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.


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 (

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

Recommended books for Junior Doctors in Psychiatry

A lot of Junior Doctors ask about the useful books as they are about to start their journey of Psychiatry Training or very first job in Psychiatry.

Here are some recommended books and resources.

Please Note: I am putting the Amazon links for the books, but please search them online to see if you can find them cheaper from other resources or there may be an more recent edition available.

Oxford Handbook of Psychiatry – 4th edition

Pocket-sized book from Oxford Handbook series, a good start for reading if you are new in Psychiatry.

Shorter Oxford Textbook of Psychiatry – 7th Edition

This book is also from Oxford series but much more detailed in compare to the handbook and if you are interested in a textbook of Psychiatry. This might help.

Psychiatry: Breaking the ICE Introductions, Common Tasks, Emergencies for Trainees

Highly recommended & very useful book for the junior doctors starting in Psychiatry. Plenty of useful tips.

Psychiatry at a Glance – Sixth Edition

Short and simple book for the new starters in Psychiatry

The Maudsley Handbook of Practical Psychiatry – 6th Edition

This is very handy short book from Maudsley and can help junior doctors.  

The Maudsley Prescribing Guidelines in Psychiatry – 14th Edition

This is very useful for prescribing in Psychiatry and also for the MRCpsych exam. The 14th edition is due in June 2021.

Sims’ Symptoms in the Mind: Textbook of Descriptive Psychopathology

Probably a more advanced textbook of Psychopathology but can be very useful for trainees. You may find this in your library.

Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry

Small book but very useful if like to know more about Psychopathology

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry.

Nice book particularly for the physical health conditions that you will encounter in Psychiatry.

The Doctors Guide to Critical Appraisal – 5th Edition

If you like to have a basic understanding of the statistics and medical research along with critical appraisal. This book is a good start, not particularly related to Psychiatry but research in general.

NICE guidelines on Mental health and wellbeing

This is a free online resource and you will find over 60 guidelines relating to mental health.

ICD-10 Diagnostic criteria for Mental Health

This comes in a book form but also available free online. A new version of ICD-11 will replace it in the future.

Please feel free to suggest any other books in the comments and I will add them to the list.

How to use RCPsych Portfolio Online

In this YouTube video, Dr Palwasha Mukhtar is showing us how to use RCPsych portfolio.

Dr Palwasha Mukhtar is a Core Trainee in Psychiatry and she is kindly showing us the basics of RCPsych Portfolio. In my experience the junior IMGs struggle to understand the portfolio online as it may be their first experience of using an electronic portfolio. By this video, you can hopefully understand some basics.

There are lots of useful information on the RCPsych portfolio website.

The Work Place Based Assessments (WPBAs)…

MTI in Psychiatry guide for the IMGs – By Dr Amitkumar Chougule

Dr Amitkumar Chougule is an IMG Psychiatrist from India with an MD in Psychiatry.

Amit came to the UK on the MTI via RCPsych scheme and has now also successfully completed his MRCPsych exam.

He has written a helpful and comprehensive guide focused on the things IMGs should know about the MTI Psychiatry.

Amit has also written about his experience of securing the MTI which you can read from the link below.

PLAB vs MRCPsych

Psychiatry aspiring IMGs commonly ask me, which route is better for the purpose of GMC registration? PLAB or MRCPsych?

Having done both exams in my career. I thought I should compare them.

Disclaimer: Please note this is based on my experience only and not an official guide or version of the Royal College or the GMC. This is written in Jan 2021 and exam criteria, free and regulation will change with time so check the official websites for updates.

Who are the exam conducting authorities:

PLAB: General Medical Council – UK

PLAB is a medical licencing exam for the UK and results in the award of GMC registration.

MRCPsych: Royal College of Psychiatrists – UK

MRCPsych is a membership postgraduate exam i.e. post graduate qualification so you will gain you a Membership of Royal College of Psychiatrists. MRCPsych is also a well-recognized qualification outside of the UK as well.

MRCPsych can also be used to gain GMC registration.

What is the level of knowledge tested?

PLAB: Foundation doctor or internship level, which is broad based knowledge involving multiple specialties expected of a recently qualified doctor.  

The level of knowledge is that you would expect from a well-trained foundation doctor in the UK.

MRCPsych: The level of knowledge you would expect from a middle grade or a ST level Psychiatrist.

MRCPsych tests the knowledge required to understand and manage common mental conditions. It requires a greater depth of understanding and experience of Psychiatry.

