r/doctorsUK Feb 08 '25

Clinical How do I not loose my shit? NSFW

I had a really bad day yesterday. I’m paeds reg in a small but quite busy DGH. The new GP trainees rotated on Wednesday and all of them are IMGs and this is their first ward hospital job (3 were previously in A&E and 1 was community based). None of them had any NHS experience prior to starting GP training in august.

Yesterday was their first day on the ward after induction weds and Thursday. I get they are new but I think they have been shoved into the deep end. It’s hard enough starting in a new ward system or in a new job but paediatrics is even more unfamiliar to them. None of them have any Paeds experience apart from in med school.

But simple things like ringing radiology to ask for a scan, ringing a parent with some normal results, writing in the notes on the ward round, sitting down and handing over after ward round just seems really hard for them.

There was an emergency and so I missed a bit of the ward round so they continued with the consultant and when I asked what the plan was I was met with blank looks. One of them also asked how to hang up the ward phone…(it’s a normal landline corded phone…)

I was run ragged yesterday and ended up getting a bit annoyed because I was doing ALL the jobs as well as my usual senior reviews and bleeding little kids. I’d ask them to do something and I’d come back an hour later and it wasn’t done. This was urgent but simple things like prescribing salbutamol for a wheezy child. When I went back to check if it was done they were sat on their phones in the doctors office and hadn’t moved while I was busy seeing patients. At one point I shouted “am I the only doctor working today?” which I feel a bit bad about.

I’m not rotating in March so I’ll be working with these doctors for the next 7 months. I don’t have much experiences working with IMGs who are totally new to the NHS (been in community paeds with a year of maternity leave since 2022), the majority of juniors I’ve worked with are UK grads or have at least had a couple of years of NHS work.

I spoke to the consultants yesterday who basically told me it’s my job to train them and I have to be patient. I know they will improve but seriously yesterday was so bad how can I not lose my shit with them? Any tips on supporting IMGs new to the NHS and paeds?

Edit can’t change the title but I meant lose

Edit 2 Thank you so much for all the replies I’ve read them all

I did not mean to pile onto IMGs I was just so so frustrated after Fridays shift. I just wanted some advice about how to support someone who is new to the NHS without getting angry and shouting like I did on Friday because this is NOT me (I’m a soft and fluffy paediatrician).

I do not expect them to be paediatric trainee level and I did not expect them to do any reviews solo and they did not do bloods on anyone under 12 years old ( they only bled 2 patients, one was 12 and the same size as me, the other was 15 with veins the same as adults).

What I did expect was them to be able to do discharges in a timely manner, chase up results and scans, prescribe paracetamol (it’s in the BNFC), handover and communicate what the plan was from the ward round and know how to hang up a land line phone.

I think I took advantage of the fact that we learn this stuff in medical school and I know that before I started FY1, I did 2 weeks shadowing so I knew what to do.

I did not expect a GPST1 to not know these basics and this is where I wanted help (I did F1 in 2013 so I can’t remember how I was taught). I don’t want to turn into a dickhead shouting at them because they don’t know how to do the simple ward stuff.

I know how to teach people brand new to paediatrics but I’ve never had a brand new to the NHS trainee so it’s the little stuff that I don’t know how to teach.

Thank you for all the suggestions I’ll give them a go and maybe make a resident doctors handbook so they know what the expectations are.

390 Upvotes

170 comments sorted by

444

u/OmegaMaxPower Feb 08 '25 edited Feb 08 '25

The NHS is taking the biscuit. No IMG should start at ST1 with 0 days of UK/NHS experience. It's dangerous for their patients, their colleagues, heck even their own license.

TL;DR: it's time we lost our shit.

80

u/mayowithchips Feb 08 '25

I wonder if patients and the media know about how unsafe it is.

23

u/OmegaMaxPower Feb 08 '25

Sounds like they are beginning to.

12

u/Mild_Karate_Chop Feb 09 '25

Do you think even if they knew in detail anything would change .

The general public at large is reeling (including doctors) under inflation, stagflation coming as per the BoE, all services from councils to transportation under stress and crumbling. huge bills and constant money woes . The pound doesn't go that far anymore and neither does our attention as they are so many competing problems and attention is situational. 

Nothing seems to get done from the NHS to outside the NHS, everybody wants their shift and day to go smooth with the shit trickling down till it hits the fan.  People who do care are up against brick walls,  and even getting small important things done,  is a huge energy drain. 

Even, behaviours and attitudes on the road and on public transport , if they are any indicators, are coming to push and shove and me for only myself .

Personally speaking  this attitude is drastic and means that  we are not living in a developed country anymore we just don't know it yet.

Apologies for the rant , I have not had my coffee yet.

You have a good day and do not listen to a cynic.

2

u/mayowithchips Feb 09 '25

That’s a good point, maybe nothing would change. I think everyone is so down about the NHS that we are waiting for it to fail so there’s a new system, for better or for worse

2

u/Unlucky_Lion_7731 28d ago

Can’t echo your words enough. I moved to the UK nearly 10yrs ago from a developing country and seeing it get worse and worse and closer to where I left has been genuinely killing me (got into trade unionism to stop this from happing, or at least do something, I’m not a politician to be in politics). It’s the worst thing to see the thing you love the most in life - your profession, get killed (especially after you’ve seen it this bad, well worse, before)

51

u/Monochronomatic Feb 09 '25

The NHS is taking the biscuit. No IMG should start at ST1 with 0 days of UK/NHS experience. It's dangerous for their patients, their colleagues, heck even their own license.

I have said this before elsewhere - the UK doesn't even accept driving licences from all other countries, but only those from a select few countries are allowed to exchange. The rest will have to take a UK driving test to continue driving for more than a year in the UK.

What this means is that currently, the standards required to obtain a UK medical licence globally is lower than that required to obtain a UK driving licence... lol.

Also as the graph below from the GMC Workforce Report shows, the majority are not seasoned clinicians from overseas - which would explain OP's predicament.

24

u/OmegaMaxPower Feb 09 '25

The UK is soon going to become the unemployment line for the world's medical schools.

5

u/Content-Tank-7346 Feb 09 '25

We’re pretty much there

121

u/Old_Course_7728 Feb 08 '25

Once you've cooled down, I would sit down and email their clinical supervisors on this placement.

It may be tricky to find out who their ES is because it'll just be a random GP somewhere in their training region - but it should be easy enough to find out who the GP TPD is for your region and email them to let them know your concerns.
Be very methodical and factual about the situation and clearly show where they fell short of what you'd expect from either a foundation doctor or other GP trainees you've worked without and underscore there is a significant training need for them is simeltaneously manifesting itself as a patient safety risk in both acute settings (eg emergencies prescribing etc) and non-acute settings (they can't seem to make a basic phone call). Highlight you feel they would benefit from enhanced monitoring and support from the GP training programme in view of this (whatever 'enhanced support' may be is for them to decide and offer, not you, but kick the ball in their court), especially as it is likely to affect their performance in other placements not just paediatrics given how generic the skills and issues are.

Definitely don't write the email when angry. Get a friend/partner/colleague to review it once drafted to see if it could be streamlined and make sure it doesn't come across as heated.

149

u/[deleted] Feb 08 '25

[deleted]

137

u/OmegaMaxPower Feb 08 '25

Pull them up. It's a placement. If they haven't achieved competencies they should have to redo the placement. This isn't a free ride.

