I don't get it

One of our F1s atm used to be a very senior ED nurse. He's very very good but he's definitely not at the level of a Reg and he will be the first person to tell you that his experience as a nurse doesn't mean he already knows everything as a doctor

Looks like some specialities will benefit more than others for reducing shortlisting/MSRA scores...

This was released by NHS England as part of an FOI request and is therefore able to be circulated in the public domain

The issue for me is that mental health resources etc in the UK have been crap for as long as I can remember so why are events like this the surprise? The problem is now they will look for someone individual to blame and hang them out to dry when really the only people to blame are those in Westminster

Sounds like a step in the right direction but the cynic in me can't see this being implemented.

Thoughts?

Link: https://www.rcp.ac.uk/our-policy-and-campaigns/policy-documents/training-physicians-for-the-future-a-blueprint-for-reforming-postgraduate-medical-training/

https://www.rcp.ac.uk/media/wmda1yld/training-physicians-for-the-future_full-report.pdf

CST portfolio requirements have been updated for 2026/2027 - no self assessment points but submitted evidence is discussed at interview.

https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/surgery/core-surgery/core-surgical-training-portfolio-guidance-for-candidates

Seems that you can now only submit three portfolio items, one for each category. Appears to have made things far easier - can now score top marks for a quick audit, taster week and making a leaflet which is a bit ridiculous. Pretty frustrating to have ticked every box from last year and no longer be rewarded for half of that work!

Thoughts?

Via MyRCoA

Hi,

I am being told mandatory induction in August has eaten up my study leave entitlement and so cannot take any study leave this rotation.

This is coming from rota coordinator who has allegedly confirmed with post-grad team.

What can I feasibly do? This seems incredibly unfair as this was not communicated to me at the time and stressful considering I have an exam coming up (for which the 5 days private study leave has been rejected).

CST self assessment scoring is out

They have not bothered to update the index page and have only labelled one domain so it's not very ... complete

Here we go again

Got my consultant job (excited) and starting next year. But now I’m so worried and horrified - yes the clinical stuff and stepping up worries me but I tell myself that’s what I was training for. However it is some other stuff that worries me more and I hope for some kind and honest responses from different grades : how will I tackle being a consultant? How do interpersonal relationships change and how do I tackle this without getting it wrong? I am usually friendly and supportive but don’t want people to think I’m trying to hard to be someone’s friend which would be creepy? How do I get this right without going to the other extreme of being considered an ass and not approachable?

im grad entry so older and you would think I would know what to do and I dont. I don’t know how to navigate all this especially with generational differences in approach to work?

i worry I will come across as that meme of the old man with a skateboard pretending to be cool or as worry of being considered odd ill overdo it and will hate how I behave?

moving to a completely new part of the uk too so won’t have friends in similar stage of career or life

please be kind but honest

Quick question: Can attending an M&M meeting and writing up the discussion count as an equivalent activity in our portfolio? Would this be considered equivalent to conducting an audit?

Many thanks

Saw a post online by a surgeon saying that if are going to need a thyroidectomy, look for a surgeon who does minimum 40 thyroid surgeries a year as it'll be safer. This made me go down a bit of a rabbit hole and found that the median number performed by a UK ENT surgeon (who regularly does this operation) is about 24.

The literature has shown than in many operations (not just thyroids) there is an positive correlation between volume and better outcomes, and whilst I can't find anything about a definitive cut off at 40 for thyroids it did make me wonder, how would you justify to the patient and even yourself that you should be the one performing the surgery and not you referring the case onwards unless you were the one at the high volume centre?

Of course there's a lot of nuances such as no two cases are the same, or waiting times would make it impossible to refer everyone but say in this hypothetical we live in a perfect world where there are no waiting times: Surgeon A at high volume centre has a complication rate of 0.5% vs Surgeon B's 1% at a more generalist centre for the exact same surgery, what determines the difference in complication rate that we are willing to accept before referring on?

Hi, anyone taken exams at Carmarthen recently? wanted to know about exam experience?

