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Um Hello everybody. My name is Anastasia. I'm a core surgical trainee. I'm based in the West Midlands. I work in Stoke on Trent. I'm a city too currently and I'm also the regional representative for West Midlands and I also happen to be an international medical graduate and I'm not alone today. I am here with George. I'll let the flo on you just to introduce yourself. Thanks, Anastasia. I'm George. Um as mentioned, I'm one of the surgical registrars in ST five up in NHS highlands. Um I'm an I MG as Anastasia said, and I'm the region representative for asset from the north of Scotland and good luck and happy to see all of you today. Thank you. So, uh thanks George. Today, we've been invited to speak about our experiences of being international medical graduates in the NHS. And uh we've been discussing with George, how are we gonna approach the, the topic and uh how we should better deliver it to all of you. So I was reflecting on my journey as an international medical graduate, taking it from the moment I graduated to where I am now. And I thought following the linear approach and explaining all the obstacles that I have faced and sorry guys just want to check. Have you moved your slides? No, not yet. Not yet. OK. Oh, but I can't move it. You're right. Can I? Yes, I can. Yeah, that's fine. Can you see my, my slides moving? Yes, good, excellent. Thank you. Um So what, where was it? I was saying uh following the linear linear approach and uh all the obstacles that we have faced and how we have overcome them, them would be probably most uh useful for you. I tried to make this presentation um useful, not only for international graduates, but also for uh local graduates for two reasons. First of all, uh local graduates work closely with IM GS. So I think it is important to understand the journey of an I MG and have an informed opinion on the topic. And secondly, I think to sum it up, this is a presentation of a person who can to the UK with zero portfolio with zero knowledge. No, well, close to zero knowledge of what a a surgical application entails and made it to surgical training. So I guess that could be um insightful and helpful for uh local graduates who feel that their portfolio is lacking at this point in time. Uh Very briefly, I would say that my motivation for coming to the UK and pursuing surgical training, mostly it was based on the fact that the training here is uh structured. It is quite fair, it is a national selection. Um Obviously, there are difference differences between the regions, but all trainees have to have uh certain uh have to follow certain rules, they have to pass through certain checklists. And at the end of the training, uh you get awarded the, the certificate of completion of training, which is uh internationally recognized and therefore allows you to practice in different areas of the world. And as I said, it, it, it looks like a linear journey when uh looking at it from where I'm standing now. So I graduated back in 2019 in Greece, where I am from. And I graduated from the A uh Aristotle University of Thessaloniki, which is a prestigious university for Greek standards. But I'm sure uh most British people have never heard of it. Um So I thought that I wanted to pursue training abroad for the first time when I was a third year medical student. And then over the uh final two years of medical school, I uh essentially made the decision to come to the UK um as a I MG as a European graduate, having finished a six year medical course, I wasn't eligible to apply for foundation year one. As I was supposed to be having the competence of somebody who has finished foundation year one. So the next best option was to do a foundation year to stand alone program for which the applications open up in January. So essentially for six months, I was doing a nonmedical service provision job just because I was told it's better to not learn bad habits, to not start in a system uh where you won't be practicing for the rest of your life. Um I did my appli I completed my application, I was accepted and in August of 2020 within the midst of COVID and everything I joined the NHS. And I guess the first uh problem that I encountered was speaking to uh my peers, I realized everybody was uh almost ready to apply for specialty training. At that point in time, I had zero, literally zero audits just because audits uh doing it on this mostly a British thing. It's not something well known in Greece or other uh areas in Europe. And therefore, I couldn't have done it as a medical student. Um Even though I had been involved in research at the time, I had zero published work and zero present like national presentations apart from, you know, local informal presentations and I was involved in teaching. I really enjoyed it, but I didn't have anything to prove it. I was doing mostly informal peer teaching. So as you can imagine, I wasn't quite application ready at the time. Uh But that was not the only issue I was facing. I started doing uh acute and geriatric medicine as part of my rotation. And I really struggled in the beginning. II was definitely not up to par with the local graduates. I was enough to but feeling like I was drowning in a system that I didn't know how it was operating. And I was honestly thinking, uh there is no space, there is no place for me. I was slow. I wasn't confident with my decisions and reflecting back, I now can understand uh that when I was a medical student in Greece, my program with my medical school curriculum was focusing on basic sciences. I did a lot of anatomy, physiology. I did have um I didn't know basic sciences be behind what we're doing, but there was no communication skills teaching. I didn't know how to properly consent the patient. If you can imagine, I didn't know how to properly bre break back news. And you can imagine that that's uh a an insufficiency when you're expected to be a senior house officer. And um I wanna be positive here and I wanna say within the first couple of months, things improved significantly and that was because I did have support from seniors. And I also uh put a lot of personal effort in studying in out of hours and in and doing the work outside the working hours so that I could be uh sufficient. Um At that point in time, as you can imagine, there was no time to think about portfolio, especially within the 1st 34 months of being a foundation doctor. Uh What I focused on was thinking of my next step and I wasn't quite training ready. Uh It is quite obvious. Yes. So I decided to pursue a first grade job. Uh II told myself this is supposed to be enough to stand alone. But I'm mostly at the level