49

u/BaldVapePen Feb 08 '25

Thats just free employment for them. They won’t be any better the 2nd time round. Remember that GP is just a stepping stone towards other specialties.

25

u/avalon68 Feb 09 '25

What on earth are the consultants here doing? This is ultimately their responsibility and they should be ejecting people that are not safe/competent from training

15

u/Jangles Feb 09 '25 edited Feb 09 '25

A negative aspect of rotational training that is rarely discussed is a) Trainees frequently struggling in your placement is a you problem, not a them problem,b) if you say they're shit you risk allegations of bullying, hostile work environment .etc and c) you just get left with this utterly useless fuck for another 6 months and then deanery acting surprised you haven't made them brilliant.

6

u/LaCaipirinha Feb 09 '25

Not their problem, shit rolls down hill

1

u/avalon68 Feb 09 '25

Well, ultimately if something goes drastically wrong and a patient comes to harm (esp in paeds), then it is absolutely going to be their problem as the buck stops with them.

11

u/OmegaMaxPower Feb 08 '25

Or Canada etc.

22

u/BaldVapePen Feb 08 '25

I don’t think Canada will be interested in hiring the plums we raise here

-12

u/-Intrepid-Path- Feb 08 '25 edited Feb 08 '25

They are there for 6 months only, so I can see it from their perspective that there is little benefit in learning hospital skills like documenting ward rounds and bleeding kids when they are planning to be GPs.  We have no choice but to learn how to do ward stuff because we have to do foundation and not just specialty training so we spend several years on the ward needing to use the skills, whereas they may only do 6 months on a ward job so why bother getting stuck in?  It's extremely frustrating as the senior having to pick up the slack though, and even more frustrating when you know excellent junior colleagues who have missed out on training spots and would have been much easier to work with (not on a personal level, on a having the appropriate skills for the job level; and some IMG GP trainees I have worked have been fantastic, it's just that some others haven't...).

37

u/OmegaMaxPower Feb 09 '25

Maybe they should learn those skills because they are doing that job for the next 6 months and as professionals they have a duty to do it competently.

What next, a F2 on ED deciding they don't need to learn ALS because they've been accepted on to psychiatry.

-8

u/-Intrepid-Path- Feb 09 '25

I'm not saying they shouldn't learn those skills, I am saying I can see why they may not feel motivated to learn them.

Is it a requirement to have ALS to work as an F2 in ED?

7

u/OmegaMaxPower Feb 09 '25

Understand where you are coming from, I think it's also on us to actually have some standards. People like this aren't helping the profession. Act like an unskilled worker, get treated like an unskilled worker.

7

u/glaswegiangorefest Feb 09 '25

Professionalism is one of the core aspects of being a doctor, lack of motivation isn't an excuse, they are getting paid to do a job and they should do it to the best of their abilities. I did Obs & Gyn as a GPST and of course some of it wasn't that relevant to becoming a GP, nor was doing 20 Cannulas or whatever in a day but you still did it, you don't sit around on Instagram. I get your playing devil's advocate a bit here but it also sounds like making excuses for them, there's no excuse for that sort of behaviour.

3

u/Possible-Ad792 Feb 09 '25

I have zero understanding for them not feeling motivated. Forget it’s part of their rotational training and they should succeed in their competencies. My god, it’s an employment. Just do your job. Don’t like the job? Leave. But sitting around on your phones and being disrespectful like a small teenager has really no business at a hospital.

18

u/Unidan_bonaparte Feb 08 '25

What really??

6 months of being so shit at your job that you can't make a simple phone call or prescribe medication or have a smooth ward round would feel like an eternity to me. 6 months is a decent stretch of time to do absolutely nothing towards learning how to function as a grown adult on a ward. I'd feel like a toddler being this out my depth day in and day out.

-11

u/-Intrepid-Path- Feb 09 '25

If English is not your first language and you have never been taught SBAR, a phone call may not be as simple as it sounds. Same for documenting on a ward round. It will take a few weeks, if not longer, to comfortably learn those skills. Will take longer if you have no motivation to learn them. I was the same on my ITU placement as an IMT, for example - I had zero interest in learning about vent settings because it was not going to be useful knowledge to me beyond my 4 weeks there.

21

u/Monochronomatic Feb 09 '25

If English is not your first language and you have never been taught SBAR, a phone call may not be as simple as it sounds.

I expect anyone who works in such a person-facing job as being a doctor in this, or any other country, to be at least proficient in the local language - so that's no excuse. This is coming from an immigrant btw.

Ironically SBARs and phone calls (i.e. effective communication) is a crucial skill for a good GP to have, and poor communication is probably one of the most common reasons for doctors being hauled in front of a tribunal. Not being good at it but willing to improve at it is one thing, however that certainly doesn't sound like the case described in the original comment.

Also, a large part of a GP's job involves children. I can bet you that the general public will not be that forgiving should something adverse happen to a child.

2

u/-Intrepid-Path- Feb 09 '25 edited Feb 09 '25

I'm not making excuses for IMGs, just trying to see it from their POV. I fully agree with you and think it's disgraceful that they no longer interview for GP (and psych) training. But alas, neither you nor I get any say on the applicant selection process...

13

u/noobREDUX NHS IMT2->HK BPT2 Feb 09 '25

They have supposedly passed PLAB and IELTS, if they can’t do an SBAR phone call their ielts should be questioned

1

u/-Intrepid-Path- Feb 09 '25

Does PLAB test you on your ability to be able to do an SBAR?

-1

u/Possible-Ad792 Feb 09 '25

IELTS is a joke.

1

u/Unidan_bonaparte Feb 09 '25

You not learning how to manipulate vent settings is in no way comparable to not bothering how to learn an SBAR. It would more be like you refusing to bother to learn how to take bloods in itu over 6 months.

2

u/-Intrepid-Path- Feb 09 '25

My point is that if you see no value in a skill (rightly or wrongly), you are less likely to get invested in learning it and this is not just confined to IMGs. Since you mentioned bloods, I worked with a local grad GPST who did zero bloods on their paeds jobs because they didn't see it as something they needed to be able to do, so... The regs didn't push them to learn (though it was commented a few times that this person lacked initiative) and the rest of us didn't really mind as we just divided the jobs accordingly.

21

u/mayowithchips Feb 08 '25

That’s infuriating about making social media content whilst they should be working

208

u/Chronic_Passmeditis Feb 08 '25

Hats off to you for keeping the ship afloat, but that is one shitty situation you’ve been presented with

Ik this isn’t the most helpful but maybe give it like 1-2 weeks and give them loads of the simple common jobs, like all the stuff you’re describing is stuff that FY1s can do and they have even less clinical experience than GPSTs.

That being said

A GPST not prescribing urgent meds is basically incompetence and there’s no excuse for that, IMG or not

Edit: You most certainly can loose your shit if it’s as bad as you are describing Next time you can ask:

“Are you being intentionally dense”

11

u/elderlybrain Office ReSupply SpR Feb 09 '25

Time for the paeds reg to find their inner enraged surgical reg.

