How to Get a Job in the UK Rhys Latham – FY1 Wirral Rhys Osborne – FY1 Leicester Wirral Leicester The System • British medical degrees are 5 years. After this they receive partial registration with the General Medical Council. They get full registration after they complete their FY1 year. • The 6th year we do in Prague is the equivalent of the FY1 year i.e. it counts as an internship. • This makes us ineligible to apply for FY1 jobs at the same time as the British students. So how do we get in? • We are encouraged to apply directly for FY2 jobs but we can still do FY1 if we want. • We have to apply for the left-over jobs after the British students have been assigned their jobs. • These become available from approximately April and are advertised individually on the NHS jobs website. Types of Jobs • LAT vs. LAS • Locum appointment for training vs. Locum appointment for service. • Prague graduates do not have to get a training post for either FY1 or FY2. • We will not be discriminated against when we apply for specialty training programmes. How to Get a Job in the UK • What to do during medical school • Applying for the job • Interviews • Life as an FY1 • Questions • Further questions in the pub! What to do during medical school Anything that will improve your application form The Application Form • Asks specific questions that you must answer • All the application forms will be scored against one another • Candidates with the best application form will be invited for interview • Whoever has the best score based on the application form and interview combined will get the job • To maximise your chances, start scoring points now! What earns you points? • Degrees/qualifications • Extra courses e.g. BLS, ILS, ALS, basic surgical skills etc. • Your answers to the 6 questions… Application Form Questions 1. Describe your experience of clinical audit (max 150 words) 2. Describe your relevant teaching experience (max 150 words) 3. Details of your most relevant research work and publications in peer-reviewed journals (max 500 words) 4. Give examples of your approach to working in a team (max 150 words) 5. Please explain your areas of clinical skill and competence relevant to this post (max 150 words) 6. Please provide any other supporting information that you think may be helpful (max 500 words) References • You need at least two. • Try to get at least one each from Prague and the UK. • Any reference from a practicing UK doctor is likely to carry more weight on your application. UK Electives • Medical school websites usually have a link for information about electives. • Hospital department websites. Look for lists of consultants and email them your CV and letters of recommendation. • Do this well in advance of your intended placement. • Getting things done in the NHS is sloooow! Build a Portfolio • Job applications for higher positions follow the same application form. • The only difference is that more will be expected of you the further up you go. • Start building your portfolio now: it’s not sucking up, it’s being professional. The Application Process The Crucial Questions • What am I applying for? • When should I start to consider applying? • How do I go about applying? • What will I need to be eligible? What am I applying for? Locum Appointment for Service (LAS): LASs are temporary posts without a recognised training component. This means that the employee will not usually be assessed for competences required in a foundation or specialty programme. The doctor is appointed a Clinical Supervisor but not an Educational Supervisor. When should I start applying? • Whenever you like! • Jobs from August usually start to advertised from May onwards • You can apply for a job without having finished your degree, as long as you disclose this information • Job lengths can vary, try to go for jobs that are at least 6 months • Some jobs will offer training and competency assessment in spite of them being LAS posts • Jobs may be advertised as late as 1 week before they’re meant to start, so you need to be flexible 18 How do I go about applying? • All posts are advertised on www.nhs.jobs.uk • You can apply for either foundation year one or foundation year two jobs (F1, FY1, F2, FY2) • You can apply before graduation and before obtaining your GMC registration • However, you must state this in your application and you cannot start your job without either! • The GMC registration is the rate limiting step in the process GMC Registration • All the information can be found at: http://www.gmcuk.org/index.asp • You can start to apply for your registration before you finish your studies, I would recommend about a month before • Online application • The process will take between 1 to 2 months to complete, depending on how organised you are • This can be frustrating, so make sure you get all your documents ASAP The GMC Website What you need for the licence • Money. The fee for the 1st year is £185 • Documents: • Proof of identity • Evidence of qualifications and compliancy letters • Certificate of Good Standing • Employer references What happens after the online application? “When you have submitted your application, we will send you an email with a list of documents that we need to see. You must send photocopies of these documents by post.” “Once we have recognised your qualification you will then need to bring all originals of these documents to your identity check.” Evidence of qualifications and compliancy letters • This is essentially your diploma, which will of course need to be officially translated and notarised • Officially the GMC website will state that you will not need: • “A