How to secure Psychiatry ST training – An IMG Experience by Dr Awab


(Please note this blog was written in Dec 2020 and describes the recruitment round of Feb 2021 – The recruitment criteria and process may change with time)


I am Dr. Awab. Having graduated back in 2011 from Pakistan, I did my FCPS psychiatry training (Pakistani fellowship training) from 2013 to 2016 in Pakistan, after which I got accepted into the 2 year HSE/CPSP scholarship programme in Ireland where I completed the rest of my FCPS training from 2016 to 2018. By the end, I was fortunate enough to have passed the MRCPsych exams along with the FCPS exams that enabled me to work as a senior registrar/ specialist in Pakistan.

What is an ST4 post?

Some IMG’s like myself might not be familiar with the route to becoming a specialist in the UK. The psychiatry training programme in the UK requires 3 years of core psychiatry training (CT1-CT3), passing MRCPsych and then completing another 3-5 years of specialty training (beginning with ST4), depending upon the subspecialty chosen. Upon successful completion of specialty training, one is awarded with either a CCT or a CESR(CP), that enables you to practice as a consultant in the UK. An ST4 post is where you have either completed the 3 years of core training (CT1-3) or equivalent (Certificate-C required), which in my case was the FCPS training.

More information about the different routes to attaining a specialist post is available below:

Why choose an ST4 post:

There would not be a definitive answer to that since everyone has their own priorities and circumstances. A few possible reasons could include:

  1. Planning to pursue your career as a consultant in the UK.
  2. To better your skills and competencies via an organized and supervised training programme.
  3. To widen your opportunities in other parts of the world.
  4. A combination of the above.

How to apply:

I applied during the covid-19 pandemic, therefore certain procedures have been modified, and certainly made easy for doctors residing outside of the UK. You can find updated information on the process via this link:

Preparing to apply:

There would be certain requirements and their prerequisites you will need to fulfill, such as having a valid GMC registration or being eligible for it. You can check your eligibility here:

As for me, I applied for GMC registration via an ‘acceptable postgraduate qualification’ i.e MRCPsych route, having done IELTS to prove my English language skills.

The next steps involve fulfilling the person specification criteria as per While the list seems endless, it is worth noting here that if you have an MRCPsych qualification and have been training or working in psychiatry anywhere over the last few years, you would likely have fulfilled many of these criteria and all you need to do is to put the required documentation in place.

Many required skills and competencies are mentioned on the core competence equivalence report a.k.a the certificate C, and you will need your current or previous supervisor to fill and sign it for you. Meanwhile if there are certain intended learning outcomes (ILO’s) on the certificate C that you have not accomplished, you can always complete them in a certain period of time.

Next steps include creating an oriel account, and looking out for the application window to open. Meanwhile you will need to prepare the evidence for your self-assessment. A few documents are required at the very beginning of the application process, including:

  • Certificate C (signed by the supervisor) – Core Competency equivalence report
  • CASC result showing your score (I attached a pdf file of the email I received that included my CASC score)
  • Supervisor’s report (I attached the CPsychI supervisor report form filled by my previous Irish supervisor, however, no specific format is mentioned)

It would therefore help if you have those ready as soon as possible.

The oriel application asks for 3 referees over the past 2 years that can be contacted by your employer. A referee can be any senior, consultant or supervisor in your specialty that you have worked with. I found it important to list the referees only after I took their permission and ensured they were the ones who checked their emails regularly, or were accessible if I needed to request them to check their emails.

Once the window opens, you will be able to score yourself against the self-assessment criteria while making sure you have the required evidence for each domain that you can upload on your oriel account. For me, it really helped to gain a few points given my FCPS training in Pakistan where I had written a dissertation and published an article based on that, as well a few presentations that helped me score more than I was initially expecting. Therefore it might help closely looking at the domains to make sure you avail every point you can. will show you the updated self-assessment criteria, guidance on the scoring and the kind of evidence you can attach for each scoring domain. It even displays the average scores for the previous round that may help reassure you if you feel you are scoring low. If there is time before the window closes, it might be worthwhile completing an audit, presenting a poster, submitting an article or anything that can help you score higher, as well as to request a few letters of recommendation and other evidence for the self-assessment scores.


I received interview guidance as well as the oriel link to booking an interview, which, if done at the earliest possibility could help you secure a convenient time slot.

The interview was held online via MS teams, the link of which was shared with me. It is worthwhile testing the link on your computer well beforehand.

The interview structure and questions were shared with me a few days in advance, offering enough time to prepare.

On interview day, I signed in at least 10 minutes prior to the commencement time. I waited quite some time before I was let in and was greeted at the virtual reception. I was required to show my passport and to rotate my laptop around the room to verify I was alone in the room. Then there were another few minutes of waiting before I was in the virtual interview room, where I met the administrator, two clinical assessors, and an observer. After the introduction, I was asked the stems questions/ scenarios I was informed of earlier.

I found the interview rather straight-forward as I had my response ready to the already known stem questions while a few probing questions were asked at the end that were directly related to the respective scenarios. The interview lasted an exact 15 minutes and I was informed at the end to check my account on the offers day.


You will be able to see the recruitment process timelines that will show the preferences window as well. Since covid-19, preferences have become more favorable since one can now choose between all specialties as well as dual specialties, and all we need to do is to rank them in order.

My choice of placement was based on a balance between career opportunities, accessibility, safety rating of the area, family life, proximity to people of my descent, cost of living among others.


Check your oriel account and email on the offers day. Upon receiving an offer, you will have the choice to accept, reject or accept with upgrades. The latter is if you did not get your first preference and would like to wait and see you can still get it.

Important points:

  1. Do ensure you meet the eligibility requirements for GMC registration, English language requirements, visa and funds’ requirements well in advance to avoid delay when the time comes.
  2. Try and collect the required documents such as good standing certificates well in time for GMC if you are not currently registered.
  3. Certain elements of the process were modified due to covid-19, including the absence of clinical stations that were marked as per the CASC score instead, while the interview was conducted online, saving time and travel costs. The portfolio station was modified in a way that no documents were required apart from the passport for identification. will provide accurate and up-to-date guidance on the process should anything change.
  4. Keeping a careful record of your documents such as supervisor’s reports, workplace-based assessments, proofs of workshops, certificates, publication, presentation, feedback reports, letters of recommendation, etc. would come in handy.


Contrary to the common assumption that foreign doctors have next to none chances of acquiring a higher training post, I got the post, and that too, within my first preference area and specialty.

How well do first timers in the UK excel as trainees, I have yet to discover.


Following acceptance of an offer comes a flood of emails and paperwork from several different organizations involved in the hiring and training process. It is crucial to stay organized, and in my case, I created a checklist.

I would like to share a detailed guide regarding the steps leading from acceptance of the offer to first day at work in the UK once I am there.

Best wishes

M. A. Awab Sarwar

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