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HOW TO IMPROVE YOUR CHANCES
GME
in Pakistan GME in
THE UK GME in THE
USA
Whenever there is intense
competition for jobs in any field, not just medicine, the fundamental principle
for success is to be amongst the best.
If there are as many as 1000
job applicants for a single post (and this indeed has been reported to be the
case in many instances), the consultant who is hiring you must have a reason to
choose you over the other 999. The first point to remember is that SHOs actively
contribute to the NHS. They are not just taking from the system by obtaining a
valuable training experience, but they are also giving back to it by rendering
their own expertise. Therefore, when a consultant sits down and goes through a
stack of applications and CVs, he is looking for someone who can do a very good
job as an SHO.
The key to improving your
chances then is to convince this consultant that you will be able to do the job
better than everyone else who has applied.
In order to do this, you must
first know which credentials are highly valued and sought after in applicants to
the SHO post and then strive to obtain them:
Most doctors who go to the UK
have an MBBS degree and a PLAB pass - and that is all. These two are the
only pieces of evidence documenting their credentials. It is not surprising then
that most doctors who go with little else on their CV besides these two
accomplishments find it difficult to get jobs. A medical degree and a PLAB-pass
are the minimum acceptable criterion needed just to apply for SHO posts in the
first place. Having only this, and nothing more will not make you competitive.
The consultant hiring you must have a reason to choose you amongst the other
hundreds of applicants – all of whom also have medical degrees and PLAB passes.
“Growing you CV” is an
important concept that was covered in some detail in a BMJ Careers issue in June
2004. The principle behind it is to work diligently at acquiring
medically-related, documentable credentials that can be included in your CV as
evidence of your ever-increasing skills (and hence, worth) as a committed
professional.
The process of growing your CV
starts in medical college. There are numerous things a student can do that can
be placed in his CV years later when applying for jobs.
The Community Medicine research
project is a wonderful opportunity to familiarize yourself with Research
Methodology. If you work very hard at it and do the job properly, you stand a
good chance at publishing your work in a medical journal. It doesn’t have to be
an internationally indexed journal. A local medical journal will do just fine.
After all, no one expects students to produce original research material of an
standard that attracts the attention of professional researchers and clinicians.
The acceptance and publication of your work while still a student will say a lot
about your dedication and application of basic research methodology so early in
your career and this will add immensely to your CV.
Probably the best investment a
student can make is to become an actively participating member of the
International Federation of Medical Students Association (IFMSA). This can
open up a world of opportunities for you. As a member, you will be able to
participate in countless workshops, conferences and seminars around the world –
which, of course includes Pakistan. There will be other opportunities as well.
For example, I myself had the chance to be a reviewer for the World Medical
Association’s Undergraduate Manual of Medical Ethics. The manual is available
now in medical colleges throughout the world, and my name is in it. When I put
this down in my CV, the consultant reading it will know that have at least a
rudimentary grasp of Medical Ethics as well as the relevant language skills
needed to review such a piece of literature. I was only able to know about the
opportunity because I am an IFMSA member. This career manual you are reading
right now is itself a credential that will go on my CV and add to it, and again,
it is being done in my capacity as an IFMSA member.
During your time as a student,
you should avail each and every opportunity to grow your CV. Take part in
workshops, attend seminars, organize medical events – and try to learn as much
as possible from these experiences. Don’t do it just so you have something to
write in your CV later on. The CV after all, is a reflection of your
professional self and not just a laundry list of accomplishments. The attitude
of doing something just for the sake of the CV is unprofessional in itself and
such an attitude will not take you far, even if it does manage to get you your
first job.
The time spent as a house
officer is often wasted. Little if any studying is done, and after the novelty
of working in a hospital as a doctor wears off, most doctors just do the
minimum amount of work expected of them. After settling into the house job, the
doctor can use his valuable 12 months doing a number of things like audits,
research, paper presentations, and courses.
Audits.
Simply put, an audit is a study
undertaken to determine whether any component of a health-care delivery system
is functioning optimally or not. An audit is not the same thing as research. In
an audit, no new medical knowledge is gained – the focus is on the medical
system itself and not the science behind it.
To give an example - an audit
was carried out in the
Camden
and Islington Community Health Services NHS Trust, to assess how many patients
met their first appointment scheduled with their psychiatrists. The audit found
that patients who had to wait more than a month for their appointment date
usually did not come at all. Based on these findings, the audit recommended that
‘party clinics’ be held in which around 10 patients would have a joint session,
thereby introducing the psychiatrist to the patients before ‘real’ one-on-one
sessions could be initiated. A second audit was done to follow up the
effectiveness of the recommendation, and it was found to work.
Audits are given great
importance in the UK
and are seen as the main tool to maintaining and continuously monitoring the
standards of health-care delivery. A doctor having conducted several audits
would be helping his CV immensely. It may not be easy to conduct a audit
in a hospital that does not have the proper infrastructure or well-established
inter-departmental communication, but an effort to overcome such difficulties is
worth attempting. Most UK graduates have conducted several by the time they are
SHOs and every attempt must be made by an overseas doctor to have several audits
in his CV when he applies for jobs in the UK.
