Career options for RCSI – Bahrain Graduates in the UK

Career Options – Basics

Applying for medical training after graduating can be daunting given the number of options available for graduates, I thought I would share my experience with applications and the types of options available for RCSI Bahrain graduates.

I went through the application process for both Training and Non-Training jobs from the end of 2019 to the start of 2020. I received offers for both the F2 Standalone program and also for non-training jobs, so I thought I would share my experience as there are a lot of different ways to get a job in the UK.

This page is primarily for RCSI Bahrain graduates, but a lot of this information will apply to everyone.

Let me begin by saying, there is no better time to come to the UK as an international medical graduate, especially one from RCSI Bahrain.

This is due to the following reasons

1. Plab 1 & 2 are relatively straightforward – Firstly, the education you receive at RCSI Bahrain prepares you well for both the PLAB 1 & PLAB 2 exam. The MCQ questions in the Plab 1 are almost identical to our final year examinations and the Plab 2 stations are very similar to the OSCEs that we have been doing since 2/3rd year.
   
   
2. There are lots of jobs – I only applied for non-training positions for 2.5 months and I got a job. During that time, there were about 300-500 jobs. And those are just the non-training jobs, there is also the Foundation Program, the F2 Standalone program and the WAST Program, which are all open to IMGs ( More on the types of jobs later). You will get a job. Everyone that I know has gotten one, it is just a matter of patience.
   
   
3. Familiarity with getting a job – There are lots of RCSI Bahrain graduates already working in the NHS and can be used as a resource to guide you through the application/ exams.
   
   
4. Familiarity with the system, to an extent – Now, we are not familiar with the NHS system from our education, but what we *are* familiar is the way they take histories/ examine/ write notes – RCSI Bahrain follows the Irish system in terms of histories/ exams/ presenting patients and that is close enough to the UK system which makes transitioning easier.
   
   
5. Training Options – In my experience, there are more training opportunities for IMGs. Now, what do I mean by that? In other countries, specifically North American countries, IMGs are generally less common in some specialties such as Emergency Medicine, Surgery, Anesthesia, Intensive Care. But in the UK, I believe there is more of a scope in getting into these training programs. Here is the specialty competition ratio for 2019/2020 that gives you some insight into how competitive specialty/ residency training is:
   
   For example, for Internal Medicine Training/ Residency ( IMT – 3 years), the competition ratio is 1.43, with 2229 total applicants and 1563 total posts. This essentially means that you have a better than 75% chance of getting a post in IMT if you apply as of 2019.
   
   This is not to say that these training posts are not competitive, they certainly are, especially for fellowship training and also for certain training programs ( Neurosurgery at fellowship level had 21 applicants and 3 spots)

Basics of Postgraduate Medical Training in the United Kingdom

The above diagram gives you a general sense of post graduate training in the United Kingdom. If you have completed your internship, you are at the end of the FY1 year in the above diagram. That is where you are in your timeline.

Foundation Years ( FY1 & FY2)

To better understand how training in the UK works, when a medical graduate passes their final med exams in the UK, they apply for a Foundation Training, this is two years ( FY1 & FY2) of clinical training, it is not specialization into a distinct pathway, but two years of broad based learning in different rotations. This is NOT Residency, but still mandatory and every UK graduate does the FY1 & FY2 years.

At the end of your internship, you would have completed FY1.

Core Training ( CT1, CT2, CT3)

Before applying for Core Training ( Residency), all graduates, both UK & IMGs must have 24 months of clinical experience.

Once this is complete, they are now eligible to apply for Core Training, similar to ‘Residency’ in the US/ UK and that is in specific fields like Internal Medicine Training ( IMT), Core Surgical Training ( CST) – this lasts for 2-3 years and then they apply for sub-specialty training, similar to a Fellowship, which lasts for 3-8 years.

If we’re comparing it to the US, generally, your ‘Core Training’ is your residency, and your training after that, the ‘Specialty training’ is your fellowship.

But remember, you CANNOT apply for your Core Training ( Residency) without having at least 2 years of clinical experience & evidence that you are qualified for entering training.

At the end of your internship in Bahrain, you have 1 year of clinical experience. So the point of the jobs you apply for is to gain that additional year of clinical experience so you can apply for Core Training ( Residency Training).

Specialty Training

The last bit of training is termed specialty training. It generally starts at ST3 and runs for a number of years depending on what specialty you choose. In Medicine for example, it is 4 years after which you get a Certificate of Completion of Specialty training ( CCT) which allows you to work as a consultant.

Putting it together – An Example

This is an example of going through the training process for someone that wants to do internal medicine and wants to become a Consultant Cardiologist.

What jobs can I apply for in the UK as an RCSI Bahrain graduate after a 1 year internship?

There are two main categories of jobs you can apply for – Training jobs & Non-Training Jobs.

Based on what we’ve said above, to apply for Core Training programs ( Residency), you need 24 months clinical experience and a certificate from a physician saying that you are ready to enter specialty training, this certificate is called the ‘Certificate to enter specialty training’ or CREST.

