Hi, I am Abhishek, an IMG from India and a former MTI trainee in Medicine in 2018 - 2020. I passed my MRCP in 2021 and I am currently a Speciality Trainee (ST3) in Gastroenterology and Hepatology in the NHS, UK. In today's blog, I would like to guide you through the Medical Training Initiative (MTI) scheme for International Medical Graduates (IMGs).
'The Medical Training Initiative (MTI) is a UK scheme that allows a fixed number of international medical graduates to work and train within the NHS for a maximum of 24 months. The primary purpose of the MTI scheme is to contribute to improving the quality of healthcare in developing countries. Therefore allocation of MTI placements is given in a priority order.' - The Academy of Medical Royal Colleges
Background
The MTI program was launched back in 2009, by the respective Royal Colleges to utilize the expertise of doctors globally and to train them according to the standards set by the Health Education England(HEE) for a fixed duration of time. Doctors from all around the world get trained in one of the best healthcare systems in the world. After their training, they return back to their home country and utilize their expertise to improve/suggest modifications to the existing health care there. NHS gains by reducing dependence on locums to cover for the shortage of doctors, getting experienced doctors on board and learning from their experience.
In other words, MTI is the sponsored route of GMC registration which allows IMGs with considerable work experience to come and work in the UK for a period of 2 years. The posts are approved by the respective royal college and based on the HEE (Health Education England) curriculum. These are at 2 levels, either at the ST1 or at ST3 and onwards. ST1 level posts are few but mostly available are posts at ST3 levels.
What are the objectives of these posts?
The benefits are 2-fold. IMGs benefit from a structured training program by the trust where they are trained and paid on par with UK trainees at the same level. This is of high standards and every trainee is being allocated educational and clinical supervisors along with study leave and study budget. The trust gains by having a fixed doctor on the rota for 2 years, thus reducing dependence on temporary/locum doctors. This greatly improves patient care and safety as it brings continuity to patient care.
How to find MTI posts?
The interview dates are usually advertised on the respective Royal College websites. The best way to find out information is to visit the relevant pages, by typing MTI followed by the royal college. For example, in order to go to the relevant page for posts in medicine, just type MTI RCP London in your search bar and that would take you to the relevant link. Go through the information provided there for finer details (ROUTE 1).
The other way would be to visit the NHS jobs website and look for the speciality jobs available. Then shortlist the ones you want to apply for, find out the email of the contact person which would be there in the job advert. Email and ask, whether they are happy to offer this post as MTI/sponsorship route for GMC registration. If they say yes, they would take it from there. DO NOT APPLY directly as you would need GMC registration for that and your application would be straight away refused without the registration (ROUTE 2).
Eligibility
Every Royal College has got its own set of rules and regulations and is not necessarily similar to each other. The generic ones are as follows.
Postgraduate degree (PG) or completed Royal College exam all parts (Royal College of Physicians London allows application without PG degree and a part 1 clear within the last 2 years).
IELTS/OET scores as per GMC requirements.
NOT FAILED PLAB. There is a grey area for PLAB appeared and passed candidates but my suggestion would be to NOT APPEAR FOR PLAB at all if considering MTI.
Work experience for a continuous 3 years (including internship after graduating from medical school) without any breaks. Any break will reset the counter to zero. It has to be proper inpatient work. Clinic work only and observer/attachment jobs are not counted/considered.
It is always better to refer to the website of the Royal College for the full and updated list as the rules continue to get modified.
Application process
ROUTE 1 - Attending an interview with the Royal College. Once successful, they will match your CV with the trusts who have asked the College for MTI fellows. Once a matching trust is found, the college sends you a sample job description (JD) and the Trust name. You are under no obligation to accept but if you do, an interview would be arranged by the HR of the trust and you would be either offered / not offered the job.
ROUTE 2 - Attending an interview with the Trust. If the trust says yes and offers you the interview. If successful, you inform the College to start the process.
Next steps
1. Once offered a job with the conditional offer letter, email it to the college and they will send you the application pack. The application pack contains the application form, sponsor form (to be filled up by your college Dean/ Head of the Department where you are currently working), 2 referee forms. There might be some other forms like a rota template, agreement forms needing your signature digitally, etc. The sponsor has to be the dean of your college or your current departmental HOD. Referees could be any senior consultant who you have worked with over the last 3 years.
2. Send them back with some other documents like your IELTS/OET score sheet, Primary Medical Qualification (PMQ) certificate, etc. You will know what documents to send as you will have a complete checklist.
3. After sending everything, a panel will go through the documents. Usually takes 3-5 working days (might vary due to COVID pandemic).
4. Once approved by them, you would be asked to create a GMC account (you could do this early also) and apply for GMC registration under the sponsorship pathway. The college will then contact AOMRC (Academy Of Royal Medical Colleges) who will issue the Certificate of Sponsorship (COS) and you apply for the tier 5 visa on that basis.
5. GMC will ask for some documents which are exactly the same as what you might have sent to the college, so in some cases like RCP, they just ask the GMC email to be forwarded to them and they do the needful from there. Another 3-5 days and your registration is done. GMC will send you an invitation to book your ID check.
