We started the section ‘Beyond the shores’ focusing on pursuing higher education abroad on the blog over a year and a half ago. Since then, we have covered various options on studying abroad, including the US, UK, Singapore, Canada, and Australia. Besides, we also covered how to prepare for various exams like FRCR and EDiR.

The plethora of choices available to the average radiology trainee in India is now phenomenal, but also quite confusing. I see an increasing trend of going abroad for fellowships/observerships, and also of giving various foreign exams. This blog is my perspective and advice on how to approach these choices and their pros and cons. I have personally spent three years in clinical fellowships in the US before coming back (so there is some bias), but have by now also interacted with numerous colleagues who have gone through different countries and systems so as to try and give a (hopefully) balanced view.

How to select the right Fellowship program for you

Know what you eventually want: In order to select the right fellowship for you, you need to first decide whether your plan is to get board certified and settle down abroad, or get subspecialty trained and return back to India. It is fine to keep both options open, but it certainly would be easier to choose the right program for you if you are clear on this upfront.

Which is the best place to learn?: First things first. While Indian training programs (especially some of the subspecialty training fellowships) are good, the fellowship training you get abroad is way better than the one you would receive in India (due to a variety of reasons we won’t go into in this blog). Overall, the clinical fellowship program from any decently good institute in the US (and perhaps Canada) is unmatchable. This is not just my opinion, but also what I have gathered from European-trained radiologists who have been my friends and co-fellows in the US. Of course European or Singapore fellowships, especially the good ones, are also excellent; you will learn a whole lot of radiology wherever you go. But essentially if you want to train in the best possible way, I would suggest aiming for a North American fellowship. (Know that Canada doesn’t need MLE scores, so it is easier to apply to but more difficult to secure compared to an American fellowship).

Where is it easier to settle down: On the other hand, settling down (at least right now in the post Brexit era) is much easier in the UK; so you could aim for that if that’s what you wish to achieve. Even Australia is opening its doors right now, and is another good option. ABR (American Board of Radiology) certification needs you to work for four consecutive years in the same institute, which is getting less predictable to secure than it used to be (but still reasonably possible). Note that these trends keep varying, so you need to know what is the scene when you are applying. Having said all this, also know that as far as salaries go, North American salaries are much more than their counterparts elsewhere.

How long a fellowship? In my humble opinion, a one-year fellowship is perfect. The European 3-month fellowships are a good option, but 3 months is not enough for an average trainee to master a subject. So if you are aiming for the 3 month fellowship, ensure that you spend at least 6 months prior to the fellowship working in a good institute in India and focusing dedicatedly in that subspecialty. For example, if you are going for a 3-month MSK fellowship, work in an MSK predominant workspace in India to prepare. Remember, all fellowships abroad are golden opportunities to learn, but they are not meant for someone to brush up on basic anatomy and common pathologies alone. The stronger your base, the faster you will impress them and the more you will learn along the fellowship. I would advise even those selected for a US fellowship to train dedicatedly on the same subspecialty in India in the time you get before the fellowship begins.

Do I really need to go abroad If I wish to settle in India? Yes and no. There are many excellent institutes in India where you can learn to become a fantastic radiologist. Having said that, the education in India is very self-driven; you will have to be more of an Eklavya learning from what you see, unlike the fellowships abroad where you will be mentored and taught by experts during the fellowship like Arjun was. So if you are an average or just above average radiologist, training abroad will be the best way forward. If you are exceptionally smart and hard working, have an aptitude for self-learning, are pro-active in attitude, and are not afraid of asking questions to the senior faculty and referring physicians to clarify doubts, then perhaps you could learn and become almost as good by simply being in a good Indian institute/ center. A smaller brownie point is the tag of a foreign-trained radiologist, particularly if you wish to settle in a metro and work in a prestigious hospital or center. The tag always helps in your application.

However, one of the biggest advantages of studying abroad is just the experience you get beyond image interpretation when you train and stay abroad. You will find it easier to create and follow SOPs, break hierarchies, confidently discuss scans with physicians, and become an overall more well-rounded radiologist and person once you are back in India.

How to plan on a successful Fellowship application

Just like Rome was not built in a day, a successful fellowship application is not something which can happen overnight; you need to plan ahead for this.

How important is having publications?: A good CV (essentially one with a few publications) is most crucial in getting the best possible institute. Know that only accepted publications can be included in the CV. Most publications unfortunately have a timeline of at least a year or so from the day you decide to write them up (even if it is a case report), so try to have a few under your belt during your residency if you wish to go abroad. Luckily, the CV can be more inclusive and includes elements beyond publications. A blog you have written, having had a departmental responsibility like say creating the resident rotation schedule, having basic proficiency in the local European language, or even working in an NGO in a medical or radiology role could help as well! Read more on how to write a good CV in our previous blog.

