Vol. 25 No 3 | Spring 2023
Consider some advanced training time in the UK
Dr Belinda Holmes
Senior Registrar, John Radcliffe Hospital, Oxford, UK / Royal North Shore Hospital, Sydney, Australia

I am a Sydney-based RANZCOG advanced trainee and currently work as a senior registrar in Oxford, UK, within the Oxford University Hospitals NHS Trust. I am a generalist, but also have a special interest in organisational structures, process improvements and change – so the opportunity to work in such a big, busy system has been brilliant. I arrived in August 2022, at the beginning of the UK clinical year, with the plan to spend my final 12 months of advanced training here. I have enjoyed it so much that I have extended this by three months. The hoops I had to jump through to get here were many, with three years planning prior to my arrival, slightly prolonged due to the Covid pandemic.

The idea of an Antipodean trainee spending their fellowship in the UK is not a new one. In fact, many of our more senior colleagues did so almost as a rite of passage. However, it seems that the process became a lot more challenging for us when the UK aligned itself more closely with the European Union (EU) and was required to preference EU-trained doctors. Perhaps Brexit will change this, eventually.

Why do it?

Essentially because it’s good experience, and it’s not too difficult a transition to make clinically.

Given we in Australia and Aotearoa New Zealand generally follow UK practices and guidelines, it’s easy to bring the skills and knowledge we have attained throughout our training to a UK senior registrar role. Likewise, what we learn there can be brought home on the return trip! We have comparable training programmes, with our written and clinical exams being equivalent to MRCOG Parts 1-3. Our training structure of a year or two of unaccredited training followed by four years as a core registrar, progressing to two (or more) years as a senior registrar, broadly matches the seven-year runthrough Royal College of Obstetricians and Gynaecologists training programme. This allows us to participate fully at our equivalent level and to gain relevant knowledge and experience for our stage of (in my case advanced) training, and we undertake similar Advanced Training and Skills Modules.

It is also great to experience working in such a big and busy system at the end of training, to see how and what works, as well as where it struggles. The John Radcliffe Hospital, where I’ve been based, is a tertiary referral hospital with over 1,100 beds, caring for over 7,500 new gynaecology patients per year and around 8,000 pregnant women annually via a 15-bed delivery suite, usually full. The suite functions beside a low-risk birth unit. After hours we work on the senior level of a multi-tier registrar roster, providing support and training to 1-2 junior (core) registrars and one resident/senior resident doctor, with both an obstetrician and a gynaecologist on-call from home. You soon become very experienced with multi-tasking and delegating, while maintaining oversight and providing supervision and training to doctors with varying levels of capability – an enjoyable challenge.

Being immersed in such a large unit means you just simply see more, and the patient populations are a different mix to those we have seen training in Sydney, bringing further variety and experience. I’ve seen conditions here that I previously only read about in textbooks when studying for my written exam, as well as some things I didn’t even learn about for that: such as anti-NMDA receptor encephalitis, first presenting in pregnancy. The opportunity to consolidate my technical skills, including advanced obstetrics and gynaecology operating, at this stage of training has been fantastic.

And let’s not forgot one of the most exciting drawcards to working in the UK – its proximity to Europe! Every time I find myself in a European destination “for the weekend” I still cannot believe it didn’t require a 24-hour flight and horrible jetlag! Sometimes, it feels like a perpetual holiday – and that makes the work in-between a lot more enjoyable.

How to do it

To work as a doctor in the UK (like anywhere) two forms of permission are required: medical registration and legal immigration status / the right to work. To obtain General Medical Council (GMC) medical registration you can either obtain it independently, or you can be sponsored by an employer.

If you obtain registration independently this gives you the advantage of the right to apply to work at any UK hospital, though you will need to go through an exams process unless you studied medicine in the UK or Switzerland. Currently, the exams we take and must pass are the Professional and Linguistic Assessments Board (PLAB) tests. They’re a little tedious, requiring revision of general medical knowledge appropriate for a second-year out of university doctor, and take a few years to complete. This is mainly due to the waitlists for the two exams: a multiple-choice that is held in various locations in the UK and abroad, including Australia; and then a clinical exam which unfortunately is only held in Manchester. It’s worth noting that this will change in 2024–2025, and we will instead be required to take a Medical Licensing Assessment, a standardised exam that all UK medical graduates will begin taking at the end of their degree.

The alternative is to successfully obtain a job with an approved GMC sponsor hospital. The sponsor hospital then has the responsibility for ensuring your English skills and clinical knowledge are appropriate to enable you to practice at the job you have been offered. The limitation of this option is that you can only work in the organisation that is sponsoring you and you must have engaged in medical practice for three out of the last five years, including the most recent 12 months when you apply. However, it is by far the quicker process and requires much less foresight and planning than PLAB. The GMC has a long list of sponsors on its website, and Oxford University Hospitals NHS Trust is one of them.

Unless you hold a British passport, the second required component is an immigration visa (Health and Care Worker visa) that allows you to work. This requires sponsorship by your employer, who will need to provide you with a certificate of sponsorship, once you have been given a formal job offer, and which you can then use to apply for the visa.

Finally, once you’ve secured all of the above, you’ll want to make sure the training is accredited by RANZCOG. This is done in the usual way, by submitting a prospective approval with details of your clinical duties and having a local training supervisor.

Closing thoughts

It’s been a great experience spending a year working in the big, busy NHS, especially at the end of my training. I’ve had the opportunity to broaden and consolidate skills and knowledge through the sheer volume of work and have seen clinical cases that I previously only knew about through reading. It’s also a great stage of training to be here, with exams behind me but not yet having consultant commitments and responsibilities. And thanks to the EU working hours cap of 48 hours per week there is plenty of time to travel. That’s a nice reward before returning to start work as a consultant! It’s also worth keeping in mind the trade-off in income: at around 66% of NSW, that’s something to plan for.

I am hoping to continue building the relationship between my home hospital in Sydney (Royal North Shore Hospital) and Oxford University Hospitals NHS Trust, and to make it easier for those who are interested in coming here in future to receive accurate and up-to-date information about opportunities. Australians and New Zealanders are regarded well in the UK. We are well-trained, with good clinical skills, knowledge and competency, we are hard-working, and we get on with the job. So come and help fly the flags!

I am happy to be contacted if anyone has any specific questions or is thinking about going to the UK and wondering how to go about it.

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