Graham Fraser (1936-94) was a pioneering otolaryngologist, in whose memory the Graham Fraser Foundation was set up, and an eponymous annual lecture and a travelling fellowship in otology were established. It’s an honour to profile the Foundation in this extended Trainee Matters article, which includes an introduction from Dr Patricia Fraser, Trustee of the Foundation, who gives an overview of the Foundation’s history and current activities. Professor Shakeel Saeed answers questions about his role as a Trustee of the Foundation; previous Graham Fraser fellow Charlie Huins reports on his fellowship experience, and future fellow Nadia Ashraf looks to the future of the fellowship.
Graham Fraser (1936-94) was a Consultant Otolaryngologist at University College London Hospitals (UCLH) whose pioneering work in the field of cochlear implantation paved the way for the development of a successful nationwide cochlear implant programme. His untimely death in 1994 aged 57 cut short much promising research and development work designed to improve the quality of life of those disabled by profound deafness.
In recognition of his outstanding contribution to the field of cochlear implantation and of the need for his work to continue, his friends and hospital colleagues set up the Graham Fraser Foundation and established in his memory an eponymous annual lecture and a travelling fellowship in otology. The late Lord Ashley of Stoke CH (1922-2012) became Patron of the Foundation at its inauguration in May 1994. The Foundation’s activities are managed academically by a board of trustees and financially by the trustees of UCLH Charities.
Professor Blake Wilson with Philip Robinson, Patricia Fraser and Professor Shakeel Saeed
at the 2015 Memorial Lecture, BCIG Annual Conference, Bristol, UK.
The annual Graham Fraser Memorial Lecture was established in 1994 and from 1996-2014 incorporated into the academic programme of the Section of Otology of the Royal Society of Medicine (RSM). The lectureship is open to any person qualified to contribute to the advancement of the science and practice of otology particularly with respect to the understanding, management and alleviation of profound deafness. The invited speakers have been drawn from among the world’s leading otologists and allied professions involved in all aspects of cochlear implantation. As a consequence the annual Graham Fraser Memorial Lecture has become an important forum for reporting advances in the field.
The twentieth lecture in 2014 was the last to be held at the RSM in London. Since 2015 the Memorial Lectures have been hosted by the British Cochlear Implant Group (BCIG) within their annual conference in response to the BCIG Council’s request to make the lectures more readily accessible to cochlear implant professionals nationwide. BCIG members are invited to nominate speakers for future lectures. Graham Fraser was a founder member of the BCIG and its first president from 1990-93.
(L-R) Professor Cathy Birman, Dr Patricia Fraser and Mr John Graham.
Owing to successful fundraising and the favourable financial climate of the 1990s, by 1997 the Foundation was able to award the first of a series of Graham Fraser Memorial Fellowships enabling UK specialty registrars in otology to spend six months with Professor William Gibson in Sydney Cochlear Implant Centre undertaking research in the field of profound deafness and gaining experience in operative techniques in otology and cochlear implantation. The fellowship was suspended from 2009-13 due to lack of funds but generous sponsorship by MED-EL UK Ltd enabled it to be re-established in 2014 with Professor Gibson’s successor, Associate Professor Catherine Birman. Once again the Graham Fraser Memorial Fellowship is being awarded annually at interviews held jointly with the TWJ Foundation in order to co-ordinate efforts in offering our respective fellowships to trainees in otology. Charlie Huins, the recipient of the 2015 fellowship, reports on his experience below. Many former recipients of the Graham Fraser Memorial Fellowship are now in consultant posts, some heading or working in cochlear implant units and others using skills acquired in Sydney for the benefit of patients in the UK. Applications are now invited for the 2018 Graham Fraser Memorial Fellowship.
Patricia M Fraser MD, Trustee of the Graham Fraser Foundation.
In conversation with Professor Shakeel Saeed
How did you become involved as a trustee of the Foundation?
I was honoured to be invited to deliver the 2011 Graham Fraser Memorial lecture in 2011 by the trustees. Following this, with the retirement of Jonathan Hazell as a trustee, I was invited to become a trustee. I guess this was based on my experience and ongoing commitment to cochlear implantation in the clinical and research domains and the fact that I am at the Royal National Throat Nose and Ear Hospital, which of course was one of the main hospitals where Graham Fraser worked.
What are you looking for in a Graham Fraser Foundation fellow?
We’re looking for a trainee who has shown a high level of commitment and aptitude in otology in the first instance. We expect the recipient to be an exemplary ambassador during the fellowship and to secure a post in otology and ideally implantation otology as a consultant.
It must be quite a competitive process?
It is competitive but we have noticed that trainees are finding it more difficult to secure out of programme training in recent years. In addition, I sense that trainees are less likely to undertake overseas fellowships than was the case during my training. This is a mistake in my opinion as overseas fellowships can add a new dimension to one’s clinical practice, and build bridges that can last a professional lifetime. This is much more difficult to do once you are in a substantive consultant post.
