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ENTERING AT THE SHO/FY2/BST GRADE
GME
in Pakistan GME in
THE UK GME in THE
USA
Note: This
sub-section provides information on what a doctor must do in order to enter the
SHO/FY2/BST grades. Practically speaking, the FY2 and BST grades will replace
the SHO grade in the next few years. For the sake of convenience the text that
follows uses the term SHO, but it should be understood that all the information
below applies equally to the FY2 and BST grades.
The chronological sequence of
qualifications an overseas doctor must attain to be eligible to apply for an SHO
grade are:
1.
House job
2.
IELTS (can be
given even in house job)
3.
PLAB 1
4.
PLAB 2
5.
Registration
6.
Finding a job
These individual steps are
detailed below:
Since getting a PRHO/FY1 post
in the UK is very difficult, the overwhelming majority of overseas
doctors who go to the UK
complete their house job in their home countries.
The IELTS is a test of the
candidate’s English skills. It stands for International English Language
Testing System. People are required to take this exam to prove they have the
minimum acceptable level of proficiency in the English language needed to engage
in their academic or work pursuits in the UK, so its not just for doctors. This
exam can be taken in many countries, including Pakistan. Currently, it costs
around 80 Pounds Sterling and is held twice a month every month throughout the
year.
The exam has four sections:
Speaking, Listening, Writing and Reading. The result of the test is given as a
number on a scale (called band) from 1 to 9. Each band, or scale
represents a certain level of competency in English. A score of 1 means that the
candidate has only a rudimentary grasp of the language. A score of 9 means the
candidate is as proficient as a native English speaker.
Each of the four sections are
scored separately on the band of 1 to 9. The individual band scores in the
different sections are then added up to give an average. For example, if a
candidate gets 8 in Speaking, 8 in Listening, 7 in Writing and 7 in Reading it
will give him an overall band score of 7.5.
In order to be eligible to take
the PLAB exam, the candidate must have an overall score of at least 7. However,
an imposition is made on the individual scores as well. The candidate must have
at least 7 in the Speaking section and at least 6 in the other sections. So if a
candidate gets 6.5 in speaking, he will not be eligible to take the PLAB exam -
even if his overall score is 7 or above.
The IELTS can be taken even
while the candidate is still a medical student, although it should be keep in
mind that the IELTS result is valid for two years. The candidate must go on to
take his PLAB exam within this two year validity period.
If a candidate gets less than
the required band score, he will have to retake the IELTS. He cannot
proceed further to take the PLAB exam unless he has received the minimum band
score of 7. Furthermore, he is ineligible to retake the IELTS exam in the
three months following his current attempt.
Unfortunately, many students
and junior doctors in our area have had a real problem with this exam, with many
continuing to get lower-than-required band scores even in their second attempt.
This exam should be taken very seriously by those who don’t feel confident of
their English skills and who don’t read, write or speak the language often in
their daily routines.
It should be kept in mind that
the IELTS is an exam and like all exams, it has its flaws and weakness which can
be exploited to allow a candidate to get through in the end. The candidate may
pass the exam because he is feeling particularly sharp or confident on that day,
or because the examiner testing his speaking skills was easy-going and brought
out the best in him, or because he learnt some ‘tricks’ that got him through.
While the exam is eventually passed by virtually everyone, difficulty in passing
this hurdle indicates a deficiency in English language proficiency that has the
potential to seriously harm the candidate’s future prospects in the
UK.
Passing an exam and living in a place where good English skills is a
professional requirement, are two different things. If a candidate with poor
English skills manages to get through the IELTS, his deficiency in the language
will eventually come across in job interviews later on, where communication
skills and confidence are important standards of assessment.
Therefore, an overseas doctor
should be very conscious of the fact that English is the language of his
professional instruction and in the UK, the language of social and professional
interaction (with everyone from patients to teachers to bus drivers). It is, as
such, his life-blood. He should therefore concentrate on improving it for this
sake alone, and not for the purpose of passing an exam like the IELTS. Improving
on a language takes time, and the earlier a medical student/doctor realizes how
important this is to his career and focuses on it accordingly, the greater his
chances will be of attaining a level of competency that will make the IELTS a
minor exam for him, rather than the sink-or-swim exam it has come to be in many
parts of Pakistan.
The Professional Linguistic
Assessment Board exam, or PLAB doesn’t actually have a linguistic component,
otherwise the IELTS would not be required. Nevertheless, the ‘misnomer’ remains
to describe an exam of a difficulty level between that of final year and
post-graduate (i.e., MRC) examinations. It has two parts - PLAB Part 1 &
PLAB Part 2.
The PLAB is basically a
registration examination that allows you to practice medicine in the UK. In that
sense it is similar to the USMLE Steps of the US system. However, there are
three important differences between the PLAB and USMLE exams:
·
The PLAB exam is
considered to be far easier, and less costly than the USMLE exams.
