Supervising International doctors:

Challenges & Opportunities

Dr Sujesh Bansal

Trust International Tutor & Consultant Anaesthetist

Central Manchester University Hospitals

3rd Nov 2016

A typical year in NHS

GMC, 2014

13,150 new doctors

Central Manchester University Hospitals

CMFT ~ 70 – 80 international doctors recruited every year

New starters Nov 2013 - Oct 2014

All grades 283

British 171

non-British 112

Europe 49

outside Europe 63

Clinical Fellows 159

British 84

non-British 75

Europe 25

outside Europe 50

Doctors according to their PMQ, GMC 2013

MTI Scheme

Recruitment in ‘Boom & Bust’

Pre MMC: Entry Points

EEA

Post MMC: Entry Points

IMG

IMG

IMG

CF’s

MTI Fellows

Challenge

Unstructured recruitment & career pathway

MTI Scheme

Robust Recruitment process

• Gap analysis of junior rota

• Identify educationally relevant posts

• Robust recruitment OSCE style process with multidisciplinary/multi-speciality involvement

Deanery trainee

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IMG – Do not prejudge

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Challenge

Variability in training, experience, career stage….

Robust Recruitment process

• Gap analysis of junior rota

• Identify educationally relevant posts

• Robust recruitment OSCE style process with multidisciplinary/multi-speciality involvement

Robust Recruitment process

• Gap analysis of junior rota

• Identify educationally relevant posts

• Robust recruitment OSCE style process with multidisciplinary/multi-speciality involvement with learning gaps identified and appropriate rota tier identified

• Supernumerary Clinical Observership

• Enhanced induction

CF: Aspirations

Clinical Fellows/ EEA Fellows:

1st job in UK

Tertiary UK clinical experience

CV : for ST jobs / Consultant job

Specialist experience

Coasting…

Speciality experience:

Post-CCT experience

CESR

Education

MTI International Fellows:

UK experience, UK career

Challenge

Variable aspirations needing bespoke supervision

Support Structure: Deanery trainee

ST trainee or

College Tutor

Speciality School

Challenge

Lack of robust support structure

“lack of relevant information about legal, ethical and professional standards and guidance prior to registration…..”

Challenge

UK clinical practice…..

Opportunities

Organise Enhanced Induction

• E-LfH Induction for International Doctors

• Corporate/ Clinical/ ANTT/ BLS/ Pain

• Trust Email i.d.

• IT software training & various passwords

• Transfer training (Inter/Intra)

• A&E session

• ITU session

• IMPACT/? ALERT / ALS

#lha14

Online training is a resource efficient method

CLINICAL

Management & QI Projects

Research

Teaching

‘Online’ Induction

Supervisors

INCREASED SUPPORT

Peer ‘Buddy’

‘Online’ Induction

CMFT International Induction

Provide Enhanced Educational Supervision

• Aware of needs of International doctors

• Initial meeting / IAC

• Frequent meeting /Peer Buddy

• 3 - 6 monthly ES report (proactive/patient approach) – WPBA (CBD, DOPs, ACEX, ALMAT)

– MSF

– Logbook

– CPD matrix

– Encourage Study Leaves

– Audit/QI

Peer Buddy System

Encourage C P D • 10 to 30 days of study leave

• £805 / year

• Internal

– Audit & Clinical effectiveness day

– Journal club

– Morbidity & mortality meetings

– Local Exam Preparation Courses

– Free days organised by the Trust / Deanery / Locally

• External

– Specialist societies

**Annual Appraisal** • Trust Employees

– Concerns re. poor engagement

• 12 monthly appraisal (9-15 months)

• Agree on appraisal date on induction

– Birthday, Previous ARCP date, Pragmatic approach

• Contact for Equiniti portfolio (alison.wake@cmft.nhs.uk)

• Bespoke workshop on Equiniti portfolio

• Maintain portfolio (Online + Paper)

• All CS/ES paperwork

Management of CFs

• Use Trust policy

• Involve CS, ES, Tutors, CD, MD

• Advice from Postgraduate Medical Education Department

– Dr Mark Forrest, Dr Sujesh Bansal

• Might need to involve

– Human Resources

– Occupational Health

How can we ensure that international doctors progress in their

professional career?

CLINICAL

Management & QI Projects

Research

Teaching

CLINICAL

Examination & International Doctors

• Additional training for international medical graduates to enable their adaptation to the UK healthcare system.

• Diversity of examiners and actors, the type of cases included in the examination and the feedback given to candidates

• Deaneries: – Additional training support

– Rotation in proven stronger training hospitals

– Trainers are given additional support.

The Specialist Register - Equivalence

• Non-UK trained doctors can also apply to join the specialist register

• They must demonstrate that their knowledge, skill and experience is equivalent to that of a CCT holder

• In 2015 – 264 CESR (49.4%)

– 18 CEGPR (56.2%)

Know the Challenges/opportunities • What does IMG wishes to achieve over the next few years?

• What training or resources would this require?

• Would this need a change in their current job?

• Strengths?

• Weaknesses? why ?

resources, further training, personality, systemic, remedies?

• What guidance or help do they need? Who? How?

• Clinical/training/organisational.

Enhanced Educational

Supervision & Appraisal to

develop relevant PDP

Enhanced Induction

& Support

Robust Recruitment