Are letters of recommendation helpful?: A good reference can be very helpful. So if you are planning to apply abroad, try to connect with radiologists in India who have personally worked abroad or who have good contacts abroad, share your plans, and ask for their advice. Try to work with them/in their institute if you can, as a good LOR is not going to come easy. There is no qualm in this modus operandi; you will usually get the LOR only if you earn it. A standard LOR is not a game-changer; everyone gets that. It’s the personal message or email recommending you which does the trick.

Is an observership needed?: Some trainees go abroad for observerships hoping that they can apply subsequently in the same institute. Most would club this with an exam (say STEP 2CS) or a conference (say RSNA/ECR), as you can kill two birds with one stone. This may be helpful (especially if you do not have a strong CV), and worth a shot if you have the time and money for it (I personally was able to secure a fellowship without doing an observership). I would suggest being practical in selecting your institute of observership. Try securing an observership which does not charge you any money, and try securing it in a city where you have a free place to stay. Importantly, the success of an observership is not just in impressing the faculty in that institute with insightful questions and great diagnoses; it is also in successfully writing a paper. So if you do secure an observership, email and tell them much before joining that you would want to publish something while you are there. Give them a few areas of interest if you have any, so that they can connect you to the right person to mentor you on this.

These are a few of my tips on how to create a strong fellowship application, maximizing your chances of securing your dream fellowship. Do feel free to add your views and experiences in the comments section, so that everyone can gain from them.

MD, DNB, DM, FRCR, EDiR et al; do you really need so many degrees?

During my MD residency, many of my colleagues also gave the DNB exams after clearing their MD. I didn’t, because I was very clear on one thing; it is going to take time and effort to clear the DNB exam without any potential benefit for me in the future. I can now safely say that I made the right choice. So let’s talk about when (and when not) to give various additional examinations.

Plan to go abroad for further training/ for settling down?: This is a no brainer. You of course have to give the concerned exam if you wish to go abroad. So you must give USMLE for going to the US or FRCR for going to UK (the latter helps even for other countries like Dubai or Singapore). You can probably secure the 3-month ESOR (European School of Radiology) fellowship even without giving EDiR, but now many trainees are giving it ‘just to increase their chances that extra bit’; so I suppose this will become a common trend up in a few years from now. You can read more on EDiR, FRCR and USMLE on these aspects in our dedicated blogs on these exams.

Want to keep the option open?: If you are giving FRCR or USMLE just to keep the option open in the future without any definite plans of going, its probably not worth the time, effort, and money (it costs at least 4-5 lakhs and a year or two to give the exams). You can instead just wait and give it later, if you do end up deciding to go abroad. It might delay your plans a little bit, but it’s safer than spending all that time and money without anything coming out of it in the end.

Broadly, I have seen more than 70% of my colleagues or residents who have given these exams without a definite plan to apply abroad not doing anything useful with the degree subsequently; and that’s quite a big figure! So my advice would be to instead try and decide fast on whether you wish to go abroad or not.

Clearing the exams might help in securing an observership?: I am not very certain on this one. You could literally go for a paid 1-month or longer observership and a vacation in the same amount that you are spending for the FRCR or USMLE or EDiR; besides if you spend that much time in publishing a few articles, you could boost your observership chances even higher probably.

Clearing the exams might improve job prospects in India?: This is one thing you must research in the region where you plan to work. If clearing FRCR improves your job prospects or salary, then it might be worthwhile giving it. However, whether this really does happen is questionable in many parts of the country, so ask people who know about this (I am not one of them) rather than taking this at face value.

What about DNB after MD? My take on this remains unchanged from my residency days. DNB is just another written paper followed by bruising practicals, and is equivalent to an MD degree. There is no reason to spend time preparing for another exam when you could instead be spending that time learning more clinically-oriented practical radiology in a good institute/center.

The sum of it regarding exams: My personal opinion is that many trainees are nowadays giving expensive and time-consuming foreign exams like FRCR and EDiR without any definite plan to make use of the degree in the future. They give it because they are free during the bond year, because the pay scales have improved and they have earned enough to pay for the exam, because there is a secondary incentive of getting to travel abroad, or because they see others giving it and feel some sort of peer pressure. Please think this decision out long and hard before taking the plunge, because it does involve a lot of time and expenditure. I would suggest to also consider utilizing this time and money instead on learning practical radiology in a good institute in India along with some research, and then perhaps going for a paid or free observership abroad in a good institute, along with a vacation. Don’t chase degrees, chase your dream.

Look forward to hearing everyone’s views on this!

– Akshay Baheti, Tata Memorial Hospital