Surviving Paediatrics as a GP Trainee- a short handy experience

by Abeera Khan

Paediatrics is one rotation every GP trainee wishes to have in the training, and I would say Yes, it’s very important and you learn a lot. However, it can be a bit daunting and hectic.

If you don’t have a Paediatric rotation, try to attend some Paediatric clinics or if you have an A&E rotation, get some exposure of Paediatric A&E. It will help you a lot.

My experience is based on the training structure I had in the department where I trained. It would be different from other hospitals. However, the main aim is to give an idea what to expect and achieve by the end of rotation. I had my GP rotation after Paediatrics, and I felt comfortable in seeing children at my practice. However, you can discuss this with your ES if you haven’t had Paediatric rotation before seeing children (especially under a year) in GP placement on your own.

Paediatric department roughly has:

Children ward and Children Assessment Unit (CAU)

Neonatal/Postnatal ward

Neonatal ICU (NICU)/ Special Care Baby Unit (SCBU)

Paediatric Immediate Life Support Course (p ILS)

We had it in our trust induction. It was a one-day course which was organised by the Trust. We did not have to pay anything. It was mandatory to attend before starting the on-calls. It is valid for one year.

The Neonatal Life Support was taught by the Consultant. It was not a proper course but we had short practise/simulation sessions organised by the department every week to keep the juniors in practise and routine.

On-calls:

This varies in hospitals. If you are working in a department where there is NICU, its likely you will have two on-call teams (one for ward and one for Neonates) both on days and nights on-call.

However, my rotation was in a hospital which only had SCBU, so we had two SHO’s on call for day (one SHO for ward/A&E and one SHO covering Postnatal ward/SCBU) but for Night on-call, there would be one SHO and one Registrar covering everywhere ( Ward, A&E referrals, Neonatal ward and SCBU).

CAU (Children Assessment Unit):

This is a short stay unit. Children can be admitted/observed here for couple of hours and then either discharged home or admitted to the ward if they are not well enough to be sent home.

They come to CAU from A&E, GP referrals/ community midwives, Health visitors. If they have any concerns, they will speak to the on-call doctor (In my trust, the Registrar used to take GP/community midwives Referrals and then advise whether they are stable enough to come to CAU directly or would need to come to A&E.

Usually there are ANP (Advanced Nurse Practitioners) supporting the doctors in CAU. They are very well trained and would see patients independently, do bloods and make the plans. You can also ask them for help if you are not confident in doing bloods.

Children can then either be discharged from CAU after assessment from a senior or admitted to the ward.

The Ward:

Ward would have patients who are under 16. These can be under Paediatricians, Surgeons, Orthopaedics etc. Even if they are surgical patients, most of the children are under joint care of Paediatricians and the other team.

Commonly seen conditions:

Bronchiolitis

Croup

Asthma exacerbation

Viral induced wheeze

(Above four more commonly seen if you have a rotation during the winters)

Rashes (various kinds)

Viral Gastroenteritis

Viral URTI

Febrile seizures

Afebrile seizures in known epileptics

Infections (Acute tonsillitis, otitis media etc)

UTI

Children with suspicion of NAI (non-accidental injury)

Children with long term conditions (e.g children with feeding tubes, cerebral palsy, children who have open access to ward). Meaning that if they have any concern, parents can ring the ward and come straight there rather than going through A&E.

Follow your trust’s antimicrobial guidance.

Neonatal Ward:

The most important thing to familiarise and getting tuned to is the NIPE check (Newborn and Infant Physical examination).

NIPE: This is the baby check you would be doing on the postnatal ward. It must be done ideally within 72 hours but in our trust the target was to do in 48 hours. Baby checks are done preferably 6 hours after birth.

You will be told this in detail in your departmental induction and would be shown how to do it by your Registrars. I will just touch base.

Always check Maternal Notes, Mum’s medical history, antenatal history, serology, blood group and history of GBS (Group B Strep). If possible, check for antenatal scans (any anomaly, oligo/polyhydramnios)

Before starting baby checks, Ask Mum

  • the ethnicity of both parents
  • history of DDH
  • Family Hx of congenital heart disease or eye problems in children
  • And if child has passed meconium (48 hours) and urine (24 hours)
  • Child breastfed or bottle fed

You need to get hands on the NIPE check as there is a baby check at 6 weeks which is done by the GP. So as a GP, you should be slick in doing these.

There is a lot of information of the gov website, link below

https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook

You can also have a read on this in OHGP (Oxford Handbook of General Practice)

Important things to know in New-born

Key thing is NOT to miss suspected sepsis in the newborn. It is worthwhile giving a read of NICE guidance, link below especially Table 1 and 2

https://www.nice.org.uk/guidance/cg149/chapter/1-Guidance#risk-factors-for-infection-and-clinical-indicators-of-possible-infection-2

What I have seen commonly in my rotation is, Tachypnoea in neonates. This is a red flag. Please don’t miss it. Screen the baby for sepsis, start antibiotics and wait for culture results.

Other commonly seen neonatal problems:

  • Hypoglycemia in newborn
  • Hypothermia in newborn
  • Jaundice (within 24 hours of birth and after 24 hours)
  • Grunting in newborn

If in doubt, ALWAYS ask for Senior help.

When covering Postnatal/SCBU/NICU, you will be asked to attend Instrumental deliveries and Caesarean sections. Make yourself familiar with the resuscitaires. Again, if not sure, ask for help. The senior midwives are very supportive and know a lot. We had NLS (Neonatal Life Support cards) tied with all resuscitaires and it is good to go through it every time you are attending a delivery.

Jaundice: Jaundice within first 24 hours – Red Flag

Consider Hemolytic disease of newborn/Sepsis

Do bloods (FBC, LFTs, CRP, DAT)

Discuss with the Registrar and consider starting Phototherapy before the results are back

Jaundice after 24 hours is Physiological Jaundice. Do bloods, plot on the Phototherapy graph. These would be shown to you I am sure. This is called ‘Treatment Threshold graphs for neonatal Jaundice’. Make sure you plot on the right gestation graph and at the correct time. I am mentioning this because this is a common mistake.

Clinics:

Some clinics you can attend in your rotation are

Dermatology clinic – would be very useful

Developmental clinic

Asthma/ Respiratory Nurse Clinic

Epilepsy clinic

Diabetic clinic

Some tips:

  • Familiarise yourself with the NICE guidelines and your Trust guidelines
  • Consult BNF C (for children) Keep the app in your phone. It comes very handy
  • Always plot Height, weight, Head circumference on the growth charts
  • If you are not confident in doing bloods in children, ask for help. You will always find ANPs, Nurses, HCAs doing this and they would be happy to help you out.
  • Be careful and not to make decisions on your own especially with children who are on child protection register, safeguarding issues, query of NAI.
  • And most important, when in doubt, Always Ask and don’t assume.

I have kept it very brief just to give an idea and outline. Best is to learn from your own experience. Hope it helps everyone out there who will be doing Paediatrics.

 

 

Getting into Core Surgical Training


— by Raisa Khan

Hi all,

I have been successful in getting Core Surgical Training this year and have received quite a few messages from people looking towards building a surgical career seeking guidance. So, I decided to share my experience here. Hope you find it useful.