Interview preparation
Both the college and trust interviews would be of the same format.
The first one is 'Take me through your CV' or something similar. This is to ease you from the initial jitters and nerves.
The second one is a clinical scenario. Make sure the ABCDE approach is at your fingertips. Any clinical emergency could be asked. Oxford Handbook of Clinical Medicine is a good resource to prepare from. Remember they just want to see that you are a safe doctor, not an expert. If not sure about something, just say I would take help from my senior (don’t say these for basic stuff). Any worsening clinical condition, even if you know the next step, mention that you would let your senior know.
The third one would be an ethical scenario. They might ask you what you know about audit, your outlook about bullying, GMC Good Medical Practice (don’t worry about the nitty-gritty) etc. Sensibly answer them.
Lastly, they would ask if you have any questions for them. This is your opportunity to clear your doubts or anything (do not ask about salary). Salary could be negotiated once the offer letter is sent to you. They do sometimes consider your experience but they have to stick to their scale.
Visa Application
The visa is Tier 5 in most cases. As mentioned earlier, some individual trusts are registered to sponsor bodies and they can provide Tier 2 visas.
Once everything is done, the RCP will contact the Academy Of Royal Medical Colleges (AORMC), who will issue the Certificate of Sponsorship (COS). As you get the COS, you apply for the tier 5 visa from the www.gov.uk website. There is the standard pathway, priority pathway and super-priority pathway.
Prospects following MTI. Benefits
Allows you to work in the UK and get paid at par with a doctor at an ST1 level.
Full GMC registration with a licence to practice bypassing the PLAB.
Allows you to access specific exams, specific coaching sessions while getting paid in UK currency and then getting that reimbursed totally/partially by your trust as a part of your study budget.
On completion, you receive a certificate of completion and this can help you negotiate for better jobs back in your home country.
You would be considered almost equivalent to a trainee doctor ( but not at all times).
The College closely looks after the trainee and any concerns from their end are promised thorough investigations. There have been cases when the trainee has been removed from a particular trust and moved to another trust.
You are provided with the opportunity and encouraged to do the Diploma in UK Medical Practice for a fee. This is available only to MTI candidates of RCP and RCPCH (other colleges might have some similar programs).
Complimentary access to the e-portfolio for 2 years. RCP trainees get the JRCPTB e-portfolio which is otherwise 169 GBP yearly.
Assigned Clinical and Educational supervisor. But remember, in the UK, training is mostly trainee directed with support from seniors and consultants.
Do's
1. Take indemnity insurance preferably before your first day of work. GMC strongly advises it and it will protect you against any litigations or complaints against you if needed. Bear in mind, they don’t provide backdated cover.
2. Keep your e-portfolio updated. Your end of attachment report following the 2 years would be done by your ES on the basis of your e-portfolio content. This is mandatory to get your completion certificate.
3. Take your time in learning. Remember you are new here, take your time and learn things. It's not a rat race towards impressing your consultants.
4. BMA membership could be quite useful at least for the initial 2 years. Then it's up to you.
5. Prepare well for the interview. The usual format is 'Take me through your CV', clinical scenario and ethical scenario. It would be followed by the opportunity for you to ask.
6. RCP and RCPCH offer their trainees including IMGs to do the “Diploma in UK Medical Practice” at Liverpool School of Tropical Medicine. It is worth doing it, but it's not free of charge.
Dont's
1. Do not take any job breaks while you are in your home country. If you do, the counter resets to zero and you have again started from scratch to get that continuous period of employment. 1 year of clinical internship is also considered, so if you don’t take any breaks, you need another 2 years to be eligible for this criteria. Clinical observerships, working in clinics outside hospitals, telemedicine are not accepted as experience.
2. Do not attempt to fabricate any evidence even if you manage to get it signed back at home. You might manage to slip through the net but if GMC gets a whiff of it, they'll investigate. If found guilty, you could be potentially blacklisted from practising in the UK.
3. Do not pull out after you have agreed to a job and COS is ready/about to be issued. You could be reported to the GMC.
4. Once you start working in the UK, make sure you arrive on time and leave on time. The latter might not be possible on some days but that should not be the norm. Staying late for work is a serious question mark on your time management skills.
5. Do not belittle any of your colleagues, be it nursing, HCAs, therapists, ward clerks or even the cleaners in your wards. Remember here everyone plays an equal role towards the benefit of patients.
6. Maintain patient confidentiality. Do not discuss patients outside your ward mentioning identifiable parameters. Do not take patient lists home and even if you do that by mistake, dispose them only in confidential bins in your hospital.
7. Never allow yourself to be bullied by anyone. Speak up against any misbehaviour against you, that could be a simple shouting to a patronising.
8. Don’t dump your work on your junior colleagues.
Further information
If you would like to learn more about the MTI scheme, please watch our FREE webinar with a Q&A session “Medical Training Initiative (MTI) for IMGs: process, requirements, top tips” at TrewLink.com
If you have any questions about MTI, I would be happy to answer them at trewlink.com.
Good luck,
Abhishek Ray
ST3 Gastroenterology and Hepatology
Written by Abhishek Edited by Julia