Paediatric Surgery Fellowships

Based at: Birmingham Children’s Hospital, Bristol Children’s Hospital, and University Hospital Southampton

Surgical Specialty Association approving: BAPU

Approval period: March 2022 - February 2025

Supervisors / Lead Consultants: Liam McCarthy, Consultant Paediatric Urologist and Transplant Surgeon, Birmingham Children’s Hospital; Mark Woodward, Consultant Paediatric Urologist, and Mohamed Shalaby, Consultant Paediatric Urologist, Bristol Children’s Hospital; Stephen Griffin, Consultant Paediatric Urologist, and Ewan Brownlee, Consultant, Southampton University Hospital

Fellowship duration: 24 months

Stated learning outcomes:

• Outcome 1: To be able to manage acutely all emergency cases presenting to paediatric urology, including obstruction and urosepsis
• Outcome 2: To be able to manage infants and children presenting with antenatal hydronephrosis in a routine clinic
• Outcome 3: To be able to manage children with neuropathic bladder and bowel
• Outcome 4: To be able to manage children with congenital bladder outlet obstruction
• Outcome 5: To be able to manage children with incontinence of urine
• Outcome 6: To be able to manage children with renal impairment
• Outcome 7: To be able to manage urolithiasis acutely and in the routine clinic

Clinical competencies to be achieved:

To understand the natural history and complications of the conditions encountered in paediatric urology, the indications and complications of non-operative management and surgical intervention, to be able to participate fully in multi-disciplinary team meetings.

Number of main operations the fellow could expect to be involved in:

Recommended PBA Level / Minimum to complete Fellowship:

• Exploration acute scrotum (torted hydatid; torsion testis): 4 / 4
• Cystourethroscopy; SPC insertion: 4 / 4
• PUV resection: 4 / 4
• Ureteric access; stent insertion: 4 / 4
• Cystoscopy and STING/Deflux injection: 4 / 4
• Ureteroscopy- rigid: 4 / 4
• Ureteroscopy- flexi: 3 / -
• Percutaneous nephrolitomy (PCNL): 3 / -
• Ovarian cystectomy; ovarian detorsion; oophorectomy: 3 / -
• Hypospadias repair: single stage: 4 / 4
• Hypospadias repair: two stage: 4 / 4
• Chordee correction: 4 / 4
• Repair of Megaprepuce: 4 / 4
• Nephrectomy (open or laparoscopic): 4 / 4
• Heminephrectomy (open or laparoscopic): 4 / 4
• Nephrostomy (open/perc): 3 / -
• Pyeloplasty (open or laparoscopic): 4 / 4
• Reimplantation of ureter (open or laparoscopic): 4 / -
• Bladder augmentation (ileocystoplasty): 4 / 4
• Bladder augmentation (ureterocystoplasty): 3 / -
• ACE (open or laparoscopic; caecal flap): 4 / 4
• Mitrofanoff: 4 / 4
• Monti Mitrofanoff: 4 / 3
• Bladder outlet procedure (bladder neck reconstruction; bladder neck sling; artificial sphincter): 3 / -
• Orchidopexy for palpable UDT: 4 / 4
• Surgery for impalpable UDT (open or laparoscopic): 4 / 4
• Laparoscopic gonadal biopsy/excision: 4 / 4
• Peritoneal dialysis catheter insertion/removal: 4 / 4
• Feminising genitoplasty: 1 / -
• Cloaca repair (PSARVUP; urogenital sinus mobilisation): 2 / -
• Bladder exstrophy closure (classic staged/ Kelly etc): 1 / -
• Renal Transplantation: 1 / -

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Manchester Children’s Hospital and Leeds Children’s Hospital

Surgical Specialty Association approving: BAPU

Approval period: Initially approved June 2023 – May 2026

Supervisor / Lead Consultant: David Keene, Consultant Paediatric Urologist [Manchester Children’s Hospital], Alexander Turner, Consultant Paediatric Urologist [Leeds Children’s Hospital]

Fellowship duration: 24 months [12months in each centre]

Stated learning outcomes:

• To be able to manage acutely all emergency cases in presenting to paediatric urology, including obstruction and urosepsis.
• To be able to manage infants and children presenting with antenatal hydronephrosis to routine clinic.
• To be able to manage children with neuropathic bladder and bowel.
• To be able to manage children with congenital bladder outlet obstruction.
• To be able to manage children with incontinence of urine.
• To be able to manage children with renal impairment.
• To be able to manage urolithiasis acutely and in the routine clinic.

Clinical competencies to be achieved:

To understand the natural history and complications of the conditions encountered in paediatric urology, the indications and complications of non-operative management and surgical intervention, to be able to participate fully in multi-disciplinary team meetings.

