IMG Guide to Speciality Training (ST) in Psychiatry- By Dr Maryam Tariq

In this blog Dr Maryam Tariq is sharing her journey as an IMG doctor of passing MRCPsych while working outside UK and securing ST training in the UK.

Introduction:

Hi, my name is Dr Maryam Tariq, and I am currently working as an ST4 dual trainee in General Adult and Old age Psychiatry in Humber Teaching NHS FT.

This Blog can be a useful guide for IMGs aspiring to join training pathway in UK on the basis of MRCPsych.

To start with, I did my initial FCPS training from Jinnah Post Graduate Medical Centre, Karachi Pakistan and then in mid-2020 went to Dublin on a 2-year CPSP/HSE scholarship programme.

I rotated in two different General Adult psychiatry posts, Psychiatry of old age and Rehabilitation psychiatry; for 6 months each. I believe my training in Dublin has immensely helped me to find my ground here in NHS as a higher trainee.

Passing MRCPsych:

For a brief background, I did my Paper A in 2018 and paper B in 2019 from Pakistan. For both Paper A and B, I had to fly to Oman as in pre COVID times these exams were not online. I personally had to go through a lot of trouble to get my visas approved and that itself can be a full story for another blog. But I would urge everyone to take these exams while they are online and can even be taken at home.

For Paper A, I studied for 2 months and did SPMM notes and Question banks of both Psych mentor and SPMM, also did SPMM mocks. For paper B, I studied for around 2.5 months and relied only on SPMM (notes, Question bank and mocks). I had some research background, so critical appraisal notes and videos by SPMM were sufficient for me, but I would strongly advice to go for other available resources as well if you find critical appraisal difficult.

I then cleared CASC in September 2021 from Dublin, I gave this exam online (lucky me😊) and used GET THROUGH MRCPYSHC by ZHANG and SPMM scenarios and videos. For clinical exam, depending on your pace you will need an average of a minimum of 3 to 6 months.

Moreover, it is imperative to join the online CASC groups and have supervised sessions by seniors and more preferably by examiners. I cannot emphasize enough that practice is the key to clear this exam so practice scenarios as much as possible.

Getting GMC Registration:

MRCPsych is a recognised post-grad qualification for the GMC in relation to getting full GMC registration. After passing full MRCPSych, you can show English competency exam (IELTS or OET) along with EPIC verification of documents and apply for the GMC registration. GMC may ask you to attend an ID check face to face in one of their offices.

GMC registration is not required at the time of application of the ST jobs but need to be in place for you to start the ST job.

Based on GMC registration gained via MRCPsych, you can also apply for non-training jobs in Psychiatry in case you have time, or you do not want to start ST training straightaway.

Applying for ST training in Psychiatry:

Apart from the exams while I was in Dublin, I had my goals set to achieve the required competencies to apply for specialty training at ST4 level in psychiatry. I gathered my certificates for organizing World Mental Health Day 2018 and 2019 and 53rd Annual Symposium in JPMC. I remained actively involved in research, critical appraisals, teaching and QIPs both in Pakistan and in Dublin. These capabilities contributed to my score during the self-assessment round.

For getting Higher Training post in UK, the route is simple and if you have your membership exam, the required OET/ILETS score/Working in an English-speaking country for the past 2 years and a completed Certificate C, then there is no reason why you can’t be shortlisted for a reputed training program in one of the following specialities.

Single Specialties: (3 years of training)

 •Child & Adolescent Psychiatry

•Forensic Psychiatry

•General Adult Psychiatry

•Medical Psychotherapy

•Old Age Psychiatry

•Psychiatry of Intellectual Disability

Dual Specialties: (More than 3 years of training)

•Dual Child & Adolescent Psychiatry/Medical Psychotherapy

•Dual Forensic/Medical Psychotherapy

•Dual General Adult/Forensic

•Dual General Adult/Medical Psychotherapy

•Dual General Adult/Old Age

•Dual Psychiatry of Learning Disability/CAMHS

•Dual Forensic/Child & Adolescent Psychiatry

Just to bear in mind that the DUAL specialities are more competitive and there are less seats available across deaneries. Dual training will also increase your time in training.

Check out this website for the current round and information related to ST application.

Higher Psychiatry Training | Medical Education Hub (hee.nhs.uk)

I will focus on elaborating on certificate C here as it is the most fundamental document which you need.

What is Certificate C and why international doctors need it?

Certificate C is the core competence equivalence report which is required if you are applying from outside UK and have not done core training in Psychiatry from UK.

