Ideal university for Medicine

[Kayt79]

DS is in Y12, and set on Medicine. He's been to a few open days already, but until he's done his UCAT next summer it's impossible to know where will be realistic to apply.

So, just out of interest, and putting aside entry requirements and "prestige", which would be your ideal universities for Medicine, based on the overall student experience?

Yep, I do IMT and medical higher specialty recruitment and while CV achievements etc get you an interview, you then start with a level playing field and are given a job based on your answers to clinical questions. Somebody dangerous can be marked as “unappointable” (and I have done this many times), or even reported to the GMC (never done this myself by I’m aware of it happening).

You also won’t progress through training if you aren’t getting decent marks in your assessments, which again are based on clinical skills not things like audit. And again I’ve known numerous trainees kicked out because they just weren’t safe to progress to the next level. That doesn’t mean they will never be, and they are given extra time/opportunities to improve, but at the end of the day if they aren’t good enough they aren’t signed off.

@mumsneedwine do you know what the story was with IMGs and why the change was made? Was it something to do with Brexit maybe? Just seems like a relatively easy thing that couldn’t be changed to make the situation a bit less dire for UK grads but have no idea who/what/why

@Kayt79 people can apply for multiple specialities but someone did the analysis and the average competition ratio is 1:4.

@Sybill think it was Brexit related, but not totally sure. It's v v stupid !

Thanks for that response Saschka. So this is all about assessing competency is what you're saying? Perhaps mumsneedwine was talking about the lower levels of progression - so the filter following F2? Can you tell me what happens there? Is that a mere lottery? I should know (my DC has been through these stages) but I'm very vague about what's actually involved tbh.

@Saschka can I ask if you're involved in ST/CT recruitment ? Because that seems to be so weirdly not based on competency. The MSRA seems a v blunt tool. No one uploads a CV. And points don't seem to include being a fantastic doctor.

I do see that you'll not last if not good enough but getting the job in the first place is the issue at the moment. Taking an F3 is near on impossible as locums dried up, and trust grade jobs are like hens teeth. I know F3s who have had to move home and get jobs outside medicine. Before leaving for Australia as they can't get work here.

This outlines the selection criteria

medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/overview-of-specialty-training/interviews-and-selection-process

most people end up working in the region they qualified in, often for the rest of their lives. So London/not London is a big decision

I'm not sure that's true. DD is a medical student in London.
When she finishes, her name goes into a lottery.
She only gets to stay in London if she gets her name drawn early in the lottery, before all the London places are taken.
I know about this situation because DD would rather not practice medicine at all if she can't stay in London.

IMT (so ST1-3 internal medicine) and ST4 nephrology. MSRA isn’t required for either of those. The points are things that most people will have done as part of foundation training - audits, teaching medical students, being rota monitor or a departmental trainee rep.

I coach a lot of our junior clinical fellows through IMT applications, and the vast majority do not have PhDs, international oral presentations, exams etc. They still get appointed.

We also don’t have a glut of applicants for our JCF and SCF posts - usually 800 completely unqualified overseas candidates, and one or two potentially appointable ones. I’ve just had to reopen an advert as we had nobody even remotely appointable apply. Very rare indeed to get a UK applicant, and we are a London teaching hospital so theoretically desirable. My colleagues in other trusts tell me the same. Perhaps it depends on the specialty, but anyone vaguely competent who wants a non-training post in our specialty can pretty much walk into one.

@Saschka very good to know. Thank you. Not sure many people can afford to live in London these days (maybe an issue ?). And my DD says being the Med Reg seems the hardest job so not too keen on IMT.

Some ex students have struggled to get fellow jobs because the adverts close so quickly. You seem to have to be lucky to see one before the IMGs do. But really good to hear jobs are there - I'll pass on your comments to the F3/4s I know who are currently without work. Most are Londoners.

anyone vaguely competent who wants a non-training post in our specialty can pretty much walk into one

Please bear with a layman. There are a few acronyms flying around here.

Could you explain what a non-training post is, the post which seems to be up for grabs even in London? As opposed to a training post? Are the latter also easy to get in your specialty in London?