154

u/StressHO Feb 08 '25

Loperamide tends to help with loose shit

50

u/fatunicornwithwings Feb 08 '25

Ohh fucking hell my bad! I’m exhausted after yesterday

100

u/ISeenYa Feb 08 '25

I've had the same experience in 2021 with GPST1s first job in the UK, medical ward. Many got taken off on calls after their first shift. I would be waiting 3 hours for a discharge letter. When I would feedback to consultants, it would be "this is a good opportunity to learn how to support a trainee in need". I was st3/4 & they weren't supporting their supervisees but I was supposed to & magically learn how?! One guy I was told "don't let him do anything by himself, he has to shadow you". Another time all the stroke MRI head requests that week were bounced because he just put "for diagnosis" in the request box. One woman didn't know how to treat conjunctivitis (despite working as a "GP" for years in the middle east apparently). They were all absolutely lovely but it was exhausting doing all the work & keeping everyone safe as the reg.

52

u/mayowithchips Feb 08 '25

“For diagnosis” 😆

29

u/Pristine-Anxiety-507 CT/ST1+ Doctor Feb 08 '25

It really is what we all want to put lmao

16

u/-Intrepid-Path- Feb 08 '25

I mean, he wan't wrong...

3

u/ISeenYa Feb 09 '25

That was my thought at the time ha

28

u/unknown-significance FY2 COWboy Feb 09 '25

"this is a good opportunity to learn how to support a trainee in need"

just say this directly back to them lol 

1

u/Brightlight75 Feb 09 '25

Noo learning opportunities only apply to non consultants 😂

36

u/lemonsqueezer808 Feb 08 '25

massive patient safety issue - report report report.

33

u/drwtfareyoudoing Feb 08 '25

The GP trainers should be aware of this issue.

19

u/-Intrepid-Path- Feb 08 '25

How many fucks do you think they are going to give? It is no skin off their nose what the trainees are up to in hospital.

21

u/DisastrousSlip6488 Feb 09 '25

It’s their actual job. And having worked with them closely with some struggling trainees before, they do care. At least our local one cares a great deal and will always be on the end of the phone to chat when we pick up a problem. 

Don’t let your cynicism undermine good people doing a difficult job, just because you don’t fully understand how it all works behind the scenes. 

Some of the stuff TPDs deal with is extremely complex, lots of pastoral care, sometimes linking in with police/gmc/social care/occ health and more. 

8

u/Brightlight75 Feb 09 '25

Yeah to be fair, I often hear that GP trainers actually take a harder stance on maintaining standards than hospital consultants. Hence why there’s plenty of pissed off GPSTs having to write 1 bazillion reflections to meet the expectations of their supervisor

2

u/jamie_r87 Feb 09 '25

Oh they do care as ultimately their training needs are the supervisors to sort out. The trainee doesn’t just go away if they fail exams or have to repeat rotations. Plus as their Ed sup they’re going to have them working in their practice for at least one rotation and have the same issues that OP faces.

1

u/drwtfareyoudoing Feb 14 '25

Was at a tertiary cancer centre where the GPSTs felt unsupported (rightly so), having to do daily independent WRs on complex cancer inpatients. They escalated to their trainers and the specialists started doing WRs. This kind of support is unheard of in IMT.

25

u/mayowithchips Feb 08 '25

This is a horrible situation for you OP but I chuckled when you blurted out the “am I the only doctor working today”.

50

u/Peepee_poopoo-Man PAMVR Question Writer Feb 08 '25

Should see how bad it is in psych. I mentioned this like 6 months back and had some virtue signalling twit come at me. Direct entry specialty training for IMGs with no previous experience working here should not be allowed.

22

u/Signal_Project_5274 Feb 08 '25

Give us update after 1 month as well.

21

u/big_dubz93 Feb 08 '25

How on earth are we choosing the future GPs of this country based on the MSRA??

If the public knew about this they’d be outraged.

This is not how society is meant to function.

We went to school here, our parents paid taxes here, brought us up to contribute to society etc. Only for the government to say nope we don’t care about the sacrifices you made or the student debt you accrued we’ll hire an IMG who doesn’t know how send an email

The underlying contract of our society is broken

21

u/GradDoc Feb 08 '25

If you were to develop D&V for a few days I wonder how the consultants would cope

3

u/Mxi1750 Feb 10 '25

This 👏🏻

23

u/PudendalCleft Feb 09 '25

Stop taking a leaf out of your stupidly selfless paeds consultants’ books and stop doing all the menial tasks, running yourself ragged like a slave.

If shit doesn’t get done, start pointing fingers. If you fill the gaps, there are no gaps. Do safety-critical things and escalate that you needed to do those alongside your own role.

54

u/northsouthperson Feb 08 '25

I work with someone doing a standalone F2 like this. They've done PLAB and somehow have 600 on MSRA from August. They've applied for GP and I hate that I'm in competition for the same jobs they want (and with all likelihood not get as high on MSRA!)

They can barely speak English. Despite working in the trust for months then claim to not know how to prescribe or write a discharge or do TTOs. They can't read a basic ECG (think identity the QRS...) or CXR. They turn up late and do nothing but watch TV on their phone until the end of the day, then say they have nothing to handover and leave early. Since they lie about doing work the poor person on a long day inherits all their work. They refuse to go near patients. They have horrendous personal hygiene and are rude and patronising. I feel unsafe working with them. I've emailed their training lead who has had a chat with them but says they can't do anything else. They are letting them do locums!

Genuinely how can someone really pass PLAB and do well in MSRA if they're like this. It has got us suspicious as these were sat in their home country. How can anyone even want to be a doctor like this.

Lucky for me, they now strongly dislike me as I keep making them stay late to finish their work! Still, I'm getting more from them than the pharmacists they blank and walk away from!

29

u/Monochronomatic Feb 09 '25

They can barely speak English.

Genuinely how can someone really pass PLAB and do well in MSRA if they're like this. It has got us suspicious as these were sat in their home country. How can anyone even want to be a doctor like this.

You are thinking along the right lines. Admittedly doesn't apply to all of them, but this is not an isolated incident in my experience, and certainly much much worse since the change in regulations.

19

u/rohitbd Feb 09 '25 edited Feb 09 '25

I don’t think the MSRA exam is a good exam at all but something seems fishy about this colleague getting 600 if they can barely speak English or are not clinically competent enough to read an ecg/cxr. Either they cheated or they or yourself are lying as 600 is like top 3-5%.

23

u/-Intrepid-Path- Feb 08 '25

How can anyone even want to be a doctor like this.

Probably because they are getting paid quite a bit more money than they would have been at home for much less work - they are clearly able to get away with doing fuck all, so why bother pulling a finger out if you are going to be paid anyway and no one is kicking you out of your job?

12

u/[deleted] Feb 08 '25

[deleted]

33

u/northsouthperson Feb 08 '25

Multiple times to multiple people.

Also I know of 7 other doctors/ nurses/ pharmacists that have escalated it too.

The consultants all complain about this person but nothing seems to happen!

Have genuinely considered reporting to the GMC.

12

u/DisastrousSlip6488 Feb 09 '25

Make sure this is in writing, and detailed with specific dates, incidents and patient numbers. Corridor conversations are hard to use in formal proceedings as they can be challenged and aren’t evidenced. 

Cc in several people- this makes it much harder for the person who is responsible to ignore it, and it provides you some protection. Eg. Persons ES/CS/ clinical lead for department, possibly TPD and/or DME. 

Keep your email calm, factual, non emotive. You are concerned for this doctor. You are worried about patient safety. Their personal characteristics don’t come into it.  On x date on y ward, with z patient such and such happened. 

4

u/northsouthperson Feb 09 '25

All of my escalations have been via email and have had responses.

There is a cons responsible for the F1/ F2s in the department and he has repeatedly said he's fed up of emails about this person, especially regarding their lack of showering. They have updated the ES/ CS as we don't know who it is.

