My 4th year in the NHS
I came to the UK in January 2016 as a non trainee SHO and worked at Wexham Park Hospital , Slough till July, 2017.
I then joined Harrogate District Hospital in August, 2017 as a core medical trainee year one ( which is now replaced by internal medical training) and worked there till July, 2018.
I moved to York District Hospital and worked there till July, 2019 as a core medical trainee year 2.
I am now working as a ST3 trainee registrar in Acute Internal Medicine since August, 2019.
I have spent 4 years in the UK now and I am now working in the 4th trust. I would like to discuss the different aspects of what I have learnt so far:
CAREER PROGRESSION FROM A NON TRAINEE TO A TRAINEE
I spent 18 months as a non trainee SHO. This was the best decision I have made so far!
1. I had plenty of time to get used to how the NHS system worked
2. I had plenty of time to get used to on calls- I started my first on call shifts after 6 months after a few weeks of shadowing.
3. I started familiarizing myself with the NHS e portfolio and was not rushed for time ( ie ARCPs, etc) and took a good one year to utilize it.
4. I had time to prepare for my MRCP 2 exam and gave it during my non training post. I did not have any training needs to meet hence had plenty of time to focus my time on my exam, which I gave 9 months into my post.
5. I felt prepared to tackle on calls, e portfolio needs, training needs by one year into my post and then decided to apply for core medical training.
SUPPORT:
I have been supported throughout my career in the NHS. On the very first day in my non training post, my supervisor who was also the college tutor said this to me:
'From today, you are not a foreign medical graduate or a non trainee. You are part of our team. You are family now. And we will take care of you'
This was very reassuring given that this was my first job in the NHS. I did not let my supervisor down either. I worked hard and when I started my on calls, I tried my best to learn as much as possible.
I filled out my portfolio on a regular basis and by the end of my placement, my portfolio had more reflections, links to the curriculum, assessments and MSFs than my trainee colleagues.
I also started an IMG representative programme in my trust with the support of my college tutor and other colleagues to support new IMG doctors.
I feel her reassurance helped me gain a lot of confidence.
I received similar support in my CMT 1 post - I still remember how my respiratory consultant stayed till 1800 just to supervise me insert a chest drain and then signed me off for it. She went the extra mile to support me with projects ( like introducing a new e-handover system) by putting me in touch with the relevant people.
I received similar support in my CMT 2 post - my renal consultant left everything to help me pass a Tessio line for a dialysis patient after I attended a simulation session arranged by her.
Then when I decided to apply for acute internal medicine, my consultants in AMU gave me a lot of tips and one even sat with me and practiced interview questions.
FINANCES
I have 2 dependents now. I came to the UK with my wife and now have a 20 month old daughter. I never struggled as a SHO and as a registrar, it is even more easy.
I always tried to do locums wherever possible. I book my annual leaves in advance ( usually before I actually start at the trust as soon as I can see the rota - which is in mid June for training posts starting in August) and plan them so that I get loads of long weekends. This way, even if I have to locum 2 days a week, I still get a day or 2 off.
I have been doing this since I was a non trainee SHO - I saved a considerable amount this way.
However I did feel a bit stressed when I had to apply for a visa extension for all 3 of us as a CT2 trainee, I had yet to pass my PACES and I had accepted a ST3 post in acute internal medicine. I did loads of locums but I had the stress of my PACES exam ( I passed it in that session after one failed attempt).
Overall, the locums helped me not only financially but as I did so many on calls, I was able to become more confident in managing unwell patients and was practically working as a registrar in my core medical 2 training post ( but of course, under supervision of a proper registrar).
I would suggest to all IMGs to do locums whenever possible ONCE they are well settled in the NHS but they need to smart about it and not burn themselves out (by pre-planning annual leaves, etc).
ACADEMICS
I have seen a variety of clinical cases in the past 4 years and thanks to the loads of regular and extra on calls I have done, I do feel that I have learnt a lot. I have yet to learn a lot more but I do not feel I have been 'stagnant' and just managing UTIs and CAPs
I worked in rheumatology, cardiology and elderly medicine as a non trainee, respiratory, stroke and elderly as CT1 , renal, gastro and neurology in CT2 and now I am rotating in respiratory medicine as a ST3 trainee.
