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When I saw the dreaded words “Oriel: Application not matched” pop-up on my phone my heart sank. This was my second attempt at a urology national training number (NTN), and I had put my life on hold whilst preparing for it. Tears filled my eyes and truthfully, it was difficult to stop the insecurities from creeping in.

Moreover, the thought of telling my family and friends this disappointing news (again) felt like a mammoth task. The next few weeks were a blur as I slowly absorbed the news and brainstormed my next plan. I was so focused on the NTN interview that I forgot to have a plan B! 

After not obtaining an NTN on the first try, I was fortunate to have been offered a registrar-equivalent senior clinical fellow role in the same urology department where I was working as a core trainee. Finding my feet in this new role was a challenge but being familiar with the environment and people smoothed my transition immensely. As I experienced my first registrar on-calls, my first independent emergency operating out of hours and my first clinics, I affirmed that urology was indeed my vocation. I was more determined than ever not to let this rejection deter me from pursuing this career path.

After doing some research, I discovered that there are alternative routes that can be taken to obtain specialist registration including the Certificate of Eligibility for Specialist Registration (CESR) pathway. Personally, I felt that a curriculum-based training programme suited my learning style better and thankfully, my family circumstances granted me freedom to move around the country if needed. Hence, I decided that I would re-apply for NTN again the following year. From my previous experiences, I appreciated that there were no guarantees that I would successfully attain an NTN on my next try. Therefore, I decided that I was going to make the most of the coming year – a fruitful year that was going to be worthwhile regardless of the outcome.

Through serendipity, I was introduced to a post-graduate Master of Surgery (Urology) programme at Canterbury Christ Church University. It was tailored to supplement urological knowledge and provide experience in academia. There were options to do this part-time or full-time. I took a leap of faith and signed up for this full-time, with huge support from my supervisors and my department. It was not easy juggling a full-time job and full-time study; often travelling from London to Medway post-nights to attend my lectures. I recall many late nights and weekends performing literature searches, writing my thesis, and preparing presentation slides. Despite this, I would do it all again without a moment’s hesitation. Through it, I learnt valuable skills in research and academia and met some incredible mentors and friends along the way. Most rewardingly, I embarked on a project in surgical education and training, which I am passionate about.

This project gave me the opportunity to present my work at many forums including the South Thames Regional Urology Meeting (STRUM), and the European Association of Urology (EAU) and British Association of Urological Surgeons (BAUS) Annual Meetings. These conferences were also tremendous educational treats packed with inspiring speakers and exceptionally passionate urologists from around the continent. I also attended a transperineal prostate biopsy course organised by the European School of Urology (ESU) which took place in Marseille, France. It introduced me to cutting-edge technology in fusion biopsies and taught me instrumental MRI interpretation skills. To top it off, travelling to these conferences and courses gave me the chance to fulfil my wanderlust and explore places I might not have thought to visit. I am sure that being in training would have given me similar opportunities, but not being in training certainly did not elude them from me.

My two years out of training gave me the breathing space to re-affirm my career choice. I took this treasured time to learn about myself as a urologist and explore my interests and passions in urology. I had the autonomy to choose the projects that truly interested me and gave me the opportunity to contribute to the field. With every presentation, operation and patient interaction, my self-confidence was restored, slowly but surely. My mentors became my biggest supporters as they guided me through my first rigid cystoscopy and on to supervising my first independent flexible ureteroscopy and lasertripsy. My colleagues became my closest friends who lifted me through my darkest times and constantly spurred me on to do better.

As I approached my third try in obtaining an NTN, I drew from all my previous experiences to guide my preparation. I signed up for interview courses which I had previously missed out on and started practising with a study group early. My clinical experience with surgical procedures and outpatient clinics gave me the knowledge I required for the interview. Through all the public speaking and presentations, I learnt how to control my nerves and present myself more confidently. The main difference with this interview attempt was that I was proud of the progression and experiences I had professionally, and I did not have to rely on an NTN to validate the year that I had. Although, achieving that would be the cherry on top.

When I received that dreaded “Oriel: Application not matched” email more than a year ago now, I thought it to be the worst possible thing that could happen to me in my career (and life planning too). Instead, I am so grateful to have had these extra years to develop clinically and academically at my own pace. More importantly, it has put everything in perspective. Getting an NTN was not the panacea for my urological training and progression. Everybody’s journey is different and ultimately, hard work and passion will take you where you want to be eventually. Deviating from a route I had envisioned myself to take was scary and overwhelming. However, it gave me a unique opportunity to grow as a person and a surgeon. I have met some of the most fantastic people who believed in me and have been cornerstone in helping me bounce back from my pit of self-doubt. All in all, I have thoroughly enjoyed my time out of training. If you have to take a detour, you might as well embrace it and enjoy the journey!

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Kelly Ong

North Central & East London, UK.

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