For more information on audits,
you can download the “Principles of Best Practice in Clinical Audit” published
by the National Institute of Clinical Excellence in the UK - a very
comprehensive document (some 200 pages) and available free online. It is the
authoritative document on audits.
Research.
A house officer will have much
greater access to patients and as a result will be in a much better position to
do small clinically oriented research projects. If that is not possible, any
other small research will do – it could be a retrospective study. However
some research should be done during this time. As previously mentioned,
published research adds dramatically to your CV, and by the time you enter the
house job, you should be in a position to elevate the standard of your research
skills.
In a Careers BMJ article dated
16th November, 2002, overseas doctors aspiring to come to the
UK were given the following
advice:
“Once you have decided to come to the United Kingdom, don't waste
valuable time in gathering postgraduate or service experience in your own
country— the sooner you make the move, the better. The reasons for this are
twofold. Professionally, you are not too far down a particular career path and
so are in a better position to choose a specialty that offers the best chance of
progress at that time. Socially, you are more likely to be free of the
responsibilities that come with age and so are more ready to accept, for
example, an academic position that may be good for your career but often brings
a poorer salary.”
This may have been sound
advice back in 2002, when the job situation had not yet reached the levels of
difficulty seen now.
Dr. Elitham Turya, a Consultant
in Child Health, contributor to Careers BMJ, and author of the book “Your Career
After PLAB” wrote to me with the following advice:
“Work in Pakistan for about 2 years. Use the time to do one or two short research items
and 2 or 3 audits to describe in your CV. Most doctors will have MB BS and will
have passed PLAB. So why should one candidate and not another be picked? The
audits and research (short items- a few months’ works, could be retrospective
study) will improve your CV.”
It seems that currently, it
would be better to stay back and “grow the CV” in order to improve your chances
of getting a good post in the UK.
Therefore if possible, a doctor
should enter the post-graduate medical system in Pakistan after the house job
and work there for a year using that time to further grow his CV. If it is not
possible to start working immediately as a post-graduate doctor, then the
“extra” one year could be spent in a non-paid attachment with a hospital. During
the additional one year, more research studies can be done (this time, more
substantial and demanding ones), more audits, more presentations, with more
conferences and workshops attended. All this will go straight into the CV that
will as a result become considerably stronger compared to that of the doctor who
went straight to the UK after his house job.
Workshops.
The College of Physicians and
Surgeons of Pakistan (CPSP) holds workshops on a regular basis (see the
Pakistani section of this manual for more information on these workshops). The
workshops last 3-5 days and provide good credentials, all of which will look
good when added to the CV.
The CPSP offers workshops on
“Computer and Internet Skills”, “Research Methodology, Biostatistics,
Dissertation Writing”, “Communication Skills” and ”Basic Surgical Skills”. The
CPSP provides doctors attending these workshops certificates to attest to their
participation.
Membership Exams.
If the doctor spends an
additional year after the house job, he can avail that time by studying for Part
I of the membership examinations. If he works hard, then by the time he is ready
to go to the UK,
he should be able to pass the first part of the
Royal
College
membership exam of his specialty. This is a great addition to the CV, and quite
achievable if he is able to stay back an extra year after his house job.
Therefore, by firmly adopting
the concept of “growing your CV”, a doctor who goes to the UK two years after he
graduates should have (if he works very hard) the following on his CV when he
goes to the UK:
·
2-3 Research
articles
·
2-3 Audits
·
2-3 Workshops
attended
·
2-3 Paper
Presentations
·
Part 1 of the
Membership exam
This is compared to the those
doctors who only have the minimum criteria when they go to the UK: a medical
degree and a PLAB pass.
The first thing you’ll need to
do upon entering the
UK
is to complete the PLAB by sitting for the PLAB 2 exam, so you must organized
your schedule accordingly. If you have studied and are confident enough of your
knowledge, then you should sit for the first part of your membership exam.
Upon finishing these exams, you
should start your clinical attachment.
Clinical Attachments
A clinical attachment is a
period of time where a doctor is allowed into the hospital as an observer. He
can attend the rounds, clinical meetings, ask questions, see how things work,
etc… A clinical attachment can last from 6 weeks to 4 months. It is unpaid (in
fact, a few trusts in
London
now require payment) and accommodation is usually not provided in the hospital –
even if it is, you’ll most probably have to pay for it.
Currently, the doctor isn’t
allowed to do any practical clinical work - although with the change in the GMC
registration policies (in which doctors are granted full registration after
passing the PLAB) this may change.
A clinical attachment provides
a formal, supervised, hands-on introduction to the NHS system and is a chance to
make a good impression on a consultant who can later act as a reference. Both
are a major boost to a doctor’s CV.
Clinical attachments went from
being considered a favourable addition to a doctor’s CV a few years back to
being practically indispensable. For overseas doctors, getting a job as
an SHO is next to impossible now without a clinical attachment. As a result, the
demand for clinical attachments has now approached the demand for jobs. Most
overseas doctors new to the UK, apply for clinical attachments before going on
to apply for jobs.
