RCPI webinar - International Clinical Fellowship Programme (ICFP)

0:05 Good afternoon everybody. Um my name is Chennade Lucy from the Royal College of Physicians here in Ireland and you're very welcome here today uh to our webinar on the international clinical fellowship program. So over the next hour um you will hear from a number of both uh staff at RCPI and our clinical doctors in the panel discussion and we're going to cover um an overview of the Royal College of Physicians of Ireland. um the international clinical fellowship programs, uh the recruitment process, the on boarding process, um what to expect after joining and then our partners for onboarding Castell Education will also give an overview of their assistance and and the and some of

0:52 the onboarding process and then at the end there will be a 15minute session with panel a key panel discussion um with some of our clinical leads on the program. Uh so we're going to go ahead. I'm going to give the first overview um of just the college itself and share a video um to give you a flavor of what it's like to come to Ireland and to uh train here on our training programs. So uh the international clinical fellowship program um has been in place since 2014 and we have over uh close to 200 graduates of this program across many of the specialties in internal medicine, pediatrics, obstetrics and gynecology,

1:38 pathology, um public health, occupational medicine. Next slide please. Um just the actual I I've I've given that overview. Thank you. um the the the webinar. Next slide, please. Uh just to give you an overview of the actual team in the Royal College of Physicians of Ireland. Um that's me, Chenade Lucy. I'm the director here in the function. Um and then we've our senior manager, Chenade Freeman. Um Paula Kavanaaugh, our global training and partnerships manager, Adam Lumbar, our development executive. um Anton Bambilak uh our global training and partnerships coordinator and Susan Haleem McCannan our global training and partnerships program coordinator. Now all of um the team are on the webinar

2:26 today. So if you have any questions um please use the chat function and we'll endeavor to uh respond to as many of your queries as possible um during the webinar and anything we need to clarify we will we will get back to you afterwards. Thank you. Next slide please. So just to give you a sense of what our mission, vision and values are, we recently um updated our strategic plan uh last year and it runs until 2029. And the mission is really to empower, develop and support our community of learners, trainees, members, fellows and society to improve health through training, education and advocacy. And the vision is to create a global community of doctors engaged um and enabled to improve health. And our values are welcoming, trustworthy,

3:11 respectful responsive connecting and challenging. And you'll see that these mission, vision, and values are strongly aligned with the mission v vision and values within your own home country and your own health systems and and what they are trying to achieve. And partnership is extremely important for us with key partners in the GCC countries. And aligning those uh vision and values is a key part of that. Next slide, please. About Ireland. Um, so we are a very small island on the most western part of Europe. Uh, we're very well connected to the UK, Europe, North America, and Middle East. Uh, we are one of two English languages countries in the EU. Um, ourselves and Malta, but our

3:59 close neighbors, uh, the UK, are just a half an hour flight away. Um, we have a mild climate. So, you can see there's a nice umbrella icon there. I would highly recommend that you purchase an umbrella and bring one. Um, but we have a nice average temperature of about 10 in winter up to sometimes we might get to 20° C in the summer. Uh, we're a friendly place um and very safe place to live. So, we we cons consistently rank very high in the global peace index. So we're currently in 2025 ranked second home to 5 million people and uh the Royal College of Physicians is was established in the 1600s. So we have a very long long tradition um for excellence in post-graduate medical training and this is internationally

4:45 recognized. Next slide please. Um, so this is to give you a flavor of um, it's a video from our uh, tourist board and it's a really nice video to give you a sense of music, culture, scenery um, and life in Ireland. [music and singing] >> [music] [singing] >> Oh, [music]

5:37 I >> [music] [music] >> Thank you. So, I'm going to hand over to my colleague now, Adam Lumbumber, who's going to present the actual clinical fellowship programs and give you an overview on those. Thank you.

6:24 >> Thanks, Chenade. Uh, hi everyone. I hope you're all doing well. So, my name is Adam. I'm the development executive within the ORCPI global training and parachutes team. And today, I'm going to talk about our clinical fellowship programs, which offer clinical training to international doctors who are sponsored by their government, hospital or national training body. Um our programs provide a unique opportunity to develop professionally as a doctor and learn advanced skills that will be beneficial for the health services in your home country. So we can see here that the international clinical fellowship program is offered across our six faculties and institutes. So we have the institute of medicine, faculty of pediatrics, institute of obstetrics and gynecology, faculty of pathology, public health and the faculty of occupational

7:10 medicine. So the duration of our programs is typically between two to three years. Uh this will vary depending on the specialty uh in question. Uh for further information on each specialty and you can see our QR code here on the screen just to visit our e brochure and we'll reshare this at the end of the presentation as well. Um so on the next slide we can see some highlights um of our programs. So our programs are fully accredited with overseas health authorities providing hands-on clinical experience with subsp specialy exposure including rotations across Irish hospitals within your chosen specialty under direct supervision by RCPI

7:56 certified trainers within a multi-disciplinary clinical team focusing on outcomebased structured curriculums via e portfolio. So this includes annual evaluation of your training progress with study days and complimentary courses along with research and audit involvement as well. Um the next slide outlines our uh clinical and academic supports where we can see that each specialty is led by an international clinical lead or NSD national specialty director who designs the program curriculum, selects trainee for the program, assists their induction and annually assesses their progress uh and provides support to trainees and also their trainers. We also have RCPI