I believe a new version of Certificate C will be released for the August 2023 recruitment to reflect the new RCPsych 2022 Curricula. This document can be signed by any of your consultants if you have worked with them for a minimum continuous period of three months whole-time equivalent in the last 3 years before your advertised post start day.

If your consultant is not registered with GMC, then you must submit the current evidence of their registration with their respective authorities. For example, if your consultant is from Pakistan, Ireland or India then proof of their registration with CPSP, IMC etc.

Other elements of selection process:

The other elements of recruitment process are adjusted CASC exam score, online generic interview and verified self-assessment score; each having the following weightage:

  Verified self-assessment score    17.5%
  Online generic interview    32.5%
  Adjusted CASC exam score    50%

Self Assessment Domains:

Your self assessment score is based on the following 10 domains.

1 – Undergraduate Training – Additional Degrees

2 – Undergraduate Training – Prizes and Awards

3 – Postgraduate Medical Qualifications

4 – Postgraduate Training – Prizes and Awards

5 – Postgraduate Training in other specialties (7 working years)

6 – Clinical Governance, Audit and Quality Improvement (6 working years)

7 – Research

8 – Teaching

9 – Academic Publications

10 – Presentations and Poster Presentations (6 working years)

Please note that domains 5, 6 and 10 are time limited. If you have had a career break or worked less than full time, then you will need to provide a summary of your employment history so that the recruiters can see that your evidence falls within the equivalent time period.

After submission, a clinical assessor (Consultant Psychiatrist) will verify the scores you award yourself in each domain of the ST4 Psychiatry self-assessment form. Make sure that you score yourself accurately at the time of application. I will strongly suggest reading the following instructions before submitting your application form.

https://www.nwpgmd.nhs.uk/st4_psy_train_current_record

How to apply:

• All applications must be submitted via Oriel

 (https://new.oriel.nhs.uk/web/)

• This is the newer version of Oriel (Nov 2020) and so you will need to register for an account before you can submit an application.

• Aim to submit your application well before the closing date as late or incomplete applications are not accepted.

Online Interview:

You will be interviewed over MS Teams. It is a 15-minute interview and the scenarios are pre published in advance. You will be given 6 minutes on each scenario. Please expect to be prompted / asked probing questions. It is advised not to script your response or be heavily reliant on notes. Check the scenarios here:

https://www.nwpgmd.nhs.uk/st4_psy_train_current_record

Adjusted CASC Score:

May be no one told you this, but your CASC score is extremely important. I believe one of the reasons I was able to secure Dual speciality training post was due to a good CASC score, so please keep this in mind while appearing for your exam.

How CASC scores are adjusted:

Your CASC exam scores will be adjusted to be comparable between diets and between days within specific diets. The college will use a pass mark of 50% for the recruitment process, this is based on the expectation that the adjusted CASC scores are lower than the original marks obtained in CASC. For example, if the cut-off % for passing is 65% on your day of examination and you scored 65%, then your adjusted CASC would be 50%. You are required to upload evidence of your result to Oriel when applying, or if appearing in the upcoming Diet, you can provide proof of passing later on.


I hope this was helpful. I recently started my journey in August 2022 and so far, I am quite satisfied with my decision. The trainees are well supported and have their own Educational Supervisors, Clinical Supervisors and Training program Directors to support them get through ARCPs. So far, I am blessed to have a good support system in Humber Teaching NHS FT and enjoying working in NHS.

If you have any queries re exams, recruitment process or training in UK, feel free to email me at: mariamtariq27@hotmail.com

For any recruitment related queries, you can also email the recruitment team on the following address.

Psychiatryrecruitment.nw@hee.nhs.uk

I wish all of you the very best for the application process and an awarding training journey ahead in UK.

This blog was written in Nov 2022 and the recruitment process may change with time.


Developing CV in line with Medical Practises of NHS & UK

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.

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

Imposter Syndrome in the IMG Doctors

When I first joined the NHS, I was in constant fear that I am not good enough and someone will soon find out that I am totally incompetent. I felt anxious and my mind was filled with self-doubt. I will spend hours thinking about what I did in the hospital and my mind will ruminate on how I should have done thing. My mind will compare myself with other doctors working around me and I was getting the constant feeling that I am way behind everyone and will never be able to catch up.

This feeling of incompetence isn’t uncommon among young doctors and the new IMGs often feel they are not good enough. The psychological phenomena is called “Imposter syndrome” and if you are feeling like this, you are not alone.

