My advice to doctors who have come to the UK via the "non PLAB" route
This guidance is for those international medical graduates who have not given PLAB and have come to the UK via
- The MTI route
- Having a post graduate qualification acceptable to the GMC
( https://www.gmc-uk.org/doctors/registration_applications/acceptable_postgraduate_qualifications.asp)
However when they come via the 2 routes mentioned above, they have not been exposed to the system like PLAB candidates. They do have an induction course and other introductory courses but given that they have not actually practiced and been given feedback, it is a bit difficult for them. Therefore they may struggle a bit.
Most trusts do give such doctors enough leeway in the form of asking them to shadow their trainee colleagues and have regular meetings with their supervisors. Most of them do settle in a few months but some still struggle. This guideline is for those doctors who are still struggling.
Ways of introducing ourselvesWe usually refer to our senior medical consultants by Dr (surname) and our registrars and colleagues by their first names.
We refer to surgeons by Mr/Ms/Mrs (Surname).
We introduce ourselves as Dr (surname) when speaking to another senior colleague or by our first name when introduced ourselves to a patient.
I usually introduce myself as "Omar" to my patients.
We are used to calling our seniors Sir, Madam or Ma'am - These terms are not used here.
We work as a team
Most doctors who come via the non-PLAB route are working at senior posts in their home countries (ie at registrar level) and in our home countries, a registrar has a team of junior doctors under them. The way of working as a medical team is less of a teamwork and more of a hierarchy system. Therefore registrars there are not used to the concept of helping juniors in simple things like cannulation, doing discharge summaries as registrars here are as mentioned in this guideline:
http://omarsguidelines.blogspot.co.uk/2018/01/my-guideline-for-imgs-who-start-their.html
We are all friends and support each other
You will be surprised how friendly the whole team is. We greet each other in the morning, ask how the other persons weekend was (and actually show that we care. It is not like "How was you weekend" in a robotic tone and then look the other way before they answer. Show that you actually care). We help each other. Sometimes if the nursing staff is very busy and cannot pass a NG tube, one of the junior doctors will pass it. If the nurses are struggling with an angry relative, the doctors will ask the nurse if they need any assistance ( and there is a way of doing this too - you would not just butt in and ask if everything is okay. You will stand on one side just in the view of the nurse and ask if she needs help with anything in a polite tone. Most of the times they can handle it but this act of kindness takes you a long way). I remember that I once helped a HCA make a bed for a patient because everyone was busy and a patient had arrived on to the ward earlier than expected.
The ward clerks, house keeping staff, HCAs, nurses, specialty nurses, OT, PTs, SLT team, dietitians, your juniors, seniors are all colleagues and friends. You need to support each other.
Also remember that every team member gives your feedback to your supervisor. This is known as 360 degree feedback and is dynamic ( it is given all the time).
We are social
We go out with our ward on Christmas parties and other ward socials. The important thing is to be mingle with everyone and learn how to socialize. Notice how your colleagues listen to you when you are telling them something - they show that they care and also remember your story. This is what you should do too. As international medical graduates, we tend to mingle with our own nationalities. This will not help in any way. You are now in the UK - which is a very diverse country with people from all over the world. If you restrict yourself to a particular group of people, you will not be able to gain confidence or learn. So be open minded and learn how to socialize with everyone.
The GMC guidance on patient centered care.
As PLAB candidates, we are tested on the domains of "Good Medical Practice" as mentioned here:
https://www.gmc-uk.org/guidance/good_medical_practice.asp
It is important to go through these and also practice this as well. It is difficult to read them when you do not understand what these mean therefore make sure that you observe people using this guidance in their clinical work when you are shadowing them.
Of course, nothing can be learnt till you actually practice it so make sure that you apply this under supervision of a colleague and get feedback.
For example, how to greet a patient, how important it is to maintain eye contact, showing empathy, maintaining the patients dignity by asking for a chaperone (politely) when examining certain systems, etc.
Adhering to the local and national guidelines
This includes antibiotics guidance, other pathways like chest pain pathways, what investigations to send for a patient who has been admitted. These topics have been discussed in other sections of this blog too.
Prioritizing what to learn.
When international medical graduates start working in the NHS, they are overwhelmed with information. However given that we are human, we can take a limited amount at a particular time. So it is important to prioritize.
For example, if you have just started working in a surgical specialty and it is your first week, rather than focusing on the steps of a complex open heart surgery, you should be learning the basics like pre op and post op care, consent, how to manage emergencies, how to escalate, the local guidance on VTE prophylaxis post op, etc.
You will learn the steps to that complex surgery in time. However if you know the aforementioned basic stuff, you can easily manage as a junior doctor and once you are confident enough you can start studying and learning the clinical stuff.
Exams
As mentioned above, your main priority should not be your exams when you start work. Make sure that you are settled well in the NHS system before considering to sit in any exams. The system is overwhelming enough for new doctors- do not overburden and stress about exams at this stage.
