A proposal to promote excellence in surgical practice has, rather surprisingly, been met with mixed feelings from trainees and trainers alike. Many excellent surgical departments in the UK provide clinical fellowships to support surgeons wishing to enhance their experience in specific subspecialties. It is common practice for trainees approaching the award of the Certificate of Completion of Training (CCT) to seek fellowship posts overseas to improve their knowledge and skills in order to make them more competitive for the consultant posts of their choice. I have often quoted the experience gained by many of my ex-registrars who have undertaken fellowships in Australia, Canada and America and who confirm the added benefits gained when embarking on consultant practice. So the concept of fellowships is not new.

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