The current MRCPsych syllabus includes:

Behavioural Science and Sociocultural Psychiatry, Human Development, Basic Neurosciences, Clinical Psychopharmacology, Classification and Assessment in Psychiatry, Organisation and Delivery of Psychiatric Services, General Adult Psychiatry, Old Age Psychiatry, Psychotherapy, Child and Adolescent Psychiatry, Substance Misuse/Addictions, Forensic Psychiatry, Psychiatry of Learning Disability, Critical Review

Check this for further info on the MRCPsych exam syllabus:

How many parts are there and the exam format?

PLAB = Two parts

PLAB-1: 180 (MCQs) multiple choice questions – 3 hours exam time

PLAB – 2: 18 scenarios (OSCE stye stations) each lasting 8 minutes and aims to reflect real life settings including a mock consultation or an acute ward. 

MRCPsych = Three parts

Paper A & B: 150 questions (mixture of MCQs and EMI) – 3 hour time

CASC: 16 stations OSCE style

CASC morning circuit will allow 4 minutes to read the instructions and 7 minutes to complete the consultation task.

CASC afternoon circuit will allow 90 seconds to read the instructions and 7 minutes to complete the consultation task.

What is the Eligibility Criteria:


Medical qualification awarded by an institution listed on the World Directory of Medical Schools.

English language criteria for example:  

  • IELTS academic – 7.0 in each testing area and an overall score of 7.5
  • OET medicine version – Grade ‘B’ in each testing area (speaking, listening, reading and writing)

For a full article on English criteria:

You can take PLAB following your graduation and during internship in the home country.


You do not require to have GMC registration or UK experience to take MRCPsych.

You do not need English language exam to sit MRCPsych but English competency will be required for the GMC registration after passing the exam.

Paper A: Can be taken by any fully registered medical practitioner (doesn’t require GMC registration)

Paper B: 12 months experience in Psychiatry (further info below in link)

CASC: 24 months experience in Psychiatry  (further info below in link)

How much is the exam fee?

Please see the latest information from the exam websites.


PLAB 1 = £239 (240 from April 2021)

PLAB 2 = £875 (879 from April 2021)


Pre-Membership Psychiatric Trainees (PMPT) and affiliates of the College taking exams in the UK and Ireland are entitled to a discount.

Paper A: £486 (PMPT and affiliates) £539 otherwise

Paper B: £437 (PMPT and affiliates) £485 otherwise

CASC: £1004 (PMPT and affiliates)  £1115 otherwise

What are the exam dates and locations?

Since Covid-19 the schedule of the exams have been disrupted and the best advice is to check the official websites for the most recent updates.


PLAB-1: All across the world, various countries and dates.

PLAB-2: GMC testing centre, Manchester, United Kingdom.

GMC has continued to conduct the PLAB-2 examination during the Covid-19 crisis.


The MRCPsych including all parts, has been continued during the Covid-19 pandemic as an online exam including the CASC exam. All part of MRCPsych  can be taken from your own home.

Before Covid 19, the papers and CASC exam took place twice a year in the UK with a few overseas options. However, the situation has now changed.

Please check for ongoing updates on the RCPSych website.

How many times can I attempt the Exam?


You must pass PLAB 2 within three years of the date you passed PLAB 1. 

You can attempt the exam (PLAB-1 and 2 each) four times.

If you’ve failed the exam four times, you can apply for one final attempt. You will need to demonstrate evidence of additional learning over a 12 month period and make an application


Once you have passed your first written paper  (Paper A or B). You have 1,643 days from the date the results are published to complete all remaining parts of MRCPsych.

If you haven’t completed all parts within the 1,643 days, you’ll need to re-sit all parts to pass. 

However there are special circumstances which you may be granted an extension, for instance if you took maternity leave, or worked part-time.

Where can I find Covid-19 related updates?



What is the recommended time required for preparation?

This will depend on the individual doctor, their expertise and experience. In my own experience:

PLAB: 4 months for PLAB-1 and 6 weeks for PLAB-2 (during and immediately following my internship in Pakistan).

MRCPsych: 4 months for each paper and around 3 month active preparation for the CASC exam (whilst I was training in the UK).

Both exam require research of the curriculum, online learning, courses and study partners.

Which exam would you recommend for the purpose of GMC registration?

This will depend on your experience, expertise and future goals.

The PLAB exam is a much easier in comparison to the  MRCPsych in my opinion and for the junior IMGs I usually suggest considering the PLAB initially.

The PLAB is also less expensive than the MRCPsych exam in terms of fees. However, since Covid 19 the MRCPsych can be taken from your home country and you can save money on travel and visa fees.

The MRCPsych requires a certain level of expertise and experience in Psychiatry and is relatively easier to pass if you are working in the UK. However if you working outside of UK, it will require more effort in compare to UK trainee but it is possible. If you are an experienced psychiatrist you should certainly consider it.