My Background:

I graduated from Pakistan (2016)

Completed my FY1 /housejob in my home country (2017)

Came to the UK in February 2018 and worked as FY2 equivalent SHO post in London. I did 6 months of Neurosurgery then switched jobs and did 6 months of A & E because not being in a proper FY2 training program I wanted to get mixed exposure of all specialties and I thought A&E is the best way to learn.

It was during this year when I started building my CV towards a career in surgery and sat the interview in round 1 (2019)

Restricted Labour market test (RLMT):

Now this topic has been discussed many times but just to review as many new IMGs are still unaware.

UK recruitment process in general has two rounds annually. If the training placements do not fill up in round 1, a second recruitment round is opened.

According to UK legislation, if you are a non-European/non-UK citizen, you cannot apply for Surgery in round one as you would be subjected to RLMT which means that European and UK citizens would automatically get preference over you. Technically you can apply to round 2 of certain specialities like GP and IMT but because some specialities like surgery and radiology are quite competitive, all the posts get filled up in round 1 and there is never a round 2.
There is a way to get around this (there always is!)

  • If you are a UK/ European citizen no RLMT
  • If you are on spouse visa of a UK national no RLMT
  • Get into another specialty training program instead first with relatively less competition ratios. These programs would be open for round 2, and you should be able to pass RLMT if you are selected. You will then be sponsored a HEE TIER 2 visa. So, once you’ve got National Training Number, you will be exempted from RLMT. You can now openly apply for any training programs in round 1. Popular specialities to get into include Medicine/A&E and GP training. Use this time well to build on your portfolio for Surgery or any other speciality you wish to pursue.

Note: I would also advise applying to an FY2 LAT post especially if you are FY2 level and I know one or two people personally who have been successful in obtaining a surgical number via this route. I was exempted from RLMT otherwise would have favoured this route because it’s a more structured pre-speciality training programme with more opportunities to build your portfolio. However, bear in mind that once you have been invited for interview (whether you have British passport or not), it all depends on your interview score regardless of Nationality. You compete openly with all candidates.

Applying for surgical training

Person Specification:

It is extremely important to go through the person specifications for surgery which are updated every year to know where you stand and what you now require to do from this point. Below is the link.

https://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/Core%20Surgical%20Training/Core%20Surgical%20Training%20CT1.pdf

Note: The most important clause in the person specification is you are only eligible to apply if you  have 18 months or less experience in surgical specialities (excluding foundation modules) by the time of intended start date.

Now this becomes confusing because most of us are not in a proper foundation program so we are unsure exactly in what way this applies to us. It is the two year experience that we have had after graduation (internship/ SHO job etc) which counts towards foundation modules equivalent. Then you can do another 18 months of surgical experience on top of that if you want to but not more then that by your intended start date.

So many IMGs have become ‘over qualified’ to apply having not been aware of this rule.

Building a portfolio:

This stage stressed me the most because I sat the CST interview having less than 10 months experience in the NHS at that time and was worried all year thinking how I would I be able to build a surgical portfolio in less than a year with only one year of post grad experience. In the end I really did not have very much on my portfolio, but I realised I didn’t need to.

Here is the link to all what is needed on the portfolio of a core surgical applicant.  https://www.pathway.oriel.nhs.uk/Web/Sys_Documents/ec260250-b7fa-428e-9f13-281d9404e39c_2019%20Self-Assessment%20and%20Portfolio%20Guidance%20for%20Candidates%20-%20for%20advert%20V3.pdf

But here I will just summarise my own portfolio sharing my personal experience which may help people who are in the same situation as I was.

1.Postgraduate/undergraduate qualifications:

I did not have any undergraduate qualifications. Many IMGs have a BSc I did not even have that. Technically speaking I did not have any postgraduate qualifications either but I claimed marks in this category for FCPS Part 1 in Surgery (the postgraduate exam which is a pre-requisite to surgical training in Pakistan) and kind of considered MRCS A equivalent and got scored for it. Many interviewers know about the FCPS.

2.Surgical courses:

1 mark per course relevant to surgery and maximum 4 marks. During my year I had done

ALS and ATLS

BSS (Basic surgical skills course)

Red dot radiology courses (Chest X-ray course and A&E survival course)

EVD stimulation neurosurgery course locally and

a local start surgery related course from Pakistan not the RCS one.

Out of these only BSS, ATLS, EVD stimulation and START surgery was related to surgery so I claimed marks for those. All courses are available on RCS website.

https://www.rcseng.ac.uk/education-and-exams/courses/surgical/#Surgical=True&Dental=False

Note: You do not necessarily need to have completed the high-profile RCS surgical courses such as BSS, ATLS, Ccrisp to claim a mark. Any course related to surgery gives you a mark if you can validate it. It may even be a 1-hour local hospital course or an online module or workshop. However, the RCS courses broaden your surgical knowledge and can help in the interview. Book in advance because they can be taken up very quickly. For this reason, I could not do the CCrISP (Care of Critically ill Surgical Patient) course before interview.

3.Additional achievements:

This I believe was my strongest area as I had some distinctions in various subjects during medical school and a gold medal in Paediatrics. I scored full 5 marks in this category.

Any prize, scholarship, grant that you have received which is open to all trainees is a national prize.

4.Quality Improvement program:

I did only 1 QIP. The portfolio section on this point is quite clear you do not need to participate in many QIPs rather do 1 and claim the highest points if you do it properly i.e if you design, lead, implement change and present it at a regional or national meeting. I teamed with one of my senior more experienced colleague and very good friend and we came up with the idea for the audit ourselves, closed the loop, implemented the changes and submitted it as a poster to present at the upcoming Society of the British Neurosurgeons national autumn meeting. (I was in neurosurgery at that time). I got full marks for this.

Note: Your audit doesn’t have to be very fancy, mine wasn’t even related to surgery, it was a neutral topic. You can easily present findings at a local meeting (gives you two marks less than the full marks) and also if you submit to regional/national conferences lots are willing to accept.

5.Teaching experience:

I had to go in retrospect to collect evidence for this. Any teaching I had given to colleagues/ juniors or any medical topics related discussions during medical school and FY1 year, I contacted them through social media requesting to fill feedback forms for me. Where I could not do this, because it is difficult to collect evidence in retrospect, I put the feedback I had received over facebook, whatsapp , lifted the comments put them within quotation marks, printed them on a paper and stuck it in my portfolio (my interviewers liked this idea). Then I compiled the results and showed them on pie charts and line graphs demonstrating that I had reflected on positive and negative feedback I had received. I had done a lot of informal teaching especially helping people with IELTS and marking essays for them that I didn’t want to miss out on but like many IMGs we do not have the trend of keeping evidence, so I had to go in retrospect.

I discussed with the teaching lead in my trust and designed group tutorials on anatomy related topics for medical students to be delivered over a series of months. (1 half hour teaching once a month for 4 months) I got a certificate for that. I scored well in this section.

6.Training in Teaching:

I had no qualification in teaching or any diploma. I had done a short local course in teaching methodology and requested a certificate for that. I would advise doing the ‘teach the teacher’ course so that you have some sort of training in teaching. I had not done this at that time. So, didn’t score much here. Here is the link.

https://www.medical-interviews.co.uk/product/teach-the-teachertrain-the-trainer-course?gclid=CjwKCAjwqLblBRBYEiwAV3pCJhJ0o1O5DYqMvPEZzdHxmMbXf7T7CtPK42iQfMmLfiaMurVhZ-zKphoC3TMQAvD_BwE

7.Presentations:

I put the poster presentation presented at a national meeting in this section as mentioned under the QIP category. Try to do a national oral presentation which will give you the maximum marks. I also printed out slides of a few local presentations I had done and stuck them in my portfolio.

