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Challenges in Training

Training after being an overseas doctor - by Jonathan Noël

Jonathan Noël (past BSoT Chair and former trainee in the London North Deanery) writes about coming to the UK for training after a period of time abroad:


As the Chair of BSoT (the organisation that leads urology training opinion in the UK and Ireland), I started my medical career in the UK in an SHO post with no training recognition. I graduated from the University of the West Indies, did a one-year internship (known as FY1) and did the necessary steps to GMC Registration.

GMC Registration is complicated, but the International Graduate Unit are professional and effective in the process. Depending on the location of your medical school training and nationality, the process ranges from direct registration to sitting the Professional and Linguistic Assessments Board (PLAB) test

Once you are GMC registered, the time comes for you to scout for jobs. I am so pleased that BSoT has now made available pre-National Training Number (NTN) posts that have high educational value in urology: those wishing to pursue a career in this amazing specialty should take advantage of this.

Applying direct from overseas into a training post is a challenge, but not impossible, depending on your previous experience. Options available are:

  • applying to posts without training recognition, in order to gain beneficial NHS experience;
  • applying to a research post, will always be favourable in the present evidence-based medicine world; or
  • applying to a Clinical Teaching Post.

The above will improve the application for training-recognised post.

Overall, if your goal is to secure an urology NTN, it will usually take prior experience in the NHS to get a sense of your experience, as judged from a UK standard. A research degree is not mandatory, but experience in it is; it adds another layer to the portfolio discussion. 

Applying for training with too much experience under your belt can be a disadvantage as, ultimately, the NTN must "mould" future urological surgeons from the UK and Ireland’s training scheme.

There is never a "one size fits all" in this amazing surgical career in the UK. It can take you in many directions that one could not fathom coming from overseas.

No matter where you are from, if you work hard, show commitment to the specialty and strive for excellence in yourself and in the teams/departments you work with, I can guarantee your commitment will be recognised and rewarded.

Interdeanery transfers - by Katie Chan

Katie Chan (formr BSoT Communications representative) writes about the process of setting up an interdeanery transfer (IDT).


For most, people Speciality Registrar training will be completed within one deanery but, for some, there will be changes in circumstances which necessitate transfer to another region of the country. This is where the interdeanery transfer process comes in.

The IDT process is currently run through the HEE London Deanery as a national IDT programme. There are two windows for transfer - one in August and one in February. There are two stages, eligibility and allocation:

1. Eligibility

The criteria for IDT are strict, and rely on you proving that “a significant change to personal circumstances has occurred that could not have been foreseen at the time of commencing your current training programme”. There are four different categories under which you can apply:

  • a disability;
  • primary carer responsibility;
  • parental responsibilities; or
  • committed relationship.

In addition, you must have at least 18 months of training remaining, and have completed at least nine months at the point of application.

2. Allocation

Even if you are deemed eligible for transfer, your transfer cannot go ahead if there is no post for you to transfer into. This is often the stage at which transfers fail.

Urology is a small specialty and there may not be any numbers advertised in that region for the year that you are applying. Even where there is a number available, the region may be seeking a trainee with more or less experience than yourself (e.g. they may want an ST6 rather than an ST5). Additionally for urology, there is only one national selection round a year and, given the competitiveness of the specialty, most deaneries are full by the end of the process.

There is no requirement for the deaneries to prioritise the IDT process over the national selection process and, therefore, although there may be training positions available at national selection, these may not have been put forward to the IDT process. There is no easy way to overcome these issues, but urology does have the advantage of being a small specialty and most training programme directors (TPDs) are supportive of trainees with a genuine change in personal circumstances. The British Medical Association (BMA) and the IDT team regularly work together to try and improve the process for all involved.

For severely extenuating circumstances that cannot wait for the IDT window, you can speak to your TPD and to the head of your School of Surgery. Urgent transfers can happen, but they are rare, and are at the discretion of the heads of Schools of Surgery for both deaneries that are involved. 

Tips for success

The following will help your IDT application to progress smoothly:

  • involve your TPD and educational supervisor early in the process;
  • plan, plan, plan ...
  • read the forms until you can recite them, and then read them some more; and
  • keep in regular contact with the IDT team, to make sure your information has been received and that your application is progressing as it should