial impact of doing a fellowship abroad, can be expensive. And I've also been fortunate in New Zealand that actually relatively the salary is reasonable. And if you're kind of worried about money, for example, you're on a single person's salary because your partner can't work or you're going without a partner. depending on what your circumstances are, then it's probably advisable to look at the specifics of the fellowship. For example, I know often in Canada, they don't always pay that well sometimes, so you may need more additional funding. Also, there are specific arrangements with some fellowships where you get private assisting fees, but you might not get an actual salary for the actual fellowship. I think in America, quite often, you don't necessarily get a salary for the fellowships. You'd have to of self-fund that bit. So it's important to kind of know what you're dealing with in terms of the finances that you're going into.

Alex Ashman:
That's very sensible, lots of form filling, lots of planning ahead, lots of being organized. I guess lots of reaching out to people. Is there anything else you think people should know when they're sort of going into a fellowship they should do to make sure they get the most out of it, you know, when they're actually there?

Elinor Warner:
I think, yeah, just mainly sort of do your research by talking to the previous fellows, you know what to expect before you get there and making sure you sort of met virtually or in person the fellowship supervisors, again, to get a sense of them. I suppose also thinking about what you really want to get out of it, like where are your either weak points or, you know, what you're trying to develop longer term so you can focus on that for the year, all important and useful things to do.

Alex Ashman:
You've got to have a specific thing that you want to get out of the fellowship from the, from the get-go and sort of know what you want long-term. That makes sense.

Elinor Warner:
I suppose not necessarily, but I'm not sure I necessarily went with. I think my focus was just really wanting to do a lot of cutting honestly, and have a lot of experience of independent operating and getting myself ready for being a consultant back home without the same level of supervision that I've had as a registrar. That was my priority.

Alex Ashman:
Yeah. And you mentioned to me that you've got a consultant job for when you come back. So congratulations on that. Thanks. You know, you've had a lot of pros to the fellowship. You've had, you know, a lot of good experiences and thank you so much for a lot of good advice on people going into this in the future. So thanks.

Elinor Warner:
No problem, really nice talking to you, Alex. I'd be very happy to answer any questions if anyone wanted to reach out to me. I'm always happy to discuss it or give any advice or anything I could do to help anyone else going through the process.

Alex Ashman:
Summy Bola is a consultant head and neck surgeon at Oxford University Hospitals. She undertook the Royal Marsden Head and Neck Surgical Fellowship in 2023 and has received the RSMIA research prize for her work on circulating tumour markers and has also been recipient of the ENT Master Class Gold Medal, the Phillipsdale Prize and Barnaux Best Presentation Prize. Summy, thanks so much for joining us today. Thank you. You've done the Marsden Fellowship, so just tell us how was that for you? What was your sort of experience clinical and non-clinical?

Summy Bola:
Well, it's quite a broad opener. So, experience clinical in a very objective way was three theatre lists, a couple of clinics and MDT. Three theatre lists a week, sometimes four. The Royal Brompton is very close and we would sometimes do joint cases when we needed cardiothoracic and I would say in summary, there was a fair amount of operating. There was a good deal of complex cases of neck dissections. And as a fellow, I was with two registrars and I would say there was enough work for everybody. The clinic was very interesting. We would get quaternary referrals. We'd get complex cases from other places. And we'd get the bread and butter, tonsil cancers, oral cancers, thyroid cancers, as well as some non-cancer work. it wasn't all cancer, there was some variation. So there was a good variety and a good volume. In terms of non-clinical experience, very much enjoyed it much liked the team, not just the doctors, but the allied health professionals. I thought they were excellent. And you sort of enter and become part of this Marsden family almost for a brief period where you're taken under the wing of these super specialists and you can get as much as you put in, I would say. So if you're putting in the time, you will get a lot out of it.

Alex Ashman:
So perhaps the difference isn't that they do things completely differently there, but it's just so super specialised and so unusual with wonderful stuff that it kind of gives you that extra level that you wouldn't get elsewhere and even in a sort of tertiary sense.