Note: I claimed points for the same poster presentation in both presentation and QIP section. You can do that. One achievement can give you marks in other areas as well.

8.Publications:

I scored 0 marks for this section. I had no publication at all neither am I aware of proper research methodology. This is my weak area on which I plan to focus now however, it may be reassuring to some that it is quite possible to get a decent portfolio score with no research experience at all. I had collected data on an AI based surgical project which I just put down on a paper explaining the objectives and expected outcomes and stuck it in my portfolio which at least showed my commitment to speciality if not give me any marks.

9.Leadership and management:

I had to collect evidence in retrospect for this category. I was part of the blood donor’s society in my college and got a certificate made. I managed the house officer rota during FY1 rotation and got a letter made for that as well. I was part of an NGO (non-medical) in my home country during college years before medical school and presented at an annual function related to that. I had a very old certificate which I put in my portfolio. Here is the link.

http://www.kef.org.pk/

Note:  In our home countries we do not have the trend to keep evidence for every small thing we do. So, for evidence that you may need to collect in retrospect you can type statements yourself and email them over to people concerned to electronically sign for you and send back. You do at times have to struggle to chase people up, but it is doable.

10.Commitment to surgery:

This may include a surgical taster or internship which I had not done. MRCS part A which I did not have. I had attended three surgical conferences. 2 in Pakistan and 1 in the UK I put certificate of attendance in portfolio. I was member of RCS, ASIT surgical societies which you can just mention in CV don’t really need to show evidence. I had also maintained a surgical logbook which is very important. You don’t need to put in major procedures in it. Don’t worry if you are not getting theatre time. You can put in simple wound suturing. In fact, you can put in multiple entries of simple wound suturing it just shows you are continuously improving your skills and have good hand eye coordination. My rotation in A & E injuries proved helpful to fill this slot. This is the e-logbook most people use and is free.

https://www.elogbook.org/

I even put in evidence of extra- curricular activities and linked them to surgery although this is not required e.g I am interested in photography and put in printouts of my best shots. The manipulation of the camera and fixating your eyes on the object is also an example of hand eye coordination as is playing cricket, piano etc. 

Note: MRCS A doesn’t have any marks in the portfolio section. It demonstrates commitment to speciality which can also be shown in various other ways. Even a failed MRCS A attempt shows commitment to speciality!

Lastly, don’t underestimate the importance of a well organised portfolio. There are 3 marks for a well-structured, thoroughly organised portfolio. There are many you tube links that show how to structure a surgical portfolio and what folder to use.

Interview Preparation:

The interviews took place in January this year. I started preparing during middle of December and gave the interview end of January. There are three stations in the interview and each station is 10 minutes long. Each station contains 33.3% marks. There are around 500 posts and around 2000-2500 people apply. I am not sure about the exact marking scheme but if anyone does please share.

I did not attend any interview course however I have been told the RCS interview course is helpful and costs around £400.

My preparation revolved around going through interview books lightly, writing down my own answers, practicing in front of the mirror, recording my own voice and listening to it and practicing with another colleague taking turns in being the examiner and candidate. I prepared for it the same was as we prepare for PLAB 2.

Interview books:

This ISC Medical interview book is standard for every CT/ reg interview and everyone uses it.

https://www.amazon.co.uk/Medical-Interviews-2nd-comprehensive-techniques/dp/1905812175/ref=sr_1_1?adgrpid=58716443688&hvadid=259146711005&hvdev=c&hvlocphy=9046003&hvnetw=g&hvpos=1t2&hvqmt=e&hvrand=16308274973141731571&hvtargid=aud-615159460541%3Akwd-315198738893&keywords=isc+medical+interview+book&qid=1554934510&s=gateway&sr=8-1

This is the specific core surgical interview guidebook. I went through both books but mainly used the surgical one.

https://www.amazon.co.uk/Core-Surgery-Interview-Definitive-Interviews/dp/0993113834/ref=sr_1_fkmr1_2?keywords=isc+surgical+interview+book&qid=1554934565&s=gateway&sr=8-2-fkmr1

Portfolio station:

I have already gone through this in detail. They basically have 10 minutes to go through your portfolio before you come in. Then they simply flip your portfolio and would ask you general questions about an audit you performed or a prize you received. Make sure you know your portfolio inside out and know where each thing is placed so that if they ask you to flip over to that section you can do so with ease. They mark you exactly according to the portfolio checklist link given above. So, you already have an idea of what you are scoring here.

Sometimes they may ask you general questions such as:

Tell us about yourself? Why surgery? Why train in the UK?

Is empathy important for surgical trainees? What do you like most/least about this speciality?

Example of good/bad communication? Are you a good team player/leader/manager/teacher?

What is your proudest achievement? Audit/research experience? Among many others.

Now all these questions are repeatedly mentioned in all interview books and everyone can go through them. What will set you apart is if you write down answers to these main questions that are most likely to be asked (not all) according to your experience and keep on practicing them. Always remember a well-rehearsed but natural sounding answer will always come as a natural flow to you especially during under pressure interview time! While writing the answers always use the CAMP structure and it is hard to go wrong.

Example of a question using CAMP structure:

Where do you see yourself in 10 years’ time?

C-Clinical reasons: post CCT/FRCS, aim for international fellowship, confident in supporting juniors etc

A-academic reasons:  masters/PhD, teaching opportunities, clinical lectureship etc

M-managerial reasons: engaging in clinical governance, becoming clinical lead etc

P-personal reasons: marry, have kids, support family, travel etc 

I wrote my own answers points like this then practiced them. Recorded and listened to my own voice while practicing.

Management Station:

This station gives you a chance to claim max marks. It consists of two parts. The first part is a presentation. You are emailed the topic beforehand. It is usually always the same. Talk about your leadership experience and how you intend to apply this during your core surgical training. You have 3 minutes to talk so make sure you don’t exceed 3 minutes. It reflects poor time management. After that they will ask you questions from your presentation for 2 minutes. The best way to go about this is talk about your leadership experience with an example from work and then talk about experience out of work and finish by reinforcing how this would be useful in your CST for a well-rounded effect. Remember to reflect on certain qualities of good leaders and team players because those are the qualities, they are looking for in a good core surgical trainee.

For example:

Clinical leadership experience: If you talk about leading ALS reflect on it using leadership qualities and sell yourself. ‘I was quick to assess skill levels, delegated tasks appropriately, organised team through clear assertive communication, strived under high pressure environment, was decisive about treatments etc’

 Non clinical leadership experience: If you  decide to talk about demonstrating leadership by your experience of heading a surgical/medical society during medical school highlight points like ‘properly engaged with my committee, prioritised events, time management, provided autonomy to members, encouraged them to think creatively and come up with own ideas’.

Clear presentation reflecting such views will constantly remind interviewers that you know exactly what it takes to be a good leader and team player.

The next half of the station (5 mins) you will be asked a general management question like dealing with difficult colleagues, angry patient etc that I will not go into the detail of and which are present in every interview book and come up in almost every speciality interview. The key is to use the SPIES structure that everyone is familiar with. If not, you will find it under management section in all interview books for sure.