·
There are only 2
parts to the PLAB exam, not 3 like in the USMLE Steps (or 4 if you count USMLE
Step 3).
·
The PLAB is a
pass/fail exam. It makes absolutely no difference to your credentials if you
pass the PLAB by an extremely wide margin or just manage to get through by a
single mark. This is in contrast to the USMLE Step 1 and Step 2 CK exams, in
which a candidate’s scores affects the strength of his CV.
PLAB Part 1
The first part of the PLAB
exam, the Part 1 is administered in a number of countries, including Pakistan
where it is held three times a year: in March, July, and November. Currently,
the exam cost 145 Pounds Sterling.
In order to be eligible to take
the exam, the candidate must be a medical graduate (he cannot give it
before graduation) from a WHO-recognized medical college and also have the
minimum required IELTS score in hand during the time of application.
The exam consists of a 3 hour
paper containing 200 questions. The questions are called “Extended Matching
Questions” or EMQs - which simply means they are multiple choice questions with
a variable number of possible answers to the questions posed of which the best
one is selected. The exam concentrates on the clinical subjects, not on basic
sciences. There are also a few questions regarding medical ethics, evidence
based medicine, epidemiology, and public health.
PLAB Part 2
This part can only be taken in
the UK. Recently, the capacity of the PLAB 2 center in
London
has been expanded enormously, and now the exam will be held several times a
month every month, throughout the year. Currently, the exam costs 430 Pounds
Sterling.
The Part 2 is a examination of
clinical skills - not a paper-based EMQ exam. The system devised for testing the
candidate’s clinical skills is called the Objective Structured Clinical
Examination, or OSCE.
When you start the examination,
you will go to your first “station” in which you will be given some
instructions. It could be taking history from a patient there, performing an
clinical examination, or a number of other things. You will have 5 minutes to
accomplish your task and 1 minute of pause to think before each station. There
are 14 stations in all, with two “rest” stations – so the exam lasts a total of
96 minutes. The primarily skills tested for are:
·
History taking
and diagnosis based on history alone.
·
Proficiency at
physical examination
·
Communication
skills with patients
·
Management of
emergency cases
In order to get a job as a
doctor, you must be registered as one in the GMC’s register of medical
practitioners. The fee for registration is 155 Pounds Sterling.
Currently, there are 4 types of
registration:
Provisional:
Granted to those in the PRHO posts.
Limited:
Granted to doctors who have just obtained their first supervised training posts.
It is granted on submission of the job contract the doctor receives from the
hospital in which he is hired.
Full:
Granted to those who have passed PLAB, and worked for at least 12 months in a
supervised training post in the UK. With full registration, the doctor can work
in any grade in the NHS – it doesn’t have to be supervised.
Specialist:
Granted to qualified overseas specialists.
Starting from the summer of
2005 (some sources say it will be from April 2005), the GMC will introduce
reforms on registration procedures for overseas doctors. It will abolish limited
registration. From then onwards, all doctors who have passed PLAB will be
granted full registration automatically.
This move has been warmly
welcomed by overseas doctors in the UK. Currently, overseas doctors need a job
contract in order to be granted limited registration. The problem was that it
was difficult to get a job without the registration. There was, as a result, a
difficult Catch-22 situation in which you needed the job to get the
registration, but getting the job was difficult without having registration
already. Therefore, the abolition of limited registration represents one less
hurdle overseas doctors have to contend with.
With automatic
full-registration after passing PLAB, there will probably also be a change in
the nature of clinical attachments. Previously, doctors who passed the PLAB and
went on to do a clinical attachment could only be passive observers. With full
registration, however this will probably change as they’ll be allowed to
practically demonstrate their clinical skills. (Clinical attachments are
explained in the next section)
After securing the minimum 7
band score the IELTS exam, passing the PLAB exam and getting registered, the
next step is to find the first job. This is the hardest part of the entire
process. As already mentioned, the job situation in the UK for SHO posts is
exceedingly difficult.
Jobs are advertised in the
careers/job-opportunities sections of the British Medical Journal (BMJ)
in Lancet (another reputable medical journal) and the NHS Careers
Website. The jobs are then applied to as per the instructions in the
advertisement.
There is a very important point
to note here. Jobs are advertised in “seasons” – in that most SHO posts start in
February and August and advertisements for these posts start to appear a couple
of months before the jobs start. For example, advertisements for jobs starting
in August start appearing from April onwards. Therefore it is very important
that you plan your move to the UK keeping these seasons in mind. Arriving after
a job season is over will make it very difficult to find anything better than a
locum or trust grade job.
Another point to note is that
with the introduction of the FY2 in August 2006, the job season will only come
around once a year. Since FY2 posts last a year, there won’t be any openings for
new FY2 posts until that one year is over. | 