8:43 certified trainers um who help new trainees adjust to the Irish healthcare system work with trainees to meet training goals as per the curriculum and signs off on end of year evaluations um as well. So on the next slide I'm going to talk a little bit about our entry requirements um for our programs. So you can see here to apply uh candidates must be a citizen of Saudi Arabia, Oman, UAE, Kuwait, Qatar or Bahrain. Um candidates must hold a primary medical degree completed through English. Have completed a structured internship. Have completed residency training and the incorporated exams. Have a minimum of one year's experience post residency training in your chosen specialty. H

9:30 also be eligible for registration onto the supervised division with the Irish Medical Council. Um so here for Omani candidates um they must meet a minimum English language requirement at the time of application which is the OE so that's a minimum of two B's and two C's taken within the last year or an IELTS with an overall score of 6.5. Um so then to start in post you must have an ISS of seven with a score of 6.5 in each of the four domains or O with a score of B in all four domains. Additionally you must have confirmed sponsorship with a government body with whom RCPI has an OEU. Um there are also

10:17 some specialty specific entry requirements which can be seen on this slide. Um so for instance we have geriatric medicine uh in which case applicants must complete the MRCPI or MRCPUK prior to applying. Paliative medicine applicants must complete 12 months of acute unselected take in required specialties prior to applying for histopathology applicants must complete the FRC path part one uh prior to program start. Um, and then occupational medicine applicants must complete the LFOM exam uh prior to the program start date. Um, so next we're going to watch a short video showcasing a day in the life of an international trainee in Ireland.

11:07 Good morning. I am Dr. Tal Zaharani. Welcome to a typical day of my life here in Ireland. It's an early start for Dr. Talal as he prepares for a busy day at Children's Health Ireland. A short walk from his new home, he begins his day with a sense of purpose and dedication to patient care. Dr. Tal makes his way through the vibrant city of Dublin, the capital of Ireland. Dublin is a safe and friendly city [music] with lots to see and do. At Children's Health Ireland, Dr. Dr. Talal is part of a supportive environment where collaboration and teamwork are at the heart [music] of patient care. After a busy morning with patients, Tal meets with his trainer, Professor Dez Cox, and other consultants who ensure he gains experience and

11:52 exposure to a range of medical cases. Beyond the hospital walls, Tal enjoys moments of respite, savoring the rich culture and making friends in his new home. A day in the life of an international fellow is a tapestry woven with dedication, compassion, and a commitment to making a difference. Dr. Talal is working toward a brighter, healthier future, gaining important experience and skills to bring back to his home country.

12:39 Good afternoon everyone. My name is Paula Kavanaaugh and I am the global training and partnership manager here in the Royal College of Physicians of Ireland. Today I'll talk you through the RCPI process for international clinical fellowship program. So the purpose of it this overview is to give you a clear understanding of how the recruitment process works from start to finish and to highlight the key stages involved including timelines, assessment points and decision making milestones. Next slide please. So what are the recruitment stages? Recruitment begins in April which is when applications open. At this stage, candidates submit their application in line with the published eligibility criteria, program entry requirements, and required supporting documentation. During this

13:27 period, we focus on providing guidance and clarity to ensure candidates understand the requirements and expectations of the program. The next phase takes place in June and July once applications close or CPI undertake a structured eligibility verification and application review process. This includes verification of documentation assessments against the published eligibility and program criteria and the short listing of candidates in line with the specialty specific requirements and available training posts. The final stage then takes place in September. Shortlisted candidates are invited to attend an in-person or online interview which are conducted with the relevant key stakeholders. Following the

14:12 interview process, outcomes are communicated and the onboarding and pre-arrival process begins for successful candidates in preparation for their entry into the program. Overall, this phased approach ensures a fair, transparent, and robust recruitment and selection process, fully aligned with RCPI governance, quality standards, and program requirements. With that in mind, I'd now like to show you a short video that walks you through the structure of the application process and provides a helpful visual overview of the journey from the application to acceptance. The process of joining one of RCPI's [music] prestigious international programs couldn't be easier. When you're ready to [music] apply for one of our residency or fellowship programs, you can start

14:59 your application online and through [music] our website. For residency, you need to have completed your degree through English, [music] completed or be near completing a structured internship. For fellowship, [music] you need to have completed a primary medical degree through English, completed a structured internship, completed [music] a national residency program, and passed the associated final board examination. For both residency [music] and fellowship programs, you will require provisional sponsorship from a government body we have an agreement with. Remember, [music] you don't need to have an English language certification or MRCPI to apply for [music] either program. Make sure to submit all required documents correctly. And if you have any queries, [music] just reach out to the RCPI team and we

15:45 will be happy to help. If your application [music] is shortlisted, you'll be invited for an interview in one of the Gulf Cooperation Council countries. Successful [music] candidates receive an offer within a few days. Officially accept your offer by email. The RCPI [music] team along with Castell Education will support you right through onboarding into the program and training itself. If you need to meet English language proficiency [music] requirements, we offer one-on-one tutoring to prepare for the OE or LTS examinations. [music] For those joining the residency program, RCPI tutors will provide tutoring and access to a question [music] database for the MRCPI part 1 examination. RCPI [music] and Castell Education will help you register with the Irish Medical