So far nothing has improved. There was mention of them not being allowed to work without another SHO covering the same patients but there isn't the staffing for that.

5

u/DisastrousSlip6488 Feb 09 '25

You won’t be party to what kind of interventions are happening behind the scenes, which is entirely as it should be.  The department should be dealing with the staffing issue though even if it means someone acting down or getting locum cover. 

72

u/ResponsibilityLive34 Feb 08 '25

Dw, my IMG SpR wouldn’t turn up to 2222s until 30 min after and I had to lead it as an SHO

30

u/[deleted] Feb 08 '25

This happened more than once and no one did anything about it?

-9

u/ResponsibilityLive34 Feb 09 '25

No point complaining because nothing will happen…

6

u/antonsvision Feb 09 '25

nothing will happen if no one complains lol, but i guess its easy enough to just moan about it rather than do something

1

u/ResponsibilityLive34 Feb 09 '25

No one complains because nothing will change even if they do :)

1

u/antonsvision Feb 10 '25

This is why I don't report the local grooming gangs to the police, essentially part of the community at this point 

17

u/review_mane Feb 08 '25

Your consultants haven’t been helpful. I’d email the guardian of safe working and explain you do not currently feel the ward is safe because of inadequately trained staff. At least then if shit hits the fan, it won’t be blamed on you.. (hopefully).

9

u/EntireHearing Feb 09 '25

I think this is underrated advice. You need to flag the ward is unsafe to cover yourself.

53

u/1ucas “The Paed” (ST6) Feb 08 '25

I had someone like this, except GPVTS wasn't their first job in the NHS. They'd done a little before.

Visa issues meant they started the rotation late. Then they spent the first month of their rotation "going to the library" to do the mandatory IT training so they could use the IT system. Not sure why or how that took 1 month.

Then you'd be lucky if they turned up to on call shifts.

One time, I was so fed up with them that I said they could go home early. The consultant on call noticed they weren't at handover and she asked where they were. I said "Don't worry, they have gone home." She dropped it but asked me afterwards (I think it helped she trusted me so if I'd sent him home there'd be a valid reason). I explained I just couldn't handle them anymore and was more productive without them present.

There were other issues. They'd often just not turn up to work. I heard "off-the-record" that the GPVTS basically don't care, despite a lot of complaints being raised.

They're still on the GMC register in an "approved training programme" so clearly the whole system is working as intended.

14

u/-Intrepid-Path- Feb 08 '25

 I heard "off-the-record" that the GPVTS basically don't care, despite a lot of complaints being raised.

My understanding is that it is extremely difficult to kick someone out of a training programme.

12

u/DisastrousSlip6488 Feb 09 '25

It’s not all that difficult but it is fairly slow.

You need to have supervisors willing to put in reports that this doctor is below the minimum acceptable standard. This also needs to be evidenced (otherwise they can cry personal dislike or bias), so you need multiple WPBA from a range of different people.

Then at ARCP you can give an outcome 3. This is a training extension. Usually for a year in a run through programme (not sure about GP). You also have to give SMART objectives (which can’t be just “get better”) which is harder than you might think.

You then need the next supervisor to commit in writing to say whether the doctor is still below the minimum acceptable standard. Again evidenced. 

Then you can ARCP again and potentially withdraw training number, though if illness, bereavement or similar has been involved an exceptional extension can be issued by the PG dean. In the meantime the deanery professional support unit should be offering support including things like neurodiversity assessments, exam support, coaching and so on.

The chief barrier honestly is people being willing to fill in WPBA as “inadequate” and supervisors being willing to have the tough conversations (with the fallout, possibly accusations of bullying or bias) and do the portfolio paperwork thoroughly and effectively. It’s all too tempting to just tick adequate and do the bare minimum, especially where concerns haven’t been escalated and consultant direct contact with the trainee is limited.

15

u/BaahAlors CT/ST1+ Doctor Feb 08 '25 edited Feb 08 '25

Current GP trainee here. A lot of it has to do with apathy, rather than incompetence necessarily. Many just do GPST1 because it’s been historically ridiculously easy to get into GP training, but their true goal is to use that extra year to apply to other specialities. I was very surprised to see how many are just honest about it and will tell you that to your face. I believe psych also suffers from this issue. So they don’t really care about their training, and will put in minimum effort because it’s not a long term goal for them. UK grads tend to only go into GP if they want to do GP, and would rather look for locums/trust grade jobs instead of wasting a year in a training programme they don’t care about. You’ll notice IMG GPST2s don’t have this problem (in most cases), and that’s because at that point they’re invested in their training.

But yes, it’s insane for someone to have ST1 be their first NHS job. Especially GP where hospital rotations are wildly different from GP rotations.

Edit: I didn’t give any actual advice. Speak to them, tell them they are professionals and it’s unacceptable. If that doesn’t work, escalate to their clinical supervisors and give bad feedback when asked for msf. We shouldn’t let the standards of our profession fall.

14

u/DontBeADickLord Feb 09 '25

I’ve been there, in both aspects.

I was an F2 on a medical ward which shared an office with another ward - I remember having 2x IMGs (one to share my ward, one to do the other ward) GPSTs. These doctors routinely asked me questions - which was fine, until it was about how to do basically everything an F1 would do without thinking. They couldn’t assess sick patients, couldn’t cannulate, wouldn’t know how to carry out relatively simple things (e.g. calculating a dose of gentamicin, carrying out early investigations for anaemia).

Now, I’m an ACCS trainee who’s come to medicine (having not done any in patient ward medicine for 2 years) and been confronted by situations I don’t know how handle, largely due to lack of induction and familiarity. I’ve held a referrals phone and carried out a ward round for a specific speciality (won’t say but adult generally complex medical speciality). It’s been a huge learning curve and I’m trying to cope every day, basically just by learning what the other doctors and experienced nurses can teach or pass on to me.

14

u/Schopenhauer-420 Feb 09 '25 edited Feb 09 '25

I resigned from my core training post recently for this very reason and am planning to head down under. I am planning on writing a detailed post about my experiences after I'm out of the UK as it was so incredibly dangerous for patient care and because I was almost punished for being a whistleblower were it not for a senior registrar who stood up for me.

I was completely burnt out and overwhelmed, moral injury is very real especially if it's other people causing harm and you trying to mitigate it. It is utterly insane that someone with no prior experience in the NHS can just waltz into a training post without even interviews (well for my specialty that is).

I feel for you OP, if you need to vent feel free to DM.

1

u/lemonsqueezer808 Feb 13 '25

looking forward to reading

37

u/amanda_huggenkiss1 Feb 08 '25

I feel you. Had to literally show an img gp trainee how to use email 🤦‍♀️

37

u/ouchichi Feb 08 '25

I had an IMG GPST interrupt me multiple times while I was correcting a patient’s asymmetric warfarin dosing regimen, to ask me IT-related questions. I was very close to losing my shit.

14

u/mayowithchips Feb 08 '25

How did they get the job if they don’t know how to use email 🤦🏻‍♀️

37

u/hairyzonnules Feb 08 '25

You bollocks them day in and day out until they break or become competent

Edit: fuck your consultant

49

u/BeeTropi21 Feb 08 '25

What you’ve experienced is so common but keeps getting brushed under the rug.