Number of main operations the fellow could expect to be involved in:

Recommended PBA Level / Minimum to complete Fellowship:

• Exploration acute scrotum (torted hydatid; torsion testis): 4 / 4
• Cystourethroscopy; SPC insertion: 4 / 4
• PUV resection: 4 / 4
• Ureteric access; stent insertion: 4 / 4
• Cystoscopy and STING/Deflux injection: 4 / 4
• Ureteroscopy- rigid: 4 / 4
• Ureteroscopy- flexi: 3 / -
• Percutaneous nephrolitomy (PCNL): 3 / -
• Ovarian cystectomy; ovarian detorsion; oophorectomy: 3 / -
• Hypospadias repair: single stage: 4 / 4
• Hypospadias repair: two-stage: 4 / 4
• Chordee correction: 4 / 4
• Repair of Megaprepuce: 4 / 4
• Nephrectomy (open or laparoscopic): 4 / 4
• Heminephrectomy (open or laparoscopic): 4 / 4
• Nephrostomy (open/perc): 3 / -
• Pyeloplasty (open or laparoscopic): 4 / 4
• Reimplantation of ureter (open or laparoscopic): 4 / -
• Bladder augmentation (ileocystoplasty): 4 / 4
• Bladder augmentation (ureterocystoplasty): 3 / -
• ACE (open or laparoscopic; caecal flap): 4 / 4
• Mitrofanoff: 4 / 4
• Bladder outlet procedure (bladder neck reconstruction; bladder neck sling; artificial sphincter): 3 / -
• Orchidopexy for palpable UDT: 4 / 4
• Surgery for impalpable UDT (open or laparoscopic): 4 / 4
• Laparoscopic gonadal biopsy/excision: 4 / 4
• Peritoneal dialysis catheter insertion/removal: 4 / 4
• Feminising genitoplasty: 1 / -
• Cloaca repair (PSARVUP; urogenital sinus mobilisation): 2 / -
• Bladder exstrophy closure (classic staged/ Kelly etc): 1 / -
• Renal Transplantation: 1 / -

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Nottingham Children’s Hospital

Surgical Specialty Association approving: BAPU

Approval period: Initially approved June 2023 – May 2026

Supervisor / Lead Consultant: Manoj Shenoy, Consultant Paediatric Urologist and Alun Williams, Consultant Paediatric Urologist

Fellowship duration: 24 months

Stated learning outcomes:

• To be able to manage acutely all emergency cases in presenting to paediatric urology, including obstruction, urosepsis and postoperative complications.
• To be able to manage routine GP referrals and make management plans (with consultant support).
• To be able to manage infants and children presenting with antenatal hydronephrosis to clinic.
• To be able to manage children with neuropathic bladder and bowel.
• To be able to manage children with congenital bladder outlet obstruction.
• To be able to manage children with incontinence of urine.
• To be able to manage children with renal impairment.
• To be able to manage urolithiasis acutely and in the routine clinic.

Clinical competencies to be achieved:

To understand the natural history and complications of the conditions encountered in paediatric urology, the indications and complications of non-operative management and surgical intervention, to be able to participate fully in multi-disciplinary team meetings.

Number of main operations the fellow could expect to be involved in:

Recommended PBA Level / Minimum to complete Fellowship:

• Exploration acute scrotum (torted hydatid; torsion testis): 4 / 4
• Cystourethroscopy; SPC insertion: 4 / 4
• PUV resection: 4 / 4
• Ureteric access; stent insertion: 4 / 4
• Cystoscopy and STING/Deflux injection: 4 / 4
• Ureteroscopy- rigid: 4 / 4
• Ureteroscopy- flexi: 3 / -
• Percutaneous nephrolitomy (PCNL): 3 / -
• Ovarian cystectomy; ovarian detorsion; oophorectomy: 3 / -
• Hypospadias repair: single stage: 4 / 4
• Hypospadias repair: two-stage: 4 / 4
• Chordee correction: 4 / 4
• Repair of Megaprepuce: 4 / 4
• Nephrectomy (open or laparoscopic): 4 / 4
• Heminephrectomy (open or laparoscopic): 4 / 4
• Nephrostomy (open/perc): 3 / -
• Pyeloplasty (open or laparoscopic): 4 / 4
• Reimplantation of ureter (open or laparoscopic): 4 / -
• Bladder augmentation (ileocystoplasty): 4 / 4
• Bladder augmentation (ureterocystoplasty): 3 / -
• ACE (open or laparoscopic; caecal flap): 4 / 4
• Mitrofanoff: 4 / 4
• Monti Mitrofanoff: 4/3
• Bladder outlet procedure (bladder neck reconstruction; bladder neck sling; artificial sphincter): 3 / -
• Orchidopexy for palpable UDT: 4 / 4
• Surgery for impalpable UDT (open or laparoscopic): 4 / 4
• Laparoscopic gonadal biopsy/excision: 4 / 4
• Peritoneal dialysis catheter insertion/removal: 4 / 4
• Feminising genitoplasty: 1 / -
• Cloaca repair (PSARVUP; urogenital sinus mobilisation): 2 / -
• Bladder exstrophy closure (classic staged/ Kelly etc): 1 / -
• Renal Transplantation: 1 / -

Fellows will be required to complete mandatory interim and final feedback as per RCS monitoring protocol.

