My advice to IMGs who are starting in training posts (ST1/2/IMT)
This blog post is for those IMGs who have accepted training posts in:
1. GP training
2. IMT
Here are some tips:
PORTFOLIO:
Get used to your portfolio from day 1.
Here is what you should do:
1. Pay for it ASAP ( You will be sent an email a few weeks/days before your post starts).
2. Open the different forms and see what they mean.
I have made a guideline on it here:
http://omarsguidelines.blogspot.com/2017/03/maintaining-your-e-portfolio.html
3. You will have access to online tutorials of whatever e-portolfio you get so use this opportunity to learn about the features.
4. You will be explained about your portfolio in detail in your induction as well. However, try to familiarize yourself with it before that so that you can ask questions or confusions you have.
5. Send assessments to people you know will give positive comments. These can be any health care assistant from HCAs to consultants.
6. Send assessments for ACATs to consultants who have post taked your patient you have clerked when you are on call (you need to see at least 5 patients to send an ACAT).
7. Send assessments for CBD, mini-CEX to your consultants and registrars ( registrars are very helpful especially during night shifts as they may have time to discuss your case with you and you can send them an assessment).
8. Reflect! Do reflections on
- Any interesting cases you have seen
- Clinics you have attended
- A new clinical experience: your first LP for example, teaching your colleague on how to do a LP.
- Teaching you have done
- Teaching you have attended
- Leadership : leading a CRASH call, managing a sick patient and delegating tasks.
Do this on the day you see these cases/do the procedures/attend teaching sessions as you will have everything fresh in your mind.
9. Make it a habit of opening your portfolio everyday and using it- for reflections, sending assessments, etc. This way, it will become a part of your daily routine.
ON CALLS:
FOR GP TRAINEES:
Unfortunately, GP trainees have to do on calls. Which means that they will either cover wards or clerk patients ( in hours and out of hours).
Some GP trainees have chosen GP training for this very purpose- to avoid the stressful on calls however unfortunately it is part of their training in their first 2 years .
You will be expected to cover AMU, surgery and sometimes, PAEDS.
You will also be rotated into different medical specialties - gastro, renal, endo, respiraotry, cardiology, stroke ( maybe not all of them but some of these) and surgical specialties
Hence, take this opportunity to assess sick patients. Initially, you may find it very overwhelming but with time, you will get used to it and will learn how to prioritize jobs ( Sick patients on AMU vs an urgent discharge summary vs a nurse asking you to prescribe pain relief).
As a GP when you start in your surgery/practice, you will see a few really sick patients who have walked into your surgery/ when doing home assessments and you will have to do a quick assessment, along with calling 999 ASAP. So learn your ABCDE approach, participate actively in CRASH calls and also try to lead a few when you are confident enough.
FOR IMT TRAINEES/ST1 TRAINEES:
For IMT trainees, unfortunately on calls will become your bread and butter ( unless you decide to do dermatology as specialty training). Get used to these on calls as much as possible. Work on ambulatory care unit (part of AMU- like a clinic where patients who are well enough to not be seen in ED or admitted to AMU) because in IMT year 3 ( and then subsequently specialty training), you will be expected to review potential discharges and ambulatory care teaches you just that - ie which patients meet the ambulatory care pathway, how consultants manage such cases and what the different pathways are ( ie DVT pathway, cellulitis pathway, etc).
Try to go to ED RESUS and assess patients under supervision of your registrars. You will become confident and once you are a few months into your training, you will have to manage them independently ( the registrar on nights may be busy with another sick patient on the ward). Hence, do not shy way from ED resus.
When there are no patients on AMU to clerk, you may have to clerk patients who have been referred to medicine in ED. Get used to seeing patients there. The computer systems in ED may be slightly different. You will also become friends with your fellow SHOs in ED who will later be your fellow registrars - and trust me, the ED registrar is a very useful person to be friends with. They can manage any acute issue and are an excellent guide.
Also volunteer to see a sick patient on the ward if the take is not too busy (of course, clerking is a priority for you to expedite post taking by consultants ). This way, you will learn how to manage complex patients who have been inpatients for ages. You will also get to know the ITU team this way. The ITU nurses and registrars are amazing people and like the ED team, they are always willing to help.
Do not hesitate to discuss DNARs with elderly patients. You can observe your colleagues/seniors doing this and can also attend local DNAR discussion workshops in your trust but you will not learn till you do it yourself. Remember, ask your consultant/ registrar to supervise you when you have this discussion for the first time so that you can get feedback.