Once you are well settled and know the system, you can start preparing for your exams (25 % of the course of these exams is what you have already learnt therefore that initial period of "getting used to the system" will help you in your exams)
Mandatory learning
Boring as it may sound, this is also an important part of your learning. This includes some "e learning" and some "face to face" learning modules which are mandatory for all health care professionals. If you have not attended these, your supervisor will be asked to remind you. To avoid this, contact your HR and supervisor as soon as possible and ensure that you get access to these mandatory learning modules.
ALS is also a part of this. Contact your resus officer in your trust to ensure that you have a slot booked.
Read this guideline on ALS:
http://omarsguidelines.blogspot.co.uk/2017/12/my-guideline-for-als.html
IT access
Ensure you get access to all departments (most trusts have smart cards), all software and familiarize yourself with these. You can go to the library out of hours and just get to learn how to work the different functions. Remember your passwords (there are loads) but try to memorize these.
If in doubt, always email the IT team.
Escalation
PLAB candidates are familiar with this term. When you are stuck in something (ie you are unable to cannulate, do an ABG, are not confident with dealing with an angry relative , have made a mistake), always escalate - that is, inform your seniors.
If you are a SHO- inform your registrar. If the registrar is busy, inform your consultant. If the consultant is busy, inform the registrar on call. Never ever do something you are not comfortable with.
Legal issues:
You should be aware of this:
https://www.citizensadvice.org.uk/health/nhs-and-social-care-complaints/complaining-about-the-nhs/taking-your-complaint-against-the-nhs-to-court/clinical-negligence-in-the-nhs-taking-legal-action/
And therefore have an indemnity insurance. I have made a guideline here:
http://omarsguidelines.blogspot.co.uk/2017/08/indemnity-insurance-for-imgs.html
Other topics.
I have covered a lot on other topics which are equally necessary in other sections of this blog. Please go through the table of contents and go through the relevant posts in detail.
Remember, be outspoken and smart about everything. Escalate any concerns be friends with everyone. Show that you are a caring, compassionate doctor and colleague. This will take you very far in life.
- The MTI route
- Having a post graduate qualification acceptable to the GMC
( https://www.gmc-uk.org/doctors/registration_applications/acceptable_postgraduate_qualifications.asp)
For convenience purposes, I will refer to these 2 routes as the"non-PLAB route"
When doctors come to the UK via the PLAB route, they have a basic idea of how the NHS works as the syllabus of the PLAB 2 exam is how to become a good foundation year doctor (https://www.gmc-uk.org/doctors/plab/23450.asp). They know how to introduce themselves, understand the importance of patient centered care, team work and how to escalate to seniors. These basic things help them to adjust in the first job in the NHS easily.
When doctors come to the UK via the PLAB route, they have a basic idea of how the NHS works as the syllabus of the PLAB 2 exam is how to become a good foundation year doctor (https://www.gmc-uk.org/doctors/plab/23450.asp). They know how to introduce themselves, understand the importance of patient centered care, team work and how to escalate to seniors. These basic things help them to adjust in the first job in the NHS easily.
However when they come via the 2 routes mentioned above, they have not been exposed to the system like PLAB candidates. They do have an induction course and other introductory courses but given that they have not actually practiced and been given feedback, it is a bit difficult for them. Therefore they may struggle a bit.
Most trusts do give such doctors enough leeway in the form of asking them to shadow their trainee colleagues and have regular meetings with their supervisors. Most of them do settle in a few months but some still struggle. This guideline is for those doctors who are still struggling.
Ways of introducing ourselvesWe usually refer to our senior medical consultants by Dr (surname) and our registrars and colleagues by their first names.
We refer to surgeons by Mr/Ms/Mrs (Surname).
We introduce ourselves as Dr (surname) when speaking to another senior colleague or by our first name when introduced ourselves to a patient.
I usually introduce myself as "Omar" to my patients.
We are used to calling our seniors Sir, Madam or Ma'am - These terms are not used here.
We work as a team
Most doctors who come via the non-PLAB route are working at senior posts in their home countries (ie at registrar level) and in our home countries, a registrar has a team of junior doctors under them. The way of working as a medical team is less of a teamwork and more of a hierarchy system. Therefore registrars there are not used to the concept of helping juniors in simple things like cannulation, doing discharge summaries as registrars here are as mentioned in this guideline:
http://omarsguidelines.blogspot.co.uk/2018/01/my-guideline-for-imgs-who-start-their.html
We are all friends and support each other
You will be surprised how friendly the whole team is. We greet each other in the morning, ask how the other persons weekend was (and actually show that we care. It is not like "How was you weekend" in a robotic tone and then look the other way before they answer. Show that you actually care). We help each other. Sometimes if the nursing staff is very busy and cannot pass a NG tube, one of the junior doctors will pass it. If the nurses are struggling with an angry relative, the doctors will ask the nurse if they need any assistance ( and there is a way of doing this too - you would not just butt in and ask if everything is okay. You will stand on one side just in the view of the nurse and ask if she needs help with anything in a polite tone. Most of the times they can handle it but this act of kindness takes you a long way). I remember that I once helped a HCA make a bed for a patient because everyone was busy and a patient had arrived on to the ward earlier than expected.