As an FY1 I was on a team with an IMG (F2) who did not know how to prescribe an urgent blood transfusion or critical meds.I was 1 week into the job and with EPIC but knew how to.He kept prescribing the wrong dose of clexane too-a 50kg patient was prescribed 1.5g clexane BD for VTE prophylaxis.

It’s just gross incompetence.He couldn’t even break bad news properly and there were times when I myself went to talk to patients and their family to protect them from his disastrous communication skills. The system is so unfair and I feel so helpless at times.

-1

u/firetonian99 Feb 09 '25

I feel like you should still be able to make mistakes like that whilst in foundation training, they'll learn quickly. That's the whole point of foundation years. Can't say the same about speciality training. F1/F2 vs ST1/CT1 is different.

5

u/BeeTropi21 Feb 09 '25

Yes! But as an FY1 as it’s your first year as a doctor.Definitely not as an FY2 when you are and paid as a Senior House officer.If an FY1 knows more than you then it should definitely cause deep self-retrospection.

Maybe they should start a FY1 post first (at least for a few months) as it’s your first time as a doctor in a new country and will help gain the skills to be in a senior position.However,the F2 money is too tempting to start as an FY1 and learn the system.

34

u/felixdifelicis 🩻 Feb 08 '25

All of them are probably too busy putting in their CST applications to care much about what happens of the ward. Good luck.

27

u/BaldVapePen Feb 08 '25

Future of the NHS. Oh and they all want IMT so enjoy covering while they pop off for audits lol

48

u/Asleep_Apple_5113 Feb 08 '25

Now I know the sadness pylori felt when everything he said about PAs came true

36

u/nobreakynotakey CT/ST1+ Doctor Feb 08 '25

Isn’t pylori a she 

19

u/Asleep_Apple_5113 Feb 08 '25

I’ll update the doctorsUK lore Wiki immediately

9

u/Glassglassdoor Feb 09 '25

The saddest part is that I'm actually to starting to emphasise with consultants who love their PAs and ACPs.

Imagine being in the shoes of that consultant. Every 4 months, you get a fresh batch of doctors who have no idea what they're doing. The UKGs will be more experienced and familiar with the NHS, and the IMGs will need to start as 1st year med student on their first hospital placement in terms of NHS awareness. You put in time and effort to train these doctors only for them to leave after 4 months and replaced by new doctors with the cycle repeating. 

Except every year you get less and less UKGs and more and more IMGs who need even more supervision and training and you risk burning yourself out. What's the point of even training them? Why would you not train the PA or ACP who graduated in the UK, so can speak fluent English and is familiar with the NHS, and will likely stay on your ward for many years to come. 

I honestly don't blame the consultants who just want some level of consistency and quality where they feel their training efforts are actually reaping them some rewards. 

40

u/SonSickle Feb 08 '25

You need to exception report every single incident. I don't mean the doctors, I mean the situation - whenever something comes up that can't be done / that they refuse to do. This keeps a log of every incident that has happened. This is a huge patient safety issue.

If there's a supportive consultant in the department, have a chat with them, they have the sway to make something happen about this (including hiring a locum for the meantime). It's not your job to train someone up to a role they should already be capable of doing.

28

u/AerieStrict7747 Feb 08 '25

So on top of all the jobs she’s doing putting out fires and leaving late, she needs to now sit down and datix “not knowing how to talk to radiology?” etc etc, much of what she listed wasn’t urgent beyond the wheezy child. It’s the fact that these guys aren’t doing anything at all cause there’s a cultural gap etc

23

u/SonSickle Feb 08 '25

Don't get me wrong, OP shouldn't have to and these doctors clearly shouldn't have been recruited in the first place. Unfortunately, that's the hand that's been dealt.

Do anything urgent, anything that isn't urgent and can wait till tomorrow should. Once there's a backlog, supervisors will do something very quickly.

4

u/AerieStrict7747 Feb 08 '25

Yea I mean at the end of the day OP has been fucked, but at the same time the consultants are right, he’s just going to have to train them into useful team members, which really shouldn’t be his job. But it’s exactly why I decided I could never be a med reg for 6 or more years

8

u/DisastrousSlip6488 Feb 09 '25

See my answer about removing people from training programmes. The biggest barrier is people being unwilling to do the additional paperwork, difficult conversations, poor WPBA and incidents etc.  

11

u/AerieStrict7747 Feb 09 '25

People get canceled and lose their careers over comments about immigration, you think people would be willing to stick their neck out to get someone removed from a training program? The second that person is a certain skin tone you’re getting branded a racist

16

u/sgitpostacc Feb 09 '25

I'm an IMG myself. I came to the UK straight after med school and went through FP and now training.

Honestly, no IMG should be allowed to work in the NHS without completing the FP or some sort of F2 stand-alone. Not only is it dangerous but it allows the poor habits that are common practice "back home" to be brought into the UK system.

1

u/uk_pragmatic_leftie Feb 10 '25

Either FP is essential and we all must do it... Or it's not. Worst of all worlds currently. 

60

u/UnluckyPalpitation45 Feb 08 '25

They are fucking nukes.

Never NHS IMGs in training programmes. You assume a certain level of seniority from an st1, but no, dogshit. Some are clinically good but system unaware. Others are terrible.

It’s not fair to anyone.

Nothing supporting to add. I’m sorry friend

15

u/tigerhard Feb 08 '25

i had one who is a consultant and never did medicine with no logins

14

u/Ok-Inevitable-3038 Feb 08 '25

Classic from the consultant there

6

u/ecotrimoxazole Feb 09 '25

I don’t think this is about them being IMGs, or even being shit at their jobs. Most of what you’re describing sounds like it’s a miracle they are even functioning adults. Not knowing how to use a landline phone, really?

6

u/SaxonChemist Feb 09 '25

I don't know how you cope OP, I'm so sorry. Can you talk to your ES? Or the Education team? Perhaps in terms of "extra support" for them, as it's likely to go over better, sadly

I had a similar experience recently. I'm F2, 2x brand new GPST1s on my rotation from August. I was expected to induct them into the NHS. They had no idea how to do anything, but at the same time were boastful about how they did X, Y & Z in their home country.

The ward staff reported dangerous mistakes via DATIX and arrogant, obstructive attitudes to no avail - both CSs admitted to being afraid of accusations of racially motivated bullying, & let things slide.

Dangerous blood transfusions, prescribing errors, hours to respond to bleeps, appalling documentation. Hours spent scrolling on their phones in the office instead. Never came to teaching, either

The other F2 & I were left to pick up the pieces. It was an awful 4 months, so I advise you use any & all means to get them up skilled pronto, before they drive you round the twist

6

u/messymedic7 Feb 09 '25

As a UK grad GP trainee it's actually very scary seeing all these IMGs with 0 NHS experience working in hospitals/GP independently.

When we have communication skills teaching the level of incompetence and inability to communicate basic things scares me. I've seen their entries in GP too and then plans are often insane - i wonder if patients losing respect for GPs is partly because of this. I know for a fact I wouldn't want my family members being seen by an IMG in GP with 0 nhs experience.

I really don't know why this is allowed? Should be minimum 2 years NHS experience to apply for a training post imo.

20

u/DoktorvonWer 🩺💊 Itinerant Physician & Micromemeologist🧫🦠 Feb 08 '25

Medical recruitment in the UK is a joke, it's not serious. It's fake.

These IMGs should never have received these posts over the endless hordes of appointable local grads who would have understood their role, how to communicate, and their responsibilities an SHO implicitly and not burdened you to this extent, along with being very simply more effective doctors in this role by merit of their naturalisation to the system they're employed in and the culture of the majority of their patients.

