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RCS Senior Clinical Fellowship Scheme

Providing a quality mark for surgical education

The transition from senior trainee to consultant can be a challenging step. RCS Senior Clinical Fellowships help bridge the gap. These peri-CCT Fellowships typically last for between six and 18 months, and are in a range of specialties.

RCS Senior Clinical Fellowships are jointly approved by the Royal College of Surgeons of England and the appropriate Surgical Specialty Associations. The Fellowships normally focus on expert training in a sub-specialty, such as knee, skull base, or bariatric surgery.

The Fellowship Scheme was established in 2012. By June 2019 there were 75 Fellowship programmes with approval under the Scheme in the UK and abroad, across eight of the 10 surgical specialties. A survey in October 2019 of current RCS Senior Clinical Fellowship Scheme Fellows, their Supervisors, and recent former Fellows indicated high levels of approval for the Scheme. 94% of respondents agreed or strongly agreed “I am overall satisfied with the Scheme”. One Fellow said: “It is providing me with good clinical experience that will help my transition to working as a consultant. Having the RCS endorsement adds credibility and weight to the fellowship on my CV.”

Applying for Fellowship programme approval

Consultants who have set up a senior clinical fellowship programme, or who are planning to set up a programme, and would like to apply for approval under the RCS Senior Clinical Fellowship Scheme can download the application form, complete it and send to qa@rcseng.ac.uk. Also see the guidance notes. See 'Information for consultants' below on this page about the benefits of programme approval. The current fee is £2,250 for three-year approval - this fee is subject to variation, for example, where there is more than one programme from the same provider, or if there is more than one fellow at a time on a programme.

Applying to be a Fellow

If you would like to be a RCS Senior Clinical Fellow, you will need to contact the Supervisor / Lead Consultant of the Fellowship programme you are interested in. Ask the Supervisor / Lead Consultant if or when there is a vacancy for a Fellow. They will tell you how to apply, if appropriate. Please go to the appropriate Fellowship Specialty webpage listed below for more information.

Information for Fellows and Supervisors

Main purpose of Fellowship Scheme The RCS Senior Clinical Fellowship Scheme was established in 2012 by the Surgical Specialty Associations (SSAs) and the RCS England for Fellowship programmes in the UK and abroad. The main purpose of the Scheme is to give Fellows high quality hands-on training, particularly in a sub-specialty, which will enhance the Fellow’s ability to provide a high level of surgical care to their patients, in a way that does not impinge on the opportunities of other trainees.

Programme approval Each Fellowship programme has a Supervisor who sets up the programme and applies for approval from the Fellowship Scheme. The programme should have clear learning aims and outcomes, and should provide training typically at a level higher than normally received under the Intercollegiate Surgical Curriculum Programme. The application is reviewed by the appropriate SSA/s, Specialty Advisory Committee Liaison Member and Training Programme Director (#). If the specialty reviewers are supportive, the RCS Quality Assurance Operational Group then decides whether to approve the application. Approval is for three years; after this time the Supervisor will need to apply for reapproval, which includes a review of previous Fellows’ logbooks.

Fellows Senior surgical trainees at around the time (shortly before or shortly after) of their Certificate of Completion of Training (CCT, for UK Fellows) who meet the person specification, and any other requirements, of a Fellowship post, and who are eligible to work in the country where the programme is based (including having GMC registration and the appropriate visa for programmes in the UK), are eligible to apply for a Fellowship post. A third of Fellows are from EU counties and a third are from non-EU countries (see international training info). The Fellow will be an employee at the NHS Trust or similar organisation where the Fellowship programme is based. Most Fellowship appointments are for 12 months, though some are for six and some for 18 months. The Supervisor should ensure that colleagues the Fellow works with are aware that the Fellow is a senior trainee. The UK-based pre-CCT potential Fellow will need to find out whether the Fellowship will be considered Out of Programme for clinical Training (OOPT).

Outcomes and competencies Early in the Fellowship, the Fellow and their Supervisor will discuss and agree a learning agreement. Over the period of their Fellowship, the Fellows are expected to achieve the learning outcomes (the knowledge, skills and behaviours the Fellow is expected to achieve) and clinical competencies (the ability to do something successfully) for their Fellowship programme. The programme should also provide opportunities for audit and research. Each programme should have a training structure in place with regular assessments to underpin the fellow’s progress.

Service and training The expectation is that the Fellow’s timetable will enable at least a balance of service and training on the Fellowship programme, or where possible more training than service, approximately as follows: Service: clinics, on-call ($); Training: theatre and endoscopy sessions with Supervisors, learning activities, audit & research, multi-disciplinary team (MDT) meetings; A mix of service & training: ward rounds.

Operations Each programme has a number of main operations the Fellow can expect to be involved in, with where possible an indication of the proportion of these which the Fellow performs at an independent level. Information on learning outcomes, clinical competencies and expected operation numbers for each Fellowship programme is available on the RCS website. Fellows are required to record their operations using the eLogbook.

Interim feedback About three months after starting their post, the Fellow is asked to provide interim feedback to the RCS Senior Clinical Fellowship Scheme on their experience in the Fellowship to date. This feedback is reviewed by the RCS Quality Assurance Operational Group. If there are any causes for concern, the Fellowship Scheme will look into these as soon as possible and report to the Scheme Chair and the QAOG. Fellows are welcome to submit interim feedback more often to the Scheme - simply download and send the completed interim feedback form to qa@rcseng.ac.uk.