Summy Bola:
There is that, but actually the majority was bread and butter, but there were some very unusual cases happening there. And there were people that could not be operated on elsewhere that were referred in, so you definitely got that aspect of work in the UK. And that was one of the sort of incentives to apply there was that you would get that experience and that exposure. We would also have people who'd have recurrence and recurrence in head and neck cancer is something we're seeing more. People are living longer. People are being diagnosed earlier in their lives. And so they have a longer period where they can have a secondary cancer and those patients are harder to treat. They have different anatomy. They've been exposed to radiotherapy. And so it was even if we weren't treating them, it was absolutely fantastic to have them discussed in our MDT amongst the oncologists, people who run trials. There's a large volume of research being done there. And so you can become up to date with what's going on in your country. So, and also in MDT clinic, if you have questions, the oncologists would be very happy to give you a short teaching on what their latest injection or immunotherapy was targeting and draw some diagrams on the board for you and have a little personal teaching session. it was fantastic.

Alex Ashman:
At Karl Storz we’re proud to be supporting this podcast. Trusted by prestigious

hospitals, universities and medical associations, our dedication to patient safety goes

beyond equipment. We’re committed to advancing education, hosting over 500

events each year to train the next generation of surgeons. Karl Storz. One name, all

solutions.

Was there anything challenging about, I don't know, not uprooting yourself as much as say someone going to New Zealand or Australia, but sort of uprooting your normal schedule for a year and going somewhere completely different?

Summy Bola:
Yes, definitely. I did think about Australia and Canada. There was a period where Canada was going to be an option. I've actually worked abroad before after my F2 year. I worked in South Africa for two years. So I didn't that itch to work elsewhere. I already had done that. I'd experienced another healthcare system, but I was open to working abroad just because I wanted volume. I felt that I needed that before I became a consultant. looking, you've got to, think for anyone looking at fellowships, you've got to look at where your family can move and Australia just wasn't one of those places. Canada was a possibility, but the timing just didn't work out. So I did speak to some units in Canada. I sent my CV across, we had some conversations. That also didn't work out, but when I looked at the fellowships in the UK and spoke to the fellows at those units that I was looking at, I did find some units that were doing high volume and also complexity. It definitely met the criteria of what I felt I needed before I became a consultant. And then there was a question of, do I apply for a TIG? So that's a national application where you're competing with other people and there are designated places in the UK that have the TIG fellowship programs. When I looked at the centers, so some centers have pulled out now, when I looked at the centers, the geography just didn't match where we could go to. the end, London was a key player as was, I looked at the Birmingham fellowship. I know that they're also a high volume unit. And I spoke to the current fellows and I said, asked how many lists do you do? How many necks have you done? What is the expectation? And I visited the Marsden and I really liked it. I met Finn Poleri. He's a very dynamic man and a pleasure just to have a conversation with. He can talk about most subjects very easily. And I saw the way his theater was run. I saw what the current fellow was doing. And I also saw the current fellow was quite good, which I think set the bar for how what I needed to do and how I needed to be coming in. And I was also attracted to the other work being done there in terms of the thyroid work being done by Dai Kim and Cyrus Kirowala was there doing some craniofacial work, some oral cancer work. And I hadn't had any exposure to oral cancer. So I did want that before I became a consultant. What I didn't realise was how heavy the recon part of the fellowship would be. So you are expected to stay around after the resection. I've come from a unit where you do the ENT resection and you do have a little break, but in the Marsden, the recon surgeon, very excellent surgeon, is actually part of the team and he would be doing all the reconstruction for the head and neck cancer patients. So you would be doing the resection with either a consultant or the two registrars and you would stay and help with vessel prep, flap insetting and just doing those final bits. I found that really useful just to appreciate that side of things.

Alex Ashman:
That's a lot of exposure, which is good. So I mean, from what you said, sounds like once you've decided a domestic fellowship is the thing, you want to know that it's a centre that's going to give you what you want and you want to know that it's going to be manageable in terms of getting there so you can turn up and do your best. Do you have any other tips on how to choose a fellowship for people looking at thinking of doing one in the next few years?