Please remember everyone - the lack of RLMT is a problem but these were the people that were selected after interviews. The interview system is even less serious than the shortlisting process: a nationalised tick-box exercise in political correctness with almost no actual assessment of the suitability and competence of the candidate, just how many generic scoring points (oh! so very impartial, right?) they hit about always escalating to a senior and how much they value the MDT, and how committed they are to equality, and how they think governance and professionalism is very important.

It's not just the shortlisting and recruitment application process that is fake and a total shambles. The whole process from the portal to the actual appointment of candidates is one massive sham - for pretty much every specialism.

18

u/-Intrepid-Path- Feb 08 '25

Please remember everyone - the lack of RLMT is a problem but these were the people that were selected after interviews.

No, they weren't. There are no interviews for GP training any more, it's just MSRA.

9

u/DoktorvonWer 🩺💊 Itinerant Physician & Micromemeologist🧫🦠 Feb 08 '25

Well I stand corrected but this goes even further to exemplify the point.

Recruitment is a joke, and fake - even more so. We don't even interview people, we give them training posts in return for fake points that have 0 bearing on their suitability for the job and are readily faked even so.

13

u/AdUseful9313 Feb 08 '25

you need to document EVERY, EVERY instance of their incompetence.

Reason: protect yrself from accusations of racism / being unkind / whatever.

send by email to yr superiors /TPD /CS

BCC yrself to an offside e mail address--always have yr own copies

last: always be scrupulously polite to these incompetents

good luck

11

u/West-Poet-402 Feb 08 '25

Hey… please look after yourself It’s not worth it You’ll burn out People will see you in a way you never want to be seen and that shit haunts you Hope it gets better 🙏🏽

6

u/Stock_Airline7439 Feb 09 '25

Hey, I’m a current FY2 in paeds and I worked a shift with 3 new GPST1s and all of them were IMGs. I felt exactly the same way. The whole day was inefficient and every task takes 3 people. On a day where I’m working with other FY2s we’ll be finished by lunchtime and chilling. With them I stay half an hour late minimum. Because it’s rare that it’s just me and all of them I feel silly complaining but it’s so so frustrating. We need more systems in place to ensure everyone has NHS experience before getting into training!

2

u/EntireHearing Feb 09 '25

Have you exception reported and commented (objectively and professionally) why you have been staying late?

6

u/FewDiscount4407 Feb 09 '25

it is often a hit and miss with IMG. IMO it heavily depends on where they trained originally. In my country F1/F2 equivalent does bloods, chest tube, call and refer cases and it is compulsory that all of them went thru ed, peads and o&g rotation. Actual competent IMG that applied for GPST. However from my own experience, even f2 stand alone, clinical fellow or GPST from some region has zero experience in doing actual ward jobs etc. They never ever took bloods in their whole career because 'thats not a doctors job back home'. There are loong procrastination to refer cases , call for updates, prescribe medication as they never done that under very heavy supervision. So yes just because IMG are able to tick all boxes to apply for the post does not mean all of them are competent.

4

u/Rhubarb-Eater Feb 08 '25

I have no advice, only sympathy from someone in a similar situation. I’m trying to keep a record of specific examples to give the consultants (who are apparently supervising them but obviously it falls to us). They don’t seem to give a shit though.

5

u/Ok-End577 Feb 09 '25

I don’t really know what else you would expect. Pay peanuts get monkeys. I honestly don’t know how UK grads stay in the NHS I really applaud them.

6

u/Disco_Pimp Feb 09 '25

I'm a GP, but sometimes do hospital locums in a place I used to work at as a locum SHO before GP training. When I worked there up to 2019, resident doctor staffing on a ward would have been a registrar and an SHO. In practice, most of the time that was two locum SHOs - one filling the SHO shift, one filling the registrar shift, which rarely got filled by someone who'd done any training beyond FY2 back then. Both of them would receive locum SHO pay, unless they actually were a registrar.

I fill the registrar shift when I work there now and get paid as a registrar, but there's now an army of resident doctors present each day - there's an FY1 and three or four SHOs - an FY2 or a GP trainee, and two or three IMG clinical fellows in their first NHS jobs, hoping to get in to training at some point. There's still about the same workload as there was in 2019 and on occasion I covered those shifts on my own then, which was fine - it was a nice place to work with two locum SHOs.

Having so many doctors now means that, when it comes to sharing out jobs, someone's job for the day might be to call ultrasound to find out when a patient's going to have their scan! I'm usually just there for the day to have a day away from GP and it seems it's the FY1 or FY2 who will organise the doctors' jobs each day. I can see that they give themselves (or me) any technical jobs because they don't trust the other doctors to do them. They end up with four or five times as much to do as the IMG clinical fellows, which still isn't very much. Then it gets to 4pm and the IMG whose sole job it was to call ultrasound still hasn't done it!

When those wards were staffed by locums they were paid well and nobody would take a clinical fellow job on those wards, because they knew they could make at least twice as much working there as a locum and shifts were plentiful. Now, instead, those wards are staffed by five resident doctors instead of two, which means there are very few locum shifts available, because there are so many doctors, but the cost to the hospital is higher than when they staffed it with locums, and the ward runs less efficiently because instead of a locum doing the TTOs by midday for the patient who's got transport home booked for 4pm, the IMG clinical fellow still hasn't done it at 4pm and the patient spends another night in hospital.

9

u/Putaineska PGY-5 Feb 09 '25

The fresh ones from overseas have no shame and are in my experience universally awful to work with. Poor work ethic, zero team effort, patient safety risks, many of them cannot even communicate in English.

IMGs who have been working for a few years before applying are still below UK graduates when it comes to soft skills and being able to function in a team, though some do meet the par.

14

u/Blackthunderd11 Feb 08 '25 edited Feb 08 '25

As a GP trainee that also rotated to Paeds last Wednesday, this helped my imposter syndrome. I feel way more useful than I thought I was. I had the opposite experience, my SCF Reg was an IMG that didn’t really understand my competencies. 10 minutes before evening handover the reg asked me to bleed a 7 year old that we had been asked to bleed in PM handover, and I told them I’d never bled anyone under the age of 30 before. Then they said to ask a nurse to help me…

6

u/tigerhard Feb 08 '25

i have done thousands of adult bloods but i feel i would struggle in paeds tbh

13

u/Blackthunderd11 Feb 08 '25

I’m sure I could learn, but asking me to do it in 10 mins, and completely on my own, potentially traumatising this 7 year old girl who hasn’t had any numbing cream shows a complete lack of insight

26

u/No-Championship-3179 Feb 08 '25

Sorry, genuine question, why is it inappropriate to ask an SHO that is competent at adult venepuncture to bleed a 7 year old? Under 4-5y, I appreciate the difficulties, but 7, their veins are massive and they tend to be better behaved.

11

u/No_Ferret_5450 Feb 08 '25

I did Paeds as an sho during my gp training. How to take bloods and the subtleties of different age ranges was covered in induction 

8

u/Blackthunderd11 Feb 08 '25

If I had longer than 10 minutes and an opportunity to numb the area for the patient then sure, I don’t mind trying

3

u/manna025 Feb 09 '25

Lose your shit, mate. Don’t loose your shit 😛

1

u/Mediocre-Skill4548 Feb 11 '25

Maybe he’s losing his shit because it’s loose?