Fellowship completion When they have completed their Fellowship post, the Fellow is asked to provide their logbook and final feedback on their experience as a Fellow. Their Supervisor is asked to provide a sign-off statement about the Fellow's achievement of the learning outcomes and clinical competencies required for the Fellowship. The Supervisor’s sign-off will be informed by the Fellow’s performance in assessments, and the Fellow’s logbook.

Certificate The Fellow's final feedback, logbook and Supervisor's sign-off are reviewed by the QAOG to determine the award of the Fellowship Certificate. The information on operation numbers and the Fellow’s level of independence in these is used to inform the decision-making process about the award of the Certificate, but the key criterion is whether the Fellow is judged to have achieved their learning outcomes and clinical competencies. The Certificate is awarded jointly by the RCS and the appropriate Surgical Specialty Association (SSA); the feedback is shared with the SSAs. The Certificate is signed by the Chair of the RCS Senior Clinical Fellowship Scheme. Fellows who are awarded their Certificate can either receive the Certificate at a RCS Diplomates' Ceremony, or the Certificate will be sent to them. There is an appeal process available to Fellows who are not awarded the Certificate after completing their Fellowship.

Further information please contact qa@rcseng.ac.uk

# at the time of writing, the Trauma & Orthopaedic Specialty Advisory Committee does not review Fellowship programme approval applications. For Fellowship programmes outside the UK and Republic of Ireland, suitable alternatives to the SAC and TPD are requested to review the application.

$ not all Fellowship programmes include an on-call element.

Financial Support for Fellows

Although Fellows are normally employed on a salary, they often face significant additional expenditure during their Fellowship. These costs can include additional accommodation and transport - and training and courses, for which financial assistance is no longer available for Post-CCT Fellows.

Some financial assistance may be available to help with RCS Education courses. The College offers a range of awards, grants and lectureships. Some Surgical Specialty Associations generously provide Fellows with financial assistance - it is worth asking the Association for your specialty if any help might be available.

We also provide someguidance on looking for support from charitable trusts and foundations.

Fellows from Outside the UK

About one-third of RCS Senior Clinical Fellows are from European Union countries, and one-third are from other non-EU countries. To work in the UK, Fellows must have the appropriate visa and be registered with the General Medical Council (GMC). Through the Medical Training Initiative’s International Surgical Training Programme, the RCSEng may be able to help medical graduates obtain GMC registration, and provide other assistance in enabling non-UK Fellows to work in the UK.

Current Fellowships

RCS Senior Clinical Fellowships are currently approved in these specialties:

See this guide for information about the Scheme's criteria and standards. See the National Fellowship Register for a full listing of approved RCS Senior Clinical Fellowships.

For further information please contact the RCS Quality Assurance Department at qa@rcseng.ac.uk or on 020 7869 6236/6201

Comments from recent fellows

The Fellowship was excellent – the training and career development worked very well for me. I highly recommend it” - Laparoscopic Colorectal Fellow

The fellowship was very useful and has greatly enhanced my career” - Endovascular Fellow

The fellowship immensely helped in not just improving my overall experience but also the confidence to step up and take on more challenging roles” - Laparoscopic Colorectal Fellow

The RCS fellow gets to do an enormous amount of operating of complex cases with one to one supervision” - Neuro-oncological Surgery Fellow

My fellowship supervisors have been extremely supportive always are available for advice and are very approachable … I am now proud to be appointed as a Consultant Urological Surgeon” - Urological Robotic Fellow

Information for consultants

Perhaps you have spotted an opportunity for developing high quality sub-specialty training for surgeons around the CCT stage. Why not meet the challenge with a RCS Senior Clinical Fellowship? Approved under the RCS Senior Clinical Fellowship Scheme*, these Fellowships have a number of benefits, including:

  • Expert review by surgeons in the appropriate specialty
  • Assistance for you in attracting high calibre candidates
  • Assurance that posts offer a high quality learning experience, reflecting the standards set by the RCS, specialty associations and the ISCP
  • Interim and final monitoring of Fellows
  • Certification of Fellows, who can receive their Certificate at a RCS Diplomates' Ceremony
  • Listing on the National Fellowship Register
  • Use of the RCS Logo on course materials and website
  • Use of the strap line ‘This RCS Senior Clinical Fellowship post has been approved by the Royal College of Surgeons and [……] [specialty association(s)]
  • Listing in RCS Bulletin

To apply for Fellowship Approval, please visit the Accreditation Portal or contact the RCS Quality Assurance Department

The approval process

There are five main stages in the Fellowship approval process, outlined in the chart below. At each stage, the applicant may be asked to amend their fellowship programme. The time taken between initial application and final approval can take about four to six months, depending on the availability of reviewers, the straightforwardness of the application, and the timing of RCS meetings.

  1. Initial application
    Supervisor applies for fellowship approval or reapproval via the online application system.
  2. Initial review
    Initial desk-based review by the RCS to ensure the application is ready for specialty review.
  3. Specialty review
    Application review by the appropriate Surgical Specialty Association/s, Specialty Advisory Committee, and Training Programme Director.
    The application proceeds to RCS Quality Assurance Operational Group if the specialty reviewers recommend approval.
  4. Quality Assurance Operational Group
    Review by the RCS Quality Assurance Operational Group of the application and the specialty reviews.
    The application proceeds to RCS Council for final decision if QAOG recommends approval.
  5. RCS Council
    Final approval decision by RCS Council.
    If granted, fellowship approval lasts for three years.

*the title of the scheme was changed in April 2016 from the National Surgical Fellowship Scheme to the RCS Senior Clinical Fellowship Scheme

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