16:31 Council, visa applications, and finding accommodations, schools, and childare. [music] We even assist with everyday tasks like opening a bank account. You will arrive in Ireland 2 weeks before your start date to settle in your new home, attend an induction day, [music] and then begin your journey to advance your medical career in one of our Irish hospitals. Graduates [music] from the Royal College of Physicians International Residency Training Program and International Clinical Fellowship Program have [music] gone on to achieve the following roles and advancements in their careers. apply to an international program with RCPI today. >> Thank you for your time. I'll now hand you back to my colleague Adam who will talk you through the onboarding process.

17:18 >> Hi again. Uh so now I'll walk you through a very simplified outline of the onboarding process. So within the global training and partnerships team, we have a dedicated coordinator to help you progress through the onboarding process. So the first stage of the process is the one-to-one onboarding meeting which really is an opportunity for a coordinator to introduce themselves to our candidates. So this one-to-one meeting also gives candidates an opportunity to ask any questions h you may have as you embark on your training journey with RCPI. We then refer you to our brilliant colleagues in Castell Education for English language tuition or relocation services um who we will hear from shortly. The next step is then to leers with the clinical lead for each program who will

18:03 confirm your year one clinical placement or hospital allocation. This is confirmed well in advance of your program start date to give you enough time to secure accommodation in your allocated uh training area. H once each of the above steps have been complete, we can then apply for your work permit under the atypical working scheme. So this is needed for you to take a post in Ireland. Um RCPI will apply for this on your behalf. And coming towards the end of the process, Castell will then assist you with your entry visa application while also advising you with regards to your travel plans from the Middle East to Ireland. H provided the candidate successfully moves throughout the onboarding process and has arrived in

18:49 Ireland, you are then handed over to my colleagues in the international delivery team who will support you for the duration of your training program in Ireland. Um lastly, you will attend our induction in Dublin, which is a great opportunity to meet your fellow international trainees and to link in with RCPI staff in advance of commencing your program with us. Um, I'll now hand you over to my colleague, uh, Miss Hannah Flynn from Castell Education, who will tell us more about their relocation supports and services. >> Thank you very much um, Adam. Um, so first of all, um, as Adam said, my name is Hannah and, um, I'm head of postgraduate services here at Castell

19:35 Education. So, thank you to RCPI for inviting us to participate in today's webinar. What we'd like to do over the next uh few minutes is just tell you a little bit about um how we here at Castell can make your transition to Ireland that little bit smoother with our personalized English language tuition and then a range of uh pre-arrival and incountry support services. So um the next slide please. Um, for any trainee who have yet to meet their English language requirements, um, RCPI will refer you to us here at Castell for English language preparation. So, we'll send you a welcome email, um, outlining the English language services that we provide, and then we'll gather information from from you on your exam preference, so be it

20:20 IELTS or O. um will gather your level of English, if you have an exam booked already, um your availability for tuition, and then you'll be assigned a personal professional English language tutor, and they'll contact you then to schedule in onetoone classes. So, your tutor then will carry out um an initial diagnostic assessment just to determine your level and just to see what gaps or what skills that require um the most attention. Um there's also a correction service available if you wish to submit any pieces of writing and there'll be onetoone speaking practice. The tutor then will track your progress and feedback is provided to RCPI on a fortnightly basis in relation to training engagement and progress. So Castell will work with you until you sit

21:07 your exam and once you receive your results we'll review them. Um for any trainee who have not met the requirement, you'll continue with um your tutor and getting your English language tuition. And then when a trainee has met the English language requirement, um then you're referred to onto me here in the post-graduate um services to begin the first stage of your relocation support. So next slide, please. Um so once the training is referred to us for the relocation support the first thing that we'll begin to work with you on um is your medical counselor registration. So what we'll do is we'll give you lots of um suppose detailed very easy to follow step-by-step guidelines from each for each part of the process from u getting your

21:52 credentials verified in Epic um to getting your supporting documents notorized and completing the online medical council application form. uh will review your application with you just to make sure everything's fully prepared before you submit. Then, as Adam mentioned, once you get your work permit, your atypical working scheme, we will then give you guidelines on applying for your visa. We can review your online visa application for you before you submit and we can also provide you with templates for some of your supporting documents. if you are bringing any family with you, we can advise you on um their visa applications. And then once you're here in Ireland, we'll guide you through the process of applying for your Irish residence permit, your IRP card, which

22:37 effectively takes over from your entry visa. And at any time, if you need to travel to a third country for any courses or conferences as part of your program, we can provide you with advice on applying for visas for those countries too. Um so in terms of accommodation um Castell will support you every step of the way. So from giving you advice on temporary accommodation options for your initial weeks in Ireland to working with you to establish your preferences and based on your requirements we can give you some permanent accommodation recommendations and options. We are happy to arrange appointments for you to view properties that you're interested in. We're happy to lease with the agents and landlords on your behalf um and then help you submit the applications for any properties that you'd like to proceed

