You passed the exams, gained GMC registration, succeeded with your job hunt and interview, your Tier 2 visa has been approved, and you’ve finally packed your bags. Now you’re about to start your first job in the NHS, congratulations!
Now it’s time to get ready for work!
I don’t have to tell you how daunting it is to start your first job as a doctor in a new country. I’m sure you’re feeling the nerves as you count down the days to when you officially become an NHS doctor.
We’ve been there and we know how you feel! It is certainly intimidating, and some people will say that nothing will prepare you for this, but we feel there are many things you can do to prepare yourself.
Here are our 10 tips to help you hit the ground running.
1. Arrange a period of shadowing at work
In our humble opinion, the single most useful thing you can do to prepare for your first job in the NHS is to arrange a period of shadowing. Shadowing is essentially observing, very much like a clinical attachment. It gives you the chance to familiarise yourself with the hospital, ward, and team before taking on full responsibility for your role.
Most hospitals will allow you to start your job with 1 to 2 weeks of shadowing, therefore the shadowing period is paid. This is the ideal scenario.
The best way to arrange this is to bring it up at the interview and then follow it up after you’ve been offered the job. It’s helpful when requesting shadowing to stress its importance in aiding your transition to the UK and enabling you to succeed in your role. Who doesn’t want a new team member to succeed, right?
Unfortunately, there are some hospitals that do not allow you to start your job by shadowing. Instead, they may ask you to come in one week before your official start date so that you can shadow. The main difference here is that it is unpaid. If you are in a position where this is the only choice, we still believe that an unpaid shadowing period is better than nothing.
Related: How to find a UK clinical attachment
2. Set a date for induction
An induction is essentially a formal introduction to the trust and to the department, it is usually conducted by a senior member of the team like a registrar or Consultant. The kinds of topics that are covered in induction include information about the hospital, any important phone numbers and people that you should be aware of, how the on-call system works, knowing who your supervisor is etc.
Many hospitals skip this entirely for non-training jobs, but it is vital as an IMG to get a real introduction to the department so you can start off on the right foot. Again, you can ask about this during your interview and follow it up after you’ve received a job offer.
3. Buy or borrow the Oxford Handbook to the Foundation Programme
We highly recommend this Oxford Handbook. It not only has concise information about managing common conditions in most specialties at junior level, but also several important chapters on how the NHS and hospitals work.
Definitely buy your own copy if you’re starting in a junior level job such as FY1, FY2, SHO, Junior Clinical Fellow, ST1/CT1. You can check the prices here on Amazon.
If you’re starting with a middle grade job such as a Registrar, Specialty Doctor, or Senior Clinical Fellow, this book may still be helpful as an introduction to the NHS and hospital life since almost half the book is dedicated to this topic. But it may be more useful to buy the Oxford Handbook for your specific specialty. You can search for the relevant book here.
4. Read up on key topics for your specialty
Whatever specialty you will be working in, it’s a good idea to read up on the key topics. There is obviously a lot to learn and you’re not expected to know everything as soon as you start, so we suggest that you focus on the following:
- The top five patient presentations of your specialty
- Eg. For general surgery this would include abdominal pain, rectal bleeding, palpable masses, trauma, and sepsis.
- Hone in on the important points of a thorough history and examination for these presentations, the differential diagnoses, and initial management.
- The top five emergency conditions in your specialty
- Eg. In ophthalmology this can include acute angle-closure glaucoma, globe rupture, giant cell arteritis, retinal detachment and microbial keratitis.
- Focus on the assessment and management, in particular how you would be expected to manage these conditions at your level.
- Practical procedures that you are likely to encounter or perform
- For hospital jobs, this will always include venepuncture and cannulation.
- For medical jobs, this might also include lumbar puncture, nasogastric tube insertion, and chest drain insertion.
- You will not be expected to perform higher-level procedures on your own at first, but you should know the indications and complications, what equipment is required, and how the procedure is done so that you can assist. If you do well, your senior will hopefully be happy to supervise you to perform the next case.
All of these topics will be covered in the relevant Oxford handbook, search for yours here on Amazon.
5. Ensure you have the daily essentials in your work bag
There is no need to over pack your work bag with medical equipment as most things you’ll need for work will be available in the hospital. But there are some essentials that you should have to make life easier (and healthier!) for yourself.
We have dedicated an entire article for this here on the 12 essential items for IMGs working in the NHS
6. Set goals
It’s easy to get bogged down with day-to-day work and find that after 6 months in a job, you have not achieved anything or made any progress towards your career goals.
