IMG doctors commonly ask, how they can improve their CV in line with the requirements of the NHS and make it attractive for the NHS hospitals and UK training system?

IMGs have good clinical exposure from their home countries and usually they can demonstrate clinical skills far more easily but struggle to demonstrate skills in the other areas which are also deemed important in the UK. 

This blog may also help medical students aiming to practice in the UK as it is important to start developing your portfolio early in the career keeping in mind the specialities you are aiming for.

You can break down your profile or portfolio into following sections.

• Clinical Experience
• Teaching Experience and Teaching Qualifications
• Teamwork, Leadership & Management Experience
• Audit& Service Improvement Projects
• Courses, Training and Conferences
• Research Experience
• Reflective Practice
• Extracurricular Activities

It is important to look at each of these sections and reflect how you can develop yourself in these areas and how can you gather evidence of your progress.

Clinical Experience

It is important to understand the level of skills required for the particular job or grade you are targeting as it will help you prepare the CV accordingly.

Basic Psychiatry related skills would include:

• Communications Skills
• Taking a Psychiatry history
• Risk Assessment
• Understanding Psychiatric emergencies and their management.
• Ability to identify and diagnose common psychiatry conditions  
• Understanding common Psychiatric medications
• Use of ECT
• Some understanding of different subspecialties of Psychiatry

When you apply for Psychiatry training in the UK, you are expected to have achieved the skill levels of a UK equivalentfoundation doctor. A foundation doctor in the UK completes two years of foundation training which is equivalent ofan internship or house job. You can see the level of skills required at this level on the Certificate of Readiness to Enter Specialty Training (CREST) form which you can be downloaded from the link below:

https://www.oriel.nhs.uk/Web/ResourceBank/Edit/MTA3NA%3D%3D

I suggest IMGs to download this CREST form early in their internship in their respective home countries and review all the competences. Try and achieve all the competences whilst working in the home country and gather ongoing evidence of your progress.

The level of clinical skills required for a particular training or non-training job can be seen with the person specification and job description. You can download person specification for training jobs from the HEE (Health Education England) website

https://specialtytraining.hee.nhs.uk/Recruitment/Person-specifications

Documentary evidence of your progress:

There are several ways to document your clinical experience and expertise. You can use

• Work Place Based Assessments (WPBAs)
• Log Books 
• Supervisor Reports
• Reflections  

Keeping a record of your progress as a junior doctor is good practice and you can create your own logbook or evidence folder.You can download the Psychiatry portfolio framework and some workplace-based assessments forms from this blog post.

Old Style Psychiatry Portfolio

Electives & Clinical Attachments:

Electives and clinical attachments within the NHS can help you develop a better understanding of the system, gain clinical exposure, network with UK based doctors, find research and audit projects and gain references. 

International medical students can consider doing electives in the UK and qualified doctors can find clinical attachments. Although these experiences can be arranged free of cost and easily, it can cost a fair bit of money to travel and live in the UK for that time period.Bigger cities and especially London are generally very expensive but you can find electives and attachments in rural settings with equally good amount of clinical exposure and relatively much cheaper cost of living and possibly provision of hospital accommodation.  

You can evidence your electives / attachment experience by gathering feedback, a letter to confirm your involvement and reflections on your learning.  

Teaching Experience and Teaching Qualifications

Teaching experience can help you develop your own knowledge, communication skills and demonstrate your commitment to a speciality. Most IMG doctors already have teaching experience with medical students and junior doctors in informal setting but struggle to prove it and place it on their profile.

It is important to gather evidence of your teaching activities. Evidence could be

• A certificate confirming that you delivered teaching.
• A letter from senior confirming your teaching activities.
• Feedback from the students you were teaching.
• Your reflection on teaching session as in how it went.

It will help if you can get some more details on the teaching environment on the certificate, letter or reflection. Some details like

• Number of students and their level
• Setup of session (bedside, lecture, workshop)
• Learning objectives and outcomes

Many types of feedback forms are freely available on the internet. Teaching feedback form can be downloaded from:

https://www.jrcptb.org.uk/documents/evaluation-form-teaching-and-presentations

https://www.mededcoventry.com/Educators/Feedback-Forms

Please consider teaching beyond the level of medical students and junior doctors. Teaching could be multidisciplinary involving nurses and other health care professionals or even general public. You can set up your own teaching sessions or join already planned teaching activities.

Here is an example of how you can set up teaching session locally.

Setting up Teaching Sessions locally

Formal Teaching Qualifications:

There are teaching courses available which can help you improve your teaching skills like for example the “Teach the Teacher Course”

Here is an example of Effective Teaching Skills (for Clinicians) via Cardiff University.

https://www.cardiff.ac.uk/professional-development/available-training/short-courses/view/effective-teaching-skills-for-clinicians

If you are more interested in an academic career & formal qualifications relating to teaching, you can consider qualification in Medical Education for example:

• Postgraduate Certificate in Medical Education
• Postgraduate Diploma in Medical Education
• Masters in Medical Education.

These courses are available via UK universities for both e-leaning and face to face learning, although very comprehensive, they can be expensive and require a lot of time commitment. 

Here is an example of formal teaching course from the Cardiff University:

https://www.cardiff.ac.uk/study/postgraduate/taught/courses/course/medical-education-msc

Team Work, Leadership & Management Experience

The UK healthcare system expects doctors to be excellent team players with leadership qualities. IMGs are involved in team working, leadership and management activities but may not understand how to evidence their progress. These activities could be in clinical or non-clinical setting.