23:24 with. Then once you've been accepted for a property, we can review your lease for you and then give you um just move in advice and advice on setting up your utilities. For any trainee coming to Ireland with children, we can support you then in your search for a school place or um a childare place. So when your hospital location is confirmed by RCPI, we'll work with you to establish your school and childare requirements. We'll contact the schools and the crashes on your behalf. We'll establish the vacancies and then we'll send you on um the application information. Um so [clears throat] then next slide, please. Um when you've booked your travel for Ireland, we'll arrange a driver to pick you and your family up at the airport and transfer you to your temporary accommodation. you'll be um

24:10 presented with a personalized welcome back upon arrival. And then um just during that initial transition period, we'll have an out ofour support service available to you just in case anything urgent should arise. And we'll also arrange like welcome video calls with you after your arrival just to kind of help you on what to focus on in your first couple of weeks here. And then once you're settled in your permanent accommodation, we just give you lots of information and advice on settling into life in Ireland. So, from getting your bank account, getting a mobile phone number, um setting up all the utilities, getting your part to health insurance. If you're interested in driving in Ireland, we can guide you through buying a car, renting a car, um finding your GP. Um we'll give you information on the local transport um network, local orientation, anything that you need. Um

24:57 and that support then is available to you then for the entire duration of your program. Um so any questions that you have like of a non-academic nature just always feel free to reach out to us. Um and anytime that that you'll be rotating to a new clinical site we'll um we'll guide you through um getting new accommodation if you need new uh schooling or child care for your family. Um at different times in the process you might need to say renew your IRB card, renew your medical council. Um we'll guide you through all of that all the way up until the very end of your program. we will give you some information um on preparing for your departure. Um so I hope that has just given you a little bit of insight into what Castell's role is here and just how we can make your transition that little bit easier and smoother. So thank you

25:42 for your time. >> Thanks Anton. Uh hi everyone. My name is Zoe Edwards. I'm the education and training delivery manager here in RCPI. Um, if you just go to the first slide there, Anton. Thank you. Perfect. Don't know why there's a scribble over there. It's not mine, I promise. Um, so, uh, as Adam mentioned earlier, once you have gone through the, uh, really extensive onboarding process to enter onto the clinical fellowship program, once you've arrived in Ireland and are ready to start your program is when you'd be handed over um, to our team. So we're basically here to support you end to end from the start of your program right

26:28 through to program completion. Um so this is the team here. So on the international clinical fellowship program you will have a dedicated program coordinator and that is Mappy Defeno. So she is really your uh initial contact person for any supports that you may need throughout the program and we have a number of supports listed there. uh we're here to ensure that you can um meet your program end to end in terms of your curriculum. So we provide support for your e portfolio uh system. So you'll receive a training session in that and we can also offer support as you move through your program to ensure that you're logging and completing all of your clinical and educational requirements. We also provide support for any general program queries that you might have and we are the initial

27:13 liaison person between yourself uh and your trainer. We also have an international hub which is a virtual learning environment where there's a number of supports uh available to you in the form of uh reading resources and also videos to help you adjust to the Irish healthcare system but also signposting to different supports within the college. We also um provide opportunity to attend study days and educational programs and we'll signpost those opportunities to you. Uh as Adam mentioned earlier as well, you have an annual uh evaluation with your clinical lead. So we facilitate and run those evaluations for you and uh link you in with your trainer to complete your various quarterly assessments as well. We also provide support meetings. So we

28:00 will check in very early on in your program to see how you are settling in, but we will also check in with you at various points during the year just to ensure that you are getting on okay in the program. Um so we're always available for a one-to-one support meeting um and Mappy will signpost that to you as you start the program and we can signpost you to various functions within the college as well. We have a health and well-being department who are there to support you and can link you in with various supports within the Irish healthcare system as well. uh if you are looking for information on exams or particularly related to your curriculum, we can also signpost you to that team as well in our education department. Uh there's a QR code on the screen there as well that is linked to our international training handbook. Um you'll receive a

28:46 copy of this at your induction when you arrive in Ireland as well, but if you'd like to scan that, uh that also lists all of our policies and procedures and kind of outlines the program from start to finish as well. So, it's a useful resource to have. Um, happy to answer any questions on the kind of uh in program side of the house if you want to pop anything into the Q&A box there. Happy to answer that. I'll hand back over. Thank you. Thank you, Zoe. Um, so I think now we're moving on to the panel discussion phase of this webinar. So um I'm going to hand over to my colleague Chenade Freeman who's going to chair this session. Thank you.

29:32 >> Hi everyone welcome good good afternoon. Um as Chenade said my name is Chenade Freeman and I'm the senior manager for examinations global training and partnerships here in uh in the college and um I'm very pleased to facilitate today's panel. Um I hope everyone found the presentations earlier helpful. uh and I will now ask the panel just a number of trainy focused questions. So the aim really of this session is to give you a better understanding and insight into our international clinical fellowship program and to provide you with actionable takeaways from this afternoon's session. Um during the panel discussion we will also answer as many questions as we can uh in the Q&A chat box. Um so firstly I will introduce you

30:19 uh to our panel. We have Prof. Cesley Quinn who is the international clinical director for all of our programs and she's also the international clinical lead for hystopathology. We have Prof. Declan Cody who is the international uh clinical lead for pediatrics. We've Prof uh Connell Denny is who is the international clinical lead for endocrinology and diabetes. Prof. David Bradley who's the international clinical lead for urology. Um Hannah Flynn who you met earlier is the head of postgraduate services uh with Castell education and Chenade Lucy who is the director of uh development business development exams in RCPI.