What does the future hold?
As Gerry O’Donoghue said [in his 2016 Graham Fraser Memorial Lecture, delivered at the recent British Cochlear Implant Group Annual Conference] this is the “end of the beginning” when it comes to cochlear implantation. This field has arguably been the most exciting area in clinical practice and research in the last three decades in ENT surgery (apologies to rhinology and laryngology!) and continues to move forwards at a tremendous pace.
Professor Shakeel Saeed.
GRAHAM FRASER FELLOWSHIP REPORT
Sydney Cochlear Implant Centre, Australia, April - October 2015
I remember exactly where I was when I received the phone call from Dr Patricia Fraser informing me that I’d been successful at the competitive interview that had taken place at the Royal College of Surgeons of England the day before – I had been awarded the Graham Fraser Fellowship in Sydney. I was off to Australia!
The six months there lived up to the initial euphoria and temporary hoarseness of hearing the news. It was a huge honour to join the illustrious list of previous fellows to head to Sydney to work under the guidance of Associate Professor Catherine Birman based at the Sydney Cochlear Implant Centre (SCIC). Generously sponsored by MED-EL since 2014, I am enormously grateful to Cassandra Brown and the Graham Fraser Trustees for giving me such an incredible opportunity.
Sydney Cochlear Implant Centre.
With the team at SCIC.
Established in 2002 by Professor Gibson, SCIC (www.scic.org.au) is a non-profit charity – a fact that I was initially unaware of – receiving only limited funding from government. It is the largest cochlear implant programme in Australia and one of the largest globally. It is the nerve hub of several outreach centres scattered all over New South Wales and also up in Darwin, using weekly video conference meetings to coordinate the entire service.
Audiological services based in centres across the state allows a wide catchment area across New South Wales with post-surgical ‘switch on’ and mapping occasionally performed remotely if patients live in a particularly distant area. It was an interesting process that I’d never seen before, demonstrating the use of technology to find solutions to such challenging situations. A recent merger with the Royal Institute for Deaf and Blind Children has opened doors to collaboration to assist hearing impaired children access the hearing world through cochlear implantation.
Associate Professor Cathy Birman
Cathy Birman succeeded Professor Gibson in 2014 as Medical Director of SCIC, where she is responsible for the daily decisions and future direction of the programme; she is also Clinical Director for RIDBC. With a vast experience in cochlear implantation – she recently performed her 1000th implant in early March 2016 – she is a superb teacher and trainer, seemingly always with a memorised statistic to back up her knowledge. Continually active in research, she is in high demand to present both nationally and internationally. With superb interpersonal skills with both patients and fellow staff, she was a pleasure to work with and learn from and a great sense of humour had us laughing seemingly non-stop for six months.
Professor Bill Gibson
Now essentially retired, ‘Prof’ (as everyone affectionately refers to him) still runs a Ménière’s clinic – his great passion – at SCIC and is actively involved in the weekly clinical video conference meetings, offering the benefit of his years of experience. Always keen to teach, he shared his theories regarding the pathology behind this disease and he is still very active in its research, supervising PhD students at the University of Sydney and directing a study day at the university to which patients and the public are invited. It was a pleasure to spend time with such a highly respected clinician I had heard so much about.
With Prof Birman and Prof Gibson.
With Prof Gibson in his consulting room.
With Cathy Birman at Royal Prince Alfred Hospital.
Meeting Prof Clarke.
My timetable gave me a tour of Sydney every week. From operating at Children’s Hospital at Westmead (CHW) on Mondays, clinic at SCIC on Tuesdays, a general clinic at Royal Prince Alfred Hospital on Wednesday afternoons and Cathy’s two private operating days on the last two days of the week – Thursdays at the Sydney Adventist Hospital in Wahroonga and Fridays at Macquarie University Hospital – following Cathy was a weekly anticlockwise circuit of the city. Aside from fantastic exposure to all aspects of cochlear implantation, other clinics included general paediatric ENT clinics and a monthly microtia clinic, both at CHW. Aside from excellent clinical experience, both in operating and patient management, I gained valuable insight into the structure of the complex Australian healthcare systems that are so very different to the NHS.
Operative experience was mainly cochlear implants, with me being involved in 82, being primary surgeon in 43 of those. The youngest child was five months and the eldest patient 93. Building on a great basis of CI experience in my final year of training, learning from Cathy, with her wealth of experience, was superb, particularly the nuances of implantation involving difficult cases such as syndromic children and post-meningitic patients.