Clinical Station:

They will judge your surgical clinical knowledge here, but it is actually more about a logical and structured thinking approach. The clinical scenarios in the surgical interview book mentioned earlier are more than enough to prepare from.

Whatever the clinical scenario may be the approach is always the same.

Just some tips from my personal experience of the approach I followed. People have different ways to come up with interview answers.

Initial management: ‘I will approach the patient using the standard ABCDE protocol (logical thinker) making patient safety my prime concern (safe doctor) I will make sure my patient receives adequate analgesia according to the WHO pain ladder. (empathy)

You have demonstrated to your interviewers three qualities of a good surgeon right in the very first sentence!

Go through your ABCDEs systematically and expand on where you think the problem is and fix it. Standard ALS/ATLS approach which I will not go into the details of. You need to keep on practicing them till they become second memory.

Differential Diagnosis: Often you may encounter scenarios where you may have to narrow down your diagnosis. They key is ‘categorise to survive!’ For example, post op fever (infective/non infective causes), hip fracture (extra/intra capsular), low urine output (pre renal/renal/post renal causes)

Investigations:

BBFIS (use a mnemonic so it makes it easy to remember)

Bedside- urine dip. ECG

Bloods

Fluids-pleural/ascitic tap

Imaging- X-ray/US/CT

S-Special tests (related)

Optimizing for theatre:

A: Anesthestist check/analgesia

B- Pre-op Bloods,group and save, cross match

C- CXR, Consent form

D- DVT prophylaxis, stopping blood thinners etc

E- ECG, Stopping Eating and drinking!

Management:

It revolves around surgical and non-surgical management.

I believe it’s worth doing the care of the critically ill surgical patient course for non-operative management. I have still not done it so can’t give a review about it.

For surgical management at post FY2 level it is not essential to know details of a surgical procedure but should know the basic incisions, surgical knots, basic anatomy etc.

Surgical topics to be aware of:

ASA Classification

WHO Pain ladder

WHO Theatre check list

Jenkin’s rule, type of sutures

Disinfection/sterilization

Capacity and consent

Post op complications

Key Points:

Getting into CST is quite doable. The only problem is lack of guidance because many people probably have not pursued this path so first hand experiences from people who have applied will help all.

Many people believe having visa restrictions is a big hurdle but in reality, once you’ve passed RLMT in any way you choose, it’s a fair game. It then depends solely on your interview preparation with no discrimination. A friend who applied to round 1 (visa restriction but in a psych training post) got a training number whereas a few UK graduates I know were unsuccessful in securing a job.

You do not need a very strong portfolio. As explained having been only 10 months in the UK I managed to collect a lot of evidence in retrospect. I initially thought having no publication or MRCS would affect my portfolio because people generally feed that into your mind, but it didn’t.

Solid interview preparation is a game changer! At least I believed that worked for me. You can read through interview books a million times but if you don’t practice in an interview setting it can become difficult. The more you practice with people, write down your own answers and sell yourself the better you will become at this. (Think PLAB 2). UK graduates go through a lot of interviews (med school, foundation modules, speciality training) so they understandably have a lot more interview exposure than IMGs do, not to mention the language barrier, so it is just a way of stepping up your game.

I have tried to write as detailed a review as possible. It is based on my own personal experience and lots of people may have different opinions regardless I hope it is found helpful. Good luck with all future training ventures. God Bless!

Getting into Radiology Training

— by Abeera Khan

Hi everyone. I have been successful in getting NTN for Radiology.

I am on Tier 2 HEE sponsored training visa, so I was exempt from RLMT restrictions. I applied in November 2018 when the R1 opens. I knew I had to have certain things in my portfolio before the application opens, so I don’t have to worry about that from Dec-Feb as this is the time you prepare for MSRA and interview.

The recruitment timelines are available on RCR website. The window period of MSRA, result dates, interview dates (subject to change) are published.

https://www.rcr.ac.uk/clinical-radiology/careers-recruitment/specialty-recruitment

PERSON SPECIFICATION:

Most important thing to go through is the person specification for Radiology. It comes up every year.

https://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/Clinical%20Radiology/Clinical%20Radiology%20ST1.pdf

It is almost same every year but go through it and ty to get maximum things you can. It does not matter what specialty you are working in.

MSRA (Multi-specialty recruitment assessment):

It is one of the important steps that you need to clear in order to get an interview slot. You can use any pool (emedica, passmedicine, pastest) for preparation. A cut off point is set for MSRA and candidates scoring above that are invited for interview as there is usually 600-620 interview slots. This year the cut off marks were 451. So, you needed to score 451 and above and be in the top 620 candidates to get the interview invite. You don’t get to know what the cut off score is till the date you get the Interview invite.

Once you get the Interview slot, you have a fair chance of getting the training number as the competition ratio is then 1:2 which is not that bad.

MSRA accounts for 33% and this is added to your interview score to make overall ranking.

I don’t know how they scale the MSRA scores. But it has equal weightage as either of the interview stations and carries 40 marks total.

Interview Preparation:

There are couple of Interview courses run in December and January. I took the following one.

https://www.radiologyinterviews.com/

They had 2 courses this year, in Early January and Late January. I opted for later one as I knew I would be sitting for SRA in early January. Interviews are in late February, so I had 3 weeks’ time for preparation after attending the interview course. They sent the manual in December which was quite helpful. Make sure you book them well in advance. I think I booked them in September/October. There were also Mock interviews conducted same way as the real Interviews.

Things to have in your Portfolio:

Start working on these from now on if you want to apply as time passes very quickly and if you are in another training, you would have to be 100% committed to that. You will be marked on 5 sections

  1. Taster week and radiology Courses
  2. Audits and QIP
  3. Postgraduate qualifications
  4. Teaching experience and teachings delivered
  5. Research (Publications and Posters)

Taster week – this is a must. You will be marked on it in interview. Spend 3 days or more in radiology department of your hospital. It would be very easy. You can go and talk to any of the consultant. I just spoke to Clinical Director of the department and he was more than happy to guide me. You can do it in your Annual leave, study leave, zero day. If you don’t get a day off, spend a weekend. I shadowed him on a Saturday on call in addition to other week days.

I wrote my experience of taster session. I did not have a formal certificate of taster session. I asked him to send me an email confirming that I did a taster session with him on following days and kept it as evidence.

Radiology Courses:

It is good to attend at least one Radiology related course. It shows your commitment to specialty.

I had 3 courses in my portfolio.

  • A&E Survival course
  • Chest x ray survival course (link below)

https://www.radiology-courses.com/

  • Essential radiology Course for Junior doctors

https://www.rcr.ac.uk/meeting/essential-radiology-junior-doctors-1

Apart from this, I had certificate of ultrasound workshops on Carotid doppler and antenatal scans I attended in my home country (as I was doing my training in Pakistan).

Make sure you write reflections on the courses you attend and how it has helped you and incorporate it into your practise/teachings.

Audits and QIP:

Again, you will be marked for this in Interview. So, the main thing is that its best to have a Radiology Audit. It will give you full marks. And its best to have at least one audit and one QIP in your portfolio.