document confirming the training leading to the award of your primary qualification meets the standards detailed in Article 24 of Directive 2005/36/ EC” • This, however, is bullshit • This is issued by the Czech ministry of health at Palackeho Nam. 4 and takes 30 days to process • You must have your diploma number to be eligible to apply for this Certificate of Good standing • Issued by the Czech medical chamber: • International Department Lékarská 2 Praha 5 15000 • 0042 20 257 215 285 • Officially a “certificate of non-membership” • You will first have to get a criminal records check done, this can be done before you graduate and takes a week to arrive Employer References • This is not needed unless you have worked as a doctor before elsewhere • Which for most of you will mean happy days Summary of Registration • Start early, apply online for your registration and for your criminal record check before you finish your exams • The earlier you finish, the earlier you can get your diploma and the earlier you can get article 24 • Once you have all the documents they need, post the copies to the GMC • They should process all these within 2 weeks and then invite you for your identity check where you will need to provide the originals • If it all checks out, you’ll get your number that day there and then NHS Jobs • This is a centralised job advertising service for all the jobs in the whole NHS • Use it to search for relevant jobs • There is only one application form for most jobs • Some jobs may either direct you to their own application form on a separate website or ask for an additional CV • Each job will have a person specification – read it! The Application Form • It’s divided into: • Personal information • Qualifications • Employment history • Referees • Supporting information (the 6 questions mentioned earlier) • Monitoring information Qualifications • This includes: • Essential qualification – your general medical degree • Desirable qualifications – any other degrees/ accreditations • Training courses – E.g. ALS • Membership of a professional body – State here that you have/have not got GMC registration, and if not that you have applied for it • You can also mention when you are due to finish your degree Referees • Here you can list 3 referees of your choice • I would recommend to get one from the UK if possible (e.g. your supervisor during an elective), and 2 from Prague (one clinical and one non-clinical) Supporting Information • “In this box please give your reasons for applying for this post and additional information which shows how you match the person specification.” • Make sure you read the foundation programme curriculum before trying to answer these questions, as it will give a good insight into what they expect from you as an F1 • There are 6 questions/sections • Remember there is a word limit for each section, so be concise The STAR Approach • Situation – describe the background • Task – describe the problem that had to be solved or job that had to be done • Action – describe the actions that you took (‘I’ not ‘we’) • Result – describe the outcome (it doesn’t matter whether it was successful or not – the interviewer is most interested in your ability to assess the outcome against the original task/objective. What did you learn from this exercise? Describe your experience of clinical audit • What is audit? • “A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change“ • Explain your experience of audit, including what you did and what it was about • It is important to try and rely your understanding of WHY we do audit, what you actually did is less important Describe your relevant teaching experience • Include anything you might think relevant, it doesn’t have to be medical • Anatomy dissection assistant, histology tutor • Any presentations you might have made Details of your most relevant research work and publications in peer-reviewed journals • Not essential but if you have something, great! Give examples of your approach to working in a team • Any sports teams, projects • Here they want to see that you can work effectively in a team and to display qualities of leadership if necessary • Show that you appreciate the importance of teams, and their essential role in healthcare (MDT’s etc) Please explain your areas of clinical skill and competence relevant to this post • Electives, time on the wards • They want to know what you did, and more importantly how that will aide you in your job as an F1 • Concentrate on things that you know an F1 will be doing e.g. bloods, taking histories etc • Sell your skill set Please provide any other supporting information that you think may be helpful • This has a 500 word limit, where as the other sections you are limited to 150 so is a good place to add bits you couldn’t fit into the other sections • A good opportunity to talk about Prague and how it has help to develop you as a person • Oral examination process • Any clubs, extracurricular activities Some useful websites • https://www.medicalcareers.nhs.uk/ • http://www.gmc-uk.org/index.asp • http://www.foundationprogramme.nhs.uk/pages/home • http://www.jobs.nhs.uk/ The Interview • Standardised process – you will all get the same questions • Objectively marked • Usually a panel with 2 doctors and someone from HR • Know your application and CV inside out • Clinical scenarios – ABCD approach • Last about 10 minutes What you will be asked • Audit • Your time in Prague • Your clinical experience • A common scenario Life as an FY1 The key to being a good FY1 is to understand your role within the team. •Life on the wards •Life on-call •Clinical scenarios A day on the ward • Morning ward round: consultant +/or registrar, junior doctor, nurse. • FY1’s job is to write in the notes and to have blood results and scan results ready. • The most senior doctor present will make a plan for each patient. • The junior doctors carry out the plan. How to write in the notes • SOAP acronym. • Subjective • Objective • Assessment • Plan How to write in the notes • Subjective: patient is complaining of abdominal pain. • Objective: apyrexial, EWS:1 HS: I + II + 0 Tender, involuntary guarding, bowel sounds heard How to write in the notes • Assessment (often “impression” is written instead): acute appendicitis • Plan: Blood tests, US abdomen/pelvis, Erect CXR, NBM IVI Don’t forget to sign it! After the ward round After Lunch… • Now it’s time to do the jobs that the ward round created. • Prioritise – this is a key skill which you will learn. • Typical ward jobs: taking blood, cannulas, ABGs, ordering tests and scans, prescribing drugs, fluids and blood products, writing referral letters to consultants, liaising with other departments, chasing results of investigations, writing TTOs. • Update the list. • Last thing: hand over to on-call doctors. • Go home. A day on-call • It starts off the same – with a ward round. This time accompanied by the night staff. • Jobs after the ward round again need prioritising. • What’s different this time? Clerking new patients • The process of taking a history and examining the patient. • This is done on a clerking proforma which has subheadings to help you to organise yourself. Clerking Proforma • • • • • • • • • Presenting complaint Hx of PC PMHx Social and family Hx Allergies Drug Hx Physical exam Working diagnosis Plan Senior Review • The working diagnosis and plan sections are useful for your own development but they won’t be the final call! • You then present your patient to a senior – either a consultant or a registrar. • Most important for the junior doctor is the ability to take a good history and examine the patient appropriately. Clinical Scenario 1 A nurse bleeps you and tells you that a patient is scoring a 4 on her EWS. Temp: 38.2 HR: 121 BP: 134/75 What do you do? RR: 24 O2 sats: 98% on room air Clinical Scenario 1 • Gladys is an 84 year old lady who has suffered a stroke. • She has been in hospital for two weeks and is doing very well. She is medically stable and has been progressing well with physiotherapy and occupational therapy. • She still has weakness down her left hand side. Clinical Scenario 1 • Assess the patient. ABC first! • Take a quick history of current events. • Physical exam • Check drug chart to see if any symptoms are obviously attributable to recently started medications. Clinical Scenarios 1 • Gladys says she’s not feeling too good. She started to feel hot and sweaty a few hours ago and didn’t feel like eating her lunch. • Heart sounds are normal • Bibasal crackles on auscultation of the lungs. • Abdomen soft non-tender. Bowel sounds heard. Impression? Chest infection Clinical Scenario 1 What’s the plan, doc? •Take bloods •Blood cultures •CXR •Urine dipstick •MSU •IVI •IV paracetamol •IV antibiotics Tell a senior! Clinical Scenario 2 • On an admissions unit, Mark, a 56 year old electrician presents with a 48 hour history of abdominal pain, vomiting and loss of appetite. • Observations: Temp: 38.1 RR: 18 HR: 86 O2 sats: 99% on room air BP: 151/82 Clinical Scenario 2 • Heart sounds normal • Lungs clear • Abdomen: pain in RUQ. Murphy’s sign positive Impression? Cholecystitis Clinical Scenario 3 • It’s 22:00 and your bleep goes off • A nurse on geriatrics would like you to come and review one of her patients who has new onset confusion • She’s wandering around the ward and getting a little agitated • EWS 1 (HR 105, RR 12, BP 137/78, Temp 37.4, Sats 98% RA) Clinical Scenario 3 • What do you do? • Quickly assess the patient – Who are you? – Where are you? – What’s the date/time of year? – Ask about any symptoms e.g. chest pain, dysuria – Has she fallen? Head injury? • Read through the most recent entries to gauge what her baseline is, ask the nurse for a quite synopsis of her admission Clinical Scenario 3 • 82, nursing home resident • Admitted following a fall – no head injury or # • Was undergoing rehab and due to be discharged shortly, usually compos mentis • She is disorientated and it is not possible to take an accurate history • She’s beginning to get very agitated • What do you do? Clinical Scenario 3 • Simple things first! • Do a good examination – look for any signs of head injury or infection • Tender suprapubicly and smells uriney • Differential diagnosis? Likely UTI • Bloods, MSU, CXR, ECG, IVI and empiric antibiotics • What else could it be? Consider CT head if doesn’t improve Clinical Scenario 4 • You’re on the surgical assessment unit and a 45 year old gentleman has been sent in by his GP with severe right loin pain • Sudden onset, comes in waves • Radiates to the groin • 10/10 at it’s worst, currently about a 5/10 • Has recently been working on a building site for long hours in the sun Clinical Scenario 4 Examination •Appears in pain, orientated •EWS 0 •Airway patent •Chest clear, HS 1 + 2 + 0 •Tender right loin, no guarding/signs of peritonism •BS present •No pulsatile masses Clinical Scenario 4 Differential Diagnosis •Renal colic •Pyelonephritis •Pancreatitis •Cholecystitis •Gastritis •Pneumonia •Ischaemic bowel •AAA Clinical Scenario 4 Management •Bloods (including amylase, urate, calcium and phosphate) •Analgesia •Antiemetics •IVI •Imaging • Colic – CT KUB • Pyelonephritis – USS KUB Thanks for listening! Good luck with your studies and job applications! Any questions?