Best wishes:

Psychiatric Secrets of Success: Who Wants to be a Specialist Registrar?

Based on:

Naeem A. Psychiatric secrets of success: who wants to be a specialist registrar? Psychiatric Bulletin. 2004;28(11):421-424. doi:10.1192/pb.28.11.421


This paper aims to help trainees successfully negotiate the important ‘step up’ from senior house officer or equivalent grade to specialist registrar. It outlines the current structure of higher specialist training programs in psychiatry, stresses the importance of early planning during basic specialist training, and provides a guide to success in the shortlisting and interview stages.

Completion of basic specialist training, with the award of the MRCPsych, is an important milestone for psychiatric trainees. By this stage, most trainees will know which branch of psychiatry they wish to pursue at specialist registrar level. Since 1997, completion of the Calman reforms to higher specialist training has required specialist registrars to be recruited to training programs rather than to individual posts. These reforms aligned the UK system of specialist training with the European Union directives on medical training. The subsequent restriction of national training numbers available for each psychiatric training scheme has placed an important hurdle in the path of prospective higher trainees – the specialist registrar interview.

Higher specialist training programs

There are currently six higher specialist training schemes in psychiatry, covering general adult, old age and forensic psychiatry, child and adolescent psychiatry, the psychiatry of learning disability and psychotherapy. They make applications through regional deaneries, who advertise any vacancies in BMJ Careers. Training in a single specialty, leading to the award of a single certificate of completion of training, or CCT (formerly CCST), requires 3 years of training. Trainees undergoing training in the psychiatry of learning disability, general adult or old age psychiatry may spend one of these years in another appropriate specialty. Training in a combination of specialties (leading to a dual CCT), or in a lecturer post in a single specialty, requires 4 or 5 years, depending on the combination. The College’s Higher Specialist Training Handbook  outlines the requirements for specific dual CCT combinations. The number of regional specialist registrar vacancies is restricted by the availability of national training numbers. Vacancies depend upon existing specialist registrars completing their training and securing a consultant or locum consultant post, or moving to train in an additional sub-specialty, or the acquisition of funding for an additional national training number. Trainees can get helpful careers advice from regional higher specialist training programme directors, and by looking at any published regional ‘competition ratios. In recent years, specialist registrar recruitment to general adult psychiatry has become less popular compared with the psychiatric sub-specialties, owing to the perceived increased workload for general psychiatry consultants without improved resources.

Specialist registrars wishing to transfer to another training program in the same specialty should plan well ahead, liaising with the program directors, postgraduate deans, and future trainers. Although temporary geographical transfers (6–12 months), to gain specialist experience offered by another region, can be done with the trainees retaining their existing national training number, permanent transfers require allocation of a new number by the new region.

Wide regional variations exist for specialist registrars wishing to train flexibly, with some regions unable to fund all their flexible trainees. Over recent years, child and adolescent psychiatry has seen a rise in the number of flexible trainees.

Overseas doctors without UK residency rights can apply for fixed-term training appointments, which carry a fixed-term training number. They categorize these as ‘type 2’ specialist registrar training programs.

Senior house officer training experience

In applying for specialist registrar schemes, trainees who have given some thought to higher training during their senior house officer (SHO) years can reap the rewards of any earlier work. Although gaining a broad clinical experience and passing the MRCPsych examinations are the priorities for most SHOs, they should also be encouraged to engage in other activities that might benefit their future career plans. This includes participation in audit projects, undergraduate medical student teaching, management meetings (involving service development or risk management), and learning basic computing and research skills (e.g., performing literature reviews). Educational supervisors should ensure that clear, focused education and training objectives are set at the beginning of each SHO placement. Each target should be realistically attainable, as the European Working Time Directive can considerably shorten SHOs’ available ‘training time’. Therefore, a trainee interested in a future career in a ‘organic’ branch of psychiatry (such as learning disability psychiatry, old age psychiatry and neuropsychiatry) could realistically:

  1. Complete a regional audit looking at ‘off-label’ prescribing in old age psychiatry.
  2. Lead seminars for medical students on the ‘physical theories’ of schizophrenia.
  3. Perform a literature review on the use of antipsychotics for challenging behavior in people with learning disability.
  4. Contribute to a management meeting looking to develop a local protocol for the pharmacological treatment of challenging behavior.