All of these rotations have given me a lot of knowledge but you can never stop learning. I heard a very interesting quote by one of the programme directors for our core training program:
'At the end of the day, ask yourself this question: What 3 new things did you learn today. Then reflect upon them. You will never stop learning and will not feel stagnant in anyway'
BULLYING:
There are a lot of reasons behind struggling but one of the reasons can be bullying. Unfortunately, not a lot of people are aware of systems which have been put in place to speak up. One such system is "Freedom to Speak up". This is what this is about: https://improvement.nhs.uk/resources/freedom-to-speak-up-whistleblowing-policy-for-the-nhs/ Read about it in detail. Find out who your Freedom to Speak up Guardian is (Talk to your HR if you do not know). If you have any concerns, raise them with that Guardian so that the bully is fed back about what (s)he has done (anonymously). People who can support you are: 1. Your supervisor 2. Your colleagues ( The doctors mess is an amazing place to vent out- just be careful whom you vent out to. That SHO may be in a relationship with the consultant/registrar you are moaning about :P ) 3. Freedom to speak up Guardian 4. Chief registrar (if your trust has one). 5. Occupational health if you feel you are going through a lot of stress - they can direct you to the right professionals if you need any help. Also ask HR - usually they inform the new doctors about whom to contact in induction. They can be very supportive in directing you to the right people. Other helpful links: https://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/tackling-bullying-in-the-nhs https://www.nhs.uk/conditions/stress-anxiety-depression/bullying-at-work/ https://bmjopen.bmj.com/content/3/6/e002628
There is no denying that bullying exists ( and hence these aforementioned systems have been introduced) however also be careful in deciding when to report someone.
Ie, A consultant who passed a racial remark is unacceptable and should be raised.
A consultant who said ' sorry I am busy and cannot help at the moment. Please ask your registrar' does not need to be reported.
Abusing such a system can also backfire however please DO NOT suffer in silence if you feel bullied. I am happy to be contacted via Facebook Messenger if you are not sure about something and want to talk about it:
https://www.facebook.com/omar.ay.37
REPORTING:
No doctor is safe from this. We all need to be vigilant. One of my consultants told me how another consultant colleague had to step down from his role as clinical director when a foundation trainee mentioned how he passed racist remarks on the GMC trainees survey on that department. When the GMC delved into this, it was found that other doctors, nurses and other consultant colleagues had also reported him. When you do something wrong, you will be caught. And everyone is watching. So stay vigilant. This consultant in question was a British Consultant- no one is above the law here.
However also be careful when you report someone. A fellow IMG took screenshots of another IMGs comments on a post and then emailed that to the latters director. The director actually supported the IMG and dismissed the whole case. This could have gone the wrong way and the IMG reporting this could have been in trouble for unnecessarily defaming the other IMG.
Also, we all have indemnity insurance and also legal advisers hence we should all be 100% sure before we report anyone.
MENTAL WELL-BEING
This is not just a 'snowflakey' thing. This is an actual issue! And needs to be addressed ASAP!. I have seen IMGs suffer more especially if they are alone here. We as IMGs are very close to our families and when we come here, it can become very depressing - more during winter and when it is wet and windy.
There are different methods to cope:
The pursuit of happiness for an IMG in the UK: http://omarsguidelines.blogspot.co.uk/2017/11/the-pursuit-of-happiness-in-uk-for-img.html
My advice to doctors who worry unnecessarily: http://omarsguidelines.blogspot.co.uk/2017/12/my-advice-to-doctors-who-get-nervous.html
But if you are feeling stressed, depressed and burnt out, you need extra help. And there are amazing ways of getting support:
1. Your supervisor
2. Your deanery - they have special support systems. Talk to the deanery administrator.
3. Occupational health - they can even adjust on calls by talking to the rota team.
4. Your GP - who can involve the appropriate mental health services.
5. This is an amazing group:
https://www.facebook.com/groups/1215686978446877/
Read the files section of this group which has loads of information and support teams.
As colleagues, it is very important for us to recognize if anyone is going through this and get them the right support. We need to act at the right time and as early as possible. This should not be ignored. Someone going through this may not be in a state to ask for help and hence we, as colleagues play a very important role in this. So talk to people, especially the quiet one sitting in the corner.
MY JOB:
I work in the least popular field in the least popular deanery but I absolutely love it.
This is why I love acute medicine:
1. I cannot do clinics. I just cannot! I attended loads during my SHO posts and I did not enjoy any of them.
2. I love the acute management of unwell patients - starting them on NIV, liaising with ITU and the whole 'excitement'
3. I love doing procedures - chest drains, LPs, ascitic drains and I am very keen to get a good hands-on experience on ultrasound ( when I become an AMU consultant, I will want to have my own USS machine on which I can teach and train junior doctors on doing everything from USS guided cannulas to doing FAST scans ( With appropriate accreditation and approval, of course).