Resultantly, it has become very
difficult to secure a clinical attachment and it is strongly advised that
an overseas doctor secure a clinical attachment for himself before coming
to the UK.
It is worth emphasizing this
point again: Getting a job without exposure to the NHS is extremely difficult
with the current job situation. Recently, it has been observed that doctors
coming to the UK
spend months trying to secure an attachment. Doing a clinical attachment
provides no sure guarantee of job immediately afterwards, and the doctor may
well be jobless even after having done 2 or 3 clinical attachments. It is only
logical then that the time spent trying to secure a clinical attachment should
be spent in the home country, where there are no problems with living expenses
or accommodation.
There is no standard,
formalized way of acquiring an attachment in the UK. Currently all attachments
are organized by personal, direct interaction with a consultant who will
ultimately become your supervisor and be the one responsible for you. It may not
be the consultant who you first approach, but someone else who can in turn
approach the consultant on your behalf. It is ultimately all about getting the
consultant’s attention and convincing him to allow you to be ‘attached’ to him
for a period of time.
There have been a few trusts
that recently decided to centralized and formalize the process of clinical
attachments. The Calterdale and Huddersfield Trusts for example released a
Clinical Attachment Policy statement in November 2004 in which they decided that
all further applications for clinical attachments be directed to their Post
Graduate Medical Education department, who would in turn contact the relevant
consultants. The introduction of a standardized system of processing clinical
attachment applications may be hurried through due to the immense demand for
them. The Calterdale and Huddersfield Trusts have made a start, but it is not
sure how many others will follow suit, and its is also not clear if doing so
will remove the need (or effectiveness) of appealing personally to a consultant.
Since clinical attachments have
practically become a pre-requisite to a job, it is important to understand how
to obtain one, how to conduct yourself when doing one, when to apply for one,
how much it will cost, etc… Such detail is beyond the scope of this manual, but
it should be appreciated by the reader that every effort must be made to secure
a clinical attachment and due attention must be given to it when preparing to
leave for the UK.
Courses.
There are a number of courses
offered in the UK
you would do well to include in your CV.
For those planning to go into
surgery, the ATLS, Advanced Trauma Life Support, the Basic Surgical
Skills Course (BSS), and Care of the critically ill surgical patient (Ccrisp)
Course are all good additions to the CV. These courses cost around
400-500 Pounds and last for 2-3 days. Due to the expense involved, it is unusual
to find an overseas doctor applying for his first job with more than one course
in his CV. These courses are, however, a good investment and it is worth taking
another one after you have obtained the first job and have some more money in
your hands.
For the medical specialty, the
ALS, Advanced Life Support Course is being taken by overseas doctors in
increasing numbers. It also costs around the same amount, and lasts for 2-3
days. There are not many other courses in the medical specialty suitable for
doctors wishing to enter the NHS at the SHO level, so taking this one course
would be a good investment.
With little time to spare in
his busy schedule, and with hundreds of CVs to look at, the consultant will
literally not spent more than 60 seconds looking at your CV. However your CV is
you. It is a record of your life – it describes how well-qualified you
are and why you are the best applicant for the job. When writing your CV, make
sure that whatever is in those 5-6 pages is presented so well, and so clearly
that it jumps out from the page to capture the reader’s attention, causing him
to pause and consider you as a serious contender.
Perfectly good credentials that
may earn an individual the job may be wasted if they are tucked away in some
corner of the CV where it might escape the reader’s attention. The CV should not
so much be written as designed. It has become something of an art and is
a skill that you should learn well. Sometimes, you may have to apply for a job
in which some of your credentials will be more important that others, in which
case you would help your chances by sitting down and redesigning the CV so that
it is optimized for that particular job.
There is no one correct way to
write a CV, although there are many incorrect ways. Although certain
basic rules do apply, do not think there is one format out there that maximizes
success. Keep asking yourself if there is anything you could do to present your
credentials in a better way.
It must be emphasized however
that if a candidate comes to the UK without any credentials, experiences, or
qualifications to write in his CV, then any amount of tinkering and designing
will not change that fact.
When a consultant decides that
he likes what he sees in your CV, he will short-list you for the job and call
you for an interview. He will also call a number of other doctors for the same
post. Only one of them will get the job, and it is the interview which decides
who that one person will be.
In the interview, the
consultant(s) may ask you some medically-related questions, but if you have
managed to come this far, what he is really assessing is how you present
yourself. If you have a great CV with a long list of qualifications, but you
comes across in the interview as unpleasant, rude, or too timid and lacking in
confidence, the consultant not be inclined to choose you.
You must present yourself well
and come across as a confident, competent, and likeable person. These are after
all, qualities any patient would want to see in his doctor and therefore are the
traits consultants are looking for as well.
The interview is also a time
where your communication skills will be given careful attention. If the
consultant feels you have poor communication skills, it will be a big blow to
your chances of landing the job. This again emphasizes the need to be very well
versed in the English language. As previously mentioned, passing the IELTS is by
no means the end of the demand you must make on your English language skills.
You must, in this highly competitive time, by very proficient in the language. | 
