First of all I would like to thank Dr. Pushpinder Bajaj, Dr. Lalit Maini and the rest of the ISKSAA team for giving me this opportunity. I don't have words to express my gratitude towards Mr. Kapil Kumar for all his help before coming to Aberdeen and then everything he has taught during these two years. I was selected for the Long term fellowship in Aberdeen in 2016 and I started my fellowship in November 2017 after completing all the necessary formalities. It is a bit difficult to do justice to such an excellent fellowship programme within a short testimonial.

Introduction
This fellowship is part of a broad MTI programme which is run by Academy of Medical Royal Colleges, London. The programme in Aberdeen is sponsored by the Royal College of Surgeons in Edinburgh. This is essentially a two year fellowship comprising 6 months of trauma and the rest in elective unit.

The Hospitals
Aberdeen basically has two orthopaedic units:- Elective and Trauma unit.
The trauma unit is based at Aberdeen Royal Infirmary (ARI) and elective unit at Woodend Hospital. Six months of fellowship are done at the trauma unit. ARI is a major trauma centre for the North of Scotland and receives complex trauma from the whole region. It is a busy unit with four teams comprising four consultants each with a mix of shoulder, knee, complex trauma, tumour, spine and foot and ankle specialists. At any time there are about 8 registrars including speciality trainees, MTI fellows and locum registrars. The unit is very organized and has a very good support staff of junior doctors, Medical Support Nurses (MSNs) and Specialist polytrauma nurses in addition to nursing staff. There are 9 theatre sessions dedicated to Orthopaedic trauma every week. In addition, the emergency theatres are running 24 * 7. During this placement the fellows are expected to attend theatres, clinics and receive calls. This is rotated amongst all registrars placed in the trauma unit. On an average a fellow gets to attend 2-3 theatre sessions every week. This gives a wide variety of exposure to a spectrum of orthopaedic cases. There are plenty of opportunities for getting hands on surgical experience.

The Woodend Hospital is the elective unit with 6 theatres. All the elective patients are seen and operated in this unit. This is where the fellow spends rest of the fellowship. Every fellow is placed with two or three consultants for a period of six months depending on their sub specialty interest. There are on an average 2-3 theatre sessions every week. The rest of the time is spent in clinic or research if interested. In clinics, the fellows are supposed to be with their respective consultants. This presents an excellent learning opportunity as all the cases can be discussed in detail. In theatres, the fellows are the first assistant in all sessions they attend. As a result, there are loads of hands on opportunity. The consultants are kind and patient enough to teach every surgery step by step. They are very helpful and more than happy to answer any questions and provide any clarifications. There are regular upper limb, lower limb, spinal and tumour Multi-Disciplinary Meetings which everyone is welcome to attend. During these meeting complex cases are discussed among different specialities and as a fellow, it is a wonderful learning resource. Out of hours on calls are done at ARI even when in elective unit and is rotated amongst all the registrars.

Teaching and Research
In addition to the learning in the clinical settings, there are post graduate teaching sessions every 4^th Friday which everyone can attend. These are exhaustive whole day sessions and are designed for the candidates appearing for FRCS examination.

Every fellow has an option of joining the ISCP (Intercollegiate Surgical Curriculum Programme) which is a platform used to monitor the progress of learning among the registrars. There are assessments done after every 6 months by a panel and fellows are graded on the basis of progress they have made. There is constant feedback sought by the Royal of College of Edinburgh.

As a NHS Grampian employee, the fellows can also apply for an Associate Honorary membership of the University of Aberdeen. This gives them access to Eduroam (Free WiFi access in any educational institute across Europe) and a plethora of Journals through the University account. This opens up a sea of knowledge at fingertips.There are various ongoing research projects that anyone can take up if they are interested.

Aberdeen plays host to a shoulder meeting every year in the first week of October which brings together the stalwarts of shoulder surgery from the UK and the world.

Aberdeen – The City
Aberdeen itself is a beautiful city especially in Summers. It has plenty of pubs and restaurants in the city centre and is bustling with people on the weekends. Aberdeen is the gateway to the highlands which is not short of a paradise on earth. It is surrounded by places with picturesque and striking views along with beautiful and legendary castles. The summer home of the Queen of Britain, Balmoral Castle, is just a few hours away. There are numerous places in the surrounding vicinity for a weekend getaway. Aberdeenshire, as a county, is a paradise for Scotch lovers as its home to world famous malts like Chivas Regal, Glenfiddich, Glenmorangie, The Speyside etc. Aberdeen like other cities of the UK lights up during every Christmas and new year.