Personally, I observed a few DNAR discussions in my non training post, then started doing them under supervision, got feedback, attended a few DNAR discussion workshops as well, saw videos and then started doing this independently.
Remember, you need to very careful in your wording and it is best NOT to do it if you are not comfortable.
SERVICE PROVISION
You will hear this term a lot "It does not matter whether you are a trainee or not. You are just providing a service". So you might ask yourself : what is service provision?
It is basically providing the best care possible to patients. Be it doing discharge summaries, expediting discharges by doing post take ward round jobs. Either way, you learn. Even by doing a discharge summary, you learn a lot.
Because when you do a discharge summary, you go through a patients notes. You see how your colleagues have clerked a patient, how good their documentation was, what the consultants management plan was and at what point was the patient deemed fit for discharge.
Also, take this opportunity to go through the patients investigations - CXR, CTPA, ECGs, ABGs, etc and learn how to interpret them without looking at the report. This takes a few minutes and soon, you will master the basics of the usual investigations performed in medicine. This will help you a lot in the long run.
When you are asked to go on the post take ward round, rather than thinking that you are "just a scribe", ask the consultant to explain what his thinking is behind the management of this patient. Discuss your management plan with him/her. This way, you will learn a lot.
Take every opportunity as a learning opportunity - even if you are just a scribe or a "doctor at a computer doing discharge summaries the whole day".
ASSESSMENTS:
As mentioned above, start working on your portfolio early.
When you have clerked 5 or more patients, ask the post take consultant to do an ACAT for you. Also send a CBD for any discussions about a case you have had with a consultant. Of course, tell them beforehand that you would like to do an ACAT/CBD/mini-CEX with them.
These are the assessments you can do on the ward:
MSF- a feedback form which can be send to anyone from ward clerks to consultants
Mini-CEX - Ask your consultant/registrar to observe you examine a patient , supervise a discussion (ie breaking bad news, DNAR discussion, best interest meeting, etc)
CBD- Discuss a case with your registrar/consultant.
DOPS- Ask your consultant/registrar to observe you doing a procedure.
I have explained these in more detail here:
http://omarsguidelines.blogspot.com/2017/03/maintaining-your-e-portfolio.html
EXAMS:
My guideline for MRCP 2
http://omarsguidelines.blogspot.co.uk/2017/01/my-guideline-for-mrcp-2.html
My guideline for MRCP PACES - Passed in the second attempt. June, 2019: https://omarsguidelines.blogspot.com/2019/06/my-experience-of-mrcp-paces-passed-in.html
How to pull yourself up when you fail:
https://omarsguidelines.blogspot.com/2018/12/how-to-pull-yourself-up-when-you-fail.html
USING YOUR STUDY BUDGET:
You will have a reasonable study budget and study days.
There are 2 types of study leave:
1. Mandatory training
2. Private study
For both of these, inform your rota team ASAP when you get the session dates. They can easily make necessary arrangements. However sometimes, they cannot grant you leave on some mandatory training days. In this case, contact the deanery admin team who sent the dates to you and they will give an alternate date ( for CMT, the same mandatory training day is held twice for this very reason as not all trainees can attend the same day due to on call commitments and minimal staffing on the ward). Usually, the rota team needs a study leave form immediately for proof therefore do this immediately ( A helpful tip I learnt was to keep pre-filled forms in your hospital computer making it easier to fill out- all you have to do is fill out the dates of your study leave)
You will have to attend mandatory training days in different parts of the deanery. You may think that these sessions are a complete waste of time however you get to network with other trainees, get to meet the program directors of your training program and get to visit new hospitals and definitely learn something new.
If you use the train, you can get a reimbursement of travel expenses by sending the ticket receipt to your study officer and filling in a travel expenses form. You can also use it to claim for fuel if you drive( and parking- remember to keep your parking ticket as you will need to scan it and send it to the study leave officer). You must do this as soon as you have attended the training day.
You will also be provided study budget for courses which are essential for your training like ALS re-certification courses.
Some trusts provide reimbursement of travel/fuel/accommodation for privately attended courses but this is up to the program director. Some deaneries have very clear rules on their websites. If you are unsure, please ask your study officer and they will clarify everything for you.
ANNUAL LEAVES:
ROTA
PAY
RELOCATION.