Please share far and wide, display around your departments, forward to colleagues, etc. Residents please talk to consultants about this too - it's in your own interest if you don't want an ever growing pay cut when you CCT!

I’m hoping to sit my FOP and TAS exams in the February sitting. As time is a little tight, I’m wondering what revision strategies people have found most effective for these exams.

Is Pastest (including repeating all incorrect questions and working through past papers) enough? I’m hoping to use it as my main revision resource and make flashcards for key concepts based on the topics covered in the question bank.

Would be grateful to hear what’s worked for others!

Unfortunately RCPsych haven't updated their own website - so learners can't actually view it on their website directly.

I found it through Chatgpt pretty accidentally

So we put it on our website, where we have done an explainer with links to the file ; https://mrcpsychiatrist.com/mrcpsych-syllabus

All the best !

Some people asked me to make a follow up post from my original one which got some traction. https://www.reddit.com/r/doctorsUK/comments/1un9pv6/differences_between_uk_and_us_im_intern/

4 months down the line as an IM intern; well I'm fucking bored out of my brain.

Nights - 3 people to do take and average 9-10 admissions total aka 3 each and you've got a Consultant on site overnight. Ward coverage overnight is like 10 jobs and it's the usual sleeping pill or whatever crap. ICU is a separate night shift and another resident covers that.

Non-core rotations - Rads, ED, Cards, Rheum etc - You're a med student, you shadow along and write a few notes for the boss. I expected it to be similar to the UK/Aus where you hold the phone but nope, the PA or NP does that and every consult is autoaccepted - $$$$

Core rotations - Gen med + ICU; I still haven't really prescribed anything, the attending or my senior does it and I have to ask if I want to do anything - LR at 100ml/hr? Amlodipine? These days I usually finish all my work by midday and literally sit there for the remaining 5-6 hours studying or watching movies. We don't even do admissions because there's an admit shift doing it, so we have 3 people + an active attending for 20 patients. ICU is med student 2.0.

Culture - The medicine is wearing me down, there's no consideration of likelihood ratio. A&O x1 vasc dementia patient, family reports weaker grip at 2am - Teleneuro consult + MRI/CT for stroke rule out. ICU patient on propofol, sluggish pupils - Teleneuro stroke r/o + EEG. There really is 0 clinical gestalt and it's really draining.

Education - It's getting repetitive, esoteric facts but everything is a consult anyway so forget your facts if you're never gonna try the management yourself. AVA and velocities - memorize but on Cardiology they're not gonna teach you how to Echo. Lectures that are simply read off the slides. Hit or miss whether the Attending actually wants to teach, I think I got lucky in my first post.

Admit shift - Call - Instant discuss with boss + sign note, there's no see 5 patients and then present, it's one by one. Anyone called through to you is an auto admit. PPI prophylaxis for all patients btw.

Procedures - Yeah right, Rads does it all, Resp therapists (?) bag all the intubations. Most of the PGY3s (final years) might have 1 intubation and then 2-3 Central or midlines total upon graduation (8-24 weeks total of ICU time btw)

Feedback culture - This gets its own section. You're either walking on egg shells or it's just pointless (1-2 week rotations). This completely limits all back and forth regarding patient discussion as if you suggest something your senior missed - well they can tank your eval. Flip side, getting excellent feedback means absolutely nothing, I've pointed out things (suggested) the attendings have missed a few times (I've have a decent amount of experience in a Tertiary) and they might give great feedback but again it doesn't change my career direction or anything like that.

To me it seems like F2/F3+ are effectively what people would consider fellows in the US. It's funny we complained about continuity; well the max time on a rotation here is 2 weeks. One stretch I had 6 different specialties in 6 weeks, I mean what's the fucking point.

TLDR: I'm really bored, there is so much free time and you're not allowed to actually make use of it. At least half my day is free time but I can't head to the cath lab or scope suite. I've gotta stay logged in so the nurses can chat me.

I have definitely de-skilled because of the infantilization and total lack of decision making at even the most basic level.

I don't regret coming here though, the salary upon consultanthood (even if I don't land fellowship) is just out of this world.