What is Imposter Syndrome?

Imposter Syndrome refers to an Psychological experience of believing that you are fraud, not as competent as others perceive and got this position just by luck. Imposter Syndrome is not a mental illness.

The concept of Imposter Phenomenon/Syndrome was first studied by Pauline Rose Clance and Suzanne Imes, two female psychologists in 1978. They studied 150 highly successful women and found that despite their academic excellence (multiple PhD’s, scholastic honours, high achievement on standardised tests), they considered themselves to be “imposters.”

What does imposter syndrome feels like?

  • You may feel you are a fraud and people will soon find about you.
  • You may minimise your achievements and skills as a doctor so far and your mind may focus on the things you cant do yet.
  • You may feel you are not ready to take the next step in the career progression and hold yourself back from opportunities.
  • You may not ask questions or hold yourself back from conversations feeling that you may say something silly and

Why it may be more common in the new IMGs?

When the IMGs are new to the NHS, they have a lot to learn and during the initial days in the NHS they may feel completely out of their comfort zone.

The language barrier can add to the stress and IMGs may struggle to understand what is going around them.

IMGs come from different health systems and at times when they are fully clinically competent, they may not fully understand how the NHS work during the initial days and this can lead to stress, anxiety and self doubt

The new IMGs will take time to understand the new system, that’s not incompetence, that’s just adjustment. They should be supported during the initial weeks and months which will help them gain confidence.

How to over come this Imposter Syndrome?

Set yourself small goals and tasks:

When everything is looking overwhelming and unachievable, setting yourself small goals and short term tasks can help. This could be just as simple as surviving a weekend of on-call or performing a small procedure. It can give you sense of achievement.

A person with Imposter Syndrome often minimise their achievements feeling that was just part of their job, nothing special, and their brain may magnify their small setbacks as big failures.

It is therefore important to have a reflective approach to overcome this feeling. You can start identifying your small achievements, build upon them and start seeing your contribution to the wider team.

Seek feedback:

As junior doctors and new IMGs, you should seek feedback not just from your seniors but also by peers, nursing and other MDT staff.

A person with imposter syndrome may feel people are extra polite with me and just saying nice things to make me happy. It is important to overcome this feeling by getting feedback from multiple sources and making note of the positive things said about you alongside the areas of improvement.

It is often difficult to openly talk about your feelings when you have Imposter Syndrome but as Imposter Syndrome is a common phenomenon, other professionals and IMGs are able to relate with it and reassure you.

Reflect on your progress:

Sometimes I read my old CVs and reflect how far I have come. When our mind is constantly focusing on our deficiencies, we fail to acknowledge our success and we need to literally remind ourselves.  

You can make a personal development plan on how you will improve yourself in the coming months and year. Focus on one or a few things at a time. Putting things on paper or in writing can help clarify any doubts and plan next steps better.

More information:

GMC Registration via Sponsorship Route

Every time I post a comment about sponsorship route on social media I get tens of messages from international doctors, some of them asking for information and other sending me their CV to find them jobs.

So I am writing this post to explain what I know about this route.

Can I get GMC registration without PLAB, Membership exams or MTI posts?

Yes you can using the and GMC website has a list of the trust who can sponsor your GMC registration. You still need to do the English competency exam to get GMC registration.

What have you seen happening in practice?

In my experience the hospitals prefer to employ doctors with GMC registration and this sponsorship route is used by hospitals for speciosities and graded where there is acute shortage and they can not

This unusually apply to middle non training grade positions on specialities like psychiatry for experienced doctors in psychiatry.

Some hospitals will run international follow type adverts to employ doctors and they will appear time to time in the NHS jobs website.

Is the GMC registration permanent when you get it via this route?

Yes the GMC registration is permanent and when you change the job, you will still be registered. The GMC registration via sponsorship route does not mandate you to only work for that particular employer.

What about the visa type?

Unless the employer use the MTI route, you should get the Tier-2 visa.

How should I find these posts and how should I apply?

You should look out for these adverts in the NHS jobs website where they are recruiting for example the international fellows.

If you are an experienced doctor, you can apply for speciality doctor positions in the NHS using the NHS jobs website or trac job website but explain clearly in your application that you do not have GMC registration and will require the trust to sponsor your GMC registration if you are successful in the interview stage.

Parent’s UK Visit Visa

This blog is written as guidance to the IMG doctors who wish to apply for their parent’s visit visa. This is based on my experience, but please note I am not an immigration expert just someone with first hand experience. 