Trainees should aim to complete an audit cycle by either ‘closing the loop’ themselves or asking their successor to do so. Some trainees may complete a minor research project, either in an SHO research post or during their regional day-release course (if it doubles as a MSc course). However, for most SHOs participation in formal research is an unrealistic aim. Writing up an interesting case report or responding to published papers (by e-letters to journals) is more realistic. Writing e-letters can sharpen trainees’ critical appraisal skills, increase the chance of journal publication, and provide a topic for discussion at the specialist registrar interview.

Use of the College’s logbook allows an accurate, up-to-date record to be kept of the training experiences and competencies gained during basic specialist training. It can also make the hurdle of getting shortlisted for a specialist registrar interview easier to tackle.

Getting shortlisted

Most training programs require the submission of a completed, detailed application form rather than a traditional curriculum vitae. The form usually reflects a locally agreed ‘competence framework’, aimed at selecting future psychiatric specialists. Although its structure varies from region to region, they request certain information in all specialist registrar application forms (Box 1). Referees are asked to complete a ‘structured’ reference form under good recruitment practice. Shortlisting committees score each applicant based on the information in the form, using a pre-determined score sheet, which identifies ‘essential’ and ‘desirable’ criteria for appointment. Candidates need a minimum score to be invited for an interview.

Trainees should read the guidance issued with the form carefully. Some sections of the form may need to be filled in using your own handwriting; in others, typed information may be acceptable (easier to do if they can download the form from the Internet). Use your logbook to extract the salient points in your training that apply to the program you are applying for. Describing an audit on urinary drug screening in a general adult ward might look impressive in an application for a general psychiatry scheme but is less likely to stand out when applying for a learning disability scheme: quoting an audit on ‘out of license’ prescribing might look better there. Some training experiences (such as teaching or examining medical students, computing skills, and published e-letters) can apply to all training schemes.

Make sure the handwritten entries in the forms are legible, as they make copies for the interview panel to read if you are successful at reaching the shortlist. Small handwriting in blue ink does not photocopy well! If typing any sections, use a simple Sans-serif text, avoiding any fancy fonts or italics.

Properly completing an application form can take several hours. Compile a rough draft on a copy of the form and ask your educational supervisor to look through it. Respond to any changes recommended before completing the actual form.

The interview

Specialist registrar interview panels in psychiatry can daunt because of the number of panel members, who include:

  1. The relevant program director (or directors)
  2. A deanery representative (usually the postgraduate dean)
  3. A representative from the Royal College of Psychiatrists
  4. A lay representative (who usually chairs the interview)
  5. A selection of current specialist registrar trainers (including a university nominee) from the relevant specialties.

Remember that most panel members are looking for potential future colleagues. A smart dress code, appearing relaxed and ‘politely’ confident and displaying an ability to answer questions in a diplomatic and balanced way, can help to attain success.

Box 1. Generic information needed for most specialist registrar application forms

  1.  Professional qualifications (with dates)
  2. Current and previous employment details
  3. Courses attended (can include MRCPsych, section 12 approval, life support and computing courses)
  4. Audit experience
  5. Teaching experience
  6. Information technology experience
  7. Management experience (including committee work)
  8. Presentations made at local, regional, and national level (e.g., case presentations, journal clubs)
  9. Experience of evidence-based medicine
  10. Research experience (past and in progress)
  11. Prizes and publications
  12. Goals for specialist registrar training
  13. Three references (one of whom must be your most recent or current supervisor)

To ensure equal opportunity at any regional interview, they ask each candidate the same set of initial ‘stem’ questions, with follow-up ‘probe’ questions based upon their responses. The College’s competency-based curriculum for higher specialist training provides an excellent guide for specialist registrars to the topic areas that are likely to be covered in the interview ( Table 1 summarizes the main competencies, with some suggested examples. Trainees can usually adapt these to suit their own intended career plans, by quoting specific examples (e.g., realistic research projects that could be completed during higher specialist training). Think about how you would like to spend your ‘special interest sessions’, ensuring that they relate to your intended career plans.

Table 1. Core professional competencies for specialist registrars in psychiatry.

ClinicalTraining as a general adult psychiatrist with expertise in eating disorder
ProfessionalPractice autonomously and ethically, using authority appropriately
Education and teachingExperience supervising, teaching, and examining pre-MRCPsych trainees and allied health care professionals
Leader and teamworkProvide specialist input within the context of a multidisciplinary team
ResearcherContribute to the development and dissemination of new knowledge by participating in audit/research (e.g., developing a screening tool to detect eating disorder among medical in-patients)
CommunicatorMaintain good therapeutic relationships with patients, carers and other professionals
Management and service developmentDevelop a new clinical service or teaching innovations in psychiatry

Trainees should be able to describe any memorable cases they have been involved with, together with cases they did not handle so well. Saying that you have never had difficulty managing a case is unlikely to impress the interview panel. As E. J. Phelps said, ‘The man who makes no mistakes rarely makes anything’!