The best way to avoid this is to set some goals right from the start. This is known as a Personal Development Plan or PDP.
Things to cover in your PDP include:
- Clinical, procedural or surgical skills you would like to learn
- Assessments for any clinical, procedural or surgical skills that you need to complete
- Courses or conferences that you wish to attend
- Exams that you wish to take
- Any additional achievements you wish to work for your application to specialty training on such as quality improvement projects, audits, publications, teaching, presentations, leadership or management projects, etc
- Whether you aim to have your Foundation competences (aka Certificate of Readiness to Enter Specialty Training or CREST) or Core competences signed off and within what time frame
This may seem like a lot. Rest assured that you don’t need to work on all areas simultaneously. Think about what you want to focus on the first 6 months and take it from there.
Your supervisor’s input would be very helpful in coming up with a realistic and achievable PDP. It’s recommended that you meet your supervisor within the first 2 weeks of work to review it.
7. Prepare one week of outfits
Your first week on the job is guaranteed to be hectic. We recommend preparing one week of your work clothes ahead of time to make sure that you don’t have to bother with laundry and ironing during that first crucial week.
For junior doctors, the dress code is smart casual up to business casual, and you should be “bare below the elbows” whenever you are in clinical areas. That means no watches, no bracelets, no rings (except a plain wedding band), and your sleeves must be rolled up above the elbow.
For men, you can wear smart pants and a collared shirt (no tie!) with brown or black smart shoes. Blazers can be worn but must be removed when entering a clinical area.
Women can also wear smart pants or a knee-length skirt and a top that is not too revealing. A knee-length dress can also be worn. You can wear heels if you wish, but hospital jobs involve a lot of walking so we highly recommend wearing comfortable shoes!
Sports trainers should not be worn unless you have a medical condition that requires it, or if you are working in the emergency department and therefore wearing scrubs.
8. Organise medical indemnity cover
In medicine we are always dealing with uncertainty, you never really know what’s going to happen and you need to be prepared for the worst. Medical defence organisations (MDOs) offer assistance with work-related legal and ethical issues you may face. Problems you might need them for include things like dealing with complaints, GMC investigations, disciplinary hearings, and clinical negligence claims.
The 3 main MDOs are Medical Protection Society (MPS), Medical Defence Union (MDU), and Medical and Dental Defence Union of Scotland (MDDUS). All 3 cover practice throughout the whole of the UK.
Although NHS employees have some indemnity already, the coverage is extremely limited and is primarily there to protect the hospital rather than you, the doctor. Therefore it is essential that you join one of these organisations.
9. Join a trade union and have your rota (work timetable) checked
Doctors in the NHS are all employees. We all have contracts that must be adhered to, and if there are ever any problems with your pay or working conditions, a trade union is there to help.
There are two main trade unions in the UK: British Medical Association (BMA), and Hospital Consultants & Specialists Association (HCSA). We recommend joining one and having your work hours and contract checked to make sure that everything is in order before you start.
If you’re starting in a non-training job, it’s important that your first salary is correct after taking into account any previous experience overseas. It is much harder to amend this after you’ve started working.
10. Download these apps
There are several useful apps that you can download to your smartphone to help you in your day-to-day work as a doctor. These are some of the ones that we recommend:
- British National Formulary (BNF) – use this to check drug doses, contraindications and interactions.
- MicroGuide – not sure which antibiotic to use? This app lists the protocols for most hospitals. Remember, each hospital is different according to its local population and resistance rates so be sure to use your own hospital’s guidelines/
- Pando – if you need to send confidential patient information or photos within your team (with patient permission of course!), you can use this NHS approved secure app. Please don’t use Whatsapp, Viber, Facebook Messenger or any other non-secure app!
- Outlook – want to access work email on your phone? You can use this app to send, receive, and organise your NHS work email account.
- Google Drive / Dropbox – you’ll need somewhere to save your hospital and departmental guidelines and protocols. These documents don’t contain patient information so we use our password-protected Google Drive or Dropbox accounts to store them.
Starting your first job as a doctor in the UK can be scary and exciting at the same time. Making sure that you are as prepared as possible will make the difference between a positive and a disastrous experience. We hope that these 10 tips will help you prepare for your first job, if you have any tips that you would like to share for first time IMGs, please leave a comment below!
What’s next?While working in the UK, sending money overseas is something we all eventually need to do. Fees can be quite hefty and preparing for this can bring it down. Read our article on How to save money transferring money back home from the UK.
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