I'm still a bit confused about whether progression is based on clinical competency or not

Not a thread I would normally pop onto as none of mine have expressed an interest in medicine but seen in Active threads...wishing your DS luck OP!

No mention of Edinburgh or Glasgow uni though?! What's going on?! 🤣

You probably know this, but they can set up alerts on NHS jobs, and pre-prep their application form (shouldn’t need to change much from job to job - their work history and qualifications should stay the same).

Yep the AI-driven overseas blanket applications are a nightmare - some people have systems set up to apply for literally every job on nhs.jobs, no matter how inappropriate. I cannot tell you how annoying it is from a recruitment perspective as well - an absolute waste of frankly expensive consultant time to wade through 800 overseas applicants without even a single one of the essential criteria for the post. We don’t cap application numbers (because we probably wouldn’t recruit anyone decent if we did), but I can see why others do.

@Saschka thank you. They do have the alerts but annoyingly they are often working so miss the v small windows to apply. Some are only open for a few hours (reach 500 applications and then shut). One has just got a Junior fellow job - 300 miles away from home (& his wife and kids). It's such a silly system - and waste of your time !

Just looked at IMT points - need to have lots of spare time to get all those ! Amazing job though.

I’ll cover that in two separate posts as it is two separate issues.

Non-training post - junior clinical fellow (SHO level) or senior clinical fellow (reg level). A standalone post in the specialty that doesn’t lead to a qualification or allow you to progress to the next stage of training.

We need 8 SHO-level posts in our department to run a compliant full-shift SHO rota. But training numbers are capped by Health Education England, and we only have 4 training posts allocated to us (filled by doctors rotating through a training scheme, who will be able to apply for registrar level training once they finish IMT training). So, the other 4 posts are locally-appointed posts, non-training posts, junior clinical fellow posts (all means the same thing). Same job, same responsibilities, but doesn’t lead anywhere. So much less popular with UK trainees.

Lots of people use it as a stepping stone to apply for IMT training though - we make everyone do an audit/poster/teaching etc, and with an extra year of experience, your internal medicine knowledge should be good enough to get through the interview questions.

Thank you.

So are the four training posts you refer to 'F3 and F4' (or whatever the stage is known as after F1 and F2)?

And is registrar level training the four year programme after which they can apply for consultant jobs?

How competitive are those two levels of post in your specialty in your area (as an example of competitiveness, especially since you say your non training posts are there for the taking).

Progression:

In a non-training post, you can’t progress up the seniority scale. You stay at the same level, and there is no expectation of passing exams, completing assessments etc. You can turn up, do your work, and go home. Obviously lots of people in non-training posts do much more than that, but nothing happens if you don’t.

In contrast, after completing a training programme you are eligible to apply for the next step up (eg registrar training programmes, or consultant posts). When you are appointed to a training post, each year there are goals you need to meet in order to progress. You need to be passing exams at the required rate, you need to be completing a set number of assessments, and those assessments need to be scored as competent. You need 360 feedback from both consultants, peers and the MDT, as well as objective assessments of things like practical procedures, your performance in outpatients, etc. At the end of the year, your direct supervisor summarises all of this, and their report and your portfolio of assessments are reviews by a panel of other consultants from around the region (“ARCP panel”). We have national assessment criteria to mark people against (ARCP decision aids) - if they haven’t completed enough assessments, or the assessors say they aren’t performing at a high enough level, the trainee can’t progress to the next year of the training scheme. They would be given extra time initially, and referred for support in the event of repeated exam failure etc. But if they have had this extra time and still can’t meet the required standard, they are kicked off the training programme.

They can still work in a non-training post, or they can apply for other training programmes (ie if you are asked to leave a surgical training programme you could apply for GP training, or vice versa), but they aren’t eligible to work in a more senior post.

Hopefully I’ve explained that clearly - appreciate it’s quite complicated! But yes, assessment is definitely competency based. You don’t have to be a high flyer, but you do need to be safe and working at an appropriate level, and able to evidence this.

That's very clear thanks.