4. I love ambulatory care- which is same day emergency care service provided by the AMU team. I love how we can diagnose, treat and discharge medical conditions the same day.
5. I do not like how specialty registrars sometimes have to fight to get their portfolio needs met. Ie, a minimum number of scopes a gastro registrar has to do in that one year placement and has to juggle managing unwell patients on the ward, colleagues ( like new consultants, ACPs, endoscopy nurses who also need experience) , clinic commitments and annual/study leaves. I have seen how some registrars became stressed and some even had to take time off. This, however does not exist everywhere and is a very personal opinion ( I have seen some gastro units going out of the way to support trainee registrars and even SHOs who are interested in gastro)
In acute medicine, we have be signed off for all the basic things expected from a trainee SHO so that is not difficult to achieve.
6. I enjoy working with the amazing nurses on AMU - they are the most skilled nurses in medicine, apart from CCU/ other specialist nurses and it makes working with them a dream.
7. I love how acute medicine is now the front line for everything and how every trust is trying different ways to develop this. I feel acute medicine is the future of medicine in the NHS.
8. There are loads of opportunities available for acute medical consultants - the trusts are desperate to hire more AMU consultants hence offer some excellent perks - like 2 days a week on AMU, one ambulatory care shift and 2 days off per week. They can also get time to develop their skills and get involved in management ( like running the acute service of the trust at a directorate level).
Acute medicine is not for everyone however I am thoroughly enjoying it. I would love to develop USS skills and get involved with management as well as a consultant.
MY DEANERY:
I work in York and Humber. I did my core training from here and absolutely loved it. Everyone is friendly, housing is reasonably priced and Yorkshire is beautiful!
I worked near London as a non trainee and although a big city has its own charm, I could not imagine myself settling there.
I am in love with York - which was recently voted the happiest city in the UK! It has everything from history to modern architecture with a very good night life.
This is a very safe, clean and friendly place to live and raise your family.
MY ROLE AS ASSOCIATE COLLEGE TUTOR
I am passionate about helping my colleagues and I immediately took up an offer for associate college tutor in my trust. The role for ACT is explained here:
https://www.rcplondon.ac.uk/rcp-college-and-associate-college-tutors
I support the IMT trainees to ensure they get their training needs met. Through this post, I met an education fellow who then got me involved in simulation training. Now, I am part of the faculty for simulation course for IMT trainees and I have helped design the script with actors and consultants. This was a completely different experience and I really enjoyed it. This has also made me think that I am not just a registrar and I can be involved in so many projects to improve the curriculum.
MANAGEMENT
I have developed a lot of interest in the managerial side of the NHS. I attend meetings on a regular basis, feedback any concerns from trainees to managers and help improve patient flow giving suggestions. And they actually listen to me! They need more suggestions from people who work on the frontline to improve their services. If we, as doctors do not feed back our issues to the management, they will not be able to improve things for us.
I worked with the directorate over Christmas to ensure we were well staffed and had very good patient flow with more discharges than admissions.
We, as doctors do not understand how hard the management works and it is a shame we do not get to feed back to them to make things better for patients and our colleagues. My plan is to develop more managerial skills and pass them down to my junior colleagues so that we can improve the NHS together.
REMEMBERING OUR LIMITATIONS AND OUR COLLEAGUES LIMITATIONS:
I was introduced to a new IMG registrar who had 8 years of experience from his home country ( post MRCP) . He was to start as a non trainee registrar in my trust and I volunteered to help him settle. He had amazing knowledge but of course , needed time to understand the "logistics" of the NHS. The rota team then put him on the on call registrar rota 6 weeks from the day he started. He was supposed to shadow registrars till then. He was very stressed and ended up shadowing the on call registrar out of hours and was exhausted by the end of it. When I found out , I immediately emailed the management , his supervising consultant and the rota team and informed them that this is not going to work as he is extremely stressed, he will make mistakes as he is not used to the system and then we will have a major problem. He , too completely agreed with me on all of this. Within a few hours the management then agreed to ask him to work as a SHO for a few weeks , to do on calls as a shadow-doctor ( ie he will be an extra SHO on the rota and will clerk patients under supervision and with help of his colleagues) and once he feels more confident, he will inform the management that he is ready to work as a registrar. He will continue to get paid as he contracted to do so. I just wanted all of my IMG colleagues to be aware of such new doctors and ensure they are fully supported and actually help them voice their concerns. We know how the system works and also know whom to contact. This way we can avoid any mishaps. It is very easy to sit back and then blame it all on someone else when things go wrong however if we all work together, we can make the NHS a safer place not only for patients but for our IMG colleagues as well.