So these are the objectives when you’re looking for jobs –

1. Provide 12 months of clinical experience ( So you have 24 months total, if you’ve done your internship)
   
   
2. The job that you get allows you to get your CREST form signed.
   
   The next question is – what jobs do you apply for then to fulfill the above criteria?
   
   These can broadly be divided into two categories – Training Jobs & Non-Training Jobs.

Training Jobs ( FY2 Standalone & WAST)

After completing your internship, there are two training posts you can apply for, you need full GMC Registration for both posts ( i.e. have done your internship). The year that I applied for them, there were 300 F2 Standalone posts and 50 WAST posts, so there are plenty of posts if you’re prepared. I got shortlisted for an interview for both posts – I was offered a place in the F2 standalone program starting in August 2020, but I took a different non-training offer as I did not want to wait until August 2020 to start working.

So what are these two training posts you can apply for?

Foundation Year 2 Standalone post

1. I mentioned previously that UK graduates enter the Foundation training program after graduating from medical school which is for 2 years.
   
   
2. The Foundation Year 2 Standalone post is that second year in the foundation training program, it lasts for one year and is the ‘F2 post’
   
   
3. At the end of that one year, you can start applying for Core Medical/ Surgical training.
   
   
4. It starts every August – applications for the 2020 program opened in January 2020, closed in February 2020 and then the program itself starts in August 2020. So you basically start your application DURING your internship year. Applications for 2021’s intake will similarly start in January 2021.
   
   
5. There is an eligibility criteria – some of this criteria you have to meet at the time of application, and some of the criteria you have to meet before you take up your post in August 2020.
   
   
6. You need to have finished Plab 1 and also be on schedule to finish Plab 2 and get GMC Registration before you start in August 2020.
   
7. The interview is 20 minutes long and is quite straight forward, it follows the format of most interviews where you’re asked to go through your CV, then a couple of clinical scenarios and then an ethical scenario.
   
   
8. At the end of your F2 Standalone post, you get the FPCC, known as the Foundation Program Certificate of Competence. As long as you complete this 1 year of training, you will get the FPCC certificate automatically. This certificate replaces the CREST certificate, so you don’t need CREST filled out, which is one of the main advantages of doing an F2 Standalone post.

The main advantages of an F2 post is therefore as follows–

1. It commences every August, that means once you finish your internship in July, you can automatically start your F2 year in August the same year, thereby minimizing any gap in your medical training.
   
   
2. It is a training post, training posts have more support from seniors, dedicated teaching time for you. In addition, at the end of your 1 year, you get the FPCC certificate which automatically means you are eligible for applying for residency training. In contrast, the CREST form is something you have to chase consultants to sign as it is a long form where you have to give evidence of a lot of different competencies. With the FY2 standalone, you are automatically deemed competent as long as you pass your assessments.
   
   
3. It is helpful for people who are undecided on what to do – the FY2 year lasts for 1 year, but has 3 different rotations each for 4 months, so you have a variety of specialties you rotate through.
   
   
4. Application process – applications are through ORIEL website and it includes an application form and then a 20 minute interview. Everything you need to know about the application process is here.
   

WAST Training Program

This is the second available training program, the full form is ‘Widening access to specialty training’ – Website is here

WAST is a 12 month program in England that will involve 12 months of clinical experience in acute hospital settings with potentially 4-6 months in psychiatry.

This program is supposed to be for those doctors considering GP as a future career, but anyone that is eligible to apply can still apply.

Things to note about the WAST Program

1. The application is made on ORIEL, the same place where you apply for FY2 Standalone discussed above.
   
   
2. Rolling starts are offered – in Feb & August
   
   
3. Interviews DO NOT take place through skype, you have to personally attend the interview in the UK.
   
   
4. You still need to get the CREST form signed during the program.
   
   
5. There are possibly 4-6 months of psychiatry rotations, that is something to keep in mind.
   

NON- TRAINING JOBS ( Service Jobs)

Non-training jobs are the second broad category of jobs that you can apply for after your 1 year internship experience. Your objectives with Non-Training jobs will be the same as before:

1. Gain 12 months of clinical experience so you have 24 months of clinical experience and can thus apply for Core-Training positions.
   
   
2. Get your CREST form signed in those 12 months so that you are eligible to apply for Core Training programs of the field that you want to specialize in.
   

Things to keep in mind regarding non-training jobs –

What position do I apply for – Training or Non-Training positions?

This is a good question – and was honestly something that is a personal choice as there are a lot of factors to consider.

For full disclosure – I applied for non-training jobs from November 2019 and got a job in February 2020, during that time, I also applied for F2 standalone positions and got a position starting in August 2020 for the F2 standalone position in Newcastle in Medicine & GP.

Because I had accepted a non-training position already, I declined the F2 standalone offer. These are the things I had to consider and questions that you need to ask yourself –