31:06 Um so I'll just start off with the first question and I will start the the session by asking uh Prof. Quinn um what diagnostic responsibilities are fellows expected to undertake as part of the program? >> Thank you very much uh Chenade. So I speak for hystopathology really. So somebody coming in to do a clinical fellowship they're expected to participate fully in the diagnostic service. Now this does take place under consultant supervision and that consultant supervision really carries right through to the end of training and hytopathology which differs really from many other specialties. Um obviously everything is consulted and supervised but it's it's very heavily so in hystopathology everything is double signed with graded responsibility as somebody becomes more senior but there

31:51 is very very yeah focus consultant supervision throughout. Um so the duty is really that somebody would have uh first of all they would participate in specimen dissection um examining the specimens uh block taking maybe a specimen x-ray whatever is necessary constructing a comprehensive macroscopic uh description and then they would get the slides from the specimen maybe that later that the following day or two days they review those construct a microscopic report which is clinically focused and then they discuss that review the slides ETA with the with the consultant. Um and fellows are also so they're also encouraged then to participate in multi-disiplinary team meetings uh both to attend those and to present uh selected cases uh with the

32:38 consultant uh during their time. Then here we also encourage them to do an audit during their their training period and also to t to take a role in teaching to supervise uh junior trainees and indeed medical students depending on on uh whether or not they're present here at that particular time. So the the duties really are very similar to what they would be doing in their own country uh but with a greater focus on individual specialties and gaining more experience. >> Uh thank you Prof. Um my next question then is to Prof. Bradley. Um how much clinical autonomy do international fellows typically have? [clears throat] >> Thank you. So I mean the fellows will after settling in period be expected to perform similar to any of our other

33:24 training doctors and they'll be part of a team with other registar SHO interle doctors. So they'd be more senior in that um in that structure. So it would be expected that they would have a good opportunity to um develop their skills over a period of 2 to 3 years typically and as as as for our local trainees that as they become more confident and have demonstrated competency they will be given more latitude to perform with indirect supervision. Um it is the case that in neurology my own specialty that is very heavily consultant provided and so the level of supervision is certainly persists as being very significant but there will be good latitude to allow trainees to develop their confidence and their independence as they progress

34:09 through the program and they will typically progress across different sites allowing them to experience different types of departments and also different um team structures. So that that will naturally develop over the course of the two or three years. >> Uh thank you Prof. Um and then just the next question then is for Prof. Cody. Um what age groups um and pediatric subsp specialties are fellows most exposed to? >> Well, firstly apologies my camera isn't working. I tried tried yesterday with Anton, but it just h couldn't get it working. So it's just uh me talking. So like pediatrics is is essentially uh one day of age until 17 18 years of age. So you get the complete breath of pediatric training and you'll get exposed to kids

34:56 of all ages in in your in your specialty. the outpatients. Uh again, probably you're probably getting a slightly older child um coming into uh into the adolescence and you um and into young adult as well up as far as 17 or 18 years of age before they're transitioned on. But in terms of what age, it's a bit like what they're what they have in their own countries. What what sorry what you're having in your own country. Again, it's children of all ages from one or two days of age all the ways up to uh the older adolescent, I guess. Thank you. Um and then finally, Prof. Denny, um what uh level of exposure do fellows get while managing complex multi- uh morbidity cases?

35:44 Yeah, they get a high level of exposure um in you know again I'd speak for endocrinology but I'm also very aware of cardiology um uh gastroenterology and the other medical specialties rheumatology for for example um often the international clinical fellow actually gets um nearly privileged um exposure to their trainer um and uh for example in my case I I will give the fellow perhaps 10 very interesting very complex cases um that they will either manage uh help manage and learn about their management um from uh sometimes from the beginning if the patient presents a new um or alternatively some patients that have been attending me for some years I will give to the international clinical fellow and they

36:31 will be expected to follow that patient but not just to follow them going forward but also to be very aware of their past history and to see how they were managed um up until the the point at which they arrive um and we would meet um then on a a weekly basis, sometimes a fortnightly basis um to discuss individual cases. That's how the learning is done. The learning is done by experience. It's not didactic learning. It's not learning by lectures. It's learning by experience, by reading, by looking up, by uh interrogating the evidence. Um the fellows will be supervised during complex cases until they have a degree of um of uh independence in their own decision-m. Um and you know as trainers and consultants we would evaluate their decision-m um

