Posted in Association of British Neurologists Trainees on 7th Dec 2012
A medical degree is also a ticket to see the world. In recognition of this, undergraduates spend longer on their medical elective than they do learning clinical neurology. Many training schemes have formal or informal opportunities to learn skills outside of the region – but international attachments may bring with them a prohibitive volume of red tape. There is a personal odyssey where each prospective fellow networks to learn about visas, the health system and potential vacancies abroad. This is particularly unfortunate as modern era ‘ST’ trainees will be more likely to spend their four or five years within their geographical location rather than flit between departments and regions as their supervisors may have done. Many enthusiastic trainees stymied by the bureaucracy have previously worked in accredited training posts abroad – without being able to have it count towards their UK training.
In recognition of this the ABN in conjunction with the SAC has recently developed a series of Australasian Fellowships. In the first year of its inception the posts will start in February 2013; one in Sydney, one in Melbourne and a third in Auckland. Not only are these posts in sites recognised for their exceptional training opportunities but they come with the necessary accreditation – allowing the fellows to count the year abroad towards their UK CCT. The scheme (in keeping with most out of programme applications) is not aimed at those within the last months of their UK training – but is open to all on a competitive basis. If a year in the Southern hemisphere sounds tempting – you are not alone: here Matt Armstrong, Lucie Aldous, Charlotte Lawthom and I report our experiences.
Dr Charlotte Lawthom is Consultant Neurologist at the Royal Gwent Hospital in Newport. During her training in Wales she worked in Adelaide to further her epilepsy experience.
“As I sit here after one of the worst UK Summers on record, I remember fondly my time in Adelaide. I even had a pool in my private garden and I lived a ten-minute walk from the beach. Of course, I could move to the coast in South Wales and benefit, no doubt, from the sea air. Australian leisure time though, is largely predicated on outside living and (sunscreen requirements notwithstanding) is all the richer for it.
Australia is similar enough to the UK to cushion the shock of living and working in a different culture. At work, UK examination systems are grudgingly respected and UK trained doctors are generally welcomed. Working in a two-tier medical system can prove somewhat uncomfortable and paying to see your own GP (should you need to) feels bizarre. The relative wealth of the main hospitals though, is a major bonus. The instant access to investigations such as EEG and MRI spoiled me for my return to Neurology SpR training in the UK. Indeed, the availability of ictal SPECT with a 4-bed epilepsy telemetry unit in my neurology SpR placement hospital was largely responsible for my subsequent epilepsy specialty.
The location was serendipity. I applied to a service by emailing them my CV. I expected to get a Registrar in General Medicine position but was warned that Neurology can be competitive. Plus ca change! I was blessed with both, medicine first. The obtaining of a visa and related applications were quick though visiting London twice was obligatory. Leasing a car, renting a house and setting up bank accounts were painless. I started work eight days after arriving and had moved into my new house and driven my new car. I also fitted in a four-day trip to the region’s vineyard and an overnight stay in Kangaroo Island!
I had been to Australia twice before my application to work there. I confess this was motivated more by the search for life skills than a desire to practice my clinical skills in a different setting. The pace of work was everything we are used to here, and weekend ward rounds are mandatory – though I got a Thursday afternoon off in return. I rolled up my sleeves and got stuck in. I returned greatly enriched; bolstered in confidence and loaded with new knowledge. Go with an open and inquisitive nature, take the POM (prisoner of the motherland) jokes with good humour. Avoid competitive rows over sport – no good will come of it! Embrace Australian Rules Football instead. Oh, and take your own supply of marmite. Vegemite is simply not the same.”
Matt Armstrong is a technical writer originally from Southport who has been living in Melbourne for four years – here he describes the process of going to live abroad and how to mitigate against missing the best of Blighty.
“So you’ve decided to come to Australia? Well the first thing you should know is that this place is big. Properly big. If you’re heading for one of the Eastern states (that’s the bit where all the people are) then even after your flight crosses into Australian airspace you’ll probably still be closer to the place you took off from than to your destination. In a country this size, daily life for the inhabitants of, let’s say, far North Queensland or remote Western Australia probably bears little relation to that of the latte-sipping hipsters that stalk inner city Melbourne. But there are a few cultural reference points that unite this vast land.