So how competitive are the lower level training posts? Presumably less so than the registrar training programme? What about numbers per place for those?

I'm still surprised that the non training posts are readily available, given what's been said on these threads. I thought it was all doom and gloom but it doesn't sound that bad.

FY3/4 posts are NON-training posts. We don’t use the term F3/F4 posts in our trust because a lot of the people in those posts are actually experienced overseas graduates getting experience in the NHS rather than unemployed FY2s. But yes many FY3/4 posts are what I would call a JCF, junior clinical fellow. Because these are locally-appointed posts, trusts can essentially call them what they like.

SHO-level training posts in general medicine are known as IMT1-3 (internal medicine training posts years 1-3). That is a three year training programme which prepares you for registrar level training, which yes is a four year training programme in a specific medical specialty (cardiology, rheumatology) which leads to a certificate of completion of training, or CCT, which makes you eligible to apply for consultant posts in that specialty.

Fill rates for nephrology ST4 training are about 80%, meaning we don’t fill all of our posts nationally. For clarity, this does NOT mean we appoint everyone who applies - we get 2-3 times as many applicants as posts, but some of these are applying to us as a “backup” specialty (mostly for cardiology 🙄), not everyone who applies meets the threshold for interview, and not everyone who is interviewed is deemed appointable. But if you are appointable (ie basic level of safety, not a superstar) you’ll get a training post. May not be where you want geographically, we are a small specialty and the posts can be scattered across the country.

Not sure about fill rates for IMT, I’m involved in shortlisting and interviewing but don’t see much of the aftermath.

Very helpful Saschka thanks for the detailed replies - appreciated.

It think it depends on the specialty - I can well imagine surgical fellow posts being more competitive. I know dermatology clinical fellow posts locally actually have a waiting list, because dermatology is a difficult specialty to get into, and fellow posts help you gain experience. Internal medicine posts generally don’t have hundreds of people chasing them, once you weed out the blanket auto-applications.

medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/fill-rates/2023-fill-rates/2023-england-recruitment-fill-rates

IMT was 95.8%.

When talking about competency based recruitment I was talking about getting into Foundation or CT/ST 1 roles. Foundation is now a lottery and most post training roles use MSRA. Thankfully once you're in it seems that being a good doctor counts (there are so many expensive exams).

I've printed out your fantastic explanations @Saschka for my students.

The numbers on your link are incredibly interesting mumsneedwine. I'm dotting around the various regions now (delaying what I'm meant to be doing! Getting sucked in!). I may not fully understand I suppose, but it does look as if oncology doesn't fill up, or emergency medicine, both of which surprise me.

I'm not clear what the problems with the MSRA are?

As my DC has gone through various stages I've just been pleased when an exam is passed or whatever, and I've been vaguely aware of listing locations in order and rotations in order and was aware of lots of people wanting to go for cardiology etc but I've never drilled down into stats. It's all been at general chat oh good sort of level, listened to what various uni friends are doing etc.

Is the situation dire or not? It doesn't seem too bad which is actually what I thought before reading horror stories on here.

The introduction of randomization for F1 I was certainly aware of but in terms of assessment based on competency I was referring to the progression beyond F2. It's reassuring to hear that it's a thing.

@ThatllBeTheDay the problem is a lot of that fill rate is from IMGs. Not F2s. So the situation is pretty dire for those that don't get a good score on the MSRA - an exam that was originally just meant for GP applications. It doesn't contain any relevant questions for most of the others. We are the only country that doesn't prioritise our own staff for jobs.

So F2s with no training number would previously have taken an F3 to locum and gain experience, but this has pretty much stopped. Or taken a JCF role but these are hard to get as have 500+ applications and often close within hours because of the AI bot things.There are also less JCF roles now because of PAs being employed instead (who are more expensive but less trained 🤷‍♀️).

So for current younger resident doctors trained here the situation is bleak. Wish it wasn't. I'd like my DD to say here, she wants to stay here, but doesn't want to be unemployed. And Australia and others are offering her the world at the moment. I have my 🤞this mess is sorted out.

www.rcgp.org.uk/news/member-research-jobsearch-struggle