I had one Radiology audit (closed loop) This is important as will give you full marks. Present audit and get a certificate. It can be very simple, and you can get ideas from AuditLive. It’s available on RCR website. There are hundreds of templates. You have the standards and you know what you are doing. You can choose any simple audit. It doesn’t have to be fancy and complicated. Try to do one which can be finished quickly.

https://www.rcr.ac.uk/clinical-radiology/audit-and-qi/auditlive

I did the audit on Quality of Chest X-rays in image interpretation. Following is the link.

https://www.rcr.ac.uk/audit/quality-chest-x-rays

Presented findings in Radiology discrepancy meeting and got the certificate for it.

If you need access to PACS, speak to any of the Consultants in Radiology department. There is also an Audit Lead in every department. As per my experience, people are generally very nice in the department. But you need to speak to them and let them know your interest. So, I had just gone to discuss an urgent request with this Consultant few months back and then I mentioned to him I want to apply in radiology training and he gave me access to his PACS for 2 days to collect data while he was doing procedures. Then I liaised with his Secretary who booked me in for a presentation slot in Radiology discrepancy meeting and gave me certificate for it.

I had one QIP during my Endocrine rotation on Insulin prescription which I presented in the QIP meeting at the Trust. Had a certificate for that too.

Had another audit (closed loop) I had done in A&E on sepsis.

Key point: Have one radiology related closed loop audit and one QIP in a year. They asked me this in interview (How many you have done in the last year)

Post graduate Qualifications:

MRCS/MRCP

BSC or Masters

I only had BSc from back home.

Teachings:

You will be marked for

  • Formal degree in teaching
  • Teaching course and teaching sessions delivered

I did not have any formal degree in teaching, but you can attend ‘Teach the teachers course’. Please attend that.

https://www.medicalinterviewsuk.co.uk/courses/medical-teach-teacher/teach-the-teacher-course-for-doctors/?gclid=CjwKCAjw1KLkBRBZEiwARzyE78Oop06rGahoVRYhxl59Sr5E2YXf882suGxyFiYgDlPz4ND2siH-lxoCWI4QAvD_BwE

Teaching sessions: Try to do radiology teachings. Again, it shows your commitment to specialty. You can do it in your Trust or regional.

I had 3 teachings in my portfolio.

  • ‘Chest X-ray interpretation’ delivered to American undergraduate students as a part of International student teaching programme at my trust. Feedback from the students.

The same presentation I also gave to FY2 colleagues in the trust. Obtained feedback from them.

  • ‘Vertebral artery dissection’ (again a bit of touch of radiology and importance of imaging)
  • And another teaching on a medical topic.

You need to have evidence of teaching i-e the presentation, feedback and your reflection on teaching. It’s important to have all these. Stick them in portfolio.

Don’t pick complex topics. Stick to CXR, AXR, Requesting appropriate scans for different conditions. These are the topics you can choose from radiology.

Again, you will have to speak to the undergrad department/medical education department at your trust. Trust me they are always looking for people who are interested in teaching medical students/ FY1/FY2.

Research:

You will get maximum marks (max marks 2) in this section if you have a publication in a peer reviewed journal. You can still score 1 mark if you have a Radiology poster (national/international).

No marks if you have a non-radiology poster.

I had one National Radiology poster that I had presented back home. I claimed 1 mark for it, and they accepted it. I had the poster print out in A4 size and certificate from Radiology Society of Pakistan. I was not sure if they will accept my mark for it, but they did. I mentioned it in interview.

Interview Pattern:

For last 3 years since 2017, the interview pattern has changed. It has come down from 4 stations to 2 stations.

Station 1: Understanding of radiology and Commitment to specialty

Station 2: Portfolio

The clinical and ethical bit has been removed from Interview as it is tested in MSRA.

You will be given a self-scoring sheet before the Interview begins. You will have 10 minutes for that. You will score yourself on 5 sections I have explained above. Maximum marks 10. Each section carries 2 marks.

  1. Taster week and Radiology courses (If you have both, you get 2 marks. You can easily get this)
  2. Post graduate qualifications (Full MRCP/MRCS- 2marks, First class honors BSc 2 marks, Bsc intercalated 2:1 You will get 1 mark)
  3. Teaching (Formal degree in teaching 2 marks, Teach the teachers course and a teaching sessions- 1 mark)
  4. Audit and QIP (Radiology audit closed loop and QIP- 2 marks, Non-radiology audit 1 mark)
  5. Research (Publication in Peer reviewed journal- 2 marks, Radiology poster National/International- 1 mark)

This scoring was quite detailed. I don’t remember exactly everything. But just giving a fair idea what I remember. It was very precise.

STATION 1: Understanding of radiology and Commitment to specialty  (Total Marks 40) Time: 10 minutes

Two interviewers but one will be asking questions. Each interviewer has 20 marks. Make sure you make eye contact with both. You can be asked anything related to radiology in this station. Things that will help you are

  • Spending some time in radiology department
  • Talk to some Radiology Consultants/ radiology trainees or even going through RCR website
  • Attend a Radiology interview course
  • Go through Radiology café website. It has got hundreds of questions. https://www.radiologycafe.com/

Make sure to make your answers personal and relate with your previous experience and taster session. Practise these at home. Write answers of typical questions and practise speaking them. I had answers to all questions they asked. They would fire multiple questions and if you are well prepared, you would know how to respond without fumbling much.

Some Questions I was asked:

  • What are the qualities of good Radiologist and what qualities do you have which would make you a good Radiologist?
  • Radiology training structure and exams
  • How would you prepare for the exams? (It’s important you know what resources trainees use)
  • My views on outsourcing and skill mix. Remember to give both pros and cons
  • Future challenges in radiology
  • Do you remember a case where Radiology played an important role? and couple of other questions.

STATION 2: PORTFOLIO STATION: (Total marks 40) Time 10 minutes

You hand over the self-scoring sheet given to you before the Interview. The score you give yourself is verified. (So, if you have given yourself 8 marks and it is verified and accepted by interview panel members, you will get 8+8= 16/20 marks). They will see everything in your portfolio. Make sure your portfolio is organised and you know it inside out. Keep it tabs wise.

Rest 20 marks is the global impression score. The way you answer all questions related to portfolio.

Importance of reflective practise

  • Reflections on clinical events (e.g I had seen a 5-year-old in A&E who had a fall and fitted criteria for CT Head and found to have Extradural haemorrhage) I kept that at the top of all the clinical events reflections.
  • Reflections on any interesting case (e.g I had a case where patient had wrong cancer diagnosis which they found very interesting and asked me about it)
  • Multi-source feedback (print it out from portfolio)

Make sure you print out these from your portfolio. Make sure you have few Radiology related cases you have reflected upon and keep them in front in reflections section in your portfolio. Its good to reflect even on subtle mistakes. And then what you did for that, so you don’t repeat it next time.

Make sure you have something out of your academic portfolio as your proudest achievement, and keep an evidence of that too.

KEY POINTS:

It’s doable. Many people will tell you it’s very tough to get into. It is as you need to make everything radiology related in your portfolio and take out time for it. That’s the only thing. Utilise few zero days, Annual/study leaves. Attend courses, do teachings, do audits. These are the things you would need in any job. It would add up to your portfolio anyways.

It only needs commitment and precise planning to score the maximum in Interview. Spend time in radiology department, attend MDTs, attend a Radiology discrepancy meeting.