LOCUMS:
I hope this blog post helps the new trainees starting from August.
1. GP training
2. IMT
3. ACCS
This post is ONLY relevant for GPST1s and other trainees who will be working in medicine and its allied specialties.
This post is ONLY relevant for GPST1s and other trainees who will be working in medicine and its allied specialties.
Here are some tips:
PORTFOLIO:
Get used to your portfolio from day 1.
Here is what you should do:
1. Pay for it ASAP ( You will be sent an email a few weeks/days before your post starts).
2. Open the different forms and see what they mean.
I have made a guideline on it here:
http://omarsguidelines.blogspot.com/2017/03/maintaining-your-e-portfolio.html
3. You will have access to online tutorials of whatever e-portolfio you get so use this opportunity to learn about the features.
4. You will be explained about your portfolio in detail in your induction as well. However, try to familiarize yourself with it before that so that you can ask questions or confusions you have.
5. Send assessments to people you know will give positive comments. These can be any health care assistant from HCAs to consultants.
6. Send assessments for ACATs to consultants who have post taked your patient you have clerked when you are on call (you need to see at least 5 patients to send an ACAT).
7. Send assessments for CBD, mini-CEX to your consultants and registrars ( registrars are very helpful especially during night shifts as they may have time to discuss your case with you and you can send them an assessment).
8. Reflect! Do reflections on
- Any interesting cases you have seen
- Clinics you have attended
- A new clinical experience: your first LP for example, teaching your colleague on how to do a LP.
- Teaching you have done
- Teaching you have attended
- Leadership : leading a CRASH call, managing a sick patient and delegating tasks.
Do this on the day you see these cases/do the procedures/attend teaching sessions as you will have everything fresh in your mind.
9. Make it a habit of opening your portfolio everyday and using it- for reflections, sending assessments, etc. This way, it will become a part of your daily routine.
ON CALLS:
FOR GP TRAINEES:
Unfortunately, GP trainees have to do on calls. Which means that they will either cover wards or clerk patients ( in hours and out of hours).
Some GP trainees have chosen GP training for this very purpose- to avoid the stressful on calls however unfortunately it is part of their training in their first 2 years .
You will be expected to cover AMU, surgery and sometimes, PAEDS.
You will also be rotated into different medical specialties - gastro, renal, endo, respiraotry, cardiology, stroke ( maybe not all of them but some of these) and surgical specialties
Hence, take this opportunity to assess sick patients. Initially, you may find it very overwhelming but with time, you will get used to it and will learn how to prioritize jobs ( Sick patients on AMU vs an urgent discharge summary vs a nurse asking you to prescribe pain relief).
As a GP when you start in your surgery/practice, you will see a few really sick patients who have walked into your surgery/ when doing home assessments and you will have to do a quick assessment, along with calling 999 ASAP. So learn your ABCDE approach, participate actively in CRASH calls and also try to lead a few when you are confident enough.
FOR IMT TRAINEES/ST1 TRAINEES:
For IMT trainees, unfortunately on calls will become your bread and butter ( unless you decide to do dermatology as specialty training). Get used to these on calls as much as possible. Work on ambulatory care unit (part of AMU- like a clinic where patients who are well enough to not be seen in ED or admitted to AMU) because in IMT year 3 ( and then subsequently specialty training), you will be expected to review potential discharges and ambulatory care teaches you just that - ie which patients meet the ambulatory care pathway, how consultants manage such cases and what the different pathways are ( ie DVT pathway, cellulitis pathway, etc).
Try to go to ED RESUS and assess patients under supervision of your registrars. You will become confident and once you are a few months into your training, you will have to manage them independently ( the registrar on nights may be busy with another sick patient on the ward). Hence, do not shy way from ED resus.
When there are no patients on AMU to clerk, you may have to clerk patients who have been referred to medicine in ED. Get used to seeing patients there. The computer systems in ED may be slightly different. You will also become friends with your fellow SHOs in ED who will later be your fellow registrars - and trust me, the ED registrar is a very useful person to be friends with. They can manage any acute issue and are an excellent guide.
Also volunteer to see a sick patient on the ward if the take is not too busy (of course, clerking is a priority for you to expedite post taking by consultants ). This way, you will learn how to manage complex patients who have been inpatients for ages. You will also get to know the ITU team this way. The ITU nurses and registrars are amazing people and like the ED team, they are always willing to help.
