9 Tips for starting in the NHS as an IMG

I have now been working for 9 months in the NHS, this has included the second COVID wave. I’ve learned a lot and thought I would take this post to summarize some of what I have learned. Starting in the NHS with no prior NHS experience as an IMG can be tough, so here is a list of things I have learned that I hope will be useful.

  1. Be reliable, punctual and don’t run from work – The number 1 thing I will say is that you must be reliable. It is okay to not know things. What is not okay is to not be punctual or reliable. Show up to work on time, if someone asks you to do something or asks for your help – offer to help and do it if you have the time and is something you can help with. Punctuality is not negotiable, people will notice if you’re always late. It is okay to not know things as a junior doctor, but it is not okay if you are not a reliable person – ie try and finish things that you are supposed to do, and what you cannot do, *let* someone know and hand it over. Sometimes there will be too many jobs you have to do, prioritize the most important ones, and things you cannot do, learn to hand them over.


  2. Recognize that the first few weeks/ months will be tough – No matter how much medical experience you have, you will be moving to a new place and a new way of doing things. There will be lots of things you do not know and have never done before. Try and accept that things will be tough, especially mentally, and that is okay. We all need time and things will eventually improve. Ways to deal with this is finding things that will reduce your stress outside of work and even whilst at work. You will face situations where you are embarrassed that you don’t know something, and that is okay, if in doubt, always ask.


  3. Ask your HR for a shadowing month – After you accept your job, email your HR department and ask if you can have a shadowing period. My shadowing period was 1 month, during this time, I was there from 9 to 5 an would shadow the SHOs in my department, it was the biggest help to me before I started work. By the time I officially went on the rota, I was more used to my surroundings and had a basic understanding of how the department works. It also allowed me to get familiar with taking bloods, doing ABGs, catherizations, cannulas etc. I knew how to do most of those things, but you have to get used to the equipment etc, and all of that can be done during your shadowing period. The best time to ask for a shadowing period is after you accept the job. You must take the initiative yourself and email your HR department/ the person you interviewed you to request this shadowing period.


  4. Documentation is important – If you didn’t document it, it didn’t happen. As an SHO, you will be responsible for referring patients, getting advice from other specialists, booking radiology scans, having conversations with the family. You should document a lot if not all of these interactions, that way even if the patient leaves the ward you are on, the conversations and advice is present for other healthcare professionals to refer to. GMC recommends making records as events happen, or as soon as you can after the event. Remember, these are legal documents so you should make every effort to be legible and clear in your documentation, in addition, you should make sure you document in a timely manner.


  5. Read local trust guidelines – One of the most useful things I found after I started working was to read trust guidelines on various clinical issues that I encountered on the wards. My trust had specific guidelines on various issues such as Hyperkalemia, AKI, DKA etc, I think everyone has a fear that they don’t know x, y or z, but reading your local trust guidelines gets you familiar with these common things that you will encounter whilst you are working. Reading them gives you a fair idea of what is generally expected of you when you evaluate a patient with those medical issues. For example, if someone has an inpatient fall, the trust guidelines will guide you in terms of investigations they might need, what you should consider doing, when/ if they might need a CT Head. You will be surprised at how much you will learn by just reading your trust guidelines.


  6. Observe procedures before doing them – This might just be my own personal opinion, but when you move to a new place, they have their own equipment and it is also kept in specific places on the wards. During your shadowing period, you should ideally be able to observe all the procedures junior doctors commonly do, things like ABG, Catherizations, cannulas etc – if you are not confident in a procedure, ask one of the SHOs if you can observe them doing it and pay attention whilst they do it. I was personally not the best with ABGs when I first started working, but I observed a few people and then eventually managed to get fairly decent at them. Anything you are not comfortable doing, see if you can observe it first!


  7. Ask for help and escalate when you are concerned- You will be new to the system, there will be things you do not know, or something you might be concerned about. If you’re concerned, or unable to do something you’re supposed to, ask for help! If it’s a procedure that you are unable to do, ask one of the other SHOs. If it’s a patient you are concerned about, escalate it. Everyone works with a team, and my mantra is that if I’m unsure about something, I will ask, even if that includes a bleep, phone call, etc



  8. Understand how your hospital works – Hospitals have their own way of working, and the onus is on you to figure out what are the common pathways for your own hospital. For example, if faced with a deteriorating patient it might be expected for you to put out a MET call ( Medical Emergency Team), or perhaps bleep specialist nurses withing your hospital. In addition, sometimes it can be small things like for example if requesting scans, such as a CTPA, after hours, you are expected to discuss it with Radiology first etc. There are many different examples, but try an figure out how your own hospital works. Try and learn these pathways early!


  9. Referral to services and other specialties – There are lots of services within the hospital that patients will benefit from, specifically things like Occupational Therapy or Physiotherapy, these are usually present in every hospital so try and ask the occupational therapists and physiotherapists that you meet when and how to refer to them, ask your peers when they usually refer to these services. This also applies to referring patients to other medical specialties, try and learn what kind of information you need to have at hand before referring to a certain specialty, for example if referring to Hematology, you will need to have a certain amount of information before calling them up such as – recent bloods, any risk factors for bleeding/ clots, previous history, weather they are known to hematology etc. Some trusts have guidelines as to what information you should have before referring, see if your trust does and try and follow them



    The last thing I would say is this, when you are new to the country and new to the system, you will have tough days, those are hard to avoid, but slowly you will get better, it might take a few months to get to that stage. The first few months can be daunting, but you will see your own progress after 7-8 months of working in the same place.