Remember, the rota team and management is sometimes clueless about IMGs and they think they can do fine as a registrar in their trust if they have worked their home countries for a reasonable number of years and it is our duty to ensure that our IMG colleagues are eased into the system rather than thrown into the deep sea.
ROTA COORDINATORS
I am always willing to help. I do not mind being sent to a different ward as I personally do not have any training needs and just need to get used to managing unwell patients and discharging stable patients where appropriate. I am also willing to locum whenever the on calls are understaffed hence the rota team and I get along really well. They allow me urgent leaves where appropriate and I agree to extra shifts if they want a hand. If you have good rota coordinators, everything works smoothly and I have been very lucky to work in trusts where the rota team has been amazing. York Trust has the best rota coordinators so far though - they have a WhatsApp group which has all the doctors and they ask for help whenever there is understaffing/ the clerking shifts are busy. We have always been fully staffed throughout thanks to the active rota team.
MY IMG COLLEAGUES
I know a lot of IMGs who came with me, gave PLAB and got registered. Now they have families and are well settled as specialist registrars. It is amazing to see them mature and get involved in projects which help improve patient care and well being of their colleagues. There are some amazing people out there doing commendable things. My suggestion to all IMGs is to continue working hard and continue helping everyone around you.
AWARDS:
These are the awards I have achieved last year
1. Junior doctors award for compassionate care.
2. Star award on 2 occasions.https://m.facebook.com/story.php?story_fbid=2667888936615306&id=141788145892077
3. Celebration of achievements finalisthttps://www.facebook.com/YorkTeachingNHS/videos/725278654568251/
FAILURE
I then joined Harrogate District Hospital in August, 2017 as a core medical trainee year one ( which is now replaced by internal medical training) and worked there till July, 2018.
I moved to York District Hospital and worked there till July, 2019 as a core medical trainee year 2.
I am now working as a ST3 trainee registrar in Acute Internal Medicine since August, 2019.
I have spent 4 years in the UK now and I am now working in the 4th trust. I would like to discuss the different aspects of what I have learnt so far:
CAREER PROGRESSION FROM A NON TRAINEE TO A TRAINEE
I spent 18 months as a non trainee SHO. This was the best decision I have made so far!
1. I had plenty of time to get used to how the NHS system worked
2. I had plenty of time to get used to on calls- I started my first on call shifts after 6 months after a few weeks of shadowing.
3. I started familiarizing myself with the NHS e portfolio and was not rushed for time ( ie ARCPs, etc) and took a good one year to utilize it.
4. I had time to prepare for my MRCP 2 exam and gave it during my non training post. I did not have any training needs to meet hence had plenty of time to focus my time on my exam, which I gave 9 months into my post.
5. I felt prepared to tackle on calls, e portfolio needs, training needs by one year into my post and then decided to apply for core medical training.
SUPPORT:
I have been supported throughout my career in the NHS. On the very first day in my non training post, my supervisor who was also the college tutor said this to me:
'From today, you are not a foreign medical graduate or a non trainee. You are part of our team. You are family now. And we will take care of you'
This was very reassuring given that this was my first job in the NHS. I did not let my supervisor down either. I worked hard and when I started my on calls, I tried my best to learn as much as possible.
I filled out my portfolio on a regular basis and by the end of my placement, my portfolio had more reflections, links to the curriculum, assessments and MSFs than my trainee colleagues.
I also started an IMG representative programme in my trust with the support of my college tutor and other colleagues to support new IMG doctors.
I feel her reassurance helped me gain a lot of confidence.
I received similar support in my CMT 1 post - I still remember how my respiratory consultant stayed till 1800 just to supervise me insert a chest drain and then signed me off for it. She went the extra mile to support me with projects ( like introducing a new e-handover system) by putting me in touch with the relevant people.
I received similar support in my CMT 2 post - my renal consultant left everything to help me pass a Tessio line for a dialysis patient after I attended a simulation session arranged by her.