Team working is about working with other individuals, inspiring them and achieving shared objectives. Leadership is about taking initiative and leading a group of individuals. Think what you could do or have been doing over other doctors or students around you.

Some practical examples I have seen with IMG profiles:

• Setting up a project to help patients and their relatives.
• Working together on research or quality improvement projects as group of medical students.
• Setting up health information initiatives for general public
• Participating in vaccination drives
• Gathering donations and distributing them.
• Arranging blood donations.
• Working with a various different charity organisations.
• Team work and leadership in sports activities.

How to evidence these activities:

• Certificate confirming your participation
• Letter of recommendations from seniors confirming your role in these activities.
• Supervisor reports. 

Audit & Service Improvement Projects

Concept of audit can be fairly new for an IMG doctor. It is important to understand the basic principles of the audit and quality improvement in context of the healthcare. This is also the requirement for the new CREST form which is required to enter speciality training.

Quite often IMGs confuse Audits with Research or Surveys and struggle to generate ideas. In short, clinical audit is where you are comparing your current practice with already set standards in order to find the shortcomings and recommend changes to make practice better.

Medical students and junior doctors on placements in general hospital can find several ideas. Few examples from the IMGs

• Studying the standards of documentations in certain areas of medicine and comparing with what was expected. This could be history taking, medication charts, documentation of physical examination, consent forms and discharge notes.
• Studying the local prescribing guidelines for certain conditions and comparing it with current practices and identifying shortcomings.

Audits can be presented in portfolio folder with powerpoint slides, a short report and reflection.

You can read more about clinical audit from this resource:

https://www.southampton.ac.uk/sias/resources/howtoseries/howtoclinicalaudit.page

Here is an example of a service improvement project completed in Pakistan.

Here is a service evaluation project completed in Pakistan.

Courses, Training and Conferences

Course, training and conferences can help in showing your progress as a doctor and your interest in a particular speciality. Attendance of a course or a conference can be evidenced by an

• Attendance certificate.
• Reflective note on what you learnt.

IMG doctors can find lots of relevant courses, seminars, training and conferences within their home countries.

Some free online learning resources can be found on this blog post. 

Online CPD Resources

Within UK, relevant conferences and training events can be found on the relevant Royal college events pages. Like for example

Royal College of Psychiatrist: https://www.rcpsych.ac.uk/events/conferences

If you are doing a clinical attachment within UK or already started working in the NHS, you will find plenty of free and paid courses from within your trust or sometimes with local universities. Most trust websites have a link advertising courses and training events.

Research Experience

Research experience enhances your CV however at junior level it is not an essential requirement for most jobs. You can secure junior level non training or training job in Psychiatry without research experience.

Research experience can be evidenced by:

• Research papers and their reference
• Posters made from research projects.
• Abstracts of your research.  
• A letter from research supervisor confirming your involvement.

IMGs can struggle to get research experience as not all medical colleges and training schemes abroad provide research orientation, guidance or projects.

If you are interested in conducting or getting involved in research projects. You can start by

• Studying different methods of research and the hierarchy of research evidence.
• Start reading some local and international journals.  
• Developing some basic understanding of critically appraising research projects.
• Understanding the concept of research ethics and how to get ethical approvals locally.
• Finding out who is actively involved in research in your institute to see if you can be involved in an already existing project or get someone to supervise you for your own. 

There are several different methods to conduct research and some methods are very time consuming and require a lot of resources. However, conducting research is possible at medical student level by using following methods.

• Case reports and case series can be written and published
• Quantitative research (e.g. surveys) or Qualitative research (e.g. interviews) can be conducted, analysed and published.
• Literature reviews of already existing research.

If you have done any psychiatry related projects, please submit them as posters to conferences locally in your home country or to the Royal College of Psychiatrist (RCPsych) conferences.

Reflective Practice

IMGs may initially struggle to understand the concept of reflective practice. Reflection is a very simple process of documenting your learning and thought process leading to better understanding of certain situation.

You can write some reflections and keep them in your portfolio.

Reflections can be written for:

• Learning from new clinical cases and challenges.
• Learning from educational activities and training.
• Learning from conflict, significant incidents and complaints.

This blog will give you some practical examples of how a reflection is written.

Reflective Practice – Examples

Extracurricular Activities

Hobbies and non- clinical activities play a major part in the personal development of a doctor. Skills we learn outside medicine are transferable to the clinical environments.

For example:

• Team sports can help you develop your communications, team working skills, leadership style, working under pressure and allow you to motivate others. 
• Learning and playing music can teach you problem solving, creative thinking, time management and adaptability.
• Activities like travelling gives you a rich experience of exploring different cultures where you can learn from the diversity and also learn to adopt.
• Spending time with nature can help you relax better under pressure and can be a form of ensuring wellbeing.
• Working with a charity will give you the opportunity to develop for team working and management skills. 

It is worth mentioning your hobbies with some details and linking them with the skills required for a clinician.

I have seen several good examples of hobbies showcased in portfolios

• A young doctor had photos of cakes she likes to make in her portfolio.
• A doctor who loved travelling had photos of him with various landmarks.
• Pictures of trophies won in sporting events.
• Pictures of charity activities and letter confirming their contributions by charity lead.

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I wish you the very best in your future careers and I hope this was helpful. Good Luck!