Based at: Chelsea and Westminster NHS Foundation Trust

Surgical Specialty Association approving: BAPS

Approval period: Initially approved April 2016; reapproved March 2020 to May 2023

Supervisor / Lead Consultant: Mr Simon Clarke, Service Director and Educational Lead with Mr Muhammad Choudhry, Consultant Paediatric Surgeon

Fellowship duration: 12-24 months

Stated learning outcomes:

• Competency level 4 in Pull through for Hirschsprungs disease (currently level 3 at CCT level).
• Competency level 4 for posterior sagittal anorectoplasty PSARP (currently level 3 at CCT level).
• Help establish a transitional service for young adults with colorectal disease.
• Experience with pouch surgery for paediatric inflammatory bowel disease patients.
  

Clinical competencies to be achieved:

• ISCP level 4 competency for pull through for Hirschsprungs disease (CCT currently only requires level 3)
• ISCP level 4 competency for Posterior Sagittal Anorectoplasty PSARP (CCT currently only requires level 3)
• Transitional pathway for colorectal adolescent patients in northwest London

Number of main operations the fellow could expect to be involved in:

• Hirschsprung pull through – 8 per year
• Anorectoplasty –  10 per year
• EUA rectum +/- seton insertion – 20 per year
• Laparoscopic colectomy – 6 per year

additional comments:

• Assisting / observing in pouch surgery – 5, adult colectomies - 15
• Involvement in MDT meetings

Fellows awarded Fellowship Certificate (dates of Fellowship):

• Yew-Wei Tan (Jun 18 - Jul 19)
• Alexander Macdonald (Oct 19 - Dec 20)

Fellows' feedback

A summary of final feedback from the three most recent completing Fellows providing full feedback:

Learning Outcomes

“I achieved all of the learning outcomes as specified in my learning agreement”

Strongly disagree |
Disagree |  x
Neither agree nor disagree |
Agree |  x
Strongly agree |  x

Service : Training Balance

Please indicate the balance between service and training in your clinical activities:

Mostly service |
More service than training |  x
About equal |
More training than service |  x
Mostly training |  x

Overall rating

How would you rate the Fellowship post overall, from 1-5? (1=very poor, 5=very good)

1
2  x
3
4
5  x  x

Would you recommend this post to a colleague?

Yes |  x  x
No |  x

Based at: Newcastle Royal Victoria Infirmary and Leeds General Infirmary

Surgical Specialty Association approving: ACPGBI

Approval period: March 2021 - February 2024

Supervisor / Lead Consultant: Miss Victoria Lane, Consultant Paediatric Surgeon (Newcastle enquiries), with Mr Ian Sugarman, Consultant Paediatric Surgeon (Leeds enquiries)

Fellowship duration: 24 months: 12 months in Newcastle, and 12 months in Leeds

Stated learning outcomes:

• To gain experience in laparoscopic surgery for inflammatory bowel disease, to include bowel resection and colectomy. Fellows would be expected to be competent to perform these procedures under direct supervision, after successful completion of the fellowship (and depending on previous laparoscopic experience).
• To understand the operative procedure for laparoscopic restorative proctocolectomy (Ileal pouch anal anastomosis/IPAA) and be able to complete the steps of the procedure under direct consultant supervision.

Clinical competencies to be achieved:

• Level 3,4 in the main operations of the Fellowship
• Total number of cases performed will be around 400-600 procedures per year
• The post is expected to provide experience in Hirschsprung's disease (n=10), Crohn's resection (n=6-10). The post will also provide specialised exposure to specialist clinics such as multidisciplinary Cloaca clinic, pouch clinic, constipation clinic and multidisciplinary inflammatory bowel disease meetings

Number of main operations the fellow could expect to be involved in: see Clinical competencies above

Further information

Based at: Great North Children's Hospital, Newcastle

Surgical Specialty Association approving: BAPS

Approval period: May 2020 - April 2023; reapproved September 2023 - August 2026

Supervisor / Lead Consultant: Mr Alok Godse, Consultant Paediatric Surgeon, with Mr Hany Gabra, Consultant Paediatric Surgeon

Fellowship duration: 12 months

Stated learning outcomes:

• To gain experience in wide variety of general and neonatal surgical conditions including laparoscopic surgery in both, planned and emergency setting.
• To be able to operate/assist in complex Paediatric surgical, urological procedures such as Hirschsprung’s Pull through, Anorectal malformation, Bladder augmentation and more.
• There may be an opportunity to develop subspecialty interest in topics such as, Surgical Oncology, Paediatric Urology, Upper and lower GI surgery.
• To complete a relevant clinical research project with a view to presentation and publication.
• The appointed candidate will have ample opportunities in clinical governance activities ie: audits, teaching etc.