Then when I decided to apply for acute internal medicine, my consultants in AMU gave me a lot of tips and one even sat with me and practiced interview questions.
FINANCES
I have 2 dependents now. I came to the UK with my wife and now have a 20 month old daughter. I never struggled as a SHO and as a registrar, it is even more easy.
I always tried to do locums wherever possible. I book my annual leaves in advance ( usually before I actually start at the trust as soon as I can see the rota - which is in mid June for training posts starting in August) and plan them so that I get loads of long weekends. This way, even if I have to locum 2 days a week, I still get a day or 2 off.
I have been doing this since I was a non trainee SHO - I saved a considerable amount this way.
However I did feel a bit stressed when I had to apply for a visa extension for all 3 of us as a CT2 trainee, I had yet to pass my PACES and I had accepted a ST3 post in acute internal medicine. I did loads of locums but I had the stress of my PACES exam ( I passed it in that session after one failed attempt).
Overall, the locums helped me not only financially but as I did so many on calls, I was able to become more confident in managing unwell patients and was practically working as a registrar in my core medical 2 training post ( but of course, under supervision of a proper registrar).
I would suggest to all IMGs to do locums whenever possible ONCE they are well settled in the NHS but they need to smart about it and not burn themselves out (by pre-planning annual leaves, etc).
ACADEMICS
I have seen a variety of clinical cases in the past 4 years and thanks to the loads of regular and extra on calls I have done, I do feel that I have learnt a lot. I have yet to learn a lot more but I do not feel I have been 'stagnant' and just managing UTIs and CAPs
I worked in rheumatology, cardiology and elderly medicine as a non trainee, respiratory, stroke and elderly as CT1 , renal, gastro and neurology in CT2 and now I am rotating in respiratory medicine as a ST3 trainee.
All of these rotations have given me a lot of knowledge but you can never stop learning. I heard a very interesting quote by one of the programme directors for our core training program:
'At the end of the day, ask yourself this question: What 3 new things did you learn today. Then reflect upon them. You will never stop learning and will not feel stagnant in anyway'
BULLYING:
There are a lot of reasons behind struggling but one of the reasons can be bullying. Unfortunately, not a lot of people are aware of systems which have been put in place to speak up. One such system is "Freedom to Speak up". This is what this is about: https://improvement.nhs.uk/resources/freedom-to-speak-up-whistleblowing-policy-for-the-nhs/ Read about it in detail. Find out who your Freedom to Speak up Guardian is (Talk to your HR if you do not know). If you have any concerns, raise them with that Guardian so that the bully is fed back about what (s)he has done (anonymously). People who can support you are: 1. Your supervisor 2. Your colleagues ( The doctors mess is an amazing place to vent out- just be careful whom you vent out to. That SHO may be in a relationship with the consultant/registrar you are moaning about :P ) 3. Freedom to speak up Guardian 4. Chief registrar (if your trust has one). 5. Occupational health if you feel you are going through a lot of stress - they can direct you to the right professionals if you need any help. Also ask HR - usually they inform the new doctors about whom to contact in induction. They can be very supportive in directing you to the right people. Other helpful links: https://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/tackling-bullying-in-the-nhs https://www.nhs.uk/conditions/stress-anxiety-depression/bullying-at-work/ https://bmjopen.bmj.com/content/3/6/e002628
There is no denying that bullying exists ( and hence these aforementioned systems have been introduced) however also be careful in deciding when to report someone.
Ie, A consultant who passed a racial remark is unacceptable and should be raised.
A consultant who said ' sorry I am busy and cannot help at the moment. Please ask your registrar' does not need to be reported.
Abusing such a system can also backfire however please DO NOT suffer in silence if you feel bullied. I am happy to be contacted via Facebook Messenger if you are not sure about something and want to talk about it:
https://www.facebook.com/omar.ay.37
REPORTING:
No doctor is safe from this. We all need to be vigilant. One of my consultants told me how another consultant colleague had to step down from his role as clinical director when a foundation trainee mentioned how he passed racist remarks on the GMC trainees survey on that department. When the GMC delved into this, it was found that other doctors, nurses and other consultant colleagues had also reported him. When you do something wrong, you will be caught. And everyone is watching. So stay vigilant. This consultant in question was a British Consultant- no one is above the law here.
However also be careful when you report someone. A fellow IMG took screenshots of another IMGs comments on a post and then emailed that to the latters director. The director actually supported the IMG and dismissed the whole case. This could have gone the wrong way and the IMG reporting this could have been in trouble for unnecessarily defaming the other IMG.
