Dr. Kapugama’s Journey from MTI to ST training in Psychiatry.

In this Blog post, Dr. Kapugama kindly shares her impressive journey of career progression from MTI (Medical Training Initiative) to Specialist Training (ST).

I have been kindly invited by Dr. Ahmed to write something about my career progression in the United Kingdom to the Psychiatry-Training blog website. I am glad to be given an opportunity to do this and look back at the past four years of my life.


I am originally from Sri Lanka and obtained my undergraduate degree (MBBS) from the University of Colombo. I entered post-graduate training in psychiatry, almost immediately as it has been my area of interest since medical school. I then completed four years of training and completed my postgraduate examinations (MD Psychiatry). As part of the postgraduate training programme in Sri Lanka, trainees are expected to train for up to two years in another country- the United Kingdom and Australia are the popular choices in this. Quite serendipitously the Royal College of Psychiatrists initiated their Medical Training Initiative (MTI) programme right around the time I started looking for a job in the UK (late 2013). I was one of the first candidates to apply for this. I got selected and was offered a job in Leicester.

The Journey to the UK:

Until this time I had not traveled internationally and I was very apprehensive about the move to the UK.  I did not have any close friends or relatives in the UK as well. I wanted to travel to the UK for a short holiday before coming to assume duties at my job. So I planned for this- I had submitted an abstract for the Royal College International Congress and this had got selected for a poster. Also, I had had discussions with a colleague about sitting MRCPsych examinations. I felt that this would be sensible as I would be working for two years in the UK. I could fit this in neatly with my short visit. I started preparing by purchasing an online course for the exam (paper 1). I had to learn all the processes of applying for a visitor’s visa. Finally, in July 2014, I got on a flight by myself, for the first time to travel to London!

I felt a lot of emotions – excitement, terror, and happiness all at the same time in embarking on this adventure.

An old school mate had kindly invited me to stay at her place in High Wycombe, and I took a very expensive black cab from Heathrow to hers. I immediately began worrying about money and if what I brought would be enough to survive for three weeks, as I spent nearly two hundred pounds on the taxi!

The three weeks went fairly uneventfully- I attended the conference, sat the exam and managed to ride the tube without getting lost. I did find the July weather very cold.

When I came back to Sri Lanka, I was confident about going back again for the job.

Getting the necessary long term leave from the Sri Lanka Ministry of Health, and putting together, the necessary documents was time-consuming and stressful. I was communicating regularly with Leicester and the Royal College as well. I was offered hospital accommodation at the site where I would be working and I was really pleased with this.

The exam results were out and I had passed. I then thought of preparing for paper 2 which was in October 2014. I would arrive in London for the exam and travel to Leicester afterward. I started to revise again with the online course. I did not find the MCQ papers that difficult- I had revised the same things for my MD exams.

The MTI & MRCPsych:

My first job was in CAMHS- my clinical supervisor was an international medical graduate himself. I found this to be very helpful as he was able to advise and guide me on things such as opening a bank account. The set up was so different from what I was used to, and getting used to this and the weather was difficult. But as I started making friends at work, I began to relax and enjoy the work. My clinical supervisor soon started handing me cases to manage by myself and I was happy with this responsibility.

As I passed Paper 2, I started preparing for paper 3. I also took part in the Mock CASC exam organized by our trust. I had no idea of how this exam worked and I wanted to get a basic idea of the exam structure and did not care about whether I passed the stations or not. This proved to be very helpful to me later on.

I found myself making friends with my flatmates at the hospital accommodation and also with people at my workplace. I enjoyed CAMHS so much that I stayed behind after work hours just out of interest- also I was new to the country and had little to do in the evenings. Slowly I got used to the on calls. It was difficult to get familiar with the system and various processes, and in retrospect, I think I was thrown into this from the deep end. I was quite careful and made it a point to call and get advice from the registrars and consultants if anything, no matter how trivial, was unclear. Sometimes I felt silly doing this, as I was used to managing the wards, juniors and so on as a senior registrar in Sri Lanka and I was confident about my clinical skills. But I was aware that clinical skills alone would take me so far and I didn’t know anything much about the healthcare system in this new environment. For example, patients I would have admitted in Sri Lanka could be managed by the crisis teams here, and without knowing their availability, you would not necessarily make the ‘right’ decision.