I do not need to spell out here the attractions of this remarkable country – suffice to say that it lived up to all the hype! However, working in their hybrid, part-privatised healthcare system, so different to the NHS, was a whole education in itself and an important part of a fellowship abroad. Seeing how things are done differently – for better or for worse – opens one’s eyes to how to potentially improve the service we provide back in the UK, especially given the current climate of change within the NHS and the potential direction that it may be heading.
I gained an enormous amount from my six months in Sydney for which I am indebted to the Graham Fraser Foundation Trustees. To summarise everything that the experience gave me is difficult in a report but I hope that I have been able to convey the majority. Learning from professors at the top of their field was outstanding and much of what I have learned from them – from managerial to surgical techniques – I have applied in my new consultant job as part of the cochlear implant team at the Queen Elizabeth Hospital in Birmingham.
Charlie Huins FRCS (ORL-HNS).
For further information visit www.grahamfraserfoundation.org.uk
Applying for a Graham Fraser Fellowship
Applications for the Graham Fraser Memorial Fellowship (GFMF) open in July every year, with the deadline in October. Candidates are asked to submit a 300 word abstract indicating their interest in otology along with a CV. The interviews are held jointly with the TWJ Foundation at the Royal College of Surgeons of England every December, just over a year prior to the start of the fellowship. Both foundations work collaboratively and hence potential fellows are encouraged to apply for both fellowships.
The interview was somewhat daunting with a panel of eight trustees from both foundations, including some of the most highly regarded otologists in the UK. The interviewers were, however, very open and fair and genuinely seemed interested in choosing a candidate passionate about and dedicated to otology. I was asked a range of otology and general questions and spent a good deal of the interview talking about my previous work in South Africa and my interest in korfball!
The whole process is extremely efficient and well-run and I was made an offer for the fellowship by Dr Patricia Fraser the morning after the interview, despite it being a Saturday. This was, however, only really the start, as the paperwork for the Australian work visa is arduous at the very least. Extensive notes provided from previous Fellows have been very helpful to navigate through this.
I now look forward with excitement to travelling to Sydney, Australia in January 2017 for six months to train with Associate Professor Cathy Birman, for what I anticipate will be an exceptional experience.
Nadia Ashraf, ST8 Specialty Registrar, South Yorkshire.
TWJ Foundation Fellowships in Otology
The TWJ Foundation was founded in 1974 through the generosity of Mrs Lilian Wickham Higgs and her son Thomas. Mrs Higgs was deaf and the Foundation was set up in memory of her father Thomas Wickham-Jones (“TWJ”, 1847-1929). His success as the owner of a wharf in the City of London was largely instrumental in enabling the Foundation to be funded.
Patrick Jobson, an ENT Consultant in Guildford, had married one of TWJ’s grand-daughters and became the Foundation’s first Executive Chairman. Since then his ideals have been continued through his successors David Wright (President), David Proops and now Martin Bailey.
The TWJ Foundation’s specific aim is to help patients with deafness overcome their handicap. To achieve this goal the Foundation offers training and educational grants to otolaryngologists and related audiological professionals working within the NHS. So far the trustees have distributed over a million pounds on major fellowships and other grants to consultants, trainees, audiologists, audiometricians and hearing therapists during 42 years of TWJ activity. More than 50% of British otologists have been associated in some way with a TWJ grant, and it is the aim of the Foundation to continue to reach as many young otologists in training as possible from all parts of the British Isles.
“The TWJ Foundation’s specific aim is to help patients with deafness overcome their handicap.”
Over the years the major TWJ Fellowships have changed with the demands of the times. In the beginning they were mostly six-month research fellowships at major centres in the USA. More recently they have concentrated upon advanced training in otological surgery in Canada and Australasia, and have correspondingly extended to 12 months. The long-standing fellowship in Toronto with John Rutka has now come to a close, and other opportunities have opened up in its place. New fellowships have been established in Auckland, New Zealand with Michel Neeff; and in Halifax, Nova Scotia with Manohar Bance and David Morris.
Halifax harbour front.
Recently The TWJ Foundation and the Graham Fraser Foundation have combined their interviews so as minimise work disruption to the candidates, who often apply to both charities, and to help ensure that the best candidates are appointed to these differing but complementary overseas otological fellowships. The 12-month TWJ Fellowships offer training in advanced otology, neurotology, lateral skull-base surgery and implantation otology at post-FRCS (often post-CCT) level. The six-month GFF Fellowships are offered at a rather more junior level and concentrate specifically upon training in cochlear implantation. Both foundations offer a stipend of £25,000 for six months, which for the TWJ Fellowships is then matched by the host department to cover the second six months.
Major TWJ Fellowships are advertised in July / August for interview in mid-December, and commence on 1st July of the following year. The trustees also offer Short Fellowship Grants of £750 each year to help young consultant otologists visit leading European otology clinics for a week of clinical observation and personal instruction, attached to an advanced otology course at the same institution.
Full details are to be found on the website at www.twjfoundation.org.