This document summarizes a presentation about post-CCT surgical fellowships. It discusses how the apprenticeship model of surgical training is changing, with more trainees pursuing subspecialty fellowship training after completing their CCT. It provides an overview of the Royal College of Surgeons of England's Senior Clinical Fellowship scheme, which establishes standards for fellowship programs. It also shares the presenter's experience completing an RCSE-accredited robotic urology fellowship, highlighting the structured training, improved surgical outcomes, and career benefits it provided.

1. Post CCT Fellowships
RCSEng New Fellows Conference - 2016
Mr Nikhil Vasdev
MBBS MRCS MCh(Urol) FRCS(Urol)
RCSEng/BAUS Robotic Fellowship Accredited and Trained
Consultant Urological and Robotic Surgeon
Hertfordshire and South Bedfordshire Urological Cancer Centre
Department of Urology
Lister Hospital
UK
Associate Lecturer in Urology
University of Cambridge
Honorary Senior Clinical Lecturer in Urology
University of Hertfordshire
www.nvasdevurology.com

3. Introduction
• The model of apprenticeship for surgical training is changing
nationally
• The number of general surgery trainees (surgeons in specialty
training) applying to enter subspecialist fellowship training and
then commence independent practice is increasing
• Research in this area has tended to focus on how surgical
trainees are affected by fellowship training programmes
• The extra training provided to surgeons during fellowship
programmes will increase experience and procedural volume,
but whether this translates to improved outcomes remains to be
seen
Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes. Br J Surg. 2015 Sep;102(10):1156-66
hFp://www.ncbi.nlm.nih.gov/pubmed/26122269

4. Post CCT Fellowships
CCT
CESR
Post CCT
Fellowship
NTN
Independent
Consultant Practice

5. Post CCT Fellowships
CCT
CESR
Post CCT
Fellowship
NTN
Independent
Consultant Practice

6. Post CCT Fellowships
CCT
CESR
Post CCT
Fellowship
NTN
Independent
Consultant Practice

7. Post CCT Fellowships
CCT
CESR
Post CCT
Fellowship
NTN
Independent
Consultant Practice
1 – 2 years of subspecialist
Fellowship training

8. Post CCT Fellowships
CCT
CESR
Post CCT
Fellowship
NTN
Independent
Consultant Practice
1 – 2 years of subspecialist
Fellowship training
UK
Trainees
International Medical
Graduates

9. Post CCT Fellowships
CCT
CESR
Post CCT
Fellowship
NTN
Independent
Consultant Practice
1 – 2 years of subspecialist
Fellowship training
UK
Trainees
International Medical
Graduates
Structured
fellowship
training

10. RCS Senior Clinical Fellowship Scheme
• The Royal College of Surgeons of
England and the Surgical Specialty
Associations have established the
RCS Senior Clinical Fellowship
Scheme to :-
o Manage,
o Quality assure
o Publically recognise fellowship
posts in England, Wales and
Northern Ireland
All fellowship comply with
standards of educational quality
as set out by the RCSEng

11. RCS Senior Clinical Fellowship Scheme
• The Royal College of Surgeons of
England and the Surgical Specialty
Associations have established the
RCS Senior Clinical Fellowship
Scheme to :-
o Manage,
o Quality assure
o Publically recognise fellowship
posts in England, Wales and
Northern Ireland
All fellowship comply with
standards of educational quality
as set out by the RCSEng

12. hFps://www.rcseng.ac.uk/surgeons/training/accreditation/fellowships/
national-fellowship-register

13. What is a Fellowship Post?
• The College and Specialty Associations define a
fellowship post as a period of additional medical
training, beyond that available in a usual CCT training
programme, which:
o Provides a structured educational experience prior to [Eg. ST5 or above]
or immediately following CCT, designed to deliver the requirements of a
particular sub-specialty which are not readily available within the CCT
training programme
o Has an established curriculum (which includes levels of patient care,
medical knowledge, practice-based learning and improvement,
communication skills, and professionalism) where the subject matter
relates to one of the following
o Acquisition of sub-specialist skills – eg. where specialist surgery has been
centralised in line with commissioning decisions.

14. What is a Fellowship Post?
• The College and Specialty Associations define a fellowship
post as a period of additional medical training, beyond that
available in a usual CCT training programme, which:
o Acquisition of super-specialty technical skills – for example, in new
technologies and treatments which may not be readily available within a
given region or training programme
o Acquisition of multidisciplinary skills in a given clinical area

15. What is a Fellowship Post?
• Does not impinge on the training of pre CCT trainees
• Is allied to workforce opportunities
• Takes place in an institution that assumes ultimate responsibility
for delivery of the programme of training and education; this
includes providing sufficient protected time for both trainer(s)
and trainees (fellows) and necessary financial support for the
programme

16. What is a Fellowship Post?
• Has a single programme director assigned, with authority and
accountability for the fellowship post
• Has identified faculty that will assume educational and
supervisory responsibilities throughout the programme
• Has a written agreement in place specifying responsibilities for
training, teaching, supervision and evaluation of the
programme
• Provides opportunities for audit and research
• Has an external evaluation process