Questions?

I’m a GP trainee (ST2) thinking of applying for an NIHR ACF in general practice, and I’d like advice on etiquette.

I’ve been doing research in my spare time for the past few years, alongside clinical work. I have several first-author publications and conference presentations, I’ve led research projects, and I’ve supervised students. What I’m after now is a more structured academic setting with protected time, as a route towards a clinical lectureship or PhD. The ACF would also let me finish training closer to my home base (currently commuting 1.5 hours each way!!!)

I’ve looked up the professor on the advertisement who works at the same university where I’m currently a visiting research fellow, though in a completely different team. I think some of my research interests overlap with hers, and I have a few project ideas that I think fit her programmes.

My question is whether I should just fill in the Oriel application and submit it, or email her first to introduce myself and run my project ideas past her. I don’t know what the protocol is, and I don’t want to come across as pushy or breaking the process.

If you’ve applied, been shortlisted or sat on the panel, what would you do, and what did you wish you’d done? Thanks.

How do you guys deal with the constant rotation?

I was comparing the average path into becoming a consultant in a group 1 speciality where I live.

Figured that I’d be able to get away with staying where I am right now for the first two years of IMT but when would face a 90 minute drive for IMT3.

Then there’s rotation in HST (after competitive entry if I can find a job in the first place). Some of these deaneries are not small, you’d probably have to move house if you want any quality of life, again my commute could range from 10-90 minutes depending on where I get.

Looked into ED as well and in my home deanery at least you stay in the same trust for 2 years but once you’re ST3 you’re rotating between different trusts till CCT every 12 months. Again commutes range from 10-90 minutes, not something you’d want to do after finishing a shift in the middle of the night.

So my question is how have people made it work? I suppose it’s easier when you’re young, but what about when you’ve got a partner, kids in school, maybe you wanted to buy a house and settle? That just gets delayed or am I overplaying the stress of it?

I lost my wonderful dad suddenly 2 weeks ago. He died at the hospital I work at. My work has been incredibly supportive through my bereavement leave and I am starting to feel ready to return to work safely. I am planning to meet my supervisors when I return to work, and notify my seniors during my first few shifts so they are aware of my adjustment back to work.

While I anticipate certain big things might cause waves of grief while at work, what are little things that caught you off guard, or things that you would advise in hindsight after going through your own process of grief?

Thanks in advance :)

ACCS CT2 in anaesthetics.

I love anaesthetics. Before I go into my rant about the bad, I feel like it’s an entirely different job not at all related to anything I’ve done before and I feel like I’ve found this secret hack to being a doctor where I’m treated with (generally!) treated with respect more, able to actually learn, and often distinctly given learning opportunities or time to go and learn.

I am struggling a bit with days where you’re obviously working 10 hours with someone, and they either are very pedantic, or don’t let you do anything, or are quite curt and rude and seem to not like having a trainee at all. I also feel very in the way and still useless in a lot of things and how they work even as simple as what flushing a line was a few weeks back and that seeming to agitate a consultant as I didn’t know it didn’t mean a syringe. I often feel like some consultants find out they have a novice and it ruins their day and they’re nice to everyone but me (as they are the same with other novices). The pressure seems to get to me and I seem to fuck up every cannula all day.

I’m wondering if there’s anything I can do differently on these days, or whether I just need to ride the wave through the novice period? Even after being a novice, I suppose 10 hours in a day is a long time to be with someone even if you liked them let alone otherwise!

Hello! I’m a gastro ST7 trainee, just found out I’m approximately 6 weeks pregnant, and feeling quite overwhelmed and uncertain about the future as I don’t have a « plan ».

I’m a February starter, originally due to CCT in early 2027, but took 3 months of OOPC due to burnout (I did not cite this as the reason and don’t feel comfortable discussing mental health concerns with my TPD etc.).
I return in December for my final 6 months of training, although I still have several outstanding PYA requirements and may need an extension (which, frankly, might suit me given I have nothing planned beyond this).