Background:

I have been living in UK for over 15 years & applied for my mother’s visit visa at least 5 times successfully. 

Me & my wife are both doctors. I am a Psychiatrist and my wife us working as a GP. My mother is a retired college teacher living in Pakistan & my father has passed away. 

We have never used a solicitor but we have always prepared the case with many documents to cover every aspect we believe the entry clearance officer would like to know.

The main areas to cover as we saw it were to show

  • Our professional status and financial stability in the UK including accommodation.
  • Clear purpose of the visit.
  • Mother’s financial status and links in Pakistan.

Documents prepared from my mother’s side:

We do not sponsor my mother as she has her own sources of income & is not financially dependent on us. So we just write an invitation letter stating the reasons why she is visiting clearly. 

Her documents aims to show her financial condition and links in Pakistan.

  • Evidence of my mother’s sources of income 
    • Pension from government 
    • Agriculture land 
    • House she just rented out 
    • Saving bonds & interest on savings 
  • My mother’s bank statements 
    • Saving & current accounts showing money going in & coming out. 
  • My Mother’s property Documents (copies) – helps to show links in Pakistan
    • House,
    • Agriculture land,
    • Plots bought as investment.
  • My mother strong links in Pakistan.
    • Clearly describing in application or letter that she has another son living in Pakistan & grandchildren along with her own brothers & sisters. 
  • Travel history of going abroad on short trips. 
    • This helps to show she has travelled before and retuned to Pakistan.

If your parents are not financially independent, that’s alright. You can show how they are meeting their everyday needs, show if others children are supporting them and you can sponsor them and clearly say in application and your supporting letter that you will be funding their visit.

Documents prepared from our side: 

  • Invitation letter from our side clearly saying why we are inviting her to visit
    • Attending birth of grandchild 
    • Spending time with son & grandchildren.
  • Copies of my & My wife’s passports, NICOPs, our marriage certificate.
  • Letter from hospital HR saying I am fully employed & my salary. 
  • Letter from my wife’s GP surgery stating her status of employment and her salary. 
  • Copy of our 6 months salary slips 
  • Bank statements both of myself & wife. (6 months)
    • Current & Saving accounts. 
  • GMC registration certificates (just to prove we are doctors) 
  • Evidence of our house and accommodation.
    • mortgage documents
    • house ownership documents
  • Survey of house by council officer to confirm the house has enough space to accommodate her.
    • This may not be required in every case but we just did that to make sure her case is strong. You can check your local council website to see if they do immigration house surveys.
    • This is the website of our council Immigration inspections | Newport City Council

If you are renting a house, you can send the rental agreement.

Example of a letter to immigration officer

Dear Entry Clearance officer

This is to confirm that I am inviting my mother to visit us in the UK. The purpose of this visit is for my mother to enjoy a short trip to UK, see her family and spend some time with grand children.

My mother is a retired teacher and financially stable. She is sustaining her own life style and is able to fund this trip from her own sources of income. We are attaching evidence of her of source of income. (List documents)

My mother is well travelled and has been outside Pakistan on various occasions,

(details of travel history of last 5 years)

She has strong links in Pakistan which include her property, sources of income, extended family, brothers, sisters and her other son and his family which include grandchildren in Pakistan.

I am working as a NHS hospital doctor on a consultant post in the UK and my wife is also a doctor working as GP. We are attaching evidence of our finances, accommodation, professional registration and our marriage. We can easily accommodate her and entertain her during this trip.

Documents we are attaching includes. (list)


I hope this was helpful – Best Wishes

GMC Sponsorship Route for International Psychiatrists

In order to work in the UK as a Doctor,  you need GMC registration with a licence to practice.

There are several paths to get GMC registration for the international psychiatrist which include doing PLAB, passing the full MRCPsych exam or the MTI route.

There is another route of sponsorship of GMC registration via an NHS trust which can lead you to get full GMC registration and licence to practice. This route is for more experienced Psychiatrists with at least 2-3 years of experience in Psychiatry.

You still need to pass the English competency exam in order to get GMC registration like OET or IELTS and it is better if you do them before applying for the jobs expecting to get it via this route.

Why would a trust sponsor my registration?

Because there is an acute shortage of psychiatrists in the UK and especially at the middle grade or speciality doctor level. There are many empty vacancies that the trusts are unable to fill for a number of months and even years.

Is the GMC registration via sponsorship route permanent?

Yes, the GMC registration you get will be permanent and you can change the jobs if required. You are not obliged by law to continue working in the place where you were offered the job initially.

