I have been a Consultant in Nottingham since Sept 2016, immediately following the completion of my TIG fellowships and obtaining my Certificate of Completion of Training (CCT). We are a department of 16 Consultants working in a large, busy teaching hospital and major trauma centre. My workload reflects my TIG fellowship as I specialise in skin oncology and H&N reconstruction, and part of the funding for my job is provided by the ENT department. My weekly timetable on average will involve a major H&N reconstruction list with ENT (pharyngeal reconstruction or temporal bone / skull base reconstruction mainly), my own theatre list which is a mix of skin oncology cases and facial reconstruction, a H&N clinic (which includes a mixture of H&N Two Week Wait patients and nasal reconstruction patients), the skin cancer MDT and MDT clinic and the H&N MDT and associated clinic. I will also pick up joint cases with neurosurgery for extensive skin tumours or major scalp reconstruction, and I provide some of the post-Mohs reconstruction required by my Dermatology colleagues.

Since starting as a Consultant and providing a service and particular interest in skin cancer, especially of the H&N, my workload has increased exponentially. I am performing over 30 neck dissections / year for skin cancer alone, around 40 free flaps / year for the ENT department, over 20 parotidectomies / year for a mixture of benign and malignant disease, over 30 nasal reconstruction cases / year (of which at least 20 require forehead flaps) and sentinel lymph node biopsy (SLNB) for the H&N as well as other body sites. It has been a fantastic experience to see the service grow in this way, and I am hugely indebted to my Plastic Surgery colleagues who have been an incredible support for me  when the pressure of extra work has increased. I would strongly advise trainees to choose their colleagues wisely - I have struck gold in Nottingham!

Both TIG fellowships were an excellent preparation both to successfully apply for Consultant posts, but also to help in the early stages of your Consultant career.

The skin oncology TIG fellowship in Norwich is spent with the Plastic Surgery and Dermatology departments. My weekly timetable involved the skin MDT, regular clinics with either Plastic Surgery or Dermatology, Mohs Micrographic Surgery lists at least one day per week, and main theatre operating lists which were mostly with Marc Moncrieff, but did rotate between different member of the Plastic Surgery department. The skin oncology team in Norwich are superb, and working with them was a real privilege. I was given significant independence in operating, and was able to vastly increase my confidence with SLNB, and block dissections. I was given the task of preparing the MDT on a weekly basis, which was great practice for the decision making required for complex patients, and I was allowed to Chair the MDT on two occasions, which again was great preparation for the decision making required when I finish. I gained a much deeper understanding of, and appreciation for Mohs surgery, and I also benefitted greatly from time with Dermatology to improve my diagnostics skills and confidence with Dermoscopy. Since completing the fellowship I have been able to set up the SLNB service in Nottingham, which has now been running since Jan 2017, and make a number of other changes in the structure of our service here, which I learned from my time in Norwich. Marc Moncrieff has also been a superb support for me, as I have been able to contact him discuss difficult cases, or awkward problems with the setup of our SLNB service.

The H&N TIG fellowship in Birmingham was spent mostly with the Maxillofacial and ENT departments, but I was able to spend around a day a week with the Plastic Surgery team. The QE in Birmingham is a very large hospital with a huge amount going on at any given time. It was important for me to focus my learning needs on certain areas to ensure I could arrange a timetable appropriately. My focus was on H&N reconstruction, and skin oncology, but without losing out on the core skills that should be shared by all H&N surgeons, such as managing Two Week Wait referrals. Spending time working across different departments was invaluable, and as well as learning a whole array of new skills, I have made some good friends and colleagues that I still call upon for advice and act as fantastic contacts for my future career. H&N reconstruction is particular can be very stressful, and the consequences of reconstructive failure can be dramatic. Watching how a top class reconstructive team work together to support each other, and share the work amongst themselves has been such a useful lesson as I started in Consultant practice. I have had certain days, and particular cases that I know I would not have been able to perform as well had I not been lucky enough to do this fellowship.

From my perspective I would wholeheartedly recommend both fellowships to trainees with an interest in either area, and in fact I think they complemented each other very well. Going to a Consultant interview and being able to show that not only have you completed a fellowship (as most people will have) but that your fellowship is formally recognised and approved for training by the GMC does set you apart from other fellowships abroad. For trainees interested in H&N but concerned about the job market afterwards, I would reassure you that my experience was very positive, with lots of job offers / discussions as I came to the end of my fellowship. You are in a unique position to provide a well needed skill set, in particular the cross over in to H&N oncology, and I am confident that if Plastic surgeons complete this fellowship, the work will be out there for them to do.