Hi dxmedstudent ... I adore 😍 your blog. You're so helpful with the info and stories you share. Makes me look forward to life as a doc. Im hoping you could help me. Im a 5th year med student, my final year is equivalent to FY1. I want to apply to FY2 when I come back to bg (study in europe). Can you please give me any tips on how to improve my chance, what clinical skills are expected? I heard about LAS/LAT positions. Anything you can tell me would be appreciated :) ... thank you so so much x
Hello! and Thank you! I try my best :) Congratulations on getting this far, I think everyone nearing the end of med school deserves a pat on the back for making it this far.
In terms of the technicalities of what you may need to do, the GMC has lots of helpful advice for international graduates. Including guidance about acceptable overseas qualifications. Their website is particularly useful. I actually don’t think you’d have a huge problem getting in. You might be expected to do the SJT exam, look it up and see if international grads are expected to do it (there are books to help you prepare, if you do), but otherwise I imagine your applications might be based on a points-based system like FPAS or core/speciality applications. Basically, any prizes you’ve won, any publications or poster presentations are good, though not strictly necessary. Previous degrees are useful. Extracurricular achievements can also add flair. Many people don’t have much in this department, and lots of people still get in. You might be lucky and get something in the next few months, but there’s not really much you can do to drastically change your odds in a short space of time. So I don’t think it’s worth worrying too much about revolutionising your application. Just do your best. In terms of the technicalities, the 15 core clinical skills expected of FY1s are:
Prepare and administer IV medications and injections
Arterial puncture in an adult
Blood culture from peripheral sites
Intravenous infusion including the prescription of fluids
Intravenous infusion of blood and blood products
Injection of local anaesthetic to skin
Injection – subcutaneous (eg insulin or LMW heparin)
Injection – intramuscular
Perform and interpret an ECG
Perform and interpret peak flow
Urethral catheterisation (male)
Urethral catheterisation (female)
Airway care including simple adjuncts (eg Guedel airway or laryngeal masks).
I didn’t remember them off by heart, I’ve lifted them from the GMC website, in case you thought this was a new level of nerdery. These are practical things we are expected to get signed off under supervision,during the course of FY1, in order to gain full registration with the GMC. Although that’s not the only thing we’re expected to do, the curriculum is on the GMC website in the section on foundation training. On top of that, we’re expected to be able to take a history, complete an examination, and start treatment. I’d recommend getting pretty comfortable with the above things, because as an FY2 you’d be expected to be able to do them. Coincidentally, it’s where I’ve seen straight-to-FY2 international docs really struggle, because they had relatively little patient contact during their med school years, and didn’t really feel comfortable with this aspect. FY1 is partly about gaining competency in these skills, altough we do some of them a lot more than others. It doesn’t mean you have to be perfect, or ‘get it’ each time, there will still be times when we struggle. But practice is so important; the more we practice in med school, the better we will be when we hit the wards as doctors. I find it really interesting that many of the 6 year universities in Europe technically qualify you to become a baby SHO in the UK straight off, with all the responsibilities and expectations of someone who’s already been doctoring for a year. It makes sense in terms of the number of years we’ve studied, but not in terms of most people’s experience? I don’t think that another year in med school is necessarily comparable to a year as a doctor; not in terms of theoretical knowledge (I’m sure many European graduates might kick a UK FY1′s butt in terms of theoretical knowledge), but in terms of practical experience. For the reason that a lot of the schools in Europe (generalising based on the students I’ve talked to, sorry!) often focus more heavily on theory over practice, compared to UK med schools. UK med schools have increasingly moved away from bogging us down with technical detail or anatomy, to getting you practically ready to hit the wards as an FY1. We spend year 3, 4, and 5 basically mostly on the wards seeing patients, with year 5 basically being shadowing FY1 doctors. There’s always an added challenge facing graduates is that each medical school system prepares you best for the system in that country, but not necessarily for another country. What’s expected of new docs in each country can be a little different; for example, in the UK there’s a heavy emphasis on practical procedures like the ones above; in many countries a doctor wouldn’t even be expected to do most of these! But in the UK a junior doctor is often expected to. I was adequately prepared to be an FY1 here when I graduated, but I’m sure if I moved over to the US for intern year I would have struggled, because the expectations there are a bit different. I’m particularly in awe of people who choose to go abroad to start working, because it adds an extra layer of scary and difficult (though, let’s be honest, it’s always going to be scary, and regardless of that, you’ll get through OK). An FY2 year is a training year, in which you’d be treated exactly the same as ‘homegrown’ FY2s, and would prepare you for the next step (core or speciality training), so I’d advise on picking an FY2 job over a locum or trust grade job, if you can. I wouldn’t personally advise starting your career on a locum or non-training job, any more than I’d advise taking a locum position in a speciality you haven’t yet worked in. Because locums are paid more, people basically expect you to already be competent, not need much direction, and get on with things; there’s no emphasis on teaching you. These jobs are usually picked up by people who’ve worked in that speciality but want to take a little time out of training. That’s because those kinds of job usually entail less support and teaching than training jobs. You’d also be expected to navigate appraisal by yourself. I’ve met people who’ve done it, so it can be done if you have to, but it always seems like an unnecessarily stressful choice. They advised me against trust grade jobs because of the lack of support, so I’m passing on that tip. Especially if you’re new to the NHS, I’d recommend going for the most supported job you can find.