Which NHS hospitals or trusts can sponsor my GMC registration?

There is a list on the GMC website of the hospitals approved for the sponsorship application. See the link below for more information.

List of approved sponsoring bodies – GMC (gmc-uk.org)

How should I approach this sponsorship route?

The websites to apply for the jobs in the mainland UK are

NHS jobs (https://www.jobs.nhs.uk)

Trac Jobs (trac.jobs)

NHS Scotland (NHSScotland Jobs | Job Train)

You can make an account on these websites and search for the speciality doctor level posts in Psychiatry.

Clearly explain in your application that you do not have GMC registration at this present stage but you are eligible for the sponsorship route of GMC registration if offered this post.  

What is the likelihood of getting jobs using this way?

I have seen several psychiatrists using this route to get GMC registration and work in the UK.

When you apply, you have to apply widely all across the UK and you will get several rejections for probably a couple of months.

The job recruitment process in the UK work very slow and can take a few months to get short listings for interviews.

Don’t be disheartened with the number of rejections or non-contact by the hospital, you only need to get lucky once. Hopefully, eventually, your application will get to the right place where there will be a shortage and they will be happy to accommodate you.

What is the future of these doctors?

Speciality doctor is not a dead-end job and you will get opportunities for career progression.

You can work long-term on the speciality doctor role and consider applying for the CESR route to get on the specialist register to become a consultant.

You can consider passing MRCPsych exam and applying for ST training in Psychiatry and getting CCT to become a consultant.


Best wishes

GMC Registration via the Sponsorship route

Every time I post a comment about the sponsorship route on the social media platforms, I get tens of messages from international doctors, some of them asking for more information and others sending me their CV to find them jobs.

So I am writing this post to explain what I know about this sponsorship route. Please note, this is just my experience and what I have seen happening, not any official word.

Can I get full GMC registration without PLAB, Membership exams or MTI posts?

Yes, you can by using the sponsorship route and the GMC website has a list of the trust who can sponsor your GMC registration.

You still need to do the English competency exam to get GMC registration.

Check out the link below

https://www.gmc-uk.org/registration-and-licensing/join-the-register/before-you-apply/list-of-approved-sponsoring-bodies

What have you seen happening in practice?

In my experience, the hospitals prefer to employ doctors with GMC registration and this sponsorship route is used by hospitals for specialties, geographical areas and grades where there is an acute shortage of doctors and they can not employ via normal recruitment routes.

This unusually applies to middle-grade level non-training grade positions in specialties like for example psychiatry for experienced doctors in psychiatry.

Some hospitals will run international follow type adverts to employ doctors and they will appear from time to time on the NHS jobs website.

Is the GMC registration permanent when you get it via this route?

Yes, the GMC registration is permanent and when you change the job, you will still be registered. The GMC registration via sponsorship route does not mandate you to only work for that particular employer.

What about the visa type?

Unless the employer uses the MTI route, you should get a Tier-2 visa.

How should I find these posts and how should I apply?

You should look out for these adverts on the NHS jobs website where they are recruiting for example the international fellows. If you are an experienced doctor, you can apply for specialty doctor positions in the NHS using the NHS jobs website or the trac job website but explain clearly in your application that you do not have GMC registration and will require the trust to sponsor your GMC registration if you are successful in the interview stage.

What do you advise?

I normally advise experienced doctors to consider the membership route as it has other advantages as membership not only gives you a stamp of recognition and knowledge but also helps you progress to the training grades.

But there is no harm in trying for the sponsorship route.

Best Wishes

Medical Appraisal – Guide for the IMGs

All doctors in the UK should have an appraisal every year which is part of the revalidation process and requirement to maintain the GMC license to practice.

New IMGs can often get confused with this and are often unaware of the process. IMG on non-training posts often does not get proper guidance or information. This blog aims to explain some basics concepts around medical appraisal.

For the junior doctors in the training posts, their ARCP acts as an appraisal and they don’t need a separate appraisal.

What is Medical Appraisal?

You can consider it an annual review of clinical practice and GMC set it out to be a facilitated self-review of your work and scope of work. It is supported by information gathered on the full scope of a doctor’s work. The medical appraisal can be used for four purposes according to the GMC: 

  1. To enable doctors to discuss their practice and performance with their appraiser in order to demonstrate that they continue to meet the principles and values set out in `Good Medical Practice` and thus to inform the responsible officer’s revalidation recommendation to the GMC.
  1. To enable doctors to enhance the quality of their professional work by planning their professional development.
  1. To enable doctors to consider their own needs in planning their professional development.

 and may also be used 

  1. 4. To enable doctors to ensure that they are working productively and in line with the priorities and requirements of the organisation they practise in.