It is a fervently religious place. Worship is held in stadia across the country every weekend, and if you want to fit in you’d do well to acquaint yourself with the local denomination as quickly as possible. In NSW and QLD that means both codes of Rugby, while in Victoria you’ll need to select an Aussie Rules team to ‘barrack’ for (it doesn’t matter who you pick, as long as it’s not Collingwood).
The locals will happily talk sport with you for hours (although it’s probably best not to mention the cricket or the Olympics right now) so once you’ve selected a team you will have something to discuss at your next barbie, of which there will be many. This sacred Aussie ritual brings its own unspoken rules and customs: you will typically be expected to supply your own meat or salad (this is largely gender dependent) and definitely your own beer, which should be brought in your Esky (cool box) and is under no circumstances to be consumed at anything other than sub-arctic temperatures.
The beer itself is not as bad as you might think, as long as you steer clear of the mass produced fizzy lagers and seek out something from one of a growing number of small craft brewers dotted around the country (Melbourne’s Mountain Goat and Byron Bay’s Stone and Wood are particularly worth a try). Australian wine of course is just like the stuff you know and love from the British supermarket shelves, only better.
Aussie music is better than you might expect too, and all the major capital cities have vibrant live music scenes. Tune your radio to the ABC’s Triple J to hear the latest up and coming local bands. Their annual Hottest 100 countdown, held on Australia Day every January is an institution that you are likely to find yourself listening to at a barbie (see above). You may also find yourself in a pub at some point during your stay singing along to something by either AC/DC, Cold Chisel, or John Farnham, but it’s best not to admit to this in the cold light of day.”
The ANZAN Fellowships (a reciprocal direction of travel) have been in place for twenty years. Dr Lucie Aldous describes the benefits of a fellowship abroad.
“I did not have any real preconceived ideas about working in the UK prior to arriving. I was obviously aware that they had a system of health care called the NHS however did not really understand the structure of the system or the way it impacts on practicing medicine, which is something in retrospect I would have liked to have known about. There are significant differences both in the training programmes and the structure of healthcare and the way that it influences practice compared to Australia. Gaining an understanding of this was the biggest challenge for me when working in the UK, whereas the patient demographic and the spectrum of disease is not significantly different to Australia.”
My plan is to spend a year in Melbourne from February 2013 to complement my training in Wales; I (Rhys Thomas) feel that I have had ample opportunities to sample clinic based epilepsy services – but the limited epilepsy surgery programme within the Principality has prevented me from having sufficient exposure to the multimodal elements that constitute a thriving surgical programme. I want to return with a greater aptitude in a new skill – this is a common reason for a foreign fellowship: for me it is EEG. British epileptologists (unlike their colleagues in Europe, North America or elsewhere) often do not have the skills to report their own EEGs. I may not attain fluency but it would be reward to return with a greater EEG proficiency. In addition – the population of Melbourne alone exceeds that of Wales and I hope that general neurology in the big city may bring a juxtaposition with my experiences in Gorseinon for example (population 19,000).
Melbourne is the base for Professors Sam Berkovic and Ingrid Scheffer’s epilepsy genetics group and this is why Melbourne ahead of any other Commonwealth city was my first choice of location. I aim to split my time equally between telemetry and their research group. It just happens that there is world class tennis, formula one, an Ashes series and the British and Irish Lions tour during my time there…
You will of course need a visa to work here. The options are too numerous to detail here, so see www.immi.gov.au for just about everything you need to know, and most importantly get things moving early. It can take several months to complete your application (which as well as form filling is likely to involve police checks, medicals, and potentially an interview, all of which take time to organise).
Once you are here, you will need a Tax File Number when you start work (apply online at www.ato.gov.au\) and a bank account (simply wander in to a branch of any of the high street banks with your passport).
Unless you are migrating permanently, you won’t be eligible for full access to Medicare (Australia’s public health system), but you may be entitled to emergency/essential medical treatment under Australia’s reciprocal health care agreements. Check www.humanservices.gov.au/customer/enablers/medicare/reciprocal-health-care-agreements/health-care-for-visitors-to-australia to see how the rules apply to your situation. You might want to consider taking out private health insurance during your stay, or at the very least Ambulance Cover, just in case.
If an opportunity to revel in a new culture whilst sharpening your clinical skills thousands of miles from home appeals – then it is likely that the Fellowships for 2014/15 will be announced this winter with Sydney and Melbourne likely to be included as host cities.