Be aware of topical issues regarding the National Health Service (NHS), and how they relate to psychiatry. Examples include current NHS regulatory agencies (such as the National Institute for Clinical Excellence and the Commission for Health Audit and Inspection), clinical governance, revalidation, personal development plans and continuing professional development. Do not be surprised to be asked ‘broader’ questions requiring debate, such as the value of research in specialist registrar training, the benefits of audit to the NHS or controversies surrounding the consultant contract. Have knowledge of the mental health National Service Framework documents, the role of assertive intervention teams and the proposed changes to the Mental Health Act 1983. Think about where you see yourself in 5–10 years’ time.

Satisfy the panel members (who may have differing views), by giving balanced arguments, highlighting the points ‘for’ and ‘against’. Advances in Psychiatric Treatment, Psychiatric Bulletin, BMJ, Hospital Medicine and Hospital Doctor are reliable sources of review papers on topical developments. In throwing you a ‘clinical vignette’ to discuss, the panel are testing your thought processes and powers of reasoning rather than your factual knowledge; for example, how would you deal with a team member who is ‘behaving inappropriately’ towards patients? Apply your MRCPsych clinical skills by thinking broadly like the bio-psycho-social model, incorporating immediate, short-term and longterm management. Avoid extreme views or flamboyant management ideas. Most selection panels rank applicants based on the interview, application form and references, with some schemes putting more weight on one or other of these components. The panel may discuss and alter rankings if any applicants have similar scores.

Practice for the interview by asking your educational supervisor or current specialist registrar to conduct videotaped ‘mock’ interviews. Change your techniques in response to any constructive feedback.

What to do if you are unsuccessful

The reality for many SHOs wanting a specific but sought-after specialist registrar rotation is that they may be unsuccessful at their first interview. This is for those who have just got the MRCPsych. Such trainees have a range of options available, which could help strengthen their application for a second attempt.

Look out for any advertised 6–12 months locum ‘approved for training’ specialist registrar posts in the region. Although such appointments are competitive, they have the advantage of eventually counting towards the CCT award upon obtaining a national training number, as they carry the same training elements as substantive specialist registrar posts. Alternatively, locum ‘approved for service’ specialist registrar posts, with locum pay rates, may be available, although these lack formal training elements and do not count towards the CCT award.

Discuss the availability of other posts with your rotation tutor, who could also help you refine your interview techniques. Taking another SHO post might allow you time to complete an audit project or enhance your teaching and management skills (by attending relevant courses, instead of the regional MRCPsych course). A staff grade or associate specialist post would provide experience at a higher grade (including section 12-related work) but might lack formal training opportunities. A clinical research fellow post would allow a combination of specialist clinical and research experience, where the latter could be continued during higher specialist training. However, beware of opting for a post that bears little relevance to your intended specialty. Time spent in a clinical research fellow post in eating disorders might raise uncomfortable questions at a specialist registrar interview panel for old age psychiatry or learning disability! An extra 6 months in an SHO post in the intended specialty would have looked better.


The College is actively continuing to review the higher specialist training programs in psychiatry. Debate continues about the possibility of having ‘generic’ general psychiatry training awards for all trainees, new training programs (e.g. in neuropsychiatry or addictive behaviour) and modification of the specialist registrar ‘research day’. Whatever changes occur over the next 5 years, the principles of obtaining a national training number will remain the same. Early planning, focused training and good careers advice are essential. Educational supervisors have a pivotal role in this. In applying for a specialist registrar scheme, try a little ‘role reversal’—what attributes would you look for if you were on the selection panel?


Naeem A. Psychiatric secrets of success: who wants to be a specialist registrar? Psychiatric Bulletin. 2004;28(11):421-424. doi:10.1192/pb.28.11.421


  1. Catto, G. (2000) Specialist registrar training – some good news at last (editorial). BMJ, 320, 817–818.
  2. Department of Health (1998) A Guide to Specialist Registrar Training. Leeds: NHS Executive.
  3. Heard, S., Appleyard, J., Aitken, M., et al. (2002) Using a competence framework to select future medical specialists. Hospital Medicine, 63, 361–367.
  4. Naeem, A., Rutherford, J. & Kenn, C. (2003) The new MRCPsych Part II exam—golden tips on how to pass. Psychiatric Bulletin, 27, 390–393.
  5. Newlands, C. & Mckinna, F. (2001) Career focus – geographical transfers in specialist registrar training. BMJ, 322(suppl. 27 Jan), s2–3.
  6. Pidd, S. A. (2003) Recruiting and retaining psychiatrists. Advances in Psychiatric Treatment, 9, 405–413.
  7. Royal College of Psychiatrists (1998) Higher Specialist Training Handbook. Occasional Paper OP43. London: Royal College of Psychiatrists.
  8. Sims, A. C. P. (1997) Has psychiatry become an unpopular specialty? British Journal of Hospital Medicine, 58, 306–307.
  9. Weston, R. (2000) Equal opportunities in the recruitment and selection of doctors. BMJ, 320 (suppl.15 Jan), s2.
  10. Whitehouse, A. (2002) The way I see it – National Competition ratios should be available for all HST applicants. BMJ, 325 (suppl.17 Aug), s55.