17. What are the benefits of fellowship training
• Fellowship approved will demonstrate that the post meets the
standards as set out by the Royal College of Surgeons and
Specialty Associations,
• Offers a high quality learning experience
• Recognition of these factors will assist in attracting high calibre
fellows
• The scheme will also benefit patients and the public, protect
the interests of trainees and fellows and improve the quality of
teaching, research and professional practice

19. My urology career pathway
• Research – National University of Singapore (2001 – 2002)
• Basic Surgical training – NUS / Northern Deanery, Newcastle upon
Tyne (2003 - 2006)
• SpR Rotation (Northern Deanery, Newcastle upon Tyne) (2006 -2012)
• RCSEng / BAUS Robotic Fellowship (Lister Hospital, Stevenage) (2012 – 2014)
* Including fellowship to City of Hope Medical Centre, LA, USA
• Consultant Urological Surgeon (Lister Hospital, Stevenage)
( 2014 – current)

20. 2009 - 2013
2014 to current

21. RCSEng / BAUS Lister Robotic Urological Fellowship

22. RCSEng / BAUS Lister Robotic Urological Fellowship

23. RCSEng / BAUS Lister Robotic Urological Fellowship

24. RCSEng / BAUS Lister Robotic Urological Fellowship

25. RCSEng / BAUS Lister Robotic Urological Fellowship
Highlights
• Structured curriculum
• 3 monthly meetings with feedback submitted to the RCSEng
• 260 hours of dry lab training
• Exposure to 315 Robotic Cases
• First surgeon on 200 Robotic Cases
• Consultant On Call rota – last 6 months of fellow
• ChM (Urol) – During fellowship (University of Edinburgh)
• Distinction in Thesis
• Research Throughput
o Thesis with distinction
o 40 papers, 4 clinical trials, 5 research projects,
38 presentations, 6 book chapters, 1 book and 7 Audits

26. Thesis during RCSEng / BAUS Lister Robotic
Urological Fellowship

27. Book published
RCSEng / BAUS Lister Robotic Urological Fellowship

28. Robotic Prostatectomy fellowship data
• Total Number of Robotic Prostatectomy = 200
• Total Number as first surgeon during fellowship = 73

30. Positive Surgical Margins – During Fellowship
Total cases (200) First Surgeon (73)
T2 + PSM 14.2 % 15 %
T3 + PSM 47 % 45 %

31. Positive Surgical Margins - Consultant data
Fellowship
cases first
surgeon(73)
Consultant
cases (119)
P value
T2 + PSM 15% 4 % < 0.05
T3 + PSM 45% 7 % < 0.05
N = 119 cases (August 2014 – June 2016)
Overall PSM = 6.3 % (National average 27%)
35
52
32
2014y 2015y 2016y
Number of Robotic cases

34. (6.3% for 119 cases)

37. Advanced Robotic Techniques – Robotic Neo-Bladder reconstruction

40. Appointments of RCSEng / BAUS Lister
Robotic Urological Fellows
Fellow Year of completion Current Appointment
Mr Nikhil Vasdev 2014 Consultant Urological
Surgeon, Lister
Hospital, Stevenage
Mr Greg Shaw 2015 Consultant Urological
Surgeon (Locum),
UCLH, London
Mr Bhavan Rai 2016 Consultant Urological
Surgeon, James Cook
University Hospital,
Middlesbrough

41. Conclusion
• The Lister Robotic Urological Fellowship is a great training
opportunity in the UK for trainees to be exposed to and
learn robotic urological surgery in a modular manner
• It is an honour to become the first UK accredited robotic
urology fellow by the Royal College of Surgeons of England
and BAUS
• Based on my experience as the RCSEng / BAUS Robotic
Urological Fellow and now as a Consultant Urological and
Robotic Surgeon training our next fellow

42. Conclusion
• A Post CCT fellowship regulated by the RCSEng ensures
o Structured educational experience
o The development of an established curriculum
o Acquisition of high quality sub-specialist skills without any
compromise to patient safety and outcomes as
demonstrated during my RCSEng Post CCT Fellowship
• Based on the patient data and outcomes collected during my
RCSEng fellowship , the data confirms improved patient
outcomes
• We also welcome applications from highly motived trainees to
apply for our fellowship (nikhil.vasdev@nhs.net)

44. Acknowledgment

45. Acknowledgment
• Mr Jim Adshead , Consultant Robotic Surgeon, Lister Hospital
• Mr Gregory Boustead, Consultant Robotic Surgeon, Lister Hospital
• Mr Tim Lane, Consultant Robotic Surgeon, Lister Hospital
• Dr Gowrie Mohan, Consultant Anesthetist, Lister Hospital
• Dr Tim Wilson, Consultant Urologist, City of Hope, LA, USA
• Dr Clayton Lau, Consultant Urologist, City of Hope, LA , USA
• Mr David Thomas, Consultant Urologist, Freeman Hospital,
Newcastle upon Tyne
www.nvasdevurology.com