The Way I See It

Post-CCT fellowships: worth a look

Authors: Andrew RL Medford 

Publication date:  19 Nov 2008

Post-CCT fellowships are controversial, but Andrew Medford claims they can be rewarding, exciting, and beneficial to career prospects

In respiratory medicine, and many other specialties in secondary care, we are too well aware of the shortage of consultant posts and the bottleneck that exists at the end of higher specialist training owing to the large number of trainees predicted to enter the specialist register, especially in 2009-10. Post-certificate of completion of training (CCT) fellowships have been an area of hot debate: they are readily advertised and promoted by some professional bodies as providing further subspecialist experience,[1] but criticised by other bodies as creating subconsultant service posts for potential new consultant equivalents.[2]

Possible concerns about these posts are the failure to be treated as an accredited (post-CCT) specialist, the lack of a clearly defined educational role in a non-training post, the setting of a precedent for future career progression to consultancy, and possibly the insidious widespread development of a subconsultant grade.

So, given all the heated debate, is it worth considering post-CCT fellowships at all if trainees who have acquired their CCT are unable to get a substantive consultant post immediately?

I attained my CCT in February 2008 but was unable to find a suitably substantive consultant post that allowed for my particular subspecialty interests, preferences, and strengths. I therefore took up (after competitive interview) a post-CCT interventional pulmonology fellowship at Glenfield Hospital, a tertiary referral centre in Leicester created in April 2008.

This is the first post-CCT fellowship in the field of interventional pulmonology for respiratory physicians in the United Kingdom. It allows me to acquire a range of new practical techniques: transbronchial needle aspiration via endobronchial ultrasound, local anaesthetic thoracoscopy, and chest and neck ultrasound with image guided thoracocentesis/fine needle aspiration, as well as other possibilities including bronchial thermoplasty and rigid bronchoscopy in theatre with laser. As part of the post I will be allowed to teach other higher specialty trainees some of these techniques.

I am also getting experience in service development (for example, development of an in-house portable ultrasound service) and further opportunities in departmental audit and research. Importantly, the environment is such that I am treated as having completed my specialist training but acquiring further subspecialist skills—that is, I am not simply continuing in the role of specialist registrar. In addition, I am able to learn in an environment removed from service delivery so I can maximise my time learning several techniques.

Many of these subspecialist skills and generic management skills will be of value on taking up a new consultant post, and it is not always easy to learn such practical skills at consultant level because of limits in study leave and heavy NHS service commitments. As a result of shortened training time and the European Working Time Directive, it is also unlikely that the higher specialist training programme will allow time to learn all these subspecialist techniques. Furthermore, we know that in respiratory medicine, and other specialties, consultant posts will be in relatively short supply for the next two to three years while we await the necessary consultant expansion.

I therefore think it is particularly important for post-CCT trainees to consider alternatives, as not all will find immediate or appropriate substantive consultant posts. Post-CCT fellowships are just one of many possibilities (such as locum consultancy, a period of research, or doing an overseas fellowship). Each of them has its pros and cons, but I believe post-CCT fellowships should be added to the list.

With the right set-up, such posts can be exciting and rewarding and offer further practical subspecialist skills and service development experience, which can only improve the chances of a subsequent substantive consultant post.

Importantly, my mentors, my employers, and I do not see taking up one of these posts as setting a precedent; attainment of CCT alone should continue to enable trainees to secure a consultant post. The purpose of this article is simply to highlight the potential value of such posts at a challenging time for jobs in my specialty,

Competing interests: None declared.


  1. Royal College of Surgeons of England: Post-CCT fellowships. [Link]
  2. British Medical Association: Post-CCT fellowships. [Link]

Andrew RL Medford post-CCT interventional pulmonology fellow Glenfield Hospital, Leicester

Cite this as BMJ Careers ; doi: