A short opinion post on challenges faces for IMGs getting surgical training positions - by Obinna Enemoh, General Surgery, Junior Clinical Fellow
Specialty training in the United Kingdom (UK) is a postgraduate education process where doctors acquire expertise in different specialties of medicine or in general practice.1 Securing a specialty training post has traditionally been a difficult process requiring doctors to achieve specific competencies, keep a comprehensive portfolio of achievements and a hectic application process. In recent years this has become more challenging due to a rise in competition ratios, especially in surgical specialties.2
International medical graduates (IMG) are doctors whose primary medical qualifications were obtained outside the UK.3 While IMGs and UK-trained graduates are now being treated equally at the application stages due to recent changes in rules, IMGs are still significantly disadvantaged. IMGs typically join the NHS mostly at senior house officer or registrar level after completing the equivalent of foundation year training in their home counties.4 While they are valuable members of the surgical team, they face significant challenges in career progression and obtaining training posts. These challenges include limited protected time for non-clinical activities like audit and research, inadequate support and supervision, differences in clinical practice compared to their home countries and difficulties in demonstrating pre-UK training competencies. Due to the eighteen-month cap on surgical experience prior to core surgical training (CST), many IMGs who are overqualified for CT1 posts apply at specialty training (ST3) level. This means they must undertake non-training roles with little educational supervision to build up their competencies and portfolio. These challenges lead to many IMGs abandoning their surgical training dreams for other specialties or training altogether. This further compounds the situation IMGs face as they find it increasingly difficult to collaborate, especially those new in the UK.
Some NHS trusts offer inductions for newly employed IMGS to help in their transition, according to the General Medical Council (GMC) recommendations.5 Subsequently, they are largely left on their own to learn on the job. Studies need to be done to find out how effective these inductions are at meeting the needs of the new doctors. Some reports suggest IMGS lack an awareness of their learning needs and supervisors fail in their responsibility to oversee their development.6 This is important in surgery as IMGs may not be used to some surgical techniques, endoscopic or laparoscopic surgery. IMGs must therefore put in extra hard work, learn and show commitment to achieve their goals of specialty training.
Social media has been pivotal for doctors to share information, and ideas and collaborate. It is now easier to organize teaching sessions, publish/showcase academic activities and learn from each other's experiences. IMGSs have used this effectively by forming different groups where they work on a shared goal. NHS trusts need to do more by ensuring adequate supervision and support for IMGS to develop and remain competitive for specialty applications.
With the current systemic bottlenecks in specialty training positions and the controversial expansion of medical associate professions (physician associates and advanced practitioners), the future of specialty training in the UK looks uncertain.7 Some disgruntled junior doctors, by their commentary on social media, believe IMGS are responsible for this current crisis. While it is evident that the system needs a paradigm change, IMGs will continue giving their best to the NHS, developing themselves and staying competitive.
Reference
How doctor specialty training (residency) works in the UK (2022) BMJ Careers. Available at: https://www.bmj.com/careers/article/how-doctor-specialty-training-residency-works-in-the-uk (Accessed: November 22, 2024).
“Rising competition in UK surgical specialties and how to maximise your chances” (2024) The Immigrant Surgeon - Advice on UK surgical training. imgsurgeon.com, 29 October. Available at: https://imgsurgeon.com/rising-competition-in-uk-surgical-specialties-and-how-to-maximise-your-chances/ (Accessed: November 22, 2024).
Al-Haddad, M. (2024) “International medical graduates: defining the term and using it consistently,” BMJ global health, 9(8), p. e015678. Available at: https://doi.org/10.1136/bmjgh-2024-015678.
Gerges, Farid, et al. ‘Surgical Training in the United Kingdom’s National Health Service: The Challenges for International Medical Graduates’. Cureus, vol. 15, no. 9, Sept. 2023, p. e44640. pmc.ncbi.nlm.nih.gov, https://doi.org/10.7759/cureus.44640.
NHS England (2022) Welcoming and Valuing International Medical Graduates. A guide to induction for IMGs recruited to the NHS, Org.uk. Available at: https://www.e-lfh.org.uk/wp-content/uploads/2022/06/Welcoming-and-Valuing-International-Medical-Graduates-A-guide-to-induction-for-IMGs-WEB.pdf (Accessed: November 22, 2024).
Kehoe, Amelia, et al. ‘Supporting International Graduates to Success’. The Clinical Teacher, vol. 15, no. 5, Oct. 2018, pp. 361–65. DOI.org (Crossref), https://doi.org/10.1111/tct.12760.
Ferreira, T. (2024) “Escalating competition in NHS: implications for healthcare quality and workforce sustainability,” Postgraduate medical journal, 100(1184), pp. 361–365. Available at: https://doi.org/10.1093/postmj/qgad131.
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