When I’ve talked to Brits graduating in Europe who want to come back to the UK to work, they’ve often been quite keen to apply for an FY1 to start with, rather than going in at FY2 like they could. Which, once I thought about it, seemed quite sensible. Firstly, there are much fewer unpaired solitary FY2 placements available; you’ll probably be stuck applying to places where an FY1 has dropped out of training. Whereas there are lots of FY1 jobs by comparison. So you might get more choice in terms of where you can apply. FY1 jobs also tend to be a bit more protected; they expect new docs to need more supervision. FY1 jobs in high-pressure specialities like paeds or obs and gynae tend to be supernumerary (no on-calls, and always with SHO supervision), and in many hospitals FY1s don’t work nights, or do less clerking, and usually have SHOs to ask for support. Whereas FY2 can see you seeing sick patients in A&E, paeds, gynae, GP or psych and you may be the only SHO around, with only a stretched registrar for advice. On top of that, you might have FY1s coming to you for advice! You might not have any of those specialities in your FY2 placement, but I personally feel they are stressful enough as an FY2 when you have experience; I certainly wouldn’t have volunteered myself to do them straight out of med school, no matter if I had one more year of theory under my belt. In general, FY2 jobs tend to be more isolated; you’re often either working a busy rota or else on a more specialised placement where you may be the only FY or SHO doctor, so there’s generally less support or community. Fy1s tend to be more social and there’s a cameraderie amongst FY1s bonding over the terror of hitting the wards for the first time that you just don’t get at any other time. FY1 jobs tend to either have another FY1 on your ward, or an SHO who can support you. More importantly, if you start as an FY1, you’ll be treated on par with everyone else who is a new doctor; people might not know that you’re actually a new doc, because they’ll expect someone who’s already got a year of experience. Most people are nice, but people can be impatient if they don’t understand the level you are working at, so if you go for the FY2 route, you should be honest that you’re only just starting out as a doc, despite your grade. Make sure people know what you feel comfortable doing, and don’t let people pressure you into doing something you don’t feel competent to do. The main drawbacks are that your first year will be paid less as an FY1 than FY2, though I believe that’s probably less pronounced now on the new contract. And of course, it would mean one more year of training. But that can sometimes be a good thing; you actually apply for core or specality training a few months into FY2, which would be really soon if you only just started working as a doctor a few months ago! The best thing about FY1 and FY2 for me were doing lots of rotations in different specialities, so that I could get a better idea of which ones I liked, and I think a lot of people would benefit from having that opportunity before picking for good. Though I can understand the draw in skipping a year and going for FY2, particularly when it’s better paid. I’m sure that starting straight as an FY2 might be the best option for some people, and since there are a lot of different med schools out there, perhaps some people from across the continent feel adequately prepared to follow that path. So I’m not about to judge anyone who decides this is the best option for them, given that they are technically entitled to make that choice. (albeit, allowed by a system that cares relatively little for our welfare or training) But having talked to people who’ve studied in a few places, if it were me, unless my med school had quite a big emphasis on seeing patients and doing simple procedures, I’d still start at FY1 if I had the choice. LAS and LAT jobs are basically similar to trust grade jobs or clinical fellowships, which can sometimes be used to count towards your training time, however they are basically long-term locum jobs in a department where there is a vacancy because they haven’t managed to get a training doctor to fill the gap. Many departments offer non-training jobs (trust grade SHO jobs), LAT or LAS jobs tend to be fewer, because departments probably prefer to get by with less responsibility for their employees. Training people is more difficult and requires more supervision, after all. Always remember that hospitals are employers: whilst they are not out to get you, they also aren’t there to do you any more favours than they have to. So look out for yourself and your wellbeing, and think hard about whether any jobs you apply to are suited for you. Hospitals just want someone to fill their job vacancies and get on with service provision. Look after yourself, and make the choice that you feel would be best for you, because the system isn’t set up to put us first. So you have to do that. Whatever and wherever you choose, do it because you feel it’s right for you, not because the opportunity exists; not every job and not every opportunity we have in medicine is in our favour. For example, some FY1 or FY2 jobs have 2 relatively low stress jobs and 1 high stress job. Whereas some offer jobs that have 3 stressful jobs in a row with a high number of on-calls. The fact that the burnout rates for those placements are higher doesn’t seem to matter to the deaneries that keep offering those rotations. So my ranking, in terms of how protected/supported jobs are is FY1 > FY2 > LAS/LAT > Trust grade or clinical fellow > Locum. If you don’t want to do an FY1 year, then starting from FY2 is more supported than going fora LAS/LAT which is mroe supported than trust grade or short term locums. My advice would be, if you have an opportunity for work experience or electives, try to do an elective in the UK to get a feel for what it’s like, and how ready you feel you’d be. Even if it’s just a few weeks over the summer, it might be worth it if it could put you mind at ease. No matter what you choose, I hope it makes you happy, and good luck for the coming years. I look forward to you joining the team :)