Summy Bola:
Yes, I would say that while you're your fellowship, you're doing one because you've probably got some things you want to do before you become a consultant. But also you need to think about what's next. So if you do not have a job lined up, but there's a place that you would like a job and that's a unit with a fellowship, I would jump straight into that unit & think about being on the on-call rotor, it's a really great way to meet the other consultants in the unit. where I work, previous fellows have been offered jobs because they've been such a great part of the team, the jobs have been created for them. So that's just something to think about. If there is a city you would like to work in, that would be a great place to find a fellowship. I would make sure that you visit, you make sure that you speak to not the current fellow, but also the one previous because different people have different experiences. And I would ask about log books and I'd ask about on-call. So I did do on-call at the Marsden, but there was no acute on-call, which did help with family life. So I do have a family. Prior to the fellowship, I was doing nursery drop-offs, nursery pickups.

a less than full-time job. And there was slight anxiety coming into fellowship, like, I'm to be full-time, I'm going do a full-time on-call, who's going to look after the kids? The stress was there, but something that I had already done was tertiary on-call for three years. So I didn't feel like I needed that experience again. was quite happy by doing ward on-call.

 It was fine. And it was great because it meant that you saw your own complications and you were able to have experience managing them. think that should be a big part of your fellowship. is really important. I think maybe one of the most important things because when you become a consultant, all your problems are your own. Yeah, you can get some help, but you own them. It's really, it's a last opportunity to get some experience managing things. And actually you find out that a lot of things you can sit on. You don't need to panic. You can think carefully, can phone a friend. Yeah, it's about doing what's best for the patient, but a lot of the time what's doing the best thing to do is to sit on it. And so that was great just to see that. And definitely with registrar timetables, you don't always get that wholesome experience because you're called away.

Summy Bola:
I don't know if you agree with that. Like sometimes you don't always see your post-ops through their whole recovery.

Alex Ashman:
Yeah, or alternatively you're on call and you're not with the boss and then two weeks later say, we had this great case last week, where were you? And you're like, I was doing nights or weekends or what have you. Yeah, that's fair.

Summy Bola:
Yeah. You don't want that. You want to be there for all the big cases. You want to be there for every case. You're very hungry on fellowship. You want all the good stuff. And if you get to a point where you can start managing the waiting list, you can even start booking the things you don't really need whilst you're on leave as cases. there are ways to maximize your fellowship definitely being part of the booking process. Also checking who's coming to clinic. Is it one of your post-ops? Even if you're off, you might want to just pop in and see them. It's a great learning experience. It's also the final part. It's the last chance before you're a consultant to get some precious training. It's so valuable and it's almost a privilege because training is a privilege. forget sometimes because you're just sort of slogging along and trying to get all your ARCP points and trying to jump through the hoops, get your exam, manage your family. And you kind of get to the end and you're like, okay, I'm here now. I'm going to be let off on my own. What do I need beforehand? Well, you've reached the end of your training.

Alex Ashman:
So Summy you were saying about fitting in childcare and how you went from being less than full time to working a full time job having been doing nursery dropouts before. How did you fit everything in? How did you fit the childcare in with the full time fellowship?

Summy Bola:
So to start, was a lot of worry about how it was going to work. The truth is the reality, just works. Every week you figure out your timings, you got to communicate with the person at home, the people at home. And we decided the fellowship was needed for a head and neck consultant job. And so we put some money aside for a nanny to be starting to do pickups, you know feeding, dinner feeding, putting to bed, because there was going to be a lot of late night operating. And I think that provided the most anxiety. was like some of these cases go on till very late at night. I am not around. And also the traveling into London meant waking up at 5.30, getting on the bus or train at 6.30. There was a lot of not being around. So it started off very intense. I did have help from my lovely mother who started traveling to our house on a Tuesday and staying till Thursday. So that helped. But if we didn't, we were going to pay for a nanny. And my husband just thought, okay, it's one year. He changed his hours, we tried to do it that it wouldn't shorten his working day too much. So if my mom was coming, he could work a little bit longer. And it was probably a bigger hit on my mom because she was sometimes in the house by herself with, you know, doing childcare. But it was one year. We showed our appreciation by providing lots of gifts and weekends away. And it was a financial hit, but it's over.

