Supporting Overseas Doctors (IMGs)

I was interviewed and selected for the post of Emergency Medicine Registrar. After selection I was helped at all levels by trust and consultancy for completing documentation and other necessary processes.  After arrival in the UK, initially I had some difficulties and trouble because of new system of work and different culture but I was very well supported by my consultants, colleagues and trust. With help of them I picked up and settled down very well in the system. Then I also helped in Critical Care Unit during the Covid-19 epidemic. I appeared for interview of Consultant in Intensive Care Medicine within 1st year of my job in UK and got selected for same. Now I am working as Consultant in Intensive Care Medicine and enjoying my work here. The initial support I received from my consultants and trust helped me a lot to settle down smoothly and progress in my career.

My experience with the NHS: A truly global opportunity 

During my first few weeks in the NHS, I was almost a rabbit caught in the headlights. Honestly, it was a huge leap from being a doctor in India to moving to the UK. Paralyzing fear, excitement, and bewilderment surmounted by feelings. Though there was immense pride that I had made it to the NHS, the emotion was quite surreal. The anxiousness was never due to the inadequate clinical knowledge but rather the shock of a new system and my crossing with the bests of the world!

Settling in: 

The transition from India to the NHS Greenwich Hospital in London was surprisingly smooth. The initial accommodation was taken care of by my job consultants. BRP was available almost immediately at the post office. Moreover, the hospital staff were quite proactive in supporting the paperwork for the bank account opening. A mandatory occupational blood test was conducted, and an overseas mentor was provided to guide me through the semantics of the hospital and department structure and ensured my well-being, overall.

Induction: 

It is no surprise that compliance is non-negotiable in the medical field. NHS is a palpable example of such an industry best practice. During my first few weeks, I completed my mandatory induction training package, both online and physical. I was given the necessary IT logins, HR orientation packs and NHS access and identity cards. Further, I was also involved in a two-week shadowing with my colleagues and seniors at the hospital on the Emergency ward. My team-mates were extremely helpful, empathetic and were supportive in addressing my naïve questions without any hesitation. I did have an initial setback at the beginning, not knowing fully the processes in place. However, over time I keenly observed the systems and things became clearer as I started putting my hands to work. At the end of my induction, I was mostly awe-struck by the compliance infrastructure of the hospital, building a deep sense of reverence for the system.

Welcome to UK Practice: 

GMC induction was very helpful in introducing me to the latest UK guidelines which was especially tailored for newly registered doctors. The session was comprehensively planned with many real-life simulations. This was very helpful in terms of understanding the local response routes, exigencies, and possible channels of communication. Additionally, GMC Ethical guidance material is a well-documented support literature to keep a medical practitioner abreast with the latest protocols in place, especially at a regional level.

Diverse cohort: 

London is a truly global city, breaking all cultural and hierarchical barriers and stereotypes. Whether one is a cleaner or a consultant, security or a pharmacist, everyone works together. The recognition is solely based on merit and I experienced this first-hand. My colleagues, teammates and support staff are not only professional but hold a deep sense of understanding for each other’s cultures and backgrounds. Moreover, the rotation system allows cultural amalgamations and unifies cohorts to work towards a single goal i.e. serving the patient. An amiable and a professional friendship was quickly established between me and my colleagues based on mutual admiration and respect. I am at loss of words for some of the support staff and nurses who are so dedicated and not wincing once at the sight of getting blood in their hands. This sense of dedication towards work keeps me motivated and driven towards service.

A cultural unanimity: 

The peculiarities between the two cultures is sometimes exciting but mostly dreadful, keeping me at the edge of my seat. For instance, back home, we often assume consent when a patient stretches out his/her hand for an injection. But in the UK, it is still necessary to ask, ‘Are you comfortable with a sharp scratch?’, providing a great emphasis on ‘service and satisfaction’ as opposed to ‘treatment only’. I have been quite proactively making friends outside my circle and with many international colleagues to seek out new knowledge about their culture, food, languages, and possibly learn any new cultural greetings or salutations which may help me in breaking barriers with patients and make them feel comfortable and at ease. The inverse exchange has also taken place where I have provided suggestions to my colleagues from my anecdotal experiences.

The infamous British Weather: 

Well, it is no surprise that the British love to talk about the weather. I come from the Southern part of India, where the summers go up to 42 degree Celsius and 15 degrees on a worst winter morning. Adapting to the zero-degree winter, gloomy weather and the unpredictable rain has been nothing less than a mind-numbing experience. However, I do wait for the summers here and enjoy an occasional barbeque with friends and colleagues. On the flip side, thanks to this mischievous weather, one cannot dismiss the variety of fashion opportunities it provides and guilty pleasure to show off one’s wardrobe.

Personal Training and Development: 

It is a well-known adage that a happy man is a productive worker. NHS takes this seriously and focuses on a holistic development of an employee through Personal Development Plan. For example, A clinical supervisor has been provided to me to guide me through professional development, discuss personal challenges at workplace and support me with my progress both personally and professionally. This program is immaculately planned, tracked, and documented by NHS.

My pursuit continues: 

My journey as a doctor began with a sole purpose of serving the sick and the needy. NHS has bestowed upon me this opportunity to provide my service to the needy and the vulnerable especially during such trying times like the Covid-19. I take this more as a challenge than a merit.   Overall, my 1.5 years journey at NHS has been a transformative experience, with innumerable twists and turns. However, I have only learnt to be more accommodative, tolerant, and positive through the process. With this motive in mind, I take each day as it comes and focus on keeping an open mind to learn something new and contributing every day – one tiny morsel at a time.

Here in this blog , I want to share my experience of my journey to the UK.   The events which were already completed before coming to UK were securing a job, and booking an place to live in UK .

I came in March and after landing in the UK, I realised that the weather was colder than I  expected. It’s good to have a transport booked to take you from the airport to your destination. From the airport I came to the Airbnb which I had already booked. The hosts were an English couple and were very welcoming. The next day was Sunday and I just got  out to see the local shops. The very same day I got the taste of London’s weather where you can get all seasons in a single day. The next day I collected my BRP from local post office . I met the right person in HR who gave me a letter which helped me to open a bank account. The HR also directed me to the occupational health department for routine blood tests. I also met my overseas mentor who guided my through the structure of the department and ensured my well being. Within a few days I got clearance from the occupational health and I was good to join from a pre allotted date.

Working in the UK is very different to what it has been back in the homeland. The transition can be quite daunting and the key is to share doubts and seek guidance and support. Being away from family and friends and adapting in a different work and ethnic culture can be very challenging. I started my shadowing which was for 2 weeks. In your shadowing its very important to observe how the NHS system works and to make the most of this time, its very important to ask a lot of questions to the person you are shadowing and to fellow colleagues. It’s easy to get overwhelmed by the work going in the busy department but everything starts making sense once you get used to it. You can also ask questions to a fellow overseas colleagues who has been working in the system from before. They can guide much better as they have undergone through the same experience and feelings of transition. Anyhow most of the colleagues are always eager to help and explain, including the consultants.

It can take a while to absorb the whole IT structure, as everything is done on computer, but it becomes a second nature simply with time and minimal practice. The clinical stuff is mostly the same but you just need to know the right protocols and pathways, in which the Trust guidance on Intranet comes very handy. I don’t want to less emphasize the fact that you may not be an excellent doctor but you should be a safe doctor. And to do this never a keep a doubt in mind and ask every question, however stupid it may seem.

Communication is the key to an easy transition. You need to gradually make friends with all the colleagues and staff. Introducing yourself when you meet them first time and a simple acknowledgement by greeting them breaks the ice and things become smoother. Culture shock is not unknown and you might feel alienated, but give it a couple of months and you will be a part of the circle as well.

It’s very important to create a social circle and make friends outside of work. You need friends to hangout with to de-stress yourself and enjoy life. Its not difficult to find people and colleagues with same origin or same interests and then build a circle. It’s also important to eat healthily and sleep well and get adequate rest. Speaking of the academic life, you will be allocated a clinical supervisor who will guide you through the various steps needed to build a good portfolio. A lot of emphasis is given on teaching and overall well being. The opportunities for personal development are manifold here and colleagues and consultants are always motivating you to progress.

Apart from these, I also want to share briefly my experience of finding a flat. There are sites like Rightmove and Zoopla which advertise flats and you can choose from various filters as per your requirement. I found a flat through Rightmove, contacted the agency, viewed the flat and eventually signed the contract for a year. The process was very hassle free. The rent and most of the other utilities like water, electricity , broadband can be paid by direct debit.

There are a number of resources available online and on GMC website which provides guidance to overseas doctors.