Clinical competencies to be achieved:

• Total number of cases performed by the fellow will be around 300-400 procedures per year.
• The post is expected to provide experience in Hirschsprung's disease pull through (n 5-10), Laparoscopic fundoplication (n 10-20), Laparoscopic splenectomy (n 5), Percutaneous vascular access (n 80-100), Hypospadias procedures (n 20-40), Laparoscopic pyeloplasty (n 5-10), Nephrectomies and heminephrectomies (10-20).
• The post will also provide exposure to specialist clinics such as multidisciplinary Cloaca clinic, pouch clinic, chest wall clinic, multidisciplinary oncology meetings, Spina Bifida clinic, Nephrourology clinic.
• Candidates selected via the ISTP programme will have an ARCP and is expected to maintain a portfolio on ISCP.

Number of main operations the fellow could expect to be involved in: see Clinical competencies above

Fellows will be required to complete the mandatory interim and final feedback as per the Royal College of Surgeons of England monitoring process.

Fellows awarded Fellowship Certificate (dates of Fellowship):

• Ryo Tamura (Sept 18 - Oct 20)
• Deon Flemmings (Oct 20 - Oct 21)

Based at:Leeds Teaching Hospitals NHS Trust

Surgical Specialty Association approving: SBNS

Approval period:October 2018 - December 2021; reapproved June 2022 - May 2025

Supervisor / Lead Consultant:Mr John Goodden, Consultant Paediatric Neurosurgeon, with Mr Atul Tyagi, Consultant Neurosurgeon

Fellowship duration: 12 months

Stated learning outcomes:

• At the end of the fellowship, the Fellow should have the ability to provide independent surgical neuro-oncology care for the broad range of brain and spinal tumours presenting in Childhood.
• The fellow will be expected to attend and present at International Neuro-Oncology conferences.
• Able to understand the endoscopic management of complex hydrocephalus and arachnoid cysts, and related anatomy.
• Understand the MDT management of patients with spinal dysraphic conditions including the closure of spina bifida and management of tethering from spinal lipoma.
• Understand the MDT management of patients with craniofacial disease.
• Understand the MDT management of patients with spasticity and other movement disorders, including the role of Selective Dorsal Rhizotomy and intrathecal baclofen.
• Have knowledge of the breadth and extent of endoscopic surgery for complex hydrocephalus and arachnoid cysts.
• Have knowledge of the management choices for patients with complex hydrocephalus.

Clinical competencies to be achieved:

• To provide a safe, comprehensive management plan for the investigation, operative management, non-operative management of patients with the full range of paediatric neurosurgery conditions.
• To have a thorough understanding of the possible postoperative paediatric neurosurgery emergencies and their management.
• To have a thorough understanding of the range of interventions available for paediatric neurosurgery - including paediatric neuro-oncology, spinal dysraphism, spasticity surgery, hydrocephalus and craniofacial conditions.

Number of main operations the fellow could expect to be involved in:

Supervisor 2018: “Much of our paediatric neurosurgery operation involves 2 consultants because it is very super-specialist operating. The emphasis would be on the fellow taking a lead role in the surgery, the pre-operative preparation (consent etc) and the post-operative management for these cases … We would expect the fellow to be present for the majority of the paediatric operating cases, with a minimum presence for 2/3 cases - translating to at least 200 paediatric neurosurgery cases during their Fellowship year. Their involvement in surgery would increase throughout the Fellowship with involvement in more complex cases once they have demonstrated suitable levels of competence. By the end of the Fellowship, we would expect the fellow to have been the Lead surgeon for an absolute minimum of:

• Craniotomy & excision of tumour (supratentorial or infratentorial): Total: 20-30; Performed: 5-10
• Endoscopic Third Ventriculostomy: Total: 5-10; Performed: 3-5
• Neonatal VP shunt insertion: Total: 15-20; Performed: 5-15
• Neonatal repair of meningomyelocoele: Total: 5-10; Performed: 2-5
• Single Suture procedure for craniosynostosis: Total: 20-25; Performed: 5-10
• Spasticity treatment - Selective Dorsal Rhizotomy & Insertion of Intrathecal baclofen pump: Total: 20-30; Performed: 5-10