2024 ABC Travelling Fellowship Report
Sina Babazadeh took part in the ABC Travelling Fellowship in 2024. Here he writes on the places he visited and valuable experience gained from visiting a range of hospitals, universities and scientific meetings across North America.
In our childhood, the letters ABC were often accompanied in books by pictures of apples, bees and carrots (turns out the zebra did it). As we grew older, they denoted the tv channel which played such great shows as ‘Monkey Magic’ and ‘Degrassi Junior High’. But in our evolved orthopaedic surgeon state, they refer to the American British Canadian Travelling Fellowship. For those unaware, this fellowship started post-WWII to exchange experience and ideas across the Atlantic, a meeting of orthopaedic minds between North America and Britain. It was expanded to include Australia, New Zealand, and South Africa in 1954. In its basic form, for Australian surgeons, it entails a tour of surgical centres in America and Canada, with one surgeon being chosen every two years to attend. I was lucky to be the chosen recipient of this fellowship in 2024. This report chronicles my five-week journey across North America, during which I visited leading institutions and learned valuable lessons about the intersection of healthcare and education.
Firstly, a brief note about selection for the ABC Fellowship. In Australia, one applies for the fellowship the year prior to leaving (odd years), by supplying an expression of interest, their CV, and two written references. A prerequisite is being under the age of 45 when leaving for the fellowship. Shortlisted candidates are then interviewed around the time of the national scientific meeting by a panel of past ABC fellows. Bribes are essential. Joking. Or am I? What they assess is your contribution to the orthopaedic community and how well you are likely to represent Australia to the wider global community. Once selected, not much happens for a few months, and then suddenly things move at breakneck speed as you attempt to line up flights, hotels, accreditation and all sorts of things. A lot of organisation goes on in those last few weeks.
My trip encompassed Calgary, Ottawa, and Halifax in Canada, and Nashville, St. Louis, Chicago, Memphis, and Denver in the Mid-West of the USA. I won’t bore you with each specific stop, but there were marked differences between every stop and especially between Canada and the US. Our Canadian hosts where relaxed and flexible and activities meandered with a gentle flow. In the US nearly every minute of our day was accounted for, with no time to waste relaxing! The Americans, although just as friendly and hospitable as the Canadians, did not waste any time and were always in over-drive, reflective of their health system.
Being a fellowship designed to exchange ideas; one would think that learning how to improve operative skills (or gain them in my case!) would be one of the main aims. However, this was not at all the case. During the five-week trip we visited the operating theatre only twice, and both times really did not learn much. The lessons we learnt on the fellowship were all about systems, and how each institution runs, how they interact with their staff and trainees, university, and research. For example, I learnt how in places like Calgary and Memphis, philanthropy plays a huge role in healthcare. Calgary is a big oil town, and hence a portion of their research relies on donations from well-off business families who set up research trusts and build institutions. In Memphis we learnt about St. Jude’s Children’s hospital, which runs entirely on two billion dollars a year in donations! Yes, two billion! This hospital pledges to look after any child that requires care, regardless of their ability to pay or where they are situated in the USA. A far cry from our understanding of the American healthcare system being inaccessible and expensive.
In Chicago and Nashville, we learnt and saw how intricately a university can be linked to a hospital, and how this translated so well to promoting clinical research. Surgeons were able to walk a few hundred meters from their rooms or the operating theatre and talk research with a scientist. Thoughts translated to experiments quickly and efficiently. The link between university and hospital also played a big role in training, with trainees and students actively involved in every facet of research.
In Memphis we saw the other side of the coin, learning how a group of surgeons can build and run a private hospital. The rules and regulations surrounding these private institutions has led to the progress in refining day-case surgery. We learnt that a day-procedure centre could be owned by a group of surgeons, but a hospital could not, with this minor fact leading to the inception of day-case arthroplasty. We learnt how surgeons can combine and share costs and profits. For example, regardless of how much operating one did, all surgeons at the Campbell profited the same. This allowed some to develop interests in research and others to take on less incentivised sub-specialities such as paediatric orthopaedics.
Americans are sports-mad, and in Denver this was highlighted by the lengths a university/surgeon group would go to to be linked with sporting teams. As an example, University of Colorado’s orthopaedic department paid a monumental amount to purchase the Steadman Clinic, who serviced the Denver Broncos. This did not mean that they would profit directly by treating the players, but merely paying for the privilege of being associated with them. In Denver we saw surgical centres attached to massive gyms where athletes would not only train, but be treated by physios and doctors on the gym floor. Just outside of the gym stood a football field, where again doctors and scientist could fine-tune athletes’ training and rehabilitation. Walk upstairs and a PRP laboratory could be found, where athletes could come and be injected there and then.