Arrange your portfolio nicely. Print out presentations (e.g 9 slides on a page) so it doesn’t take up much space. Print coloured copies as it looks nice. I did not have MRCP/MRCS or any masters. I did not have any International publication. I had one publication back home. I mentioned it but I knew I would not be given marks for it. But The radiology poster helped me in that section. You can also get membership of ESR (European Society of Radiology). It costs £12  a year I guess. You can print off the membership certificate and stick that in your commitment section in portfolio.

I have tried to write it as detailed as possible. Hope it helps All the best 😊

 

 

Getting Training where you want : An insight into upgrades and facilitated placement

¬ By Dr. Asadullah Anees Khan

        I wanted to write this post in order to help others who might be in a similar situation and are aiming to stay in a particular region while applying for Core Medical Training with a view to specialist training. My wife and I both wanted to apply for training in the same round, she was applying for GP training and I was applying for Core Medical training.

 

       Now I must mention, I really like my trust and it was the goal to stay here for further training if possible, but being on a Tier 2 visa and being subject to the Resident Labour Market Test (RLMT), I wasn’t hopeful of getting a post in this area. I applied for CMT in March, 2018. I had my interview on 26th April, 2018 and ranked my preferences. I was very disappointed when they released the offers and I was informed that even though I was deemed appoint-able to the post, I was on the reserve list due to the RLMT. I had ranked very few places and I would not suggest that but I had a few reasons for wanting to stay where I was:

 

  • We wanted to stay close to London and only ranked places within an hour from London
  • Wanted proximity to an airport
  • Wanted to stay close to where ever my wife got her GP training post (she found out a day before I found out about my preferences)

 

I had given up on getting a place after having ranked very few places but still held out for upgrades on Oriel.  Following were my preferences:

 

 

After two days, I received an email and a text message saying I had been offered a post in East Kent at Kent and Canterbury hospitals, which I was happy with. The thing I did not like were the rotations in that post as I didn’t have ITU, Gastroenterology or Respiratory rotations which are quite important in your training pathway. While ranking my preferences, I kept programmes which had Oncology at the top of my preference list while also preferring Palliative care (because it contributes to a career in Oncology). I also ranked places which were near my current place of work and preferred Surrey as my location as my wife and I like this place a lot.

Now the way the upgrade system works is if you are offered a post, you can rearrange your preferences on oriel if you have accepted with upgrades or held a post with upgrades. If you accept a post without upgrades or decline that offer, that decision is final.

 

asad (2)The picture  shows my ranking for CMT applications and the first one was at Royal Surrey which included Oncology as a rotation. I accepted my offer with upgrades and was hoping for a better offer before the offers closed.

 

On the day the offers were supposed to close, I was offered the post labelled 2 on the above picture whereas my previous post was 1. This gave me Gastroenterology and Respiratory rotations which I was very happy about. Now as the situation stood, I was upgraded to Margate hospital with both years of my CMT in the same hospital and my wife would have had to refuse her GP training post (which was in Wessex and a non-commutable distance).

 

However, we had recently read about something called a facilitated placement which is a way for them to allocate training to people who want to remain close to each other after getting training spots in different deaneries. Please go through the following guideline to help with information about enhanced preferences and ranking offers: https://www.oriel.nhs.uk/Web/ResourceBank/Edit/MTEwNw%3d%3d

Please refer to the following link as well for and read about what is says under facilitated placement: https://specialtytraining.hee.nhs.uk/Recruitment/Application-guidance

 

My wife filled out the form for a facilitated placement and she emailed it to GPNRO and CMT recruitment along with our marriage certificate on Priority 2 under the guidance for facilitated placements. While trying to accommodate people via facilitated placements, they try to match either of the two candidates rather than keeping one of them as a focal point and matching the other one. Both people can apply for a transfer based on this scheme. They gave my wife a list of places where she could potentially apply for a transfer but none of those places suited us. They emailed my wife thrice within a span of 5 days regarding new CMT posts and sent a list of places where a transfer was possible. The third and last list had a post at my current hospital. There were a couple of other places as well which would have been suitable and I emailed them with my preferences in numerical order. In a couple of days they offered me the post at my current hospital.

 

I immediately accepted because it was the first choice for me with 2 year rotations in Geriatrics (my current job), Palliative care (my first choice speciality – oncology would benefit from this post), ITU (very important to learn procedures and to manage critically ill patients), Respiratory (very important post and something I wanted), Rheumatology (my second choice speciality) and AMU as my last rotation.

 

Now my wife will be able to take her GP placement as well and we will live midway and commute to our workplaces.

If don’t know about the application process in general, please read Omar Alam’s guideline on applying for CMT and the application process: http://omarsguidelines.blogspot.co.uk/2017/02/cmt-application-process-for-imgs.html

 

some email addresses for point of contact:

CMT: ct1recruitment@rcplondon.ac.uk

GP : gpnro@hee.nhs.uk

 

 

 

IMGs work experience in Acute Medicine (AMU)

¬By Abeera Khan

Acute Medicine is a specialty concerned with the assessment, diagnosis and treatment of adult patients with urgent medical needs. Acute Medicine is distinct from Emergency Medicine (A&E), although specialist acute physicians often work in close collaboration with specialists in Emergency Medicine. In the NHS hospitals, both departments work side by side.

There can be different names of Acute Medical Unit in different hospitals like CDU (Clinical Decision Unit) or AAU (Acute Assessment Unit). AMU is a short stay unit where patients stay for a maximum of 72 hours. They are then transferred to respective wards (Gastro/Respiratory/Care of Elderly or else) depending upon their line of management, transferred out of Trust if needed or discharged home direct from AMU.

If you have worked in the NHS, you must be familiar with the breech time in A&E. The NHS Constitution sets out that a minimum of 95% of patients attending an A&E department should be admitted, transferred or discharged within 4 hours of their arrival. However, on the floor, it’s not practically possible many a times due to number of reasons (huge influx of patients, understaffing in A&E at various shift times, blood tests and other results, shortage of beds in the hospital especially during winters/weekends and many more). However, trusts do their best to reach this target.

When the patient comes to the A&E, he/she is stabilised and then transferred over to the Acute Medical unit (if the patient is undergoing medics). The AMU is a team led by Consultants, on call Registrar, on-call SHOs (CMTs, GPSTs, Trust grade, FY1/FY2), Advanced Nurse Practitioners and the base team of AMU. In my previous Trust, we had 3 SHOs who were AMU based. The Consultant can be an Acute Physician or from a sub-specialty.

AMU also receives urgent admissions from GPs, patients from chemotherapy unit for suspected neutropenic sepsis, from Ambulatory care and Outpatient department.

Aim/Purpose of AMU:

The basic aim of AMU is to assess the clinical condition of the patient, follow up pending blood and Radiology results, start appropriate line of treatment, request further tests if required, refer to sub-specialties for review, make a diagnosis and then transfer to ward/discharge home.

My experience:

I have worked as AMU based doctor for 06 months. Around 80-90% of admissions are from A&E (roughly my statistics). The AMU team (SHOs/Reg) will review the patient, clerk, follow the pending investigations, do further tests (depending what the patient is coming in with), make a management plan and discuss with the Registrar and patient is then reviewed by the Consultant.