and it's done and you can get through it. On a personal level, it was a change, not being the one at home, but approximately, I would say three or four months in, the people that you work for, they understand that you have a family. if you've worked really hard, they start saying things like, why don't you go home early today? Or why don't you come in a bit late if you want to be around for the wake up and getting ready for nursery. And you can also negotiate that with your colleagues. And you can also sometimes negotiate that with management. know, can my clinic start at 930? I'll still see the same amount of patients. I'll do my admin outside. But this means that I can be around in the morning. And so the negotiations started happening a little bit into the fellowship where I could.

also be at home sometimes. And then there's leave and then sometimes lists go down. And so you naturally get to be at home. you can work around it in the way that everybody works around it for registrar hours. The only difference is you don't get, I didn't take, you know, post on call because I wanted to be at work and I loved being at work. So that helped. loved, I loved it. You know it's…

Alex Ashman:
Yeah, something you'll choose. 

Summy Bola:
It's something you're choosing, it's time limited and it's a little more weight on my husband. then, so at the weekend, when you're probably quite tired, you still have to offer to do the laundry, the cooking. You want to pay back in some way. You've got to help in the house. don't know if there's any negotiations with any other families in the same way, but definitely the other person.

 Yes, I'm sure. If the other person's taking the hit, you've got to help a little bit more at the weekend.

Alex Ashman:
What other advice would you have for trainees who are preparing to go on fellowship in terms of getting the most out of the experience?

Summy Bola:
The key thing I would advise, and you might not agree with me, is that your fellowship is not more registrar training. You've CCT'd, it's a head and neck fellowship, you've CCT'd. You are a day one consultant, you should be a day one consultant, and you've done your exam. So this is not an opportunity to learn how to do basic head and neck operating. You should be able to manage neck trauma. You should have had exposure to thyroid, submandibular gland excision, definitely to parotids and to a neck dissection. And you can't come into a fellowship at the same level as the registrars. There are some very good senior registrars, that you can sort of think, okay, there may be some crossover, but definitely there needs to be some difference between you. Otherwise you're not going to get the most out of it. So to do that, I mean, I just come back from maternity and then I was part-time for a short while and then there was fellowship. So it definitely felt rusty, felt that I might not be as confident. And so I just embarked on just a lot of I would say hyper organisation. I contacted my tertiary unit in my deanery where I also wanted a consultant job and I asked, when are your registrars away? I booked some study leave. went and I helped and I was very proactive in saying, just give me feedback. Just be blunt. Don't worry about my feelings. I've got a short amount of time to get really good before I start my fellowship and to be to be a fellow, to be that standard. And we did some necks, we went through some laryngectomies, did some parotids by myself. And it was intense, but I think you almost got to turn yourself into a high performance athlete. Like each theatre session is a training session. So these, mean, Andy Murray doesn't have a training session and then go home. He says, you know, how was my serve? How fast did I hit the ball? Like I don't really know much about tennis, but you want to ask for detail and you want to be specific and you want to write it down and you want to go back again and do it again. you can get good quickly. So that is a tip. If you're not there, find a way to get there surgically before your fellowship. If you don't have that opportunity or you just can't manage it, then I would just be honest when you turn up in what you can do, but set yourself a personal development plan and say in six weeks this is what I want to be able to do. Can we re-discuss it? Please be open with feedback. I'm open to feedback. You're not going to hurt my feelings. And then let the other person help you as well, because they also want you to be good so that they can move to the more complex parts of a procedure. 

They don't want to be teaching you a neck dissection. There are other things in, for example, a laryngectomy, a pharyngeal laryngectomy that you need to consider and think about. And that really should be your thinking space when you're in a fellow and also as a consultant, not what I would say is the bread and butter. I don't know what you think about that.

Alex Ashman:
Right. Yeah, I think that's fair. You don't want to be turning up to your rhinology fellowship saying, can you teach me how to take polyps out or open the maxillary sinus? It's the same sort of thing, isn't it? You've got to be at a certain level so that you can get the sort of extra bits out of it rather than having to start from, you know, 10 meters behind the start line. I think that's fair. I think I agree about what you say about it not being another registrar job.

Ideally want to have the boss sitting in the coffee room while you're basically acting as the boss and the registrar is being trained by you, with the boss being scrubbed and showing you how to do things necessarily for every case. I guess it depends on what you're doing. If you're doing something super specialized or in terms of advanced techniques, that's not true. But if it's the bread and butter stuff, you shouldn't be training on that, I guess, at this point.