of an F one. I've just finished medical school. I can give myself a break and do another year of senior House Officer. And that's when things improved significantly. I started building up my portfolio. I starting uh II II was at that point confident in the system that I was working in II start, I finally became a good sho for once. Uh So uh then II think I'm quite ready. I'm applying for CSD for the first time. Um And that leads to failure. My portfolio is better than it was, but it's not quite there yet. I'm also very bad at interviewing. I'm interviewing very bad at that time. I get the interview, but I managed to tank it. I get no job. So um I take a step back, obviously, I it's devastate. I reflecting back on that, thinking back on what I was thinking at the time, it was devastating. I thought everything was I II thought my career was over. At that point in time, I thought I had to think of other avenues, but I take a step back and I decided to do a teaching fellow job. I've always enjoyed teaching. I thought it would be a good uh slow paced environment. It would let me work on my portfolio and work on my interview skills and then I reapplied for core surgical training. And the doubt at this point in time is huge. I'm thinking, what am I gonna do if I fail again? Uh What is the next step? Thankfully, I managed to get a, a core surgical training job and now I'm a cat too. So it it kind of all worked out at the end. Uh Looking at the diagram, I was trying to think what areas I can identify as areas of improvement and what advice I can give to an international medical graduate. Coming straight in uh fresh of the system. Oh I didn't say well, I'm ac two now. But as many of you may have experienced at times, you find yourself in rooms where you're the only person with a foreign accent and you still feel like you're a minority within training. So areas for improvement for international medical graduates, but also for local graduates portfolio uh application your day to day work, feeling the uncertainty, the doubt and how I have overcome the cultural issues I have faced. So taking it one by one portfolio, I think just by coming here and by being here today, you're taking, you're making an active effort, you're making the step to build up your portfolio. You are becoming more well informed. And what I would suggest is looking at the portfolio requirements quite early. Don't be like me as a no graduate if you are still an undergraduate, think of what you can do at this point in time if you're not an undergraduate and you're, you've already graduated, that's no problem. Start early, start today, start this evening, start on Monday when you go to work. Um Think about what's missing on your portfolio and start building not only early but also smartly uh t uh tailor your portfolio to your needs. Um Select the, if you're an I MG, select the jobs that you will be doing in the UK carefully. Um When I did my trust grade job, it was uh a brilliant department that I was working in. Everybody was very supportive and they did help me with projects. They gave me research, they gave me audits, they allowed me to organize the regional teaching. So uh asking questions about the departments you will be joining and thinking about getting a job that will help you achieve. Your goal is the way forward. And that I said it is important to have a mentor. It is easier said than done. And we all imagine that a mentor would be a well rounded consultant, a professor, somebody who will take us through the journey. But that's not the case. I had wonderful mentors and I can not stress enough that I wouldn't be here if it wasn't for them. Uh A mentor can be anybody if you're a foundation doctor, it can be your sho if you are an sho it could be your reg my mentors were all uh registered grades doctors and they pushed me to my limit. They uh they gave me projects, but they also expected for me to do the work to be able to uh get on the next level. Identifying a person who has the time and the willingness to be your mentor early on in your career is something that will take you to the next level. And I say here, grab every opportunity along the way and I do support that. Yes. Initially, I think uh on, on your initial days and months in the UK, you have to say yes to every opportunity as you tailor your portfolio, then you have to be smarter and think, will this help me achieve my goal? Will this improve my portfolio or am I doing the same thing again and again. And that's when you start saying nos and yes, depending on um what every project is offering you when it comes to our uh day to day again. Think about how you're choosing to enter the system. I would not recommend going into core surgical training straight away. We're coming from different systems. We do have the basic knowledge, but we, most of us don't know how the system works. So if you can enter through a trust grade job and support a uh in a role that will be supported by seniors. I think that's ideal, not only to build portfolio but also to build your confidence within the system and be ready to learn, be open to learn, be open to constructive criticism. It's not easy in the beginning and you feel like all odds are against you, but it gets better with time. And the moment you identify somebody who's willing to teach you and train you literally follow them around, follow them, learn from them, ask them actively, ask people to give you constructive criticism. A ask for feedback and improve. And if you're somebody who has had experience in a different system and now coming to the N HSI know it's difficult to leave the old habits behind, but you have to be true to yourself. If you want to belong in the NHS, you have to learn how things are done here, even even though some things you will find are difficult to adjust to you. We, we do all have to adjust if we want to be part of the system. Um when it comes to application again, you are here today. So that's very helpful knowledge of the application process planning. Quite early on asking for advice from seniors. Find people in, in your department who are willing to teach you and take you through the process, who can speak through their experience and who can maybe offer you 1 to 1 advice and interview practice and again practice. As much as you can when I think about, uh, uh, my first interview, the reason that I failed was I hadn't practiced it at all. I thought I would just appear to the interview. Uh, they will ask me questions. I will just answer and I'll get the job but it doesn't work like that. The interviews are almost like exams when it comes to training, they are structured and you have to say certain things so