Do not hesitate to discuss DNARs with elderly patients. You can observe your colleagues/seniors doing this and can also attend local DNAR discussion workshops in your trust but you will not learn till you do it yourself. Remember, ask your consultant/ registrar to supervise you when you have this discussion for the first time so that you can get feedback.
Personally, I observed a few DNAR discussions in my non training post, then started doing them under supervision, got feedback, attended a few DNAR discussion workshops as well, saw videos and then started doing this independently.
Remember, you need to very careful in your wording and it is best NOT to do it if you are not comfortable.
SERVICE PROVISION
You will hear this term a lot "It does not matter whether you are a trainee or not. You are just providing a service". So you might ask yourself : what is service provision?
It is basically providing the best care possible to patients. Be it doing discharge summaries, expediting discharges by doing post take ward round jobs. Either way, you learn. Even by doing a discharge summary, you learn a lot.
Because when you do a discharge summary, you go through a patients notes. You see how your colleagues have clerked a patient, how good their documentation was, what the consultants management plan was and at what point was the patient deemed fit for discharge.
Also, take this opportunity to go through the patients investigations - CXR, CTPA, ECGs, ABGs, etc and learn how to interpret them without looking at the report. This takes a few minutes and soon, you will master the basics of the usual investigations performed in medicine. This will help you a lot in the long run.
When you are asked to go on the post take ward round, rather than thinking that you are "just a scribe", ask the consultant to explain what his thinking is behind the management of this patient. Discuss your management plan with him/her. This way, you will learn a lot.
Take every opportunity as a learning opportunity - even if you are just a scribe or a "doctor at a computer doing discharge summaries the whole day".
ASSESSMENTS:
As mentioned above, start working on your portfolio early.
When you have clerked 5 or more patients, ask the post take consultant to do an ACAT for you. Also send a CBD for any discussions about a case you have had with a consultant. Of course, tell them beforehand that you would like to do an ACAT/CBD/mini-CEX with them.
These are the assessments you can do on the ward:
MSF- a feedback form which can be send to anyone from ward clerks to consultants
Mini-CEX - Ask your consultant/registrar to observe you examine a patient , supervise a discussion (ie breaking bad news, DNAR discussion, best interest meeting, etc)
CBD- Discuss a case with your registrar/consultant.
DOPS- Ask your consultant/registrar to observe you doing a procedure.
I have explained these in more detail here:
http://omarsguidelines.blogspot.com/2017/03/maintaining-your-e-portfolio.html
EXAMS:
This is more relevant to IMT and ACCS trainees.
Please try to get your MRCP exams out of the way as soon as possible. My advice would be to go for MRCP 1 in January ( you will have enough time to settle into the system as well), part 2 in July and PACES the following year in the third diet ( ie September to December).
Try to avoid long gaps as the knowledge of part 1 is used in part 2 and the knowledge gained from both part 1 and 2 is used in PACES - although that is more of a clinical exam.
It is not difficult to study for these exams whilst working as it is all clinically relevant. I have posted some useful guidelines here for all 3 exams:
How to study while working in the NHS
http://omarsguidelines.blogspot.co.uk/2018/02/how-to-study-while-working-nhs.html
Please try to get your MRCP exams out of the way as soon as possible. My advice would be to go for MRCP 1 in January ( you will have enough time to settle into the system as well), part 2 in July and PACES the following year in the third diet ( ie September to December).
Try to avoid long gaps as the knowledge of part 1 is used in part 2 and the knowledge gained from both part 1 and 2 is used in PACES - although that is more of a clinical exam.
It is not difficult to study for these exams whilst working as it is all clinically relevant. I have posted some useful guidelines here for all 3 exams:
How to study while working in the NHS
http://omarsguidelines.blogspot.co.uk/2018/02/how-to-study-while-working-nhs.html
My guideline for MRCP 2
http://omarsguidelines.blogspot.co.uk/2017/01/my-guideline-for-mrcp-2.html
My guideline for MRCP PACES - Passed in the second attempt. June, 2019: https://omarsguidelines.blogspot.com/2019/06/my-experience-of-mrcp-paces-passed-in.html
How to pull yourself up when you fail:
https://omarsguidelines.blogspot.com/2018/12/how-to-pull-yourself-up-when-you-fail.html
USING YOUR STUDY BUDGET:
You will have a reasonable study budget and study days.