Also, we all have indemnity insurance and also legal advisers hence we should all be 100% sure before we report anyone.
MENTAL WELL-BEING
This is not just a 'snowflakey' thing. This is an actual issue! And needs to be addressed ASAP!. I have seen IMGs suffer more especially if they are alone here. We as IMGs are very close to our families and when we come here, it can become very depressing - more during winter and when it is wet and windy.
There are different methods to cope:
The pursuit of happiness for an IMG in the UK: http://omarsguidelines.blogspot.co.uk/2017/11/the-pursuit-of-happiness-in-uk-for-img.html
My advice to doctors who worry unnecessarily: http://omarsguidelines.blogspot.co.uk/2017/12/my-advice-to-doctors-who-get-nervous.html
But if you are feeling stressed, depressed and burnt out, you need extra help. And there are amazing ways of getting support:
1. Your supervisor
2. Your deanery - they have special support systems. Talk to the deanery administrator.
3. Occupational health - they can even adjust on calls by talking to the rota team.
4. Your GP - who can involve the appropriate mental health services.
5. This is an amazing group:
https://www.facebook.com/groups/1215686978446877/
Read the files section of this group which has loads of information and support teams.
As colleagues, it is very important for us to recognize if anyone is going through this and get them the right support. We need to act at the right time and as early as possible. This should not be ignored. Someone going through this may not be in a state to ask for help and hence we, as colleagues play a very important role in this. So talk to people, especially the quiet one sitting in the corner.
MY JOB:
I work in the least popular field in the least popular deanery but I absolutely love it.
This is why I love acute medicine:
1. I cannot do clinics. I just cannot! I attended loads during my SHO posts and I did not enjoy any of them.
2. I love the acute management of unwell patients - starting them on NIV, liaising with ITU and the whole 'excitement'
3. I love doing procedures - chest drains, LPs, ascitic drains and I am very keen to get a good hands-on experience on ultrasound ( when I become an AMU consultant, I will want to have my own USS machine on which I can teach and train junior doctors on doing everything from USS guided cannulas to doing FAST scans ( With appropriate accreditation and approval, of course).
4. I love ambulatory care- which is same day emergency care service provided by the AMU team. I love how we can diagnose, treat and discharge medical conditions the same day.
5. I do not like how specialty registrars sometimes have to fight to get their portfolio needs met. Ie, a minimum number of scopes a gastro registrar has to do in that one year placement and has to juggle managing unwell patients on the ward, colleagues ( like new consultants, ACPs, endoscopy nurses who also need experience) , clinic commitments and annual/study leaves. I have seen how some registrars became stressed and some even had to take time off. This, however does not exist everywhere and is a very personal opinion ( I have seen some gastro units going out of the way to support trainee registrars and even SHOs who are interested in gastro)
In acute medicine, we have be signed off for all the basic things expected from a trainee SHO so that is not difficult to achieve.
6. I enjoy working with the amazing nurses on AMU - they are the most skilled nurses in medicine, apart from CCU/ other specialist nurses and it makes working with them a dream.
7. I love how acute medicine is now the front line for everything and how every trust is trying different ways to develop this. I feel acute medicine is the future of medicine in the NHS.
8. There are loads of opportunities available for acute medical consultants - the trusts are desperate to hire more AMU consultants hence offer some excellent perks - like 2 days a week on AMU, one ambulatory care shift and 2 days off per week. They can also get time to develop their skills and get involved in management ( like running the acute service of the trust at a directorate level).
Acute medicine is not for everyone however I am thoroughly enjoying it. I would love to develop USS skills and get involved with management as well as a consultant.
MY DEANERY:
I work in York and Humber. I did my core training from here and absolutely loved it. Everyone is friendly, housing is reasonably priced and Yorkshire is beautiful!
I worked near London as a non trainee and although a big city has its own charm, I could not imagine myself settling there.
I am in love with York - which was recently voted the happiest city in the UK! It has everything from history to modern architecture with a very good night life.
This is a very safe, clean and friendly place to live and raise your family.
MY ROLE AS ASSOCIATE COLLEGE TUTOR
I am passionate about helping my colleagues and I immediately took up an offer for associate college tutor in my trust. The role for ACT is explained here:
https://www.rcplondon.ac.uk/rcp-college-and-associate-college-tutors
I support the IMT trainees to ensure they get their training needs met. Through this post, I met an education fellow who then got me involved in simulation training. Now, I am part of the faculty for simulation course for IMT trainees and I have helped design the script with actors and consultants. This was a completely different experience and I really enjoyed it. This has also made me think that I am not just a registrar and I can be involved in so many projects to improve the curriculum.