practice as much as you can before you get there. And lastly, that's a huge topic and that's uh something that I can definitely not cover within uh 1015 minutes. But um adjusting to the culture in the UK, especially if you are a foreigner like me and you're not a, a British person who did medical school abroad. That that's a tough one when I came here. I don't know what I was thinking honestly, I thought in a year or so from now, I would be speaking more like a British person. I would be sounding more like a British person. People will accept me almost like a British person, but that's not the reality. That's very far away from the reality. So set realistic expectation. Yes, you will always have for like like a foreigner. You may always feel like an outlier. I'm now a say you and I still feel like an outlier on many occasions. Um And then you will have to answer um you, you will have to face questions about the, the role and the place of IM GS in the NHS. Um That's another big discourse. I won't be covering it today, but I would suggest whether you're a local graduate or an I MG read about the topic have a good understanding of what it entails before making any controversial big statements. Uh because it is, it is a nuanced topic and I think we should all be, uh, well, uh rounded, uh, on it before we, we get into the conversation at the end of the day, you will be judged by your work. And if your work is up to par, it doesn't matter whether you're British or Greek or whatever, uh, you will be receiving the training you deserve and, uh, you, you will be rewarded for the work that you do. So our work speaks louder than our words, I guess. And, uh, George, do you want to take this over? What happens if I don't get into training? Thanks, Anastasia, you've done a great job. Um, I think you've done all the job you need to do and we need to do together as a team, but I'll pitch in a few ideas. So Anastasia has come from Greece and she started as a co trainee myself. I come from India, I've done, uh, by the time I reach the UK, I've already done my med school and master's in surgery. So when I came over here I was still over qualified for a co trainee application uh with all the difficulties in the portfolios. So I had to find another route to get into the training process uh to make myself uh to have a career in the UK. Uh Let me start very positive. So UK is a place where you can have a fair game and an open play field. So all your skills you have had regardless of where you come from, what culture you come from will add on. They're all synergistic. So, so we we may have to make few, few tweaks and to make ourselves presentable to make ourselves fit for what they actually want us to do. But whatever we had uh is actually very beneficial. So uh I tried for uh ST three job for uh ST three job. It was not easy because as I said, uh though the clinical skills accumulate by the nonclinical portfolio, things has to be or have to be done uh afresh. So it was difficult. So I always think this way, doing an operation and doing a surgery is always very stressful, but there are lighter moments, don't we? So likewise to develop a surgical carrier into the job of consultant is a very stressful job regardless of what background you are coming from. And it is going to be more difficult if it is new to you, anything new to you, difficult. But I would say that it is, it is much more easier to be a non British trainee in the UK than being in any other health care systems across the world. That's why we some of us are still persisting to be here because we are treated very nicely here. Challenges are there, but we need to get through it. So as I said, I made my portfolio very clear. I was very, very presentable. I was always there. Uh Maybe I worked maybe 10 times more than anybody would have worked during that year. So preparation, I would be on very honestly and proudly saying I II was there when any opportunity arised. Um And I took it and I got into the ST three job. So, so if you want to be a surgeon, either you can end up through a co surgical trained job or if you are overqualified or if you want to, if you take a few years to get to know the system, which is completely understandable because it's not a race. We enjoy the journey you can get in as an ST three, even if you don't get into an ST three that you can always go through the uh article 14, which used to be called before the C A route through which all these evidences you can accumulate through various jobs you do and still you can apply for the specialty Registrar register and you can become a consultant. So my take home message would be in hindsight. I was always impatient. I was always afraid. I always doubted myself. I thought same as anesthesia. I was not fit for the job. I thought I was, I should go back. People are not treating me well. I felt that I've been cornered, I think II, I've had all these mixed emotions. But now as a hindsight, you have to be courageous, you have to put your foot on your pedal. You have to be patient. You have to enjoy the process and things will unfold at the right moment and and you don't have to be afraid of anything and like people like us and the opportunities like us. You do, you do have locally and nationally be reaching out to them is the best idea and and we're always here to support and we always learn from each of them. So that's what I thought I would share and it's open for discussion and uh either of us and probably the rest of the panel who's actually behind the screen. I would be happy to answer any of the questions straight away or as an email or as a questions in whatever way we'd like. And this is kindly given out our email. So we're happy to take any questions John when you think it's appropriate. Lovely. Thank you both very much for sharing your experiences and your genuine kind of opinions and thoughts about everything that's going on. I think this is a lot of things that no one who's kind of has a luxury of being brought up and raised in the UK and have that background. We don't really empathize as much with, with, with your experience. And I think it's really important that the next time we go to work or the next time we go to university, we have that basic understanding of, of all that work and effort that you guys are going through. Um Thank you very much for your time. There's no questions at this moment in time, but I'd be really grateful if you're happy to stay on for a few minutes just in case some come through. Thank you again very much. Sorry for overrunning. Uh Hopefully they'll have a good break. Not at all. Thank you, Anastasia and George. I really appreciate it. Thank you. So, thank you.