There are 2 types of study leave:
1. Mandatory training
2. Private study
For both of these, inform your rota team ASAP when you get the session dates. They can easily make necessary arrangements. However sometimes, they cannot grant you leave on some mandatory training days. In this case, contact the deanery admin team who sent the dates to you and they will give an alternate date ( for CMT, the same mandatory training day is held twice for this very reason as not all trainees can attend the same day due to on call commitments and minimal staffing on the ward). Usually, the rota team needs a study leave form immediately for proof therefore do this immediately ( A helpful tip I learnt was to keep pre-filled forms in your hospital computer making it easier to fill out- all you have to do is fill out the dates of your study leave)
You will have to attend mandatory training days in different parts of the deanery. You may think that these sessions are a complete waste of time however you get to network with other trainees, get to meet the program directors of your training program and get to visit new hospitals and definitely learn something new.
If you use the train, you can get a reimbursement of travel expenses by sending the ticket receipt to your study officer and filling in a travel expenses form. You can also use it to claim for fuel if you drive( and parking- remember to keep your parking ticket as you will need to scan it and send it to the study leave officer). You must do this as soon as you have attended the training day.
You will also be provided study budget for courses which are essential for your training like ALS re-certification courses.
Some trusts provide reimbursement of travel/fuel/accommodation for privately attended courses but this is up to the program director. Some deaneries have very clear rules on their websites. If you are unsure, please ask your study officer and they will clarify everything for you.
ANNUAL LEAVES:
Book your annual leaves as soon as you get your rota. This should be six weeks before your post starts. If you have not received your rota, then contact the medical staffing team ASAP.
Book urgent leaves ( like close weddings in the family) as soon as your job is confirmed in a particular trust by emailing the medical staffing team. This way, they can make the rota so that you are not on call that day and can grant you your annual leaves beforehand before everyone starts taking them.
Book urgent leaves ( like close weddings in the family) as soon as your job is confirmed in a particular trust by emailing the medical staffing team. This way, they can make the rota so that you are not on call that day and can grant you your annual leaves beforehand before everyone starts taking them.
I have explained more about this here:
ROTA
Make sure your rota is compliant as mentioned here:
https://www.bma.org.uk/advice/employment/contracts/junior-doctor-contract/rostering-guidance/roster-checklist
https://www.bma.org.uk/advice/employment/contracts/junior-doctor-contract/rostering-guidance/roster-checklist
PAY
Also, make sure that your pay is in line with the on calls you are doing here by going through this website:
https://www.nhsemployers.org/pay-pensions-and-reward/medical-staff/pay-circulars
https://www.nhsemployers.org/pay-pensions-and-reward/medical-staff/pay-circulars
RELOCATION.
This is explained here:
http://omarsguidelines.blogspot.com/2017/07/my-guideline-on-relocation-when-you.html
http://omarsguidelines.blogspot.com/2017/07/my-guideline-on-relocation-when-you.html
LOCUMS:
Preempt any "financial bombs". For me, I had 2 of these hits:
1. When my baby was born and we had to buy a lot of stuff
2. When I had to apply for my visas
Other financial hits can be:
1. Relocation - sometimes you may not get a fully furnished apartment and may have to buy furniture, white goods, etc.
2. Exams - Failing exams not only affects your morale but also your wallet.
All of these can easily be prevented by calculating costs beforehand.
The official websites explain all about costs and you can easily calculate this.
I did loads of locums and not only did I learn, but I started to really enjoy my time on AMU. I enjoyed it so much that I have taken up a training post in Acute Internal Medicine in ST3. It has given me a wide experience - procedures, managing sick patients, preempting discharge plans and most importantly, I have always had a financial cushion and despite having 2 dependents ( who needed visas twice during my core medical training- when my wife's previous visa expired, when my baby was born and then when we all applied for visa extensions when I got my ST3 post).
So do not shy away from taking extra shifts once you are well settled. Remember- you need at least a day off per week and if you are smart, you can take annual leaves around bank holidays giving you longer long weekends and bank holidays to take up extra shifts.
APPLYING FOR SPECIALTY TRAINING
Whilst working as a trainee SHO, you will get a lot of opportunities to polish your CV to apply for specialty training posts. Your supervisor will support you and ensure that you get leaves to attend courses. So make the maximum use of your training post by ensuring that you have the perfect portfolio for specialty training.