Connectivity is very good through Aberdeen. It has its own International Airport with regular flights to most of the cities in the UK and other European cities. London, Birmingham and Manchester are just an hour and half away by flight. They are well connected by train services as well. There are plenty of flight connections to India through these places. Edinburgh, the Capital of Scotland, is just 3 hours away by train or car. Within the city itself there are plenty of bus/taxi services with easy access to in and around the city.

Accomodation and renumeration
Unfortunately, the hospital accommodation is no longer available and has now been closed. However, there are a lot of affordable properties available to rent in the city within the proximityof both the Hospitals.

The fellows are paid on a speciality registrar scale with an additional on call supplements, which is more than enough to cover daily expenses, accommodation and leisure.

My experience
I started my fellowship in November 2017. After the initial induction, I was initially posted with two shoulder consultants, Mr. Barker and Mr. Khan. This helped me get an understanding of shoulder anatomy and pathology. I learned clinical skills related to shoulder pathology and saw various surgeries like total shoulder replacements, subacromial decompressions and rotator cuff repairs. During theatres, I learned the basic principles and decision making for managing shoulder pathologies. Understandably, I was new to the system and the team was kind enough not to place me on out of hours on calls for about a month. My next placement started in trauma in February 2018. This was a relatively busy time but everyone in the trauma unit was very kind and helpful. Emma and James are two MSNs who have been with the department for a long time and helped me with everything including minor day today work. The registrars placed with me took me through all the bits and pieces of the system, showed me a few hacks and were always available to help if I ran into any problems. During this period, I saw various complex procedures like acetabular/ pelvis fractures, revision surgeries for periprosthetic fractures, tibial plateau and proximal humerus fracture fixation. I got hands on experience for a variety of trauma related surgeries. The whole of trauma unit is full of staff who are cheerful, knowledgeable, enthusiastic and courteous. This placement helped me attain the understanding of working of the NHS and the various systems/softwares being used in the department for routine activities.

From August 2018, I came to the elective unit and started working with Mr. Kumar, who specializes in shoulder surgery and Mr. Bidwell who has a special interest in Knee. Both of them are very cheerful and down to earth people. They are the senior most surgeons in their specialties. Mr. Kumar is an avid teacher, very passionate, has great clinical and surgical skills. He is one of the renowned shoulder surgeons in Scotland and I was very fortunate to work for him early in my fellowship. It was always a pleasure watching Mr. Bidwell communicate with a patient and learn how to plan a patient oriented management. During this placement I started doing diagnostic shoulder and knee scopes, subacromial decompressions and minor knee soft tissue procedures like menisectomies. I had a chance to learn primary ACL and PCL reconstructions and got hands on experience of primary knee arthroplasty. I saw complex soft tissue surgeries like MPFL reconstructions and revision ACL reconstructions. I got to understand the concepts surrounding rotator cuff tears and principles of their management. Since Mr. Kumar is one the senior surgeons, he does loads of revision shoulder arthroplasty and soft tissue procedures. It was a delight to learn the basic principles related to these complex procedures.

Subsequently in the next 6 months, I was placed with three consultants, Mr. Cairns, Mr. Johnston and Mr. Stevenson who specialize respectively in shoulder, hip and knee surgeries. During this placement, I further honed my surgical skills and became proficient in knee arthroscopy, shoulder arthroscopy, primary hip and knee replacements. I again saw a variety of complex revisions both in soft tissue surgery and in arthroplasty. The icing on the cake was my last 3 months with the arthroplasty consultants Mr. Dougall, Mr. Barker and Mr. Mitchell where I got to see more difficult cases like dysplastic hips and difficult revisions.

I didn't have much interest in foot - ankle, hand, spine and tumours but if anyone has any particular interests then Aberdeen is a centre par excellence. I feel the work being done in Aberdeen is comparable to any of the best centers in the UK. In fact, Aberdeen is leading the way in Rib fracture fixation for flail chest which is a very new concept. Particularly in shoulder surgery I feel that Aberdeen is far ahead as compared to many centers in the UK and the world. There are plenty of shoulder arthroplasties – short stem anatomical and reverse, revisions for arthroplasty, revisions of cuff repairs and fairly new procedures like superior capsular reconstruction being done here on a regular basis.

I feel the MTI fellows here are treated at the same level as their own specialty trainees. They get the same surgical experience, are always involved equally in research projects and have a similar social interaction as well. During my two years of working in Aberdeen, I have never felt left out in the department. Everyone is very approachable and willing to lend a helping hand.

It has been a great journey for me over the past two years. I feel I have gained new heights in terms of professional and personal achievements. I have made new friends, discovered new places and acquired many surgical and clinical skills.

In conclusion, I would definitely recommend this fellowship particularly to fresh postgraduates.

In the end I would like to thank ISKSAA again for being associated with such a wonderful programme and would like to express my gratitude to everyone in Aberdeen in particular Mr. Kumar for helping me become a better surgeon.