Each year around 10,000 doctors who qualified overseas relocate to the UK. Practising in the UK can be an eye-opening experience for doctors – both in the workplace and culturally. New accents, unfamiliar phrases and different ways of living and working are among the challenges.
To help prepare doctors for life and work in the UK, the General Medical Council offers a free course, Welcome to UK Practice. This interactive workshop explores ethical scenarios doctors may encounter and provides practical advice on cultural, ethical and legal differences in UK practice. It is currently being delivered virtually and is open to all doctors who are new to working here or who are looking to secure work. After attending, 95% of doctors said they would change their practice as a result of information they’d gained.
In the first of a two-part series, Nigerian doctors share honest accounts of their decisions to move to the UK and their experiences adjusting to a new culture, one where being offered a ‘brew’ at work doesn’t mean what they think.
Dr Victoria Ozidu, an ST4 Psychiatry trainee working in adult psychiatry in Greater Manchester, shares her story.
I finished Medical school in Nigeria at the University of Ibadan. Following my house job, I began to apply for a residency training programme in psychiatry as this had been my interest even before medical school. However, before I could obtain a place in Nigeria, I got a scholarship opportunity to study for a masters in mental health at Queen Mary University, London, so I took it and thus began my UK journey.
On arriving in the UK, the first shock to the senses was the cold but I also quickly discovered that the healthcare system was completely different from the one in Nigeria. From the outside, it seemed well structured and organised and seemed to be working effectively. I felt I could learn a lot from the system.
I looked for opportunities to work within the NHS which led me down The Professional and Linguistic Assessments Board (PLAB) route. Those of us going through PLAB called ourselves the Plabbers!
I found that the multiple choice PLAB1 exam, though tough, seemed quite straightforward. But the PLAB2 exam seemed to test much more than clinical and communication skills, it was also a test of nerves and stamina. With at the time, 18 stations, each lasting eight minutes, it required a lot of strength and determination.
Many Plabbers come out scratching our heads, not sure whether we had pulled through or not. Then the anxiety before the results, which by result day was sky high. I was indeed very grateful when I overcame the hurdle of the PLAB2 exam.
I am currently working in the UK as a higher trainee in General Adult Psychiatry which is an exciting but challenging field – particularly during the pandemic. I had a lot of lofty expectations before starting work in the UK. I had idealised the NHS. I believed that mental health services were very well resourced and funded and there were well-delineated treatment pathways for every patient. I was brought back to earth when I discovered that this was not always the case. However, as I gained experience on the job, I discovered the great work fellow clinicians do daily in treating patients pragmatically and effectively despite limited resources and time.
The NHS definitely has its good points and, in some ways, has lived up to my expectations of providing quality care. As a new starter, I found it a bit intimidating, working in a strange environment where I did not know anyone and where I didn’t understand the electronic recording system or just how things worked in general. I remember being put on call few days after my induction. As this was my first job in the UK, I was super anxious and had to be asking questions almost throughout the shift.
Some staff were friendly but others standoffish and I had this pervading feeling of impostor syndrome feeling like maybe I wasn’t meant to be there. However, time seemed to ameliorate most of the difficulties. I learnt to work with sometimes finicky and slightly antagonistic work colleagues, I learnt to be more accepting of the fact that most people assumed I knew a lot more about the system than I did.
I worked hard to understand all patients’ varied accents, such as Cockney, Scouse or Essex, and enunciated slowly so they could also understand me. I discovered that no matter how awkward I felt initially, it was ok for me to call people by their first names, even senior colleagues. I slowly became skilled in approaching conversations regarding holidays and the weather, and I learnt to take tea breaks with other colleagues, even if I didn’t always like tea.
Living in the UK was another challenge. I learnt many, many things such as how important it was to buy really thick clothes and made the painful discovery that things like a boiler breakdown could easily become a nightmare situation. I accepted that I may live for years beside my neighbours and they may never know my name or me theirs. I learnt how to become very appreciative of the sun when it appears while I enjoyed full English breakfast and roast beef dinners.
So many times, I have learnt the hard and sometimes funny lesson of not assuming. When I first arrived in the UK, I thought I knew what people were referring to when they mentioned what a brew was. I’d always thought it meant alcohol and I always politely declined, only for me to go to work and get offered a brew there. At first, I was shocked, then realised no one could be offering me alcohol at work, and realised they meant a tea or a coffee.
Advice for other International Medical Graduates (IMGs)
I would say to IMGs wanting to work in the UK that when you start work try as much as possible to maintain a work-life balance. It is so easy to get caught up in work and picking up extra shifts. It’s a temptation to keep working to the bone especially with responsibilities back home but remember, the work never ends but if your health suffers, life will still go on. Also, no matter how difficult things might seem in the beginning, it gets better with time. Ask questions and try to get as much support as you can.
Doctors may also benefit from learning about the ethical scenarios they may experience at work on the GMC’s Welcome to UK Practice course.
So far, I can boldly say I have no regrets choosing to live and work in the UK. It is difficult to know exactly how my life would have been different if I stayed back in Nigeria. I believe I would have pursued psychiatry. However, I daresay I would have had to deal with a lot of frustration due to the inefficiencies of our healthcare system.
Working through the pandemic has been very difficult, mental health units have been overrun all over the country, both by old patients who have experienced relapses and by new ones who had never suffered from a mental disorder prior to the pandemic.
As a clinician, sometimes the burden can be overwhelming, but I have found comfort from working together with other staff as a team, seeking ways to support each other and our patients in the best possible manner. We look for opportunities every day to be kind to each other and our patients and I think in this way we are practising some of the core values of the NHS of which I am proud to be a part of.
To find out more about Welcome to UK Practice, visit this page. Places can be booked via your GMC Online account.
The Professional and Linguistic Assessments Board route is one of the options for International Medical Graduates (IMGs) who want to work in the UK. Doctors must pass PLAB1 – a multiple choice examination that can be taken in venues across the world and PLAB2, a clinical competence exam sat in Manchester, before being able to secure GMC registration.
Doctors must evidence that their medical qualification and knowledge of English are acceptable before applying to take the PLAB examinations.
Other routes to registration with the GMC for IMGs include sponsorship, having an approved postgraduate qualification and applying to join the register as a specialist.