What does an Appraisal involve?

It is a meeting within a protected time where you sit with a trained colleague who is often a senior doctor in most cases. The appraiser is usually not your line manager but someone independent. The meeting could last for 1-3 hours depending on how it went and how many details were discussed.

You will have the information recorded on one of the online systems to discuss with the appraiser.

What information you need to have or record:

Usually, you need an online account on the appraisal information recording system provided by the NHS trust.

  • A personal development plan
  • Information on the scope of your practice and job plan
  • Your activities in the last 12 months which may include educational, clinical and professional engagements
  • Reflection on any complain or serious incidents.

Different systems are used in the UK to record this information. In Wales, the MARS Appraisal website is used to record both GP and hospital doctors.

What do I put in my appraisal information?

Usually, my appraisal information will include:

  • Personal development plan for the next 12 months, also discussion around what i have achieved in the last 12 months from the last year personal development plan.
  • Scope of practice, and weekly job plan.
  • Reflections which include constraints and limitations of the job.
  • CPD activities which may include courses, training and conferences along with reflection of what I learnt.
  • Academic activities, including teaching, examining, and arranging educational events, research and audits. 
  • Personal development and other professional activities like having a responsibility of clinical + educational supervision, chairing a particular group.
  • Experience of any leadership and management activities.
  • Confidential feedback from patients and colleagues required once every 5 years and collected via an online system.
  • Any complains and serious incidents I was involved in along with reflection.

As a new IMG, you can make a personal development plan for example focused on your clinical and professional development. Your aim may be to pass certain exams, get CREST competencies and enter training which you can demonstrate in the appraisal.

How can a Medical appraisal help me as a junior doctor or an IMG?

  • You are essentially collecting the similar information which you need to maintain portfolio. So you have evidence of your progress which is useful in future applications of training or non-training jobs.
  • Appraisal is a reviewing process which helps you reflect on the last 12 months and your learning needs for the future. It will help you identify you learning needs so you can plan your professional development, improve performance, and demonstrate that you are fit to practice. 
  • You need regular and timely appraisals to pass the revalidation which is usually due for doctors every 5 years. 

How do I select who does my Appraisal?

There is usually a list of trained appraisers who are available and a booking system online.

Your local NHS appraisal unit should be able to help you with this booking. The appraiser isn’t your supervisor and doesn’t need to be from the same specialty or department.

What usually happens in appraisal meeting?

It is usually a very friendly environment where you discuss your appraisal entries and reflections along with the future plans. It is a safe space to reflect and the appraiser may suggest to you some ideas on how you can improve and knowledge and performance for the next year.

Before Covid these meetings were happening face to face and since Covid different arrangements are in place.

Any tips to make it easier:

  • Do not leave it to the last minute and try and understand how system work as soon as you start the job or find you feet in a job within a few months.
  • Ask a colleague to show you how they put in the information and deal with the online system.
  • Explore opportunities of personal development which may include training events, teaching opportunities, audits and management experience.

More information:

There is usually an appraisal and revalidation support unit in every trust and they can help you understand the process better.

https://www.england.nhs.uk/medical-revalidation/appraisers/med-app

/https://www.bma.org.uk/advice-and-support/career-progression/appraisals/medical-appraisals

NHS Interview Experience by Dr Sanaa Moledina

What does the interview of a Trust grade post in CAMHS (Child and Adolescent Mental Health Services) look like?

Interviews can be really be daunting, however, the interview for your first job in the NHS can be almost nerve-wrecking! There’s a lot that goes through the mind: you fret about yourself and your capabilities; you brood over the unfamiliar panelists and you agonize over the questions that they might ask you; you mentally pit yourself against the other candidates and the list goes on.

I was in the same boat- well, not really but kind of. I had done a few months of clinical attachment at the same Trust, but the interview was still petrifying- to say the least! I, however, managed to clear the interview, and this blog intends to give you a sneak-peak into my first ever interview in the NHS (within CAMHS as a FY3) and tips about how you can prepare yourself for one too.

Before we dive into the interview prep, you should gather a few essentials:

  1. The job description that the Trust has provided to you. It is usually the job advert given on the job’s website.
  2. Your CV or your job profile.
  3. NHS website, NICE guidelines and the BNFc (very handy!)

