Intended for healthcare professionals

Career Focus

Going from SAS to SpR

BMJ 2004; 328 doi: (Published 12 June 2004) Cite this as: BMJ 2004;328:s236
  1. Prithwiraj Saha, specialist registrar in obstetrics and gynaecology
  1. North East Thames, London Deaneryp.saha{at}


The PMETB should solve some of the problems that doctors in non-training grades have if they want to progress in their careers. Currently, it's a tough ordeal, as Prithwiraj Saha explains

Alarge percentage of staff and associate specialist (SAS) doctors (71%) qualified outside the United Kingdom, the majority in non-European Union countries.1 Currently, to get back to the training grade they have to apply in open competition,2 although this should change when the Postgraduate Medical Education and Training Board (PMETB) becomes operational in October.

I became a member of the external reference group established by the Department of Health to share my ideas for improving the working lives of SAS doctors. I strongly support moving to a competency based assessment so that these doctors have the opportunity to know where they stand and how much training they have to do. It is an enormous task for the royal colleges to provide the standard and tools of competency test. Obviously, the progress is slow.

Experience as a staff grade

I took up a staff grade job for family reasons and the immigration rules at that time which compelled foreign doctors to return after completion of their permit-free training.

I thoroughly enjoyed my job as a staff grade, and I think I had more opportunities than I would have had if I had been a specialist registrar (SpR FFTA). I established myself as an active member of our department, organising the teaching programme, senior house officer induction, and grand rounds. The opportunities as clinician extended beyond the middle grade responsibility according to the departmental needs and my ability. I completed a research project and colposcopy training. I also received two discretionary awards in the second year of my job as staff grade. These obviously helped to build my curriculum vitae.

Interview technique top tips

  • Smile profusely when you enter the hall

  • A little nervousness is helpful (it shows that you are a serious candidate), but an air of confidence is important

  • Try to err on the safe side and do not be controversial

  • At every opportunity try to project that you are a team member (questions assessing team work are often asked as appraisal is becoming more prevalent)

  • Listen to the question carefully

  • Take a pause, even if it is your well rehearsed answer, and then answer at a steady pace. Your body language should portray your enthusiasm and confidence

  • Keep eye contact with the person who has asked you the question

  • If you are unsuccessful, the experience you gain will certainly help you next time

  • Be positive in your attitude and belief. Remember your potential, and you will succeed if you persevere

I started to apply for higher specialist training programmes in the final year of the four year work permit that gave me the chance to gain the right to stay in the United Kingdom indefinitely after my tenure.

The application process

I applied to almost every deanery for a national trainee number in obstetrics and gynaecology. I was rarely shortlisted, but in my experience I had more chance of being shortlisted by deaneries which select by objective criteria rather than subjective assessment. (Deaneries are gradually moving to the numerical scoring system and this is a step in the right direction.)

I was invited to attend an interview at four of the 20 places I applied to, and eventually one deanery offered me a year 4/5 locum appointment for training position and another a national training number.

I want to share my experience of the interview to help any others contemplating the move from a non-training to a training post.

The interview experience

The interview can have two formats: in one all the panel members (up to 15) sit together in a large hall, and the other consists of three or four satellite groups each comprising three or four panel members designated to ask particular questions.

In my experience, the interview questions were based on four key areas: clinical governance, research and audit, personal development and training, and topical medicopolitical issues in general or related to the specialty.

The dreaded question

You are most likely to be asked why you want to move from a non-training grade to a training grade. Your response should show that you realise your potential and aspire to progress. You should emphasise your achievements—for example, your administrative role, teaching capacity, and audit and research activities. Take your continuing medical education diary and evidence of attending educational courses. My continuing medical education and previous training portfolio was checked in all the places I was shortlisted.

Caught off guard

Occasionally, there were some questions to catch me off guard. Success depends on your preparation (there is no alternative to intense preparation and adequate homework), but do expect some unprepared questions. Controversial issues demand a balanced answer. Try to show that you have given adequate thought to both sides of the issues. Remember, the panel members will not choose you unless you prove that you are worth taking—go for the hard sell.

A level playing field? Not likely

Although it is widely believed that once you have been shortlisted for an interview it is a level playing field, I have mixed experience of that. The feedback I received from my unsuccessful interviews was varied. One interview committee spokesperson (also a district tutor) thought that as a staff grade I was not in a favourable position to come back to a training post. This is a biased and judgmental response. My curriculum vitae and personal development do not project that. On the other hand, I was told by some that I was over qualified. This was frustrating: being over qualified should be considered an advantage. But I strongly suggest that you are not put off by this type of comment—keep trying. The box shows my top tips. Good luck.


  • Mumford C. The medical job interview secrets for success. Oxford: Blackwell Science Publications, 2000

  • For clinical governance and present practice developments:



  • Website for the royal college of your specialty for clinical guidelines and current developments and medicopolitical issues


View Abstract