Training in the UK

Information About the Writer

Dr Elmunzar Bajouri Orthopaedics Registrar

 

Training in the UK .. more than one way to skin a cat (Introduction)

Training in UK is deanery based and that allows you to move between hospitals and work under different surgeons, hence you learn different  techniques and approaches to solving the same problem.

Training jobs in UK can either be run through jobs where you start your training program after foundation years as a run through program or-as in Orthopaedic training and other specialities – is uncoupled unless you chose the academic route, here you will have to apply for core training first then reapply for higher or specialised training. The obvious issue here is that you may struggle or take longer time before getting your registrar training rotation. Luckily there are alternatives in such cases.

 

Before starting … the road signs

Before going into the details of surgical training pathways in UK there are certain Buzz words that you need to know:

• Foundation: It like internship in Sudan , 2 years for fresh starters after graduation where the junior doctor will explore different medical and surgical specialities followed by a second year in which you act as a junior SHO. You are expected to provide ward care and attend theatres and clinics as supernumerary.
• SHO: or senior house officer, it is a bad word now and its official use is banned. It was replaced by core trainee or foundation trainee according to your level. However it is used to describe a level of training among medical personnel and it stands for our medical officer in Sudan but with far less authorities, you are expected to supervise F1s in ward care, attend theatres and clinics.
• Speciality registrar: Registrar in training
• Trust grade/ clinical fellow: These are descriptions for non training posts starting from F1 to consultant.
• Core training: it is a training post which starts after foundation training, nowadays the word core trainee is used to refer to a level of seniority. It marks the start of your specialisation career and it is themed in most  specialities, e.g. in orthopaedics you end up doing 16 month of orthopaedics where you are trained to provide the ward cover for surgical patients, deal with acutely unwell surgical patients and be able to perform the simple surgical operations under supervision ( DHS, ankle, hip semi arthroplasty , … )
• LAT: stands for locum appointment for training , it is a fixed term training job ( not a full rotation)
• LAS: stands for locum appointment for service, it is a non training job for limited period of time.
• JCST: Joint committee on surgical training, it is the body that sets standards for training  and it fathers the ISCP which is the electronic portal or educational portfolio for surgical trainees ( can be used by non trainees as well)
• CCT Certificate of specialised training , it is the final certificate which enables you to be added into the GMC specialist register and hence act and work as a consultant in the UK. it is for those who are in a training rotation.
• FRC Fellowship of the royal colleges, while the MRC is used to ensure that you have the basic knowledge needed for a registrar, the FRCS is used to ensure that you have enough knowledge to finish your rotation.
• NTN When you get your orthopaedic training rotation you will be provided with a number exactly like the one given for soldiers and it is called the national training number.

As mentioned in the title, there is more than one way to skin a cat and definitely more than one path to become a consultant in the United Kingdom.

There are usually 2 types of medical graduates who come to UK from Sudan, the more or less fresh juniors and the other group are the more senior ones who finished their MD in Sudan.

 

I advice everybody and specially the juniors to try to get a national training number, it is more difficult that the other route to start but definitely easier to finish and your chances to finish and end up with a CCT and a consultant job is much better. For years we Sudanese graduates-had the assumption that getting a training number in UK is impossible, from our experience and after speaking to people from other nationalities who came to UK under similar circumstances to ours, I can confirm that the road is open to everyone , obviously you need a good plan, communication and hard work.

 

Factors that improve your chances of getting into a training program in are:

1. Foundation training , so I advice especially fresh starters to get into a foundation training program or at least to do an F2 LAT year and get signed the foundation competencies by a UK based consultant; If not possible then there is a form that can be filled by any consultant in Sudan for the application forms. That will provide you with extra points when applying for core training and more important will make you familiar with the system,  get you involved in audit and from research from an early point.
2. Core training : I think it is almost a must to get a NTN, so even if you didn’t get into foundation program, you should fight for a core training program in uncoupled specialised, it will provide you with the assessments needed, guided surgical experience,  you will be competing with trainees and that will raise you to their standard, will always have advice from consultants and trainers on how to improve yourself and get the NTN and will definitely grant you extra marks in the application form.
3. CV : There are factors in the CV that you can change and others you can’t such as :
   1. Your nationality : Cannot change, your chances get better when you have indefinite or passport, however, many of our friends and seniors got core training with non UK/ EU passports ( there is a second round now and even a 3rd round)
   2. Audits , presentations and publications: it is a culture and your first step should be speaking to your consultant and the orthopaedic department if you got stuck in a non ortho job.
   3. Higher degrees: a good way of increasing your chances, you have many options :
      1. online degrees during your core training and that can be musculoskeletal or medical education
      2. After you do you core training and foundation training you will need one year to complete your golden 5 years to get your indefinite and a good option to spend this year is a higher degree in a research job; the consultants usually help you to get these jobs ( difficult to get just by applying, and beware of research jobs without funding as may not reflect well on your CV if you did a research job without doing a reasonable project and/or publishing. Here your options can be an MD, MSC or even PHD
   4. Courses: some courses are important for your progress, always you get full marks if done in UK, if done in Sudan you may get the marks, details for each specialty are found in the relevant sections in the website
   5. MRC  : From personal experience getting Part 1/A will do you a massive favour into getting the core training while getting full membership is a must to be taken seriously during your core training and a prerequisite for NTN application and working as a registrar in UK.
   6. Teaching : Very important , my advice is :
      1. Do teach a teacher course : thats marks for granted
      2. make a feedback form and whenever you present in the department or teach medical students give them this form ( medical students always write good things), now the ISCP has ready made teaching assessment
      3. Contact the hospital simulation centre and ask if they need teachers/ trainers
      4. if your hospital organise a relevant course
   7. Leadership and commitment:
      1. speak to consultants in the department, you may get a chance to organise teaching, prepare departmental booklet, etc
      2. Membership and subscription  of societies/journals  relevant to the specialty you want .

 

Basically try to grab any chance to build up your CV, competition is tough.

 

As a core trainees you and registrar you will be assessed on regular basis and will have annual assessments called ARCP. these will monitor your progress looking at your logbook, exam status. also you will be required to provide evidence of your knowledge , clinical judgement and surgical skills  using the ISCP assessments ( Procedure based assessments, case based discussions, mini- CEX).

At the end of every placement you will be asked to provide evidence of progress as above, the main difference is that as a trainee registrar you will have logbook targets.

at the end of your 2 years core training, you will be provided with a certificate of completion if you completed your MRCS, had good progress in your assessments and had good logbook. As a registrar after completion of the 6 years, if you managed to achieve the logbook targets, good assessments and passed your exam the you will be awarded the CCT and will be added to the specialist register.

After finishing you will have the option of either looking for a consultant job or-as many people do- go for fellowships in UK or outside to better prepare yourself and improve your chances of getting a consultant job.

For those who came to UK after some experience and opt not to / couldn’t get core training, the first step will be getting used to the NHS and orthopaedic practice in the UK by getting an SHO job followed by applying for registrar job. The JCST set guidance for those who want to be registered in the specialist register and didn’t get the CCT, through the Certificate of Eligibility for Specialist Registration or CESR. the requirements in general are a period of training outside UK ( favourable to have done a training rotation), to do the needed placements with adequate logbook and assessments and be signed of each by surgeons who have the FRCS beside loads of paper work to be submitted.

That will be reviewed by a special committee which will approve and recognise your training and allow you to be in the specialist register.

 

Competition :

The competition rates vary from year to another, and between specialities however they are getting less due to many political and training related changes that put many of the local trainees from training in UK. This year some of the jobs as the remaining candidates were deemed not appointable.  It will soon revert back so … hurry.

 

Pay scales and life as a registrar:

Difficult to talk about money now as the contract are changing and it is almost like a leap in the dark, we as trainees have limited insight into how the new contract will affect our pay. In general, working in the NHS, you are more likely to enjoy a reasonable life with pay that covers all your essentials but no fire works.

After completion of training, you are more likely to enjoy a good pay whether you decided to stay in the NHS-as you will have the chance to boost your pay with private work-or abroad if you decided to leave.

The pay scales under the current system divide into basic pay according to seniority and experience, in addition to the banding which depends on how many anti-social hours and nights you work.
Obviously your banding ( extra sum of money) will depends on the number of on calls you do. Most of the on calls now are non resident, so you will be cover from home but you will need to help the SHO when needed and see all admitted patients before hand over. You may also need to come at night if needed especially with serious trauma and open fractures.