37:16 prior to the fellows starting to make decisions themselves. So we would ask them what do you think you would do next with this patient? What do you think you would do next? How would you investigate this patient? What is the most appropriate treatment for this patient? Um and then as the year develops with each of the trainers as as they pass through each of the trainers hands they get more and more independence. um um and um and uh they they still have the same level of of uh of supervision. So they get a very high exposure. You know, anyone that comes to me each year would see three or four focytoomas. Um five or six patients with adrenal cortical carcinoma. These are extremely complex cases. You know, 20 or 30 patients attend me with congenital adrenal hyperlasia that they would that they would manage. So these are the complex um um types of cases that I I

38:03 would expect the fellows to come back from training with me alone to be proficient in and that's independent of looking after complex feet looking after uh complex type 1 diabetes um um looking after complex diabetes cases and also looking after the very ordinary cases such as thyrotoxicosis graves thyrotoxicosis that comes in the door. >> Thank you profit. Um I I'll go back to uh Prof. Quinn now um for my second question. Um how much exposure is there to um subsp specialty or advanced pathology services? >> Thank you Chenade. Uh well there is a quite a significant degree of subsp specialcialization in histopathology in Ireland in the delivery of the various

38:50 services uh with particular emphasis really on catering for personalized medicine. So uh all of the large departments offer subsp specialty training uh in a wide variety of of specialties breast GI liver uh germtopathology soft tissue etc. So if a trainee, if a clinical fellow is is is still in training and is is working towards the final F4C path examination, they would rotate through all of the various specialties and gain experience. And we find our our hospitals tend to be quite complimentary in terms of uh specialization. Uh some areas are very well represented for example in St. Vincent's others very well represented in St. James's for example. Um, Cork has a has a has a a great variety of

39:35 specialties all under under one roof as has Gway. Um, and also the same goes for the North Side Matter and and Bowmont Hospitals would be quite complimentary. If then we find a trainee or a fellow is postexamination and they want to gain particular expertise in one area we can slant their training or part of their fellowship towards that and then as part of that subsp specialty training we would encourage them to you read a lot in that specialty go to the relevant MDTs uh get to know the clinicians and and really get to know the clinical context of what they're reporting so I would say really pretty well all sub specialties are very well represented in Ireland with very good training opport opportunities and as I said that would be tailored accordingly depending on the stage of of training.

40:20 >> Thank you Prof. Um just profly then um how does the fellowship uh support progression towards consultant decision making? So I mean given that trainees typically will complete a three-year program sometimes a two-year program um much like our last uh answer the sub specialization is is something that develops as the training goes through we have models where trainees will do three general years you know very similar to what our local trainee would do as part of their core neurology training and we have other trainees who have significant significant experience already coming into the program and really want to get quickly to subsp specialcialization in an area such as multiple scerosis part you know movement disorders and all of

41:07 these can be accommodated and all of the major centers that before hospitals university centers have all of these sub specialties available and the training can very much be provided with whatever it is they need to to develop their their um portfolio of skills and competencies to tailor to what they need to bring back home. So in terms of consultant level decision-m that autonomy is something we build up as the traininee goes across the years but the other thing that we do is we will gear towards areas that they want to focus on. Common themes that we get coming into us are headache, epilepsy and then more recently some of the neuroinflammatory things of multiple scerosis that can be worked in as in a form of fellowship uh towards the end of training to make sure that somebody

41:52 going home has what they need to gear towards a particular consultant type role that they may have in mind. And that goes along with the fact that as their autonomy builds their ability to to practice independently um and competently is is supported. that's supported through the ongoing assessment phases. >> Thank you, Prof. Um my next question then is to uh Prof. Cody. What level of responsibility do fellows have in acute and complex cases? >> Yeah. Yeah. Um I suppose in in a two-year program, the first six to 12 months is really getting the fellow embedded into the clinical team. So at that stage, there wouldn't be a huge amount of responsibility. they would still be expected to do all the things

42:37 like attending clinics, attending emergency department, ICU, but there would be a lot of consultant supervision I guess over that first 12 months. Um from there on really uh the fellow often takes a more senior role even among because we have obviously the SBS the specialist registars SHO's change every six months while the the fellow would have been there for the previous year. So they would start to take a much more senior role within the team in terms of at times seeing patients without having consultant supervisions. For example, in our diabetes clinic, they would our fellows would see patients on their own and and let them go. Um they would do we would encourage them to lead on ward drowns and with sometimes with us in the background. uh they within the last six

43:25 months or so they start some of them start to do a kind of a first on call service where they will be available at night if they wish. This is this this I guess this is a kind of agreed within the team within between the fellow and the consultants that they may take an opportunity to to offer and perform a first on call service and but I guess it's really at the behest of the fellow how quickly they move how much responsibility they want to take on but there's huge scope for a very senior role by the end of their uh two-year attachment. [snorts] >> Uh thank you Prof. Um and then just finally then on to um Profenity um are fellows involved across acute admissions, ward rounds and outpatients

44:11 clinics. >> Again that's specialty dependent uh for example in um gastroenterenterology um and uh cardiology. The fellows will be involved in um in or sorry not cardiology in gastronenterology for example. They are um involved in acute medical take and they are on the ward rounds uh because it is critical to um gastroenterology that they would see the acute intake of patients who would have um inflammatory bowel disease um or an acute exacerbation of that uh for example or or you know acute or sick livers. Um within endocrinology um we don't expect anybody to do general medicine and they don't do acute general take. Um but for example depending on