GP vs Psychiatry

IMG doctor in the UK frequently tell me that they are confused between choosing GP training or Psychiatry and ask for my advice.

I am a Psychiatrist, my wife is a GP. We were training and preparing for exams simultaneously , so I have some understanding of what is involved in GP training and as time has passed I have gained better understanding of the workload of GPs. So in this post I make a comparison of basic differences a Psychiatrist and GP based largely on my personal experience.

Disclaimer: This is written based on my own experience and other people may disagree. I am a Psychiatrist so I will be naturally biased towards Psychiatry  despite my best efforts to remain neutral.

Life of a Qualified GP or Psychiatrist:

Time allocated to see patients:

GP: 10 minute per patient,

Psychiatrist: 20-30 minute follow-up and 40-60 minute New patient (most cases)

Number of Patient seen in a day:

GP:  From 32 patients per day (40-50 if on-call) 2-3 average home visits daily.

GPs often refer to sessions. One session is roughly 4hrs. So a full day would be two sessions. Full time GP work around 9 clinical sessions.

Psychiatrist: 6 patients in a clinic (two clinics in a week for me)

My routine home visits will be maximum of two in a week.

Routine day:

GP: Daily clinics, frequent home visits, daily paperwork of results, letters and prescription queries. Liaison with district nurses, palliative care teams and midwives/health visitors varies on a daily basis.

GPs may have set minor surgery clinic, contraceptive clinic and baby clinic/ hospital clinic depending availability and own special interests.

Psychiatrist: Variety of job descriptions depending on the sub speciality, can include clinics, MDT meetings, community based jobs, home visits, inpatient and hospital based roles.

My Current job plan includes 2 clinics a week, one MDT meeting weekly, weekly ward round, some ward based meetings and weekly home visits. I am managing inpatients, community team and memory team.

Age and patient group:

GPs see all age groups and all varieties of medical conditions from simple conditions to complex cases. They are often the first port of call for medical care.

Psychiatry involves sub specialties that are also age specific focusing on different age groups and there are many sub specialities of Psychiatry, narrowing down the scope of work further. i.e super specialism

As an Old Age Psychiatrist most my patient are above 65 . Child Psychiatrists see patients up to the age of 18 years.

Uncomplicated mental illnesses is often managed by GPs for example simple anxiety and depression.


GPs work much harder than Psychiatrist (at least in my household).

This simply include more patients for GPs and more paperwork.

Teaching research and becoming a trainer:

GPs: You can train to become a GP trainer and also develop the practice to support medical students placements. There are also routes to train as Academic GPs. GP trainers can train GP trainees from ST1-ST3. Most practices are affiliated with local medical schools and have medical students from year 3 and 5. My wife is also involved in training independent pharmacists and nursing students.

Psychiatrist: We are expected to train and supervise junior doctors even from our ST years. Quite frequently the new consultants are clinical supervisors for juniors and soon train to become educational supervisors.

There are plenty of teaching opportunities for senior psychiatrists, including medical schools, junior doctors and MRCPsych courses. Mental Health research is also getting significant funding and focus with some cutting edge research going across the UK.

Private and locum work:

There is a shortage of both qualified Psychiatrists and GPs across the UK. Plenty of locum work available.

GPs: Some local schemes offer Golden Hellos of up to 20K.  Private GPs and portfolio GP can enhance their earning. There are numerous opportunities to do locums and develop special interests.

Psychiatry: Opportunity to do locums, Section 12 assessments, DOLs assessments and private sector work.

Private companies are managing many psychiatric hospitals / units where consultant psychiatrist salary may start from £140,000 pa.

On-calls, Nights and Weekends:

GPs can choose hours independently and practices have flexibility and organise their own rotas. GP opening hours can vary locally but majority of practices working hours are 8am to 6.30pm. You may wish to work as a OOH GP only or do a mixture of both.

Qualified Psychiatrist are much less frequently on-call and do most on-calls from home. I do only one weekend every 3 months and one weekday on-call after every 20 days.