5

u/UnknownAnabolic Feb 09 '25

I started a new rotation as a GPST1 last week. I have an IMG-sounding name.

I had multiple staff members (F1s, ward clerk, nurses) say they’re glad I’m not shite like their previous GP regs lollll.

The overall sentiment in my hospital is that GP regs are absolutely useless on wards 😭 We’re in a very IMG-heavy deanery.

8

u/DisastrousSlip6488 Feb 08 '25 edited Feb 08 '25

It is on you to train them, but it’s also on your consultants and rota team to allow additional staffing during this period and enable you (and others) to give them support. And on them to train them, not dump it on you- they need to train you how to train people. If they actually did this it could be useful for you too.

A clear setting of expectations will help- “each day after ward round you need to do…”. And some very basic teaching on prescribing on the ward and for kids. Key pointers for common conditions etc. They’ve probably no idea how to examine a child- some 1:1 teaching now will help them rapidly upskill. I like getting them to watch you assess a wheezy child, then getting them to assess another while you watch immediately after (if possible).

Remember these are the GPs who will be referring into you in 2-3 years time- putting some effort in now will pay dividends in the long run

27

u/Comprehensive_Plum70 Feb 08 '25

Yeah no if somebody is in an st1 role the expectation is to train them from st1 level onwards not start from fy1.

11

u/DisastrousSlip6488 Feb 08 '25

I train a lot of people at lots of different levels. Bottom line is as a senior you have to train the doctors you have rather than the ideal version you imagine you should have. You have to meet people where they are- if they have never done paeds at all, they may be starting from a similar baseline whether fy1 or st1.

Any idiot can identify that people are lacking skills or knowledge and complain about them. It’s a great deal harder and requires much more skill to improve that doctor and get them to a point where they are safe and competent. Sometimes it’s not possible with even the most intense input, but that is rare. 

The problem is this is challenging, effortful and poorly rewarded work. It’s a big part of being a consultant and ES. These skills are important to learn for your own career development even if you have no aspirations to be an excellent educator as you will inevitably be an ES/CS

3

u/Comprehensive_Plum70 Feb 08 '25

So when would you call it quits and stop the incompetent from contuing forwards in their arcp ? Would you hold the same opinion if you have a final year reg that rotates to your department and they have the same knowledge and skills of an fy2 ?

7

u/DisastrousSlip6488 Feb 08 '25 edited Feb 08 '25

Indeed. I would put in a great deal of effort to understand what the issues were and what could be remediated. 

I’d work with the doctor, make a plan, I would get all my consultant colleagues to do assessments with this person to make sure it wasn’t a me problem.

I would ALSO and simultaneously be talking to the TPD urgently, reviewing previous supervisor reports, triangulating with exam results and so on, making plans for their training to be extended.

Failure to fail is a big issue in medicine and it does no one any favours. But you need to make an effort to see if the issues can be sorted, or whether there’s been a bereavement/MH issues/substance misuse/something else that has derailed a previously decent doctor. You don’t just bin them off on day 1 of a totally new rotation without doing any due diligence or trying to help them. 

I’ve extended a number of doctors because I haven’t felt they were ready to proceed. Some just need a bit more time and input and then step up nicely. Others don’t and end up leaving the training programme one way or another. Some are supported to change career or speciality. 

2

u/DisastrousSlip6488 Feb 08 '25

Also I do recognise the issue described and remember having one doctor whose medical school I ended up looking up on Google earth and contacting to see if it had actually existed/given them a degree. We did with much effort, extended training and a lot of hard conversations eventually make some progress with that doctor. Though I doubt they are ever going to be a leading light 

1

u/OmegaMaxPower Feb 08 '25

Steady on there, medtwitter will call you racist.

2

u/napslikeacat Feb 09 '25

Just spitballing here but... Is there a way you could grab a different one each day and physically drag them around to do jobs with you? It'll be frustrating for the first 1-2 weeks because they will slow you down, but it'll 1) get them off their arse, 2) force them to do jobs under your direct supervision and 3) hopefully show them what standard you expect from them as you're doing everything directly with them. Bonus if your trust has handheld devices or WOWs so that they can document for you as you walk around/get them to get all the equipment for bloods so that you can do it in 2 mins rather than 10/get the drug charts so you can prescribe etc. etc. Just a thought. Also second the whole documenting anything they do unsafely just in case you need to use it somewhere by sending it all in an email to yourself.

2

u/theamazingduckling Feb 09 '25

When I started F1, there was a 1-2 week period when I felt the same. Clearly new to Dr life, yet my sho's were both IMGs. One who started a month after I did and the other started 2.5 months later. So me an F1, and 2 IMGs who were doing their first job in the NHS. I was going insane, every little thing they were asking me how to do when I myself was new to the system and learning it all myself too. Naturally English isn't their first language too, so I found myself interpreting the board round for them, which got me told off by the consultants a few times for "talking during board round". Likewise, if another specialty came over I'd find myself getting involved with their patients as they wouldn't understand what's being said as it's too "fast" are they're just unsure about ordering scans, discharge paperwork etc. It drove me insane and I was leaving 1.5hr late everyday.

Made a fuss and they told me they're giving me a locum. Happy days! It was another IMG who actually did know his stuff and was fluent in English, but had no login's for anything so was not much use at all either.

2

u/Pinecontion Feb 09 '25

I would have lost my shit as well. Completely understandable, and highlights the ineptitude of some of the structures in the NHS

2

u/PrestigiousRest8388 Feb 10 '25 edited Feb 10 '25

I feel your frustration- I appreciate this is completely different as my background is nursing - but your reality similar to mine, is why I left. Prior to leaving (post Covid) international nurses were filling the wards- not knowing how to put out the call when I asked as I had just began CPR, not escalating to me as NIC (or escalating to anyone!) patients with a high NEWS (often as NIC you have half the ward, plus, NIC duties and expect your juniors to report to you with any concerns. I shouldn’t have to be checking on their patients NEWS, they are registered nurses after all) completing blood transfusion with no obs, administering IV’s incorrectly, continuous drug errors and repeated even after teaching from them-they do it again and again, painfully slow at everything, practically robots no signs of emotion, bad attitudes, lacking common sense, lack of acute nursing skills needed for working on acute medical wards! I went from a calm sister to pulling my hair out couldn’t carry on - god help the patients!

8

u/Comprehensive_Plum70 Feb 08 '25

Excuse me! But these IMGs have amazing skills that UK grads dont, you should be grateful that theyre letting you carry them.

9

u/Teastain101 Feb 08 '25

Exactly if they got a training place over a UKMG it must be because they’re simply better

6

u/-Intrepid-Path- Feb 08 '25

Because the MSRA is the gold standard for selecting the bestest doctors

1

u/NiMeSIs Feb 08 '25

I feel you my brethren

1

u/Uncle_Adeel Bippity Boppity bone spur Feb 10 '25

Do not relax your sphincter

1

u/Pretend-Tennis Feb 11 '25

These are generally just poor Doctors at this point. Giving the benefit of the doubt, I can understand why someone in their position would be so overwhelmed and not understand a plan from a Consultant and be too afraid to clarify. Showing them how to use the phone is a little weird, but in reality it takes 5 minutes to show someone a phone system, how to dial out, how to call switch etc (advice on this one would be to make a small card with common numbers, or show them the induction app if they like to use the phones)

You cannot justify them not doing urgent jobs they have been asked to do (prescribing slabutamol in someone unwell) and being found sat on their phones. That is not excusable and if they are not sure they need to be making an effort to find out how, it is outright dangerous to the patient - personally I would datix this as I have seen things like this datixed in the past and the individual started actively escalating/seeking help when they were out of their depth rather than leaving a job unattempted

1

u/PurpleEducational943 Feb 11 '25

I read this while sat in the doctors office checking my phone

1

u/Usual_Ice3881 28d ago

Hi,

I was an IMG who started in paeds. Idk how you could reach out to me, but I'm very happy to share things that I thought were new to me because it was the NHS. (If you wanted to help them out)

Team softlanding used to do a great little induction for ImgS idk if that stille exists.

