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
- 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.
- 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.
- 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.
- 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.
- 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).
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.
- First you do a 1 year training or non-training job ( So now you’ve done your two ‘foundation’ years – 1 in Bahrain & 1 in the UK giving you a total of 2)
- Then you apply for Internal Medicine Training ( IMT) – this lasts for 3 years. This is your ‘Core Training’ or ‘Residency’.
- Then you apply for a specialty within Medicine, say Cardiology, and this lasts for another 4 years and is called ‘Specialty training’
- At the end of this, you become a Cardiology consultant.
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 –
- Provide 12 months of clinical experience ( So you have 24 months total, if you’ve done your internship)
- 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
- I mentioned previously that UK graduates enter the Foundation training program after graduating from medical school which is for 2 years.
- 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’
- At the end of that one year, you can start applying for Core Medical/ Surgical training.
- 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.
- 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.
- 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.
- 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.
- 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–
- 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.
- 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.
- 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.
- 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
- The application is made on ORIEL, the same place where you apply for FY2 Standalone discussed above.
- Rolling starts are offered – in Feb & August
- Interviews DO NOT take place through skype, you have to personally attend the interview in the UK.
- You still need to get the CREST form signed during the program.
- 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:
- Gain 12 months of clinical experience so you have 24 months of clinical experience and can thus apply for Core-Training positions.
- 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 –
- The biggest advantage of non training jobs is the fact that they are advertised all year, you make an account of your profile on the NHS Jobs website, and then you apply to the non-training post after reading the job description. Since they are all year round, you can basically start your job at any time and don’t need to wait until August to start working again.
- These non-training jobs are in almost every field of medicine – for me personally, I only applied to Medicine & Emergency Medicine positions, because one of those is what I eventually want to do. So you can get a position in your field of choice for the 1 year you need for your clinical experience.
- The pay & the hours you work will be the same as training jobs such as the F2 standalone and the WAST training program.
- On average, it takes 1-3 months from the time you get registered with the GMC to land a non-training jobs. It really depends on how many jobs you apply for and how selective you are. For me, I only applied to Emergency Medicine/ Medicine jobs – I applied to roughly a 100 jobs, got 5 interviews, and was offered the job for all three places where I interviewed ( I rejected the last 2 interviews as I had already accepted a job)
This is what will be different from the training jobs such as F2 standalone & WAST
- Trainees will have dedicated teaching time where they are allowed to leave the ward/ clinic and go for teaching – you may or may not be allowed to do this depending on the trust you work in.
- Trainees will have an educational supervisor which non-trainees usually don’t, but again, it depends on the trust you work in.
- Trainees, in the F2 standalone program have 3 rotations for 4 months each in various specialties, whereas non-training jobs are usually in one specific specialty for the whole year – like you could get Medicine for whole year but your department will allow you to rotate through the medical specialties. Or in my case I got a training job in Respiratory & Cardiology for the whole year.
- The onus is on you to get your CREST form signed by the end of the year so you can apply for Core Training. For F2 standalone trainees, they automatically get the FPCC certificate at the end of their F2 year so they can automatically apply for Core Training without worrying about getting any forms signed.
- The last thing you have to consider is the fact that some core training programs can deem you overqualified for core-training positions if you have more than 18 months of experience in that field – This is very important. This does not apply to Internal Medicine yet, but it applies to other training programs such as ACCS core training, which is what I want to do. You need to check the training program you potentially want to apply for and see if the 18 month limit applies to you. Big thing to note here is this, if you do the F2 standalone program that year will not apply to your 18 month limit, it will only apply if you’re doing a non-training program.
Applying for Non- Training Jobs
As stated before – Non training jobs are available all year around – You apply for non-training jobs mainly through two websites NHS Jobs & TRAC jobs. They both have the same jobs listed, I used NHS jobs as it has a better format.
You can find more details of applying for non-training jobs from the ‘Applying for job’s section on the website.
At this stage you apply for F2 level non-training posts.
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 –
- When you get Full GMC Registration – I got my full GMC registration in November 2019 – in my mind, I did not want to wait till August 2020 to start working, I had already spent 2 years getting my Master’s degree and wanted to get back to clinical practice as soon as possible. Since non-training jobs are available and open for applications year round, it made sense for me to apply for non-training positions and start work before August 2020. If I had gotten GMC Registration closer to August, I would have started with the training program.
- Getting your CREST form signed – The biggest thing for me when it came to making the decision was getting my CREST form signed during my non-training job. I’ve heard different stories regarding the CREST form being difficult/ easy to sign, but given that I have about 13-14 months to do all the things I have to do on it, I concluded that if I worked hard & chased people during my non-training job, I could get it done.
- Foundation Program Certificate of Completion (FPCC Certificate) – When you finish your F2 standalone training post, you get the FPCC certificate you automatically get this and this makes you eligible to apply for Core Training. You don’t have to chase consultants to sign any CREST form in a training position.
- Rotations in F2 standalone – F2 standalone is 3 rotations each for a period of 4 months. So you have to be prepared to rotate in different departments of even hospitals. For example, in a lot of F2 there were lots of rotations in OB GYN & Psychiatry – I ranked these places a lot lower as I did not want to do these rotations. For me, it was important to work in a field I enjoyed ( Medicine/ Emergency Medicine) as opposed to rotations that I knew I didn’t want to do. In F2 standalone, you might end up matching in a program where you’re not fond of the rotations you get, that is something to consider. However, also remember that in F2 standalone, you can rank what places/ rotations you want, and depending on your rank, you’ll get the place, but if you have a low-ish rank, then you should be prepared to do rotations that you may not be fond of – though again, it’s only for 4 months, so it’s not too long to be in a specialty you don’t want to be in. If you rank high, then you’ll be fine and will be able to pick rotations that you want to do. In non-training posts, you can apply only to jobs you want to do, so there is a little bit more flexibility.
Bottom Line – Every case is different and this is a personal choice
- At the end of the day, applying for a Training or Non Training position is up to you. You have to decide, based on the above factors, and your own situation, which would be better for you.
- Once you get your CREST form signed, then there is no difference if you do the F2 standalone program or if you used a non-training job at FY2 level. There are lots of IMGs that have gotten into core-training jobs after doing a non-training job for a year, getting their CREST forms signed, and then subsequently applying for core training positions.
- Be careful about being overqualified for Core Training programs if you start in a non-training job. In my case, I was keen to apply to the ACCS-IMT training programe, which is a combination of Internal Medicine training & Intensive care/ Emergency medicine training program. For this program, if you have 18 months in Medical fields ( Here we’re talking about *only* medical specialties), you are deemed overqualified and cannot apply. So this meant that I could not do my non-training position for longer than 16 months – it’s 16 because I already had 2 months of internal medicine experience from my internship at KHUH. This is one of the advantages of the F2 standalone, any experience you pick up during your F2 standalone does not count towards this 18 month limit.