44:57 the hospital that they're in there may be an on call service to the emergency department during the days um whereby they would go down and manage diabetic ketoacidosis if it came in an adrenal crisis if it came in. Uh patients with severe hyponetriia um that might require um uh hypertonic saline for example. So they're the type of of things that that acute medicine that they would uh uh be expected to to to look after. We would also expect the fellows to go on to the consultation round. This is one of the very essence of their learning that they would uh see consults um and see consults with the with the consultant. Again, this expo very good one-on-one exposure um to the consultant trainers right across the board. Not just your individual trainer,

45:42 but the many trainers that are in the in on the team. You know, for example, our team has 10 endocrinologists on it. You want exposure to each of those with their own unique perspective on how to manage patients that are on the wards. Um, again, within outpatients, um, there's a curriculum there. There are a number of outpatients, uh, clinics that you have to attend. The outpatients clinics are busy and you would be expected to see at a general endocrinology clinic 8 to 10 patients at a minimum. Uh, you would be expected to see in a diabetes clinic many, many more than that, maybe 12, 14 patients. So, they are busy clinics. um there's not always time to talk to um or or there's not always time for formal teaching at the outpatient uh clinics but you do gather information about your patients and you discuss them at a later time uh with your consultants so there'll be a

46:28 very big exposure there'll be a large case mix of patients that will be seen again as the clinical lead I expect the fellows uh to um document the patients that they have seen and to have a very good log book uh that goes through multiple cases and I will pick patients at random from those uh cases from those um from the log book to ask the uh the fellows uh to discuss those cases and how they manage them and to reflect on those cases um at the assessment at the end of the year and I know that the other clinical leads do the same thing. So that will be the overall exposure that the the the fellows have. there's a large large exposure. There's a large large case mix there for the the fellows to see. Um beyond just the complex,

47:14 there's the ordinary everyday, there's the acute, there's the non-accute. >> Thank you, Prof. Um my final question then for the clinical leads. Um Prof. Quinn, are fellows involved in multiddisciplinary team meetings and case discussions? >> Yes, thank you Chenade. uh yeah multi-disiplinary team meetings are now considered really to be an integral part of uh patient management and involves the coordination of clinical pathological imaging findings discussion by all members of the team involved in in patient care. So we very much encourage our fellows and our trainees to attend these meetings and also to participate in them uh to present cases um that they may have worked up. So that is something that we have uh

48:00 multi-disiplinary team meetings several every week and that is part and parcel of of of their training and very and a good opportunity for them to uh to develop their skills in terms of communicating results verbally etc. Uh with regard then to case discussion uh we also encouraged fellows to participate in journal clubs which uh sometimes involves reviewing a case and then a literature review. uh we also encourage them to uh participate in all of the orcpi study days uh some of which are also case-based. So as well as uh learning the skills of microscopy and developing their skills further in that regard um we very much encourage our fellows to be part of the overall team. So plenty of opportunity there. Thank you. >> Thank you Prof. Um and then uh Prof.

48:48 Bradley um how is supervision structured for international trainees? So it's modeled very much on the supervision we already use for our specialist trainees uh registars and shoos that patients are trainees are very much supervised in clinic settings on consult ward rounds in patient reviews on call um if there's daytime call for example to review a stroke in the ED something like that so the supervision is very much that for a lot of tasks especially in that first year there's direct one-to-one supervision um to make sure that the trainee acclimatizes to the environment, is confident, is comfortable and as time goes on and their autonomy is allowed to develop then it's more you know

49:34 reflection back on case discussions for example um where there isn't direct supervision for specific activities. The supervision is is will it vary from trainee to trainee because everyone is different and that needs to be customized to the individual trainee. How they respond, what their mode of learning is and how they can be best supported to develop independence which is really the aim at the end of the fellowship is that they've developed a set of skills that are relevant to them and to their supporting body that they can bring home and that they can provide a higher level of service than otherwise they would have been able to having benefited from the scheme. So I I would what I would say really is that the mode of supervision is modeled on what we already do for our local trainees at registar and SPR level.

50:19 >> Thank you Prof. Bradley. Um Prof. Cody, how does the fellowship prepare trainees for senior pediatric roles? >> Yeah, thanks Sh. I guess a lot of these answers have been have come in previous questions as well. So but it's the same as what we said previously. So in in trying to prepare the fellow for a senior clinician role or senior consultant role when they get back home is is when they start with us is by year two entrusting them with I guess clinical autonomy as their fellowship progresses where they get to the the place where they're seeing patients deciding next steps as an independent senior doctor and deciding investigations of course coming to to the consultant as well just to discuss these but taking an on take on taking on a much more uh independent role. We obviously encourage again as was

51:06 previously mentioned attending the compulsory RCPI programs uh leading at the MDTS in terms of preparing CPD for all the team members. We we certainly encourage all our fellows to attend the the um national pediatric and international pediatric specialty meetings and we encourage them to prepare audit um maybe write up um a paper on their on the audit. that's something that we think would be of great value and of course when they go back home then we always encourage them to stay in touch and to keep in touch with us and that we're always there if they have cases and we still offer them the opportunity to join our MDT meetings if they're able to dial into it. >> Thank you Prof. Cody. Um and then finally uh Prof. Kennedy um what