AMU ward rounds start at 08:00. This is called post-take ward round (PTWR) when the consultant reviews the patients admitted overnight. As there is constant influx of patients, so Consultants try to move patients to the ward if they need to stay in the hospital for few more days or discharge them home from AMU.

Example:

If the patient is admitted overnight with a mild/moderate acute attack of Asthma, had baseline investigations, CXR, ABGs, Nebulisers, steroids, antibiotics (if needed) and is now clinically stable, maintaining saturations on air and not needing Nebs, peak flow within normal range, he can be discharged home from AMU with a prescription.

After the ward round there is a handover in which the team goes through the patients and you write up on the board what further investigations need to be requested for each patient, any referrals to be made to specific teams or subspecialties within the hospital, TTOs( discharge letters) to be done, any investigations to chase up or expedite, mostly with Radiology like CT scans/MR/Ultrasound. If any discussion need to be done with Consultant Microbiologist on call or any out of hospital referrals.

It is best to work as a team in AMU. After the ward round, we used to divide work like half of SHOs used to do the jobs mentioned above and 1-2 SHOs keep clerking new patients coming in. If at times there was a bed blockage and no movement is happening from AMU to the wards, we used to finish the jobs at AMU and 2 of us (SHOs) used to go to A&E with the on-call registrar and start clerking patients there in ED who are definite admission. This helps your night team if you are working on days as staffing at night is less as compared to full day team. The same we used to do at night shifts too.

Common cases encountered in AMU:

There is a broad spectrum of clinical work in AMU. The range of clinical problems encountered is very wide, which gives the work a great deal of variability and that’s what I like best, mixture of medicine and blended work.  AMU routine is tough on everyday basis, but I like continuity of work, so I thoroughly enjoyed my rotation. You would commonly see,

Headache (Rule out Subarachnoid haemorrhage). Would have had their CT Brain from ED and would get LP in AMU.

Asthma

Acute exacerbation of COPD

Chest infection/ Pneumonia

Acute Kidney injury

Overdose (most common- Paracetamol)

GI Bleeding

Acute flare up of Inflammatory Bowel disease (Crohns/Ulcerative Colitis)

Chronic pancreatitis

UTI in elderly causing delirium

Diabetic Ketoacidosis

Cellulitis

Suspected Pulmonary embolism

Neutropenic Sepsis

Suspected cauda equina (in my previous trust, it used to come under medics)

Anaemia requiring blood transfusion

CLD patients

Sometimes patients come in for pain management, social admissions

 

What I learnt:

  • Best place to work as a team, constant support from fellow colleagues and Consultants
  • Clerk patients every day, make your own plan of management, discuss it with your Reg/Consultant and then mark it off as a CBD (case base discussion) and mini-CEX (Clinical evaluation exercise)
  • Do ACATs (Acute Care Assessment Tools)
  • Opportunity to do various procedures (Lumbar puncture, ascitic drain, pleural taps)
  • Good mix of cases keep you up to date

Overall, it’s a good learning opportunity and make the most of it when you are working in AMU (Well, that holds true for every rotation). Hope it helps.

My A&E Experience as Starting IMG

¬ By Abeera Khan

A&E is the front door of the hospital. A lot of IMGs think about picking up A&E as their first job as ED is on shortage occupation list and there are lot of vacancies in different trusts. It is commonly heard that ED job is very hectic at SHO level, and some people might tell you not to join ED as a first job. However, I can assure you that many IMGs have started it as their first job and they settled well with time. No matter where you start from, it would be difficult at first as this would be your first NHS experience.

I had many job rotations offers but I opted for A&E and AMU rotation for a year (06 months each). I worked in one of the busiest A&E departments in the North region which covers a very large population. We had an 8 bedded Resus, 15 bedded Majors with 4 Rapid Assessment Rooms, 6 in Minors/urgent care and a separate Paediatric area, fracture/plasters room and GP consultation room.

Yes, it is very overwhelming especially during winter months, but you need to understand that if its busy in ED, its busy in the medical and surgical departments too.

Watch this video to see how winter pressures affect NHS. BBC was given free access to the A&E of Royal Blackburn Hospital while I was working there last winters (2016-2017).

The best thing I like about working in A&E is a good mix of cases you see ranging from trauma (if the ED department is a trauma centre), acute medical and surgical conditions, orthopaedic emergencies (fractures), managing paediatric conditions, gynae cases to assess and then refer and common illness seen in minor area.

As a starter, it is the best place to practise ABCDE protocol. From the moment you start taking your history, you try to rule out differentials. If you have been out of practise, you will get hands on doing cannulations, blood sampling, ABGs, urinary catheters, suturing. As ED is constantly busy with rapid influx of patients, you can’t just sit and wait for the Nurses to come over and do everything for you.

There is a lot of senior support on the floor and they would always listen to you and guide you.

In urgent care/minor area, you can see, manage and discharge patients on your own if you are confident. If you are not, always consult with the Registrar.

Be very clear in your documentation. If you are not sure about reading X-rays (especially for fractures), don’t make your assumptive diagnosis. Always ask your seniors.

You can easily get your foundation competencies signed off if you are working well.

Yes, the job is hectic because it is constant brain storming. You see one patient, plan and then move on to the next. We could have a 20-minute break after 4 hours in an 8-hour shift. And two 20-minute breaks in 10-12 hours every 04 hours.

You develop good communication and referral skills when you deal with other specialties. Remember you are the one who has seen the patient and you know if patient is stable to be discharged or not. Treat the patient, not the Numbers.

Just to quote an example, I have had 5-year-old with extradural hematoma and midline shift (prompt History, examination, knowing NICE guidelines for CT scan, speaking to radiology Registrar and referring to Manchester Royal Infirmary all done in an hour) and then followed up with that patient post-surgery, reflected upon it on my portfolio.

The only thing I found hard was my Rota as there is a constantly changing pattern of shifts. You would do Standard days, long days, then twilight shifts (18:00 to 02:00, 18:00 to 04:00, 16:00 to 04:00, 12:00 to 00:00), night shifts. Be prepared for this as the ED rotas may be a bit maniac.

You can even follow up your patients in AMU/Surgical assessment Unit/Paediatrics later, as in ED you would manage the acute condition and stabilise the patient.

Another thing IMGs worry about is the portfolio. I would say that,

  • There is a lot of experience you can reflect upon in your portfolio while working in A&E.
  • You can get MSF from colleagues working at different grades.
  • You can get your CBDs and mini-CEXs signed off.
  • You can do audits while working in A&E.
  • You can get your foundation competencies signed off (I did after 04 months)

All the above things I have mentioned, I have got them all in 06 months rotation.

Only drawback I found was there is less of teaching as due to rotas, you tend to miss the teaching sessions. But then you can ask for a teaching presentation to deliver. You can always email the undergrad/postgrad department in your trust and they are always very helpful.

IMGs worry if working in A&E would help them in future or not especially when applying for training. The UK foundation trainees do get to rotate in A&E in their training as it is very essential. I applied for my CMT and GP training while in A&E and got offer for both.

I believe every work you do helps you and gives you experience and knowledge. I have a variety of background experience of working in general medicine, neurology, radiology, A&E, acute medicine, undergrad teaching and I have never regretted anything I have done so far as I feel I have learnt a lot from everywhere I have worked.