My interview had 2 general questions and 2 scenario-based questions.

Let the interview begin!

The interview usually starts with a cliché question: It could look like:

  1. Tell us more about yourself and your experience in psychiatry [I got this question]
  2. Take us through your CV and why do you think that you’re a suitable candidate for this job.

The answers of these two questions is the same! You can use the following format to answer the question:

  1. General introduction (name and country of origin)
  2. Education (start from medical school then IELTS and PLAB)
  3. Career (House-job/internship (mention the internship in psychiatry, if applicable) then discuss any clinical experience after it).

TIP: While you talk about your work experience, give a few highlights of what you were expected to do in those roles.

BONUS TIP: Use words like MDT, liaison, pharmacovigilance, safeguarding, risk assessment, crisis management, research, and quality improvement.

  • Audit and Research experience: Talk about both published and unpublished researches. Link your researches to mental health, if possible. Talk about any research or audit related courses that you have attended.
  • Teaching experience: Talk about your formal and informal teaching experiences.
  • Innovation/leadership/bringing change: Talk about how you have tried to bring any change within your medical school, workplace, or the community.

TIP: Your answer to your first question should flow like a story. Try to connect the different themes. Maybe make a mnemonic to remind you the different headings.

The interviewers can then ask you another general question. You can get any of the following questions:

  1. Other than work, what else do you enjoy and why?
  2. What are your weaknesses?

[I got asked: What would be one quality of yours that your colleagues would absolutely hate?]

  • What are your strengths?
  • What can you bring to our team?
  • How do you maintain work-life balance?
  • Why psychiatry and why CAMHS?
  • What makes you a good doctor in psychiatry?
  • Explain to us the roles and responsibilities that might be expected from you as a Trust Grade doctor. 

Sometimes, the general questions can be a bit tacky. You can be asked:

  • Why should we pick you for the job?

For this question, refer to the job description and say all the points in the job description that align with your portfolio. You can talk about all the roles and responsibilities that are expected of a Trust Grade doctor: Talk about your experience in:

  1. Clinical practice- particularly psychiatry.
  2. Working in an MDT setting.
  3. Medications and safeguarding.
  4. Research and audits/QIPs.
  5. Teaching and providing medical education.
  6. Innovation and introduction of change at hospital.
  • Why did you select this job?

For this question, begin by talking about the Trust, the area of the hospital (the hotspots in the area), the timings and the days of the job, about it being a Trust grade job (and not a training job; so that you have some time to familiarize yourself with the system) and the incentives and learning opportunities that the job offers (refer to the job description).

Now let us move to the scenario-based questions.

The hot topics for you to read would be:

  1. Depression and its treatment (learn the drugs and their doses)
  2. ADHD and its treatment [stimulants and non-stimulants]
  3. Autism and its management
  4. Eating disorders, their diagnostic criterion and classification, and their management [the marsipan protocol]
  5. Psychosis and its management
  6. Mental Health Act (criterion and assessment)
  7. Pillars of clinical governance
  8. Rapid tranquilisation protocol
  9. Suicide risk assessment
  10. MSE
  11. Antidepressants (particularly sertraline, fluoxetine, and citalopram) and their side-effects and monitoring
  12. Antipsychotics and their side-effects

The two clinical scenarios I got were:

  1. You have been called to the Paediatrics ward for a patient who has been medically managed after an attempt on his life. How would your consultation look like?
  2. You are the on-call doctor who has been called to the AnE for a 12-year-old girl who looks emaciated. She is refusing to get weighed. How will you approach the situation?

b) You are convinced that it is an eating disorder, then how will you proceed with the management?

After the four questions, I was asked if I had any questions for the panelists?

My advice would be to always ask questions- this shows your interest in the job. I asked the following:

  1. How the Trust will support me with getting my CREST competencies signed.
  2. Can I shadow the Consultants on-call if I want to learn more?
  3. Will I be provided with an online portfolio?
  4. The online trainings and competences that the Trust makes available to the new doctors.
  5. Presence of pastoral support within the Trust.

A few tips for you:

  1. PRACTICE. PRACTICE. PRACTICE. I can’t stress on this enough. Practice with someone and practice alone. Nothing can boost your confidence like practice does.
  2. Be original. Do not rote-learn books and YouTube interview clips etc. Be real. Be yourself. They have a penchant for originality.
  3. Do not stress. Try to relax before the interview.
  4. Smile! It can work wonders.
  5. Print a professional development plan (PDP: Google it). Keep it with you during your interview.
  6. Dress elegantly- goes without saying.
  7. Check the meeting link and internet connection beforehand (DO NOT BE LATE!)