‘24 Hours in A&E’: An Indian Doctor’s Journey in the NHS 

I was born and brought up in the southern State of India- Karnataka. Renowned for its pleasant weather and multinational IT Companies which attracted its title of Silicon City of India, lessor known fact remains that it also one of the states with highest number of medical colleges and home for one of the biggest hospitals which pioneered Emergency Medicine in India. I happened to be beneficiary of the latter. As I was growing up these two were exactly the career choices for me. An Engineer or a doctor. While I did clear entrance-exams held annually for the admission into both these courses, choosing Medicine was a conscious yet academic decision. Retrospectively, perhaps an early exposure to well established medical centre which I frequently visited with my folks left a lasting impression on me. As I navigated being a medical student and future career option, I happen to realise that I leaned more towards action-oriented aspect of medicine. A turning point arrived when having just finished my medical degree, I signed up for Emergency department of my college. The fast paced work environment, problem solving, people’s management skills at play, the theatrics of uncertainty, no day alike scenario and sheer dedication that is required to pull of a successful day or night got me thrilled and I felt right in place. After internship year I decided to work full-time in A&E at Manipal Hospitals in Bengaluru.

After having worked in the emergency department for 4 years in India, I decided to make a move to the United Kingdom (UK) and work for the National Health Service (NHS). This decision was multifactorial with opportunity to be part of the NHS and career opportunity in the Emergency Medicine in UK being at the forefront. Having worked in a health care setup which varied with region and socio-economic capabilities of patient, I marvelled at the welfare goal and vision of NHS which was truly representative of ‘by the people and for the people’. I was also excited about the excellent academic and training prospects under the Royal college of Emergency Medicine as well.

When I came across the Medical Training Initiative in the UK, I contacted the Royal College directly and obtained details for the application. It is a two-year training initiative for medical professionals from developing countries. I soon applied for the Medical Training Initiative and was setup for an interview with consultants from Queen Elizabeth Hospital, UK. Within a day, I was told, I was selected and given all the necessary documents to apply for the visa and make my move to the UK. The process was smooth and simple so much so that, had I joined as soon as possible, it would have taken one month between application and joining in the UK.  For doctors looking for opportunities to work in the UK, other options are by completing PLAB or Membership examinations of the respective royal colleges like MRCEM or MRCP.

I arrived in the UK on the 28th of May 2019, I had my GMC registration meeting and hospital occupational health meeting in the same week. The medical staffing department was extremely helpful, assisted me with all the documentation required to open a Bank account, National Insurance and followed up on my occupational health results. I joined the ED on the 3rd of June 2019. For the 1st week I shadowed fellow doctors in the emergency department to get used to the department and the system. Although it seemed a lot to take in in a week’s time, I soon figured that when one gets on with the work, it becomes less intimidating. I was given all the necessary IT logins, training for use of the online system and prescribing on the Trust’s user interface. I was encouraged to complete a set of mandatory training to help me face various situations as a healthcare provider in the hospital. This boosted my confidence and equipped me to deal with various situations and problems in day-to-day practise.

I have an educational supervisor and an overseas doctor mentor, who help me get accustomed to the UK, and guide me through my inhibitions and challenges. I soon realized that the system was quite different from what I had experienced in my home country. In the past one year of my work here, what sticks out most for me is that NHS is extremely structured, and protocol driven. This in fact, eases assimilation for a new doctor while also ensuring the level of care provided by him is at par with the standards expected. While strict protocols come with their pros and cons, it allows for uniformity across the whole of NHS and the UK.  NHS inspires a sense of team and healthcare community. Under its holistic fold, NHS fosters a symbiotic relationship between healthcare providers such as nurses, doctors and other staff and its patients. On an everyday basis, I witness an admirable reciprocal reverence among patient population and healthcare professionals in terms of civil responsibility and medical duty that comes with free healthcare made possible via NHS. In addition, the system enables for teamwork across specialities and hospitals within deanery, which ensures that there is someone always to help and share responsibility for management of the patient. Our A&E is a place for solving problems, ranging from clinical to social. This attributes it a character of challenge and satisfaction at the same time.

Unquestionably, work culture in the UK is very vibrant, inclusive, and professional. The hierarchy is not that evident and everyone from top-down share implicit respect for everyone’s contribution in the day’s work which is key to a successful team effort. NHS has zero tolerance to bullying and racism and compensate the healthcare workers well. Apart from this, special care is also taken to commensurate un-social hours and over time.

Over past one-year as part of NHS, I have enjoyed my experience in A&E at Queen Elizabeth Hospital, Woolwich. I believe it has contributed immensely to my growth as a doctor, supervisor, and success in academic pursuits in FRCEM examination. I have been fortunate enough to be a part of the fight against the Pandemic, it has been an experience like never before. It has also prepared me for such events in the future. I fell in love with Emergency Medicine almost a decade ago and as I am about to embark on my training in Emergency Medicine this summer, finally, becoming a consultant in Emergency medicine in NHS is closer to reality than ever before. I am as excited as I am grateful