 

Experience of Applying and obtaining a Higher Speciality Training / ST 3 post as an IMG in Medical Specilties

¬ Dr. Irfan Qamar

 

   Seven months back I moved to UK from a very well settled Job in middle east after completing my MRCP exam and the only aim to move  to this country was to enter a higher speciality training with a special interest in respiratory medicine.

    When I was moving to UK everybody around me, my colleagues and my friends thought that I am making a big mistake, it’s a perception in the mind of many people that life in UK is very tough and you will keep on struggling for a training slot but will never get it and you will not able to earn and save money. A part of this perception might be right, but one must take risks in life to progress in life.

     After my results of IELTS I directly applied on NHS jobs official website although I do get a lot of calls form many medical recruiting agencies but what I found was all the jobs which were mentioned by the recruiting agencies were also on NHS jobs website and there is no difference in applying directly as compared to medical recruiting agencies.

I got a job in acute medicine as a middle grade (registrar level) in a big DGH (district general hospital) I got my COS (certificate of sponsorship) and visa without any difficulty. The procedure is very simple and very well explained over internet.

    The beginning of a new career in altogether a different health care system was never easy, but all the people including administrative staff, consultants and colleagues were very supportive and helped me a lot to settle in the new system. My education supervisor was very helpful he was always willing to help me whenever it was needed, he also held long meetings with me just to help me to understand how things work in NHS. I was told many scary stories about NHS that you would be put alone on the duty at middle grade where you must make many bold decisions all about yourself and you would be under tremendous pressure to make such decisions, but honestly, I was never given any responsibility until and unless I was fully prepared for it. I did many mistakes as everyone is expected to do in a new system, but I was always given a feedback in a very positive way so that I can improve myself and grow professionally.

     After settling down in the new system, which took me around three months, I started to work on my application for speciality training in Respiratory medicine. First and most important thing is you need to be eligible for application for which you need Your core competencies signed off by consultant with whom you have worked in last three years and have worked continuously for three months.  As I was applying for ST3 i.e. speciality training year 3 so I need to give a proof that I have attained all the competencies that are required during year 1 and 2. Generally in UK they are attained during core medical training Hence easily called as core competencies. Their is a form which is available on ST3 recruitment website which has all the competencies mentioned on it all you need to fill it up and get it signed by the consultant. I informed my consultant well ahead of time that I need this certificate to be signed by you he agreed and started to observe my skills in managing a patient and in doing the common medical procedure. He observed all the procedures which are on that form and finally he signed it for me. I want to let you people know that any consultant with whom you have worked can sign that form it is not necessary that he should be GMC registered or he should be from UK. However, he should be a physician (medicine or allied specialties). the other requirements to be eligible are much easy to attain you should have an ALS advance life support they do not accept American heart Association ACLS.

I am writing it for middle grade doctors, so I assume that most of you have completed your membership exam MRCP that is another requirement to start ST3 training. If your are in UK core medical training, you can apply and start your training without passing PACES but cannot continue your training if you fail to pass it in first few months. They also require a proof of English if medium of education was not English in your medical college.

Then there are many more things which are in the application list for which you get marks which are very important indeed because for limited number of seats you need to get marks to become a competitive candidate. The List is long and easily accessible on ST3 recruitment website few things which you can work on to get more marks are, try to do a audit in your trust rather a full quality improvement project other things would be your research or case report publications and your presentations in various conferences the more you do the more marks you get and better are your chances to be selected. For me I did a quality improvement project and I already had publications in international journals along with poster presentations and end of the day every single thing counts.

Now that I have worked up on my eligibility and various other things to secure more marks the time came to apply for the ST3 post it was Round 2 and round 2 is easy for foreign graduates as less locals will be available during this round. You complete your application on oriel website and apply on the same website the website is simple and easy to use once the application is completed and submitted its time to sit back relax and prepare for the interview.

The interview invites will be based upon your numbers which you claim during your application and they mainly are on your academic achievements like I have already mentioned. Don’t waste your time and just wait for the invite as sometimes the invites are over short period of time so start preparing for your interview as soon as possible. I studied two books for my interview one was oxford hand book of respiratory medicine and other was Medical Interviews,” comprehensive guide to CT, ST and registrar interviews it’s a very good book and most of the non-medical questions asked during interviews are almost covered in it. At least one read is a must especially for some one like me who is not trained in NHS.

 

Interview format is different for different specialities and can also keep on changing but it is given on ST3 recruitment website, till now so many times I have referred to ST3 recruitment website, it’s official website for recruitment at registrar(ST3) level and is very important with all the information you need from preparing your application to interview and all things after interview. therefore, it is very important that you know your format right from the beginning of the interview so that you prepare according to that format.

For me the most difficult thing was to prepare a research article as it was in the format of respiratory medicine interview that you should prepare a relevant research article and present it in four minutes during one of the stations in interview. I went to one of the respiratory consultant and directly asked him about the article and he gave me a very good study to present on COPD based on which the management guidelines were about to change. I would advise, do not just google and prepare any spontaneous article, choose your article very cleverly it should be some current or hot debate related or something important like based on which new guidelines are formed or old guidelines changed or some landmark trial, not just a spontaneous article or study. Because it should be used as an excellent opportunity for you to represent your interest in the speciality and to show the future potential for the development of speciality and your interest in it.

Always work on questions and prepare the individualised answers which should be true representative of your self not just the stuff available over the internet, try to support your answers from your life time examples. every answer should be indirectly showing some positive aspect of your personality and strong commitment to the field of Medicine and respiratory medicine. There wouldn’t be a lot of questions from your personality. During my interview the main focus was on three things First thing was commitment to specialty second thing was a clinical scenario along with relevant communication skills and third thing was the research article you need to present along with a ethical scenario. The Interview was very rapid three stations of 10 minute each and 5 minutes in between each station. One important thing about the interview preparation is your medical portfolio whatever marks you have claimed during the interview you should back them up with good evidence in it. The last thing any one would need is getting not appointable because of claiming wrong marks or not carrying the appropriate evidence with them to support it. I really worked on my portfolio arranging and organising the evidence so that everything looks professional. Again, there are guidelines on the ST3 recruitment website on how to arrange and organise your portfolio.

Once Interview is over, its time to relax and wait for the outcome initially they will ask you to give priority of the regions /deanery where you would like to spend next five years of your life as a registrar trainee later they will tell you your appointable or not appointable and will be given a rank number and based on your rank number and your preferences you would be matched to a region and this matching is more or less same as Match process in USA.

27th of September 2017, new offer received through oriel system. Respiratory and general internal medicine and that also in my top priority region Kent, Surrey and Sussex Deanery. Thanks to Allah Almighty for getting a training slot that will lead In Sha ALLAH to become a consultant.

In the end all praise to ALLAH ALMIGHTY who helped me to get a trainee post in less than a year in UK and all the theories of other people turn out to be wrong about my moving from middle east to UK as there is no match to be trained from a western country and there is little or no progression of career in middle east if you’re working their at junior or middle grade.

All the best for all those who want to move, or in UK and want to apply for ST3 training post.

training-pathway

 some useful links

http://www.st3recruitment.org.uk/about-st3/overview-st3-recruitment

https://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/General%20(Internal)%20Medicine/General%20(Internal)%20Medicine%20ST3.pdf

http://blog.messly.co.uk/messlys-guide-to-st3-applications-2017/