ST doctors in Psychiatry are also mostly on-call from home.

Scope outside UK

Good opportunity for both specialities to migrate to other in English speaking countries such as Canada, Australia and New Zealand. There have also been very successful recruitment to the Middle East.

Training years:

Training time to CCT: (In most cases)

GP: 3 years (18 months of hospital placement and 18 months in GP for my wife) Recent changes involve 12 months hospital based training and 24months GP based training.

Psychiatry: 6 years (3 years of Core and 3 years of ST training)

Membership Exams:

Both training requires work place base assessments (WPBAs), evidence that you are covering curriculum and to pass the ARCPs


Psychiatry (MRCPsych) = Paper A and B (2 MCQ papers) and CASC (OSCE style practical exam)

Psychiatry membership exams are required to progress to the ST training.

No exit exam in Psychiatry during ST training


Similar pay scales as trainees and post qualification for GP and Psychiatrist.

GP Salaried positions have fixed salaries, partners take drawings based on practice performance and enhanced services. GPs can also work for local health boards for fixed no. of sessions or part of NCN groups.

There are plenty of opportunities to earn extra by exploring different options for both GP and Psychiatry. Locum opportunities  are available for both specialties.

Rotations during training:

GP: Rotate between mixture of hospital and GP placements

GP trainee remain relatively local but usually expected to drive and can be sent to GP practice some miles away but close networking with programme directors allows to have flexibility of training at closer practices if required. Hospital based training can be at different hospitals within a trust.

Psychiatry: Core trainees rotate between different subspecialties of Psychiatry and ST trainees rotate in one or two particular specialities of their choosing.

Psychiatry ST trainees also move between different trust within a deanery. My ST training was spread across three different trust in Wales.


Following completion of training and membership exams GPs register on a Medical Performers list locally and also the GMC GP register.

Psychiatrist register on the GMC specialist register and there are six different types of CCT for Psychiatrists. (General adult psychiatrist, Old age Psychiatrist, Child psychiatrist, LD psychiatrist, forensic psychiatrist and medical psychotherapy)

What happens if I couldn’t pass my membership exam or ARCPs?

GPs: You will leave GP training without qualification and will not be able to work as a GP.

Psychiatry: You can still work as a Psychiatrist at a speciality doctor level and some even progress to become locum consultants without membership exams and CCTs. You also have the option to take CESR pathway to become a substantive consultant.

Once you have around 3 year experience as a psychiatry junior doctor, you can secure, with relative ease, agency locums as a speciality doctor job and earn up to £80,000 – £100,000 per year.

I frequently say to juniors:

The advantage of choosing GP maybe shorter training period but you will hit the ground running and take on the duties of a seasoned GP immediately. There is more flexibility in working hours and days but your day can be particularly long with a heavy case load. You are often working alone so good supportive colleague and a good efficient team are important to support your working day.

So be careful as by choosing less training time, you may end up with an extremely busy job. So choose the speciality depending on your passion and interest.

This might come to you as a surprise that GPs see more mental health patients than psychiatrist. Research suggest that about 40% of GP appointments are mental health related. A huge variety in clinical conditions and build-up of close connections with patients from cradle to grave still underpins most GP models.


So if you are choosing GP to avoid seeing mental illness you may be in for a surprise.

Best Wishes

Psychiatry Training Activity

Prof. Fareed Aslam Minhas conducted the psychiatry training activity for the residents training 19th, May 2016 at CPSP Karachi in the local training units.

Psychiatry Training Activity

The following is the list of participants who attended the Psychiatry training activity at the Head Office of the College of Physicians and Surgeons Pakistan.

Proceedings of the activity:

The Psychiatry Training Activity started at precisely 1603 hrs. The dean opened the proceedings with a welcome to the trainees and asked them to introduce themselves formally. Forty-one trainees from Civil, JPMC LNH, AKUH, Abbasi, and Shifa Hospital were present at the occasion. The layout of the day’s activity was:

  1. Long Case Presentation by Dr. Ilyas (JPMC )
  2. Long Case Presentation by Dr. Amna (JPMC )
  3. Short Case by Dr. Ajay (JPMC)
  4. Short Case by Dr. Anoop (JPMC)
  5. Objectives of the activity:
  6. Focus on the current examination system.
  7. Presentations by the trainees.
  8. Feedback from within the trainees and Dean.

