My 6 months Experience as CPSP Scholarship Trainee in NHS

It's been almost 6 months since I have joined NHS as an International Training Fellow in Respiratory Medicine. But my MTI isn't through RCP, my sponsor is College Of Physicians And Surgeons Pakistan which gave me a slight advantage because I didn't require MRCP. Read here for details on the Requirements, Which Specialities can apply, and how to maximize your chances of getting selected for MTI.


The hospital I got selected was Russells Hall Hospital located in Dudley, West Midlands. Since this was the early stages also of CPSP scholarship program and Russells Hall was 1st time recruiting candidates for MTI through CPSP things weren't quite smooth. There original plan was to expose the Junior clinical fellow to Sub Speciality while keeping main focus on Acute Medicine rather than standalone Sub Specialities because they tend to be rather more difficult and invasive. That's why they kept that for FCPS part II cleared candidates but I was selected as Junior Clinical fellow in Respiratory Medicine and since I was already working as Pulmonology Fellow in Pakistan and I was supposed to be completing maximum out of the two years in Respiratory and some in Acute Medicine (Internal Medicine). But how much of Medicine will I do wasn't made clear. So there was this grey area in the advertisement which they cleared from the our batch onwards by keeping Sub Specialities only for FCPS part II cleared candidates.

Getting through with the GMC registration and   Tier 5 visa process was a tough one my experiences and guides can be found here (GMC registration and Tier 5 visa) . The actual experience begins when you start working. It's difficult no doubt because even you are a big shot back home you are start here from scratch. I have a worked at some of the best hospitals in Pakistan but still coming heres I felt I was way behind, not in terms of knowledge or experience but more like in the way of doing things. Proper systematic way of management of patients with a huge chunk of focus on the social and welfare of the patient. And meticulously following guidelines to make medical practice safe.

When I arrived at ward on the 1st day. I was asked to shadow a junior SHO to get the hang of the Basics of how to run the ward. The ward was understaffed and doctors overworked. Looking after a large number of patients is nothing new to us Pakistani doctors but looking after them the correct way definitely is. One thing that took me some time to get used to is documentation. Most of NHS is still running on paper notes though plans are to become paperless. Documentation is of course essential but documentation here was to the very next level each every thing you did or didn't do, every chat you had with family no matter how short or lengthy, any event happened must be documented with time, date your name and GMC number. You document as if GMC is opening your file next and just waiting to blame or execute you. This necessarily isn't a bad thing because it definitely can make you safe should it come to point where you are questioned by seniors or authorities. You will see not only doctors but other clinical / non clinical staff will document everything to make them safe. If you said you will do this later on, it will be documented in the notes that you said so. In any case doctors are the ones that are mostly thrown under the bus especially junior doctors and if you are International Medical Graduate it gets a lot tougher. Also read what's expected of you, working as MTI in NHS.

Whether you come as Junior or Senior Clinical Fellow or through conventional MTI you need to let them know who you are and what you are. Not by boasting what you can do, or have done but by actually doing it. You need to learn from scratch, let them see that you are improving yourself, smoothing out the wrinkles in your methods, learning and grasping new stuff quickly. That's what I did, tried to understand how to run the ward. As respiratory fellow I thought I will be doing procedures and bronchoscopy soon enough but as mentioned consultants are scared about litigations and the legal issues. They prefer someone who is experienced and has the necessary degree of education for interventional stuff. In this case it is completion of MRCP, which automatically bumps the candidate to registrar level. Of course I did have that in mind but I didn't give up. For a couple months I remained in the ward and tried to learn everything for some reason my confidence had become quite low since I had joined, probably because I thought I had learned medicine the wrong way, all my skills are outdated and rusty. To some extent it was true because we have lots to catch up as a nation otherwise we aren't too bad. Once I started to build up my confidence and Registrars started to notice my input in ward and actively participating in watching them to procedures I was allowed initially to do pleural taps under supervision then chest drains and indwelling pleural catheters and a bit of hands on the bronchoscopy. But the point is it takes time but as MTI we don't have much time there's lots to cover and we have only 24 months out of which 4-6 months are taken to settle in and make consultants and registrar develop confidence in you and work towards your MRCP so that you end at a level that you are supposed to be working at.

As of now I haven't been put on the on-call rota, there aren't any respiratory on calls as such, they work on the the medicine on call and help Clarking patients in AMU and ED and ward cover. This is definitely where you learn more especially if you are on the crash team. Usually you are put on the on call rota once your supervisors think you have the needed experience and knowledge. So I will be put on the rota soon. The other option to get experience of on call is to work extra shifts as Locum. As part of my contract I can do Locum within trust only.

So you must have goals of what you want to achieve while working here. Exam, courses, skills, tourism make your plans and start implementing on them as soon as possible. Discuss with your educational supervisor, which will be appointed to you, as to how you can achieve them successfully. Otherwise you might end up wasting your 2yrs. You need to realize you are not here just to provide service to NHS but take the most out of it with you when you go back.

Good luck! For further guidance and information continue following this blog and like and share this page.
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