We also witnessed how each respective country runs their scientific meeting. In Halifax, we attended the Canadian Orthopaedic Association scientific annual meeting, which was very similar to our own, but probably a degree larger in scope and attendance. In the US we attended the AOA Annual Meeting, which was very different from any scientific meeting I had attended before. This meeting was predominantly about leadership and training, and hence all the sessions and talks cantered on these topics, with debates and special speakers making up the predominant podium times. The Americans really liked to talk, and their usual session slot neared 45 minutes per speaker, something we’re not really used to. Also, the fashion of attendees was wildly different. In Canada, like Australia, attendees tended to dress in relaxed neat attire. In the US, suites and ties were everywhere. On the way to one session, we were told off for not wearing a tie.
We noted the differences between orthopaedic training in North American and Australia. In Canada registrars are rare. Trainees are selected from med-school and hence no unaccredited positions exist. And, because their system is a fee-for-service model, there seemed to be a push, both by surgeons and government, to keep overall consultant numbers manageable, hence training spots were fewer than expected. This meant that the onus and responsibility for on-call was more consultant-driven. Every consultant, from chief of staff to the first year, had to do on-call, and sometimes without registrar cover. They received phone-calls at all times of the day from junior staff in emergency and physicians’ assistants. In the US training was very different. Getting into a training spot seemed relatively easier than Australia (in my opinion), however each hospital had its own selection process, and hence the final year med-students would have to spend weeks travelling around the US to sit interviews for every training program they hoped to apply to. And, because there was so much competition to ensure a good consultant job after training, the registrars worked extraordinarily hard during training, putting in upwards of 90 or so hours a week (their safe working hour laws are trying to limit them to 80 hours week), with their days starting as early as 2.45 am.
The trip was not all fun and games though (although fun and games were both had on numerous occasions). As a travelling fellow you are expected to prepare five separate presentations, encompassing your research, your health-care system, and maybe something on the lighter side. These presentations need to be flexible, to either be presented in ten minutes or 30. Each site you visit picks one or two of your presentations and you are expected to present. In Canada, this was often a relaxed affair, but in the US, presentations were taken seriously, with an audience of top-notch brass hanging on every word. Listening to my colleagues’ presentations I realised that I may have been the star of a 'Dinner for Schmucks'-type scenario!
Regarding the fun and games, your hosts at each stop are usually ex-ABC fellows. They all fondly remember their fellowships and how much fun they had and how much they ate and drank. Hence, they each try and outdo each other in terms of hospitality. Food is plentiful and they really take time out of their day to show you their town and its surroundings. For example, in Calgary we took a daytrip to Banff and ate lunch overlooking the mountains, in Ottawa we went on a private safari, coming close to bears and wolves, in Nashville we spent many hours listening to country music at the Honky Tonks, and in Chicago we got a tour of the town architecture followed by deep dish pizza. This is not at all an exhaustive list of the places we were taken and food we were fed, but it’s a sample of pride each host has in their own town and the fellowship in general.
Speaking of meals, you will put on weight. As every stop passed, we noted that our clothes were just a little tighter than before. In between all the events you must find a way to exercise a little, else diabetes. As an example of the excesses of the fellowship, in Calgary we attended the town’s best steak restaurant for lunch with the arthroplasty group. We ate a two-hour, three course meal. Then four hours later, the leadership group took us back to the exact same restaurant and fed us a similarly large three course meal! Being polite guests, we could not refuse.
Like all things the fellowship does have a few downsides. Packing for the trip is stressful! You are required to pack clothes for every occasion, from sports gear all the way to a black-tie ensemble (necessary for multiple events). Also, you are expected to pack presents for all your hosts, which take up about a third of your baggage allowance alone. And because you have many internal flights, your bags can’t be over 23kg, else half your income would be spent on excess baggage. This proved a problem for one of our fellows, who decided to let his daughter pack his bags, leading to his bags being 8kg over. He tried to laugh it off at the airport until the bill for the excess baggage was presented to him. Once we landed in Calgary, he decided that it would be best to ship back half his clothes to the UK at great expense, via sea. To this day I think he is still waiting for his clothes to arrive.
Being away from work was also a little difficult, especially if you have a private practice. I had to use up every ounce of leave I had at the public hospital to cover the fellowship. But by far the hardest part is being away from family. Those with young children really struggled at times. However regular face-time calls made things a little easier. Some of the fellows had set aside little games such as dynamic maps etc with their young children to make the distance easier. Also buying presents for family at every stop helps.
To counterbalance being away from family, you end up making lifelong friends with the other ABC fellows on your trip. After five weeks, this bond is strong, and you’d proudly consider them a part of your family. We still keep in touch a few times a week to reminisce what was probably five of the greatest weeks of my life.
So, in conclusion, the ABC fellowship is a life-changing event, and I can’t recommend it highly enough, anyone who can, should apply for it. This fellowship taught me that we are very, very lucky to live in Australia; we have a great health system and a great training program. However, as a nation of orthopods, we are very individual in our thinking and very operatively focused. To be able to maintain our standards and compete against the world, we really should be more collegiate and move an inch or two away from being the barber towards being the doctor
Applications for the 2026 ABC Travelling Fellowship are now open for AOA members.