The Dean explained that he and his team have a responsibility to visit every center and meet the trainees, assign them their roles, make then understand the responsibilities of their respective training institutions as provided by the college (CPSP) guidelines and thus help the trainees to pass through the system smoothly. This was very nicely put by the Dean as ” To leave Mental Health of the country in safe hands.” His vision is to increase the number of supervisors from 40 to 60 initially and keep building it up.  Dean’s mission statement is to increase psychiatry trainees, to increase supervisors, more people pass exams with quality training, improve training, and bring it at par.

Training Activity 1

Long Case

Suggestions by the Dean: 

Long-case is presented for a remarkably interesting reason. You will see a patient for 45 mins, two examiners are watching you and they say nothing to you. At the end of those 45 minutes, examiners leave, and you get fifteen, mins to prepare your formulation for the next 30 mins to encounter two examiners. Art is that you should be able to present your history in 7-8 mins, so you need to organize your presentation in this way. In the last 22 mins, around 10 mins between each examiner, if you have prepared well then you can answer better.

The first examiner will ask about relevant investigations, Probable diagnosis, and MSE. The next examiner will ask about management, recent advances, and the prognosis of your case. “Remember, the long case is a typical representation of your ward round.” So, I am not telling you anything new, this is a clinical exam.


  1. Diagnosis not clear, schizophrenia vs mood Disorder.
  2. ICD Multi-axial Diagnostic criteria have utility in this case, for e.g.
    1.  Axis I: Primary Psychiatric Diagnosis, Medical Disorder.
    1. Axis II: Disability
    1. Axis III: Global Assessment of functioning.
  3.  Relevance of life events and relapses.
  4. They cannot guard the course of illness.
  5. Presentation needs organization.
  6. Mention Bio-psycho-social aspects in the management plan.
  7. Recent advances.

The trainee was competent, and that overall, his style, knowledge, and content are good. The Dean praised the presentation style in terms of short-term and long-term courses. This is an effective way to break the monotony of the case. 

An especially important query from trainees was answered by the Dean here. When asked about the case presentation format, Dean explained that it is ok to use a formulation, summary, case, whichever system a trainee is comfortable in. The examiners can understand. If you cannot assimilate in 8-9 mins, they will stop you. However, if you can speak for 10 mins in a flow you are doing well. 

Training Activity 2

Long-Case by Dr. Ammara from Jinnah Postgraduate Medical Institute

Suggestions/comments by Dean: 

1- Mention the Differential of Depression.
2- Mention the differential of Phobic Anxiety Disorder.
3- Importance of childhood events.
4- Medical Differential Diagnosis like hypoglycemia, pheochromocytoma, not relevant.
5- This case can do better as an out-patient, with no need for admission.

In summary, according to the Dean, this was a good presentation. He had an excellent command over language; his presentation skills were up to the mark.

Short Case 1 and 2

Comments by Dean: 

Dean clarified the expectations of the trainees regarding short cases. There are not over thirty cases/ scenarios, therefore, it is quite easy for you to prepare. Common causes include:

  • Drug history,
  • OCD assessment,
  • Suicidal risk assessment,
  • Borderline personality assessment,
  • Difference between Conversion and Epilepsy,
  • Cranial nerve examination,
  • Informational care plans,
  • Assessing cognitive functions.

Each short case is 10 mins, 5 mins to intervention, and 5 mins to the examiner. You also know that you send to medicine and neurology for 3 months, respectively. How does this role get picked up? My idea is what you know, your supervisor knows. This Hierarchy has been effective. So, I take this task to myself and so this is the job of your supervisor to tell you about the short cases.

  • Regarding the short cases, Dean said, you have 5 mins for the interview, take relevant points in the time.
  • Stay focused on information collection.
  • Keep interrupting your patient to stay focused.
  • Candidates can themselves make a key they present later.
  • Candidates MUST practice.
  • Take twenty histories from twenty drug users and see how it enhances your skills.

The dean appreciated the Journal Club presentation by Dr. Sana (Agha Khan University Hospital). According to the Dean, trainees need to know the importance of reading a journal and the journals they need to read. The aims are to stay updated, improve clinical practice, and improve self-interest in research.

We must confine ourselves to some basic journals, BJP review articles every month is an effective way to stay abreast of all the information. So, in four years of training, 48-50 articles will be read, and the trainees will be aware.

Last lesson by the Dean: The ingredients of structured training is given in the college prospectus. This session was all about that. If you don't do it in your training, please ask your supervisor to follow these guidelines. My supervisors need to help me deliver it right. 

  • The session adjourned at 2000 hrs.
  • Minutes submitted by Dr. Sobia Haqqi.
  • Chaired by: Dean of Psychiatry Prof. Fareed Minhas.
  • Co-ordinators:
  • Dr Sobia Haqqi, Dr Anil Wadhwani, Dr Jawed Akbar Dars
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