Summy Bola:
No, you've finished registrar training, that's done. if it's not for whatever circumstances worked out that you've got the logbook you wanted, there are ways to approach that. Definitely some intense training prior to fellowship. mean, people are very, they can be very helpful when you put in the effort like that. they see it, they see it, they like it, and they'll give you the training in return. So yes, my key advice is turn up and turn up as the fellow. Do not turn up as someone who still needs help taking lumps in the neck.

Alex Ashman:
Yeah. Also, I take your point about, I've heard a of people who run fellowships saying they really want someone coming to them saying, I need to get this and I've already tried to get this locally and I couldn't, or I got so far and I had to limit as opposed to, I've not really tried, but would you just give me this on a plate, please? It's kind of the attitude coming in as well, isn't it?

Summy Bola:
Yeah, that's not going to win you any friends. You've got to be proactive and also you're an adult. You're probably an adult.

Alex Ashman:
I'd say medical students are adults as well, aren't they? But yeah, I take the point.

Summy Bola:
But nobody is looking after you. No one's responsible. You are responsible for yourself as a fellow. yeah, you've got to know what you need, but also you've got to come in with something to build on. If a person teaching a fellow is building on, don't know how to do a neck dissection at all, then it's going to be very tiring for that person. And there'll be a limit to what they can give you. And that is not because

they are mean or they don't want to teach. It's just tiring. It's like once you've gone through the teaching of the neck, you then have other things that you need to do in a procedure. The thinking part. And so if a fellow is taking that energy, they're not going to get to the complex parts. Another thing is to visit multiple times.

It might be hard, especially if you have a family and if it's far away. The reason I say that is it's really great to go to a theatre list and see what the current fellow does, see if they manage the list, if they're teaching. So I went to visit once I got appointed.

And I saw the current fellow take, she had two registrars with her and she took one registrar through one neck, she took the other registrar through the other neck. And then the consultant took her through a oral cancer resection and then she prepped some vessels and then she was there for the reconstruction. So was very clear what the job was and to what level I needed to be. So I felt that was really helpful. So not just coming to visit and saying hi, but actually seeing how somebody works, how the theatre works. And it's great because the scrub staff can see your face and you're not brand new when you first turn up. Everyone gets touchy about new people in theatre because you, I don't know, they're an unknown, aren't they? You want to make sure people are, I don't know, sane and do normal things and they're not going to, well, they're going to be part of your team. It's a great way to integrate quickly, is to visit multiple times.

Alex Ashman:
Thank you so much, Summy. So we've kind of covered the pros and cons of domestic fellowship, how you kind of got there and, you know, chose the fellowship and also a good amount of advice for trainees, you know, looking to start a fellowship in the next, I don't know, year or two. I mean, anything else you wanted to add?

Summy Bola:
Only that there are some really good head and neck fellowships in the UK. I do think it's hard to know which ones are the best, just the tips I've already said, just follow their log book. Find out. Yes. Thank you.

Alex Ashman:
Yeah. Yeah. Yeah, absolutely. Go find out. Yeah. Well, thank you so much, Summy.

Thank you for joining us for another episode of WENTS and Friends, the podcast of

Women in ENT Surgery UK. If you’ve enjoyed this episode, please make sure you

subscribe on your podcast app of choice, leave us a review and share it on social

media.

Don’t forget that we have a back catalogue of episodes on a range of subjects from

mat leave and menopause to surgical training and culture change. We’re on Twitter,

Threads, Instagram and LinkedIn, so make sure you follow us for details of

upcoming episodes and events.

And if you’re an ENT UK member, you can join WENTS UK if you haven’t already via

your online membership page. Thanks again to all of our guests for this season and 

to Karl Storz UK and ENT UK Foundation for sponsoring season two of WENTS and

Friends, the podcast of Women in ENT Surgery UK.

WENTS and Friends is produced and directed by Heather Pownall of Heather’s Media

Hub. The podcast was created by Ekpemi Iruni. The rest of the team includes Anna

Slovick, Katherine Conroy, Marie Lyons, Tanya Ta and me, Alex Ashman.

Next week we'll be discussing less than full-time training with Ms.Mairead Kelly. Until then, take care and thanks for listening.