51:52 opportunities exist for research audit or quality improvement projects? [snorts] >> Yeah, a lot. Um, so it's expected that audits and quality improvement projects are carried out on a yearly basis. That's part of your log book and it's something that must be sorted out as your training with in your training plan at the beginning of the year. Um, and uh, this is something that we really want the fellows to bring back um, with them to um, the Middle East to the the um, intrinsic practice of a audit and um, and quality improvement uh, in in the delivery of patient care. uh research is always available. Um it's uh something that the fellows take up upon their own initiative. Um they will

52:37 approach their supervisor and they will um express whether or not they're interested in carrying out some research and it comes in many forms. In general there is no time for um bench research or or lab research to be carried out but there is a lot of clinical research and there are opportunities for the fellows um to uh do summer or to do schools and and um and courses in things like data analytics um the use of artificial intelligence particularly things like claude uh etc in order to help them along with the research to access large international databases. There are often large research projects going on in many of the centers and there will often uh for example in endocrinology Bowmont uh and ourselves um have um a number of

53:23 clinical trials going on um through the the clinical research facilities there that the fellows can partake in and they can become um sub investigators on clinical trials large clinical trials um and that's a very good opportunity for them to learn how clinical trials work and perhaps to try and attract um clinical trials to their own institutions when they come back. Um and then in addition to that there will also be uh for example PhD students and MD students who are doing projects um where and post-doal students who who might be a part of larger projects uh that principal investigators have that the fellows can get involved in. um you know for example um Mea um who was a fellow a number of years ago she got involved in what's called the Daisy study um which was a large study that um Mik O'Reilly

54:11 had a PhD and MD uh working on as well as um some um fellows working on this over in in the UK along with Vipka Art and she managed to network through the UK um Germany and uh Ireland um with the research that she did and brought and made some very valuable um um associates uh through that research. So um yeah the opportunity is there but again it is really important for the fellows to understand that this is based on initiative. Nobody is going to chase you down to do research. The research is something that you ask about and that you will be given the opportunity to do and when you are given that opportunity you should capitalize on the opportunity. Um uh it it is not something that we force upon the fellows. Um but it is an opportunity

54:56 that we are perfectly uh willing and happy to give to the fellows and really welcome the fellows asking about it and um as long as the fellows themselves take the initiative we will help them along the way but they must first and for first and foremost take that initiative in order to carry out the research uh and to do the research that they're asked. >> Thank you Profity and and thank you to all the uh clinical leads for for that uh informative Q&A session. Um so the final question um then before we finish is for um Chenade Lucy. Um and Chenade as director of international training and examinations what is the one key takeaway from today's session um that you would like the audience to remember?

55:45 Sorry you're on mute there. Apologies. Um I might I might make one or um maybe more than one recommendation. Um so just to reiterate the the current recruitment window is is open and the applications will close in June. Um and that's with a view to interviewing in September. Um so the September September interviews would then have a uh inprogram start date of July 27. So just bear that kind of timeline in mind. Um, I would really advise to reach out to alumni of the program. As I said at the beginning, we have close to 200 alumni of the fellowship program alone. Um, and also current trainees. So, you know, get a sense of what it's like to um, apply to

56:32 undertake the interview. If you're if you need to engage with English language tuition with Castell, um, understand what that experience is like. Um and then if you are successful at interview, I would really recommend that you engage with our partners Castell as soon as possible. Um especially if you have to take an IELTS or an OAT exam and also to um sort out accommodation or child care or school requirements. Uh pay particular attention to your curriculum. Um you need to review it. to um engage with the team here in RCPI if you have any questions, queries, if if you'd like to get involved in other things like Profity mentioned um you know the the time to start doing that is um the earlier the better really um and then

57:19 yeah just to really echo what the clinician said like make the most of your time here look at the opportunities to get involved in research in audit to attend conferences or um any um AI initiatives um you know show some initiative and get involved and put yourself forward for those. Um and then just finally I I just want to thank you for for attending the webinar. Um we've recorded it obviously and we'll we'll be circulating the recording and you can pass to any colleagues um uh that might be interested. Also um if you have any queries at all um we have the QR code I think coming up in a few minutes Anton so you can look at the e brochure you can get in contact with the team um we're here um 5 days a week 9 to 6

58:06 [laughter] so uh please do get in please do get in contact with us um and finally I would just like to thank our clinicians for taking the time out of their busy schedule to to share their insights and and information with Thank you, Chenade. Um, yeah, I'd just like to reiterate what what Chenade said there. You know, thank you to to all the panel. Thank you to the RCPI team for for organizing today and and um for the audience for your time. Um, and the the QR code is is up there. Uh, I would also encourage everyone to go to the RCPI website uh to look at the e brochure. um it's very informative. It has, you know, all the information that you need to know about the programs, the entry

58:53 criteria, the supports available, etc. So, the e brochure, um, you know, is is really a go-to kind of tool for for all you need to know about the programs. Um, so if nobody else has anything to add, I think we we can finish the session for today. Thank you everyone. >> Everyone, thank you.