If you want to specialize in cardiology, make sure you attend ECHO courses, if you do not get to rotate in a cardiology rotation, request your supervisor/ program director/college tutor to ensure you are rotated in it. You can also go to the cath lab in your free time to see procedures. The cardiology consultants will start noticing you and will help you polish your CV further. Also, do QIPs and poster presentations, attend conferences, arrange teaching. All of this is easily possible with the support of your supervisors. All you have to do is ask and show interest.
ARCP:
1. When my baby was born and we had to buy a lot of stuff
2. When I had to apply for my visas
Other financial hits can be:
1. Relocation - sometimes you may not get a fully furnished apartment and may have to buy furniture, white goods, etc.
2. Exams - Failing exams not only affects your morale but also your wallet.
All of these can easily be prevented by calculating costs beforehand.
The official websites explain all about costs and you can easily calculate this.
I did loads of locums and not only did I learn, but I started to really enjoy my time on AMU. I enjoyed it so much that I have taken up a training post in Acute Internal Medicine in ST3. It has given me a wide experience - procedures, managing sick patients, preempting discharge plans and most importantly, I have always had a financial cushion and despite having 2 dependents ( who needed visas twice during my core medical training- when my wife's previous visa expired, when my baby was born and then when we all applied for visa extensions when I got my ST3 post).
So do not shy away from taking extra shifts once you are well settled. Remember- you need at least a day off per week and if you are smart, you can take annual leaves around bank holidays giving you longer long weekends and bank holidays to take up extra shifts.
APPLYING FOR SPECIALTY TRAINING
Whilst working as a trainee SHO, you will get a lot of opportunities to polish your CV to apply for specialty training posts. Your supervisor will support you and ensure that you get leaves to attend courses. So make the maximum use of your training post by ensuring that you have the perfect portfolio for specialty training.
If you want to specialize in cardiology, make sure you attend ECHO courses, if you do not get to rotate in a cardiology rotation, request your supervisor/ program director/college tutor to ensure you are rotated in it. You can also go to the cath lab in your free time to see procedures. The cardiology consultants will start noticing you and will help you polish your CV further. Also, do QIPs and poster presentations, attend conferences, arrange teaching. All of this is easily possible with the support of your supervisors. All you have to do is ask and show interest.
ARCP:
This is discussed here:
http://omarsguidelines.blogspot.com/2018/06/arcp-in-core-medical-training.html
This is an annual review of your e portfolio to ensure that you, as a trainee are progressing well. they check everything against a certain criteria which is clearly mentioned here:
https://www.jrcptb.org.uk/training-certification/arcp-decision-aids
This is all self explanatory and there is no reason why you should not get an outcome 1 ( ie that you are progressing well and have no concerns).
THE DIFFERENCE BETWEEN TRAINING AND NON TRAINING POSTS:
http://omarsguidelines.blogspot.com/2018/06/arcp-in-core-medical-training.html
This is an annual review of your e portfolio to ensure that you, as a trainee are progressing well. they check everything against a certain criteria which is clearly mentioned here:
https://www.jrcptb.org.uk/training-certification/arcp-decision-aids
This is all self explanatory and there is no reason why you should not get an outcome 1 ( ie that you are progressing well and have no concerns).
THE DIFFERENCE BETWEEN TRAINING AND NON TRAINING POSTS:
This all depends on the trust you are working in. In the trusts I have worked in, trainees and non trainees are treated equally especially since a lot of British Medical Graduates who were actually foundation trainees work as FY3/Trust grade doctors in the same trust.
You might wonder why people do not wish to do training posts ( and hence more vacancies for IMGs). It is mainly the stress of maintaining an e portfolio, training, giving exams, going through the ARCP annually. However with proper planning, this can easily be overcome.
However as an IMG, you will notice that your training is more structured ( ie you have a proper induction), you have a clinical supervisor who is there to help you and encourage you, you have access to various training sessions ( like simulation sessions) and you feel more well supported.
You might wonder why people do not wish to do training posts ( and hence more vacancies for IMGs). It is mainly the stress of maintaining an e portfolio, training, giving exams, going through the ARCP annually. However with proper planning, this can easily be overcome.
However as an IMG, you will notice that your training is more structured ( ie you have a proper induction), you have a clinical supervisor who is there to help you and encourage you, you have access to various training sessions ( like simulation sessions) and you feel more well supported.
I hope this blog post helps the new trainees starting from August.
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