MANAGEMENT
I have developed a lot of interest in the managerial side of the NHS. I attend meetings on a regular basis, feedback any concerns from trainees to managers and help improve patient flow giving suggestions. And they actually listen to me! They need more suggestions from people who work on the frontline to improve their services. If we, as doctors do not feed back our issues to the management, they will not be able to improve things for us.
I worked with the directorate over Christmas to ensure we were well staffed and had very good patient flow with more discharges than admissions.
We, as doctors do not understand how hard the management works and it is a shame we do not get to feed back to them to make things better for patients and our colleagues. My plan is to develop more managerial skills and pass them down to my junior colleagues so that we can improve the NHS together.
REMEMBERING OUR LIMITATIONS AND OUR COLLEAGUES LIMITATIONS:
I was introduced to a new IMG registrar who had 8 years of experience from his home country ( post MRCP) . He was to start as a non trainee registrar in my trust and I volunteered to help him settle. He had amazing knowledge but of course , needed time to understand the "logistics" of the NHS. The rota team then put him on the on call registrar rota 6 weeks from the day he started. He was supposed to shadow registrars till then. He was very stressed and ended up shadowing the on call registrar out of hours and was exhausted by the end of it. When I found out , I immediately emailed the management , his supervising consultant and the rota team and informed them that this is not going to work as he is extremely stressed, he will make mistakes as he is not used to the system and then we will have a major problem. He , too completely agreed with me on all of this. Within a few hours the management then agreed to ask him to work as a SHO for a few weeks , to do on calls as a shadow-doctor ( ie he will be an extra SHO on the rota and will clerk patients under supervision and with help of his colleagues) and once he feels more confident, he will inform the management that he is ready to work as a registrar. He will continue to get paid as he contracted to do so. I just wanted all of my IMG colleagues to be aware of such new doctors and ensure they are fully supported and actually help them voice their concerns. We know how the system works and also know whom to contact. This way we can avoid any mishaps. It is very easy to sit back and then blame it all on someone else when things go wrong however if we all work together, we can make the NHS a safer place not only for patients but for our IMG colleagues as well.
Remember, the rota team and management is sometimes clueless about IMGs and they think they can do fine as a registrar in their trust if they have worked their home countries for a reasonable number of years and it is our duty to ensure that our IMG colleagues are eased into the system rather than thrown into the deep sea.
ROTA COORDINATORS
I am always willing to help. I do not mind being sent to a different ward as I personally do not have any training needs and just need to get used to managing unwell patients and discharging stable patients where appropriate. I am also willing to locum whenever the on calls are understaffed hence the rota team and I get along really well. They allow me urgent leaves where appropriate and I agree to extra shifts if they want a hand. If you have good rota coordinators, everything works smoothly and I have been very lucky to work in trusts where the rota team has been amazing. York Trust has the best rota coordinators so far though - they have a WhatsApp group which has all the doctors and they ask for help whenever there is understaffing/ the clerking shifts are busy. We have always been fully staffed throughout thanks to the active rota team.
MY IMG COLLEAGUES
I know a lot of IMGs who came with me, gave PLAB and got registered. Now they have families and are well settled as specialist registrars. It is amazing to see them mature and get involved in projects which help improve patient care and well being of their colleagues. There are some amazing people out there doing commendable things. My suggestion to all IMGs is to continue working hard and continue helping everyone around you.
AWARDS:
These are the awards I have achieved last year
1. Junior doctors award for compassionate care.
2. Star award on 2 occasions.https://m.facebook.com/story.php?story_fbid=2667888936615306&id=141788145892077
3. Celebration of achievements finalisthttps://www.facebook.com/YorkTeachingNHS/videos/725278654568251/
Please note that I'm a foreign doctor working in the NHS, just like any IMG.
Work hard and never ever give up!
Work hard and never ever give up!
FAMILY:
I have a lovely family and my daughter is growing up fast! I try my best to spend as much time with her as possible. I get to spend at least 4 hours with her after I come back from work on weekdays and then when I am off on weekends/annual leaves. As you can see, I have plenty of time off:
https://omarsguidelines.blogspot.com/2019/07/my-st3-post-in-acute-medicine.html
I personally feel I get to spend more time with my family here than I would had I been back home ( where after the usual job in a government hospital, trainee doctors do clinics in the evening which can go upto midnight).