The ward clerks, house keeping staff, HCAs, nurses, specialty nurses, OT, PTs, SLT team, dietitians, your juniors, seniors are all colleagues and friends. You need to support each other.
Also remember that every team member gives your feedback to your supervisor. This is known as 360 degree feedback and is dynamic ( it is given all the time).
We are social
We go out with our ward on Christmas parties and other ward socials. The important thing is to be mingle with everyone and learn how to socialize. Notice how your colleagues listen to you when you are telling them something - they show that they care and also remember your story. This is what you should do too. As international medical graduates, we tend to mingle with our own nationalities. This will not help in any way. You are now in the UK - which is a very diverse country with people from all over the world. If you restrict yourself to a particular group of people, you will not be able to gain confidence or learn. So be open minded and learn how to socialize with everyone.
The GMC guidance on patient centered care.
As PLAB candidates, we are tested on the domains of "Good Medical Practice" as mentioned here:
https://www.gmc-uk.org/guidance/good_medical_practice.asp
It is important to go through these and also practice this as well. It is difficult to read them when you do not understand what these mean therefore make sure that you observe people using this guidance in their clinical work when you are shadowing them.
Of course, nothing can be learnt till you actually practice it so make sure that you apply this under supervision of a colleague and get feedback.
For example, how to greet a patient, how important it is to maintain eye contact, showing empathy, maintaining the patients dignity by asking for a chaperone (politely) when examining certain systems, etc.
Adhering to the local and national guidelines
This includes antibiotics guidance, other pathways like chest pain pathways, what investigations to send for a patient who has been admitted. These topics have been discussed in other sections of this blog too.
Prioritizing what to learn.
When international medical graduates start working in the NHS, they are overwhelmed with information. However given that we are human, we can take a limited amount at a particular time. So it is important to prioritize.
For example, if you have just started working in a surgical specialty and it is your first week, rather than focusing on the steps of a complex open heart surgery, you should be learning the basics like pre op and post op care, consent, how to manage emergencies, how to escalate, the local guidance on VTE prophylaxis post op, etc.
You will learn the steps to that complex surgery in time. However if you know the aforementioned basic stuff, you can easily manage as a junior doctor and once you are confident enough you can start studying and learning the clinical stuff.
Exams
As mentioned above, your main priority should not be your exams when you start work. Make sure that you are settled well in the NHS system before considering to sit in any exams. The system is overwhelming enough for new doctors- do not overburden and stress about exams at this stage.
Once you are well settled and know the system, you can start preparing for your exams (25 % of the course of these exams is what you have already learnt therefore that initial period of "getting used to the system" will help you in your exams)
Mandatory learning
Boring as it may sound, this is also an important part of your learning. This includes some "e learning" and some "face to face" learning modules which are mandatory for all health care professionals. If you have not attended these, your supervisor will be asked to remind you. To avoid this, contact your HR and supervisor as soon as possible and ensure that you get access to these mandatory learning modules.
ALS is also a part of this. Contact your resus officer in your trust to ensure that you have a slot booked.
Read this guideline on ALS:
http://omarsguidelines.blogspot.co.uk/2017/12/my-guideline-for-als.html
IT access
Ensure you get access to all departments (most trusts have smart cards), all software and familiarize yourself with these. You can go to the library out of hours and just get to learn how to work the different functions. Remember your passwords (there are loads) but try to memorize these.
If in doubt, always email the IT team.
Escalation
PLAB candidates are familiar with this term. When you are stuck in something (ie you are unable to cannulate, do an ABG, are not confident with dealing with an angry relative , have made a mistake), always escalate - that is, inform your seniors.
If you are a SHO- inform your registrar. If the registrar is busy, inform your consultant. If the consultant is busy, inform the registrar on call. Never ever do something you are not comfortable with.
Legal issues:
You should be aware of this:
https://www.citizensadvice.org.uk/health/nhs-and-social-care-complaints/complaining-about-the-nhs/taking-your-complaint-against-the-nhs-to-court/clinical-negligence-in-the-nhs-taking-legal-action/
And therefore have an indemnity insurance. I have made a guideline here:
http://omarsguidelines.blogspot.co.uk/2017/08/indemnity-insurance-for-imgs.html
Other topics.
I have covered a lot on other topics which are equally necessary in other sections of this blog. Please go through the table of contents and go through the relevant posts in detail.
Remember, be outspoken and smart about everything. Escalate any concerns be friends with everyone. Show that you are a caring, compassionate doctor and colleague. This will take you very far in life.
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