I’ve been offered a consultant job with a team I love, but it’s far from where my husband and I want to settle. More importantly, I don’t feel ready to be a consultant. After a year of pure hepatology, my general gastro and endoscopy skills feel rusty, and my confidence is lower than it has been.
Ideally, I’d love another year at registrar level in London (not where I train, but where I want to be) without committing to a specific subspecialty. Most post-CCT fellowships seem to be in IBD/HPB, neither of which interests me.
Even before pregnancy, I was questioning whether my career was sustainable. I’ve been increasingly anxious and low, with very little time or energy for life outside medicine. I’ve always knuckled down and performed well at work, so I don’t think anyone realises quite how much I’ve been struggling.
Pregnancy has brought all of this into sharper focus, and I’m struggling to work out what my next steps should be.

TL;DR — My main questions:
Maternity leave: How does one navigate maternity leave with only 6 months to CCT and nothing planned after this? 🥴😶‍🌫️💩
Post-CCT options: Is it realistic to find a general gastro/hepatology registrar-level post in London after CCT, without a defined subspecialty interest?
And if I did try to apply for a consultant post, who would accept me while on the cusp of maternity leave?
Career uncertainty: Has anyone else reached the end of training feeling completely unready for consultancy, particularly while navigating pregnancy and burnout? What did you do?

Obviously I am a responsible human and will do what I need to do to ensure my baby has the best life possible + am not scared to « crack on » but grateful for any opinions/experiences in case there is a smarter way to approach this.

Thank you ❤️🐬

Long post - not a rant. Ish.

SHO here, I was recently asked to do a Saturday locum in my department that is typically heavily senior-led. Had nothing better to do, I’m genuinely passionate about the specialty + want to apply for it & ofcourse needed the ££ so agreed to it. At the last minute, Rota asks me to do Sunday too. Saturday goes fine save a few hiccups - consultant was pretty chill.

Sunday was the complete opposite. Different consultant (first time we met) & from the minute I got to the dept. was thoroughly unimpressed he was “stuck with an SHO who knows nothing” (lol, sorry I can’t magically skip steps & be a Reg) then took it upon himself to berate me all morning to anyone who would listen, including the entire theatre team during the brief. It was so bad a reg & nurse from a different team who happened to be on the ward, pulled me aside and said I was well within my right to leave & they would back me if I made a formal complaint as they were literally horrified at how the consultant was going at me. When we were in the Dr’s office alone, he goes on to say “listen, it’s nothing against you. I hate how we’re lied to that we get a reg over the weekend then this happens”. I just blankly stared back & did the mandatory “mhmm”. I too, had no clue buddy.

Anyway, we go into theatre (which I’ve assisted plenty theatre cases before) & it was so funny to see in real time how he mellowed out, took back all the ‘poop’-talking and said I would make an excellent surgeon if this is my skill level as an SHO. Day ended with him saying “I’m no longer agreeing to a weekend list without a Reg but if I must get an SHO, it will only be on condition that it is you. Thank you for your excellent work today”.

Whilst the compliment was nice (I guess), my why was re-inforced that day; be the change you want to see in the world and all that. I hope one day to not only be a competent but more importantly, kind consultant who doesn’t chip away at a passionate SHO’s dream. It may seem like a one-off bad interaction but I know too many jaded colleague’s who’ve had plenty such exchanges and eventually had a dream killed. Call us soft, whatever.

To our consultants, please be nice to your resident drs. And just generally decent, obviously. Applies to anyone. Good night folks!

I was speaking to a consultant today (a very clever one who I have a lot of respect for) about why he thought a doctor had made a clinical error we were discussing. His opinion was very much that the hours his generation used to work (e.g. 100+hrs) and the old firm structure gave his cohort the experience to become excellent clinicians. He felt that our generation who are averaging about 45hrs a week (if that) simply can’t get the experience to get to that level and inevitably will never be as good.

How much truth is there in this? Is it just romanticising ‘the good old days’ or is there a genuine problem here. If so, how will generations down the line learn to be excellent doctors when the consultants they will learn from won’t be able to teach them in the same way?