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:

Please refer to the following link as well for and read about what is says under facilitated placement:


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:


some email addresses for point of contact:


GP :




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.


 some useful links

Click to access General%20(Internal)%20Medicine%20ST3.pdf




ST1 Obstetrics and Gynaecology Interview Format & Experience

¬ by Abeera Khan

This is an anonymous Interview experience from a colleague of mine who applied for ST1 Obstetrics and Gynaecology in Round 1- re advert 2018. Please note it won’t be perfect as it is not my own first-hand experience. Just an outline to let you know how it works.

Kindly go through the Person specifications 2018 for Obstetrics and Gynaecology- ST1

The person specifications for each specialty comes out every year. Its worthwhile to have a detailed account of it as the interview is based on every section marked in it. And you can find it easily by typing it on google.

Interview consisted of 3 stations.

Station 1:

Portfolio station:

Questions asked related to

  • Commitment to specialty
  • Audit and QIP
  • Understanding and importance of Research
  • Teaching (Any teaching you have delivered, feedback, Importance of teaching in training)
  • Understanding of structured training programme of ObG, exams and curriculum

You will be marked on all of these things by the panel. So make the best use of it.

Station 2:

Interaction with patient (simulator)

You are given a scenario before entering the room. You have 5 minutes to understand the scenario, make up your mind what you want to ask and prepare yourself.


Day 2 Post uncomplicated vaginal delivery. Routine bloods in the patient show Hb of 71. Take relevant history, ask for relevant examination if you want to do and what would you like to do further.

Remember you must be quick in this, take relevant history (if anaemia is symptomatic or asymptomatic), any significant past medical history- pre-existing anaemia. If you say, I would like to do relevant clinical examination, the examiners will let you know that its normal.

You would then need to address Blood transfusion, how it is done and intended benefits. Ask the patient about this and gain consent. Patient may not be willing then you may have to address the side effects of not having a transfusion.

Finally, the patient agrees to have blood transfusion.

Second part of the station 2:

The examiner then hands you a paper.

Day 1 Post blood transfusion in the same patient. Patient has received wrong blood. She is clinically stable but is very angry and upset about it. She would like to make a complaint. How would you address this?

Station 3:

Prioritization of tasks with reasoning. 

You are SHO on call in a ward having surgical, gynaecology and orthopaedic patients. You have one FY1 for help. You have Medical registrar, surgical registrar and orthopaedic registrar on call in the hospital.

  1. 80-year-old lady #NOF post-surgery. She was receiving 2nd unit of blood transfusion. Nurse calls you saying patient has spiked temperature 38 degrees. Heart rate 100bpm. Blood pressure, respiratory rate and saturations normal.
  2. Patient has been admitted to the ward for investigation of abdominal mass. She has had hematemesis. She is now hypotensive with blood pressure of 80/50 mmHg, HR 100 bpm. She feels unwell and is sweaty.
  3. Young patient admitted to ward with incomplete miscarriage and alcohol intoxication. Nurse calls you to tell that she her GCS is 13 and has now had complete miscarriage. Her observations including blood pressure, heart rate, RR are all normal.
  4. Phone call from a man asking about Patient 3 (Intoxicated patient) and wants to know what’s happening with her.

P.S: The scenarios may not be complete, but I hope you understand it gives a fair idea that which task should be addressed first and foremost.