I also feel that we as parents give her undivided attention as we do not have any external people interfering in our lives. It becomes lonely though but my wife takes my daughter to baby groups on a regular basis.
https://omarsguidelines.blogspot.com/2019/07/my-st3-post-in-acute-medicine.html
I personally feel I get to spend more time with my family here than I would had I been back home ( where after the usual job in a government hospital, trainee doctors do clinics in the evening which can go upto midnight).
I also feel that we as parents give her undivided attention as we do not have any external people interfering in our lives. It becomes lonely though but my wife takes my daughter to baby groups on a regular basis.
MAKING THINGS BETTER:
I always believe in problem solving- be it at home or at work. Identify a problem, work towards a reasonable solution, involve the right people and get the job done!
At work, I turn my problems into QIPs. Here is a list of a few QIPs I am working on with IMT trainees:
1. Management of hypophosphataemia ( I realized that we did not have a proper guideline for management of hypophosphataemia in my trust- so I am doing a QIP and once I have presented this, we will introduce a new management guideline and then repeat the cycle).
2. Management of electrolytes in VT/VF - As a medical registrar on call, I saw a few patients with low electrolytes which had not been replaced. Hence I decided to make a QIP out of it.
3. Countersigning for DNACPR forms by consultants where appropriate. I saw quite a few patients with DNACPR forms which were signed by SHOs/registrars but not by consultants. Hence I am doing a QIP on this and I will also do a teaching session on how to discuss DNACPR when I present my findings.
I try to channel my frustrations into positive ideas ( ie QIPs)
At work, I turn my problems into QIPs. Here is a list of a few QIPs I am working on with IMT trainees:
1. Management of hypophosphataemia ( I realized that we did not have a proper guideline for management of hypophosphataemia in my trust- so I am doing a QIP and once I have presented this, we will introduce a new management guideline and then repeat the cycle).
2. Management of electrolytes in VT/VF - As a medical registrar on call, I saw a few patients with low electrolytes which had not been replaced. Hence I decided to make a QIP out of it.
3. Countersigning for DNACPR forms by consultants where appropriate. I saw quite a few patients with DNACPR forms which were signed by SHOs/registrars but not by consultants. Hence I am doing a QIP on this and I will also do a teaching session on how to discuss DNACPR when I present my findings.
I try to channel my frustrations into positive ideas ( ie QIPs)
FAILURE
We all fail at some point:
https://omarsguidelines.blogspot.com/2018/12/how-to-pull-yourself-up-when-you-fail.html
https://omarsguidelines.blogspot.com/2018/12/how-to-pull-yourself-up-when-you-fail.html
I failed my PACES exam, yes it was stressful but it helped me how to stand up when I fall down. It is natural to feel upset after failing but it is important that we pull ourselves up. Do not give up!
LIFESTYLE :
Overall, I feel I have got a reasonable lifestyle here. I can afford to buy nice clothes, etc and can afford a holiday every few months. I have a nice car which I never thought I could get ( Although, I got it at a bargain price- https://omarsguidelines.blogspot.com/2019/09/my-experience-of-buying-car-on-pcp-deal.html ). I get a decent take home pay and if supplemented with locums and cremation forms, it is more than enough and I get to save quite a reasonable amount.
I have a nice social group at work however we do not socialize that much on weekends- we prefer to focus our time and energy on our baby and enjoy among ourselves. But I have no regrets.
I have a nice social group at work however we do not socialize that much on weekends- we prefer to focus our time and energy on our baby and enjoy among ourselves. But I have no regrets.
MY FUTURE PLANS :
I am planning to join a flying school once I have more time and get a pilots license. I would also love to get a Jaguar F type ( but I may hold it as my daughter will not be able to enjoy it as it only has 2 seats and she will not be able to sit in it till she is older. Plus I need to save up for the ILR ( which is not cheap as you can see here: https://www.gov.uk/government/publications/visa-regulations-revised-table/home-office-immigration-and-nationality-fees-29-march-2019 ). I would also love to get an old classic ( Alfa Romeos are my weakness) and spend my weekends in a garage. Again, maybe this is something to think of later, maybe post retirement.
Overall, I have thoroughly enjoyed my 4 years in the NHS. I have gained a lot and I have a lot to learn.
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