I sat for paper 3 in April 2015 and got through this as well. I was glad that I completed the written papers without much struggle and wanted to sit for CASC in September 2015. By this time I had started my second placement- Assertive Outreach. This was an inpatient placement and I did not enjoy it as much as I did the CAMHS placement. The work was a little less stimulating than my CAMHS placement but I think I still learned a lot from the job. This was my first experience in working in a psychiatry inpatient unit in the UK and I began to notice all the differences in practices in the two countries. I spent a week with the assertive outreach community team at their base and found this to be very useful. I got the opportunity to present a poster at the European Psychiatric Association congress in Vienna during this time. I was highly excited as this was going to be my first trip to Europe. Again the visa applications took time! I enjoyed Vienna and met some Sri Lankan colleagues at the conference. I even planned a day trip to Salzburg.

My third placement was in old age psychiatry- I really loved the team of medics there and made some good friends. The general attitude from my clinical supervisor was to provide us with many training opportunities as possible. Around this time, I got the opportunity to take part in a research project with the University of Leicester, Department of Psychology. This was with regards to eye movement and word processing speeds in normal older age adults and older adults with cognitive impairment. I really enjoyed going there once a week and spending half a day. We did not complete this project and it’s still not written up, but the experience I gained is most invaluable.

I attended a conference in Athens and presented some research I had done back in Sri Lanka.

I also started practicing for CASC with two colleagues. We got together in the evenings and practiced by ourselves. My two colleagues have both sat for CASC before and they knew about the exam set up. It was useful practicing with them and with a bunch of others from time to time as well.

My clinical supervisor and registrar were also very helpful in doing practice sessions with me.

I felt that the CASC went rather well. I was hopeful that I would pass.

The ST Training:

In the meantime, I had got so fond of working in the UK and was feeling reluctant to go back to Sri Lanka in 2016. When I voiced this with my clinical supervisor, she was immensely supportive of this and promised to find out how I could apply for a registrar post. She held a position in the deanery and this made it easier to find things out. When the CASC results came, I had passed. I was advised that I could apply for registrar post by getting Certificate C ready. The only glitch I saw in this plan was to get my psychotherapy competencies signed off. I hadn’t taken on a dynamic psychotherapy case as the trainees are expected to do here and only have had experience from Sri Lanka in other types of psychotherapy. My final placement was in Intellectual Disability Psychiatry. The team there was also extremely supportive with my plans to apply for a registrar post. They arranged for a dynamic psychotherapy case for me in the Intellectual Disability Psychology Department. I started filling up the application forms and getting the portfolio ready. My supervisors advised me about the interviews and arranged for some practice sessions for me. I was really grateful for all their support. I had come to love Intellectual Disability Psychiatry by this time and decided to apply for this as a subspecialty. I especially loved seeing this subset of patients and interacting with them. I loved the exposure I got to neurodevelopmental conditions and research. All the consultants in the department were highly academic and also held higher managerial or educational positions. I found this to be very much inspiring. I wanted to get a position in Leicester and didn’t really want to move at this point to another place.

The interviews were at Manchester and I nearly got late!

On the whole, I felt that the interviews went well. When I was offered the job, I was very happy to be given the opportunity to stay a little longer in the UK. I had to go back to Sri Lanka to apply for my new visa. I spent about six weeks in Sri Lanka getting the visas ready.

I was sad to leave home yet again for the UK, but such is life.

I have been working in Leicester since then, as a registrar (ST trainee). My training which started in 2010 in Sri Lanka is nearly over now and I am hoping to complete in August 2019. This has been a long journey but I don’t think I would change any of it. I have gained a lot of rich experience in working in both Sri Lanka and the UK and I am looking forward to the next adventure of working as a consultant!

Contact email: chayakapugama@yahoo.com

Please note that Dr. Kapugama mentioned Paper 1, 2 and 3 as Part of her MRCPsych, this was the old format of the MRCPsych exam and is now replaced with Paper A & B

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