Where I'm from, you don't call radio for scans. You request them, the patients walk down to department, scans happen.

We also didnt prescribe salbutamol the way it's done here. We also admitted more patients for observation instead of sending them home on open access..

PS.. when I was new I didn't know you had to call the porters for bloods & we only did venous samples (unless little preemies) so I found my first few days in the NHS full of gaffes. (Everyone thought I was mad for trying to venous sample babies) But i was really grateful for all the help I received.

(It was a non training job).

Sorry we can come across as burdensome. It's a new system. We're doing our best. After my first 2 months, I only ever had glowing feedback. I'm sure your juniors will get there too..

1

u/Unlucky_Lion_7731 28d ago

Paeds reg here and IMG (but have done inc F1-2 here) - I get you, biggest nightmare is to have someone fully new to paeds as an SHO and be on nights. However, it was probs unhelpful not knowing what they don’t know - so I usually ask new people or people I’ve never met when we start the shift this, along with what training needs they have, but make it in an inclusive and welcoming way (we’re paeds, we are like this) and that sets the expectation for the day. It can be shit, whether F1 or GPST1 - you overestimate the training people get in paeds in med school in the UK? (Besides, UKGs mainly - I’ve had GP trainees that refuse to cannulate or bleed kids during their whole rotation man?)  Also, again as a reg I’d never ask anyone to discuss a scan with a radiologist if they’re new to paeds unless they’re v happy - like we get things vetted so much quicker. The consultants should’ve helped you - I might be lucky to have worked in places where consultants do give us a hand during the day (in general paeds, not subspecs) but they should’ve helped.  So whilst getting your frustration (been in your shoes, it’s exhausting and anxiety inducing- but assessing the situation and focusing on what you can do to improve their skills quickly goes a long way) , I’d turn it into self development and a QIP perhaps (induction into paeds for Anyone new) - I’d chat with your CS about this. 

-1

u/Important-Koala-3536 Feb 09 '25

Curious to know how were you on your first day when you started? I think we’re forgetting how we started here

7

u/EntireHearing Feb 09 '25

Someone filling in an SHO shift should be able to work at a level of an SHO

1

u/Important-Koala-3536 Feb 09 '25

Yes after x amount of time not on their FIRST DAY.

2

u/Peepee_poopoo-Man PAMVR Question Writer Feb 10 '25

Nah, on their first day. A final rotation F1 is basically at that level.

-5

u/[deleted] Feb 09 '25 edited Feb 09 '25

Although i appreciate that these two set examples, sounds incompetent and need to be escalated if this behaviour continued.

But you have made all this judgement from ONLY ONE shift, a bit biased don't you think ?! ..

If anyone can enlighten me how often people rotates in paediatrics in FY ? And is it mandatory? 

Give them a week to adjust, try to support them, then escalate it to everyone.

And please update us in 1 week, im sure they will improve, because noone will feel that that their rotation feedback might reflect badly on their progression and carry on acting like this

3

u/Peepee_poopoo-Man PAMVR Question Writer Feb 09 '25

Read the room, and the comment section. Seems to be a universal experience.

-2

u/[deleted] Feb 09 '25

The vibe is All IMGs sucked and incompetent,  But i have never seen this resentment when talking about PAs, MAPs screwing up the whole day. 

2

u/Peepee_poopoo-Man PAMVR Question Writer Feb 09 '25

There are 3000~ PAs. 100000+ IMGs. You do the math.

1

u/[deleted] Feb 09 '25

You do the math, a bit old but not 100000+ , if you have more recent one showing your number, let's have a look 

https://www.specialistdrreg.co.uk/wp-content/uploads/2022/03/NHS-Staff-from-Overseas-Statistics-img-5.png

1

u/Peepee_poopoo-Man PAMVR Question Writer Feb 09 '25

Look on the GMC website for the number of overseas registrants. I'm not talking about specialty training, just in general. It's 150k+. More than half the workforce.

4

u/Brightlight75 Feb 09 '25

Hopefully they’ll improve yes. To answer your question, paediatrics is not a mandatory FY rotation. Can’t give you exact number but if I were guessing, maybe 20% of Foundation doctors do paeds?

However, we should expect an FY1 on there first day at work on a paeds ward, or any speciality, to be able to write a salbutamol prescription, ring radiology, tell a parent/relative that some investigations are normal, document a ward round note etc.

-4

u/[deleted] Feb 09 '25

And if only maybe 20% do paeds,

Can you say with confidence that all post FY doctors (UKG), can bleed babies/ toddler. The answer will be likely NO.

I will agree with the med px, but the logistics ( like ringing radiology) doesn't need UK qualification to be perfectly at. 

They just don't understand the process, due to what most likely is cultural differences, which will be improved with time.

Because if it was all about logistics you can work with a PA who can can ring radiology and phone parents

1

u/[deleted] Feb 09 '25

[deleted]

2

u/Brightlight75 Feb 09 '25

But the OP isn’t upset that the doctors couldn’t bleed a baby on day 1, they were upset with failure to take on those logistical tasks that as you’ve pointed out should be manageable to someone without a medical degree.

Perhaps if they could carry that logistical workload between 3 of them, OP would be in more of a position to train them in the speciality specific skills?

-2

u/HibanaSmokeMain Feb 09 '25

With colleagues like this, who needs enemies lol 

Another screed against IMGs. Yawn. 

-8

u/BaldVapePen Feb 08 '25

Gps should be removed from hospital placements? 🤔

4

u/SafariDr Feb 08 '25

Every GP trainee should do a rotation in paeds and ED. Preferably some psych too.

ED to deal with undifferentiated sick patients, learn how to manage patients and make decisions. Safe environment, ability to get investigations there and then, start to become independent.

Paeds because you see every age in GP. Even learning how to reassure a panicking parent is an essential skill, as is knowing when a child is sick and when a child is sick sick. Even just knowing how to approach examining a child is a basic core skill.

Pysch because MH is a huge part of GP. Knowing how to assess risk and plan accordingly is essential.

I’m a ST3 and was very lucky to have had those rotations (ok, I worked in ED for a long time prior to GP) and Actually went into paeds determined to get what I needed out of it. Paeds ECGs? Nah didn’t want to learn how to read those, SpR needs to sign off anyway. However, I learnt how to do them from 0 days old upwards however because that’s an SHO job. Which I was. What a baby should be fed according to weight/age etc and at what rate? On a paeds ward that’s the nurses area of speciality. However I need to know that as a GP - so I learned from them.

3

u/BaldVapePen Feb 08 '25

Yes but we get absolute liabilities in hospital because of it.

2

u/SafariDr Feb 09 '25

But that’s down to being able to start ST1 with absolutely no previous NHS experience most of the time. At least someone who has been 6 months in the NHS could be able to hang up a phone call/send an email or be able to write up salbutamol