You have passed medical school and PLAB so you can easily triumph over this interview too.

I hope this little guide helped. Good luck xx

Sanaa (moledina.sanaa@gmail.com)

Clinical Attachment in Psychiatry – Anonymous Experience

What is Clinical attachment?

To explain it simply, clinical attachment is a period you spend shadowing seniors on the ward, clinic, or department. You aren’t necessarily allowed to directly participate in the clinical activities- but this may vary from Trust to Trust and from department to department.

In most cases, this post has no remuneration associated. Clinical attachment is a period of time where you observe the working of a clinical setting or department. It is similar to what medical students refer to as electives.

How to go about planning a clinical attachment?

Before leaving my home country for my PLAB-2 exam, I had booked a clinical attachment. I was interviewed and was asked to provide a few basic educational documents. I was also asked for my immunization evidence for the Occupational Health Clearance.
I would highly recommend IMGs to plan their clinical attachments right after their PLAB-2 exam so that both are covered in one trip and you can be offered a job interview at passing the exam (if a job opportunity is present within the Trust).

How to search for a clinical attachment?

Unfortunately, there is no set platform available to access clinical attachments.

The quickest and most effective way of searching for a clinical attachment is to email a Consultant in the UK to facilitate you. There are many consultants and registrars in the UK who are very keen to help the IMGs out.

You can find them on social media IMG groups or ask your alumni to connect you with them. Your email should contain details about yourself, your education, your work back in your home country, your future plans of working in the UK, and your expectations from the clinical attachment.

In the majority of cases, the Trust doesn’t charge you for the attachment rather they try to facilitate you by arranging accommodation and conveyance.

My experience with the Clinical attachment:

I did 3 months of clinical attachment (Feb 2021 to May 2021) at a Community Children and Young People Eating Disorder Services – This is part of Child Psychiatry (CAMHS) speciality.

Despite the Covid crisis, uncertainty, and travel restrictions, I was able to secure clinical attachment and my department was very welcoming.

My experience with the attachment has been extremely precious and totally worth it!

Here is why:

  1. My supervisor turned out to be the most wonderful person. He put in genuine interest in my career and well-being and helped me improve both professionally and personally. Hence, through this attachment, I found a mentor for life!
  2. I learned so much about the practice in the UK. I learned how to deal with conflicting situations; how to safeguard patients; how to work with a multidisciplinary team and delegate responsibilities within the team; and about the different services which can be made accessible to support patients.
  3. I was given the opportunity to participate in teaching activities. I held training sessions for nurses, occupational therapists, and psychologists within the department.
  4. I got to learn so much about the different eating disorders- their diagnostic criteria and
    management. I was working with a multidisciplinary team of well-trained nurses, psychologists, care-coordinators, occupational therapists, dieticians, trainees and Consultants. Moreover, my clinical supervisor held reflective practice sessions with me where I would discuss my difficulties (and feats) with him and he would help me make my way around them. He would also encourage me to attend the wards, family-based therapies, group therapies and medical students’ teaching sessions. I was also required to present a case every week in the morning meetings, which helped me a great deal in furnishing my data gathering and analytical skills.
  5. I was asked to innovate and streamline things. I streamlined the blood work-up interpretation protocol by introducing a questionnaire which helped the department assess the physical risk amongst eating disorder patients and ultimately decide inpatient admissions. We are now planning to turn this project into an audit.
  6. Regarding research, we introduced another project to screen eating disorders patients with comorbidities like body dysmorphic disorder, depressive disorder, and anxiety.
  7. I found friends! I made amazing friends in the department. We hang-out every now and then on weekends.
  8. Last but not the least, the attachment helped me to attain an interview opportunity at the Trust and today I am working here as a Trust Grade Doctor. Moreover, I do not feel the hesitancy or panic of the new job because I know the Team and I know how things work around here. There’s existing comfort, trust, and familiarity between the Team and myself.

Downsides of a Clinical Attachment

This is a hard one because there is barely any trouble with it. However, some people might miss their families and would prefer to return to their home country immediately after the exam.

Personally, the experience has had a huge impression on me as a doctor and as an individual. I would highly recommend every IMG to do a clinical attachment in the UK.

Moreover, it is important to make the most out of this opportunity by being proactive. If you show interest, you will undoubtedly be facilitated at every step of the way.

Best Wishes

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