Intended for healthcare professionals

Career Focus

Modernising Medical Careers and overseas doctors

BMJ 2004; 328 doi: (Published 19 June 2004) Cite this as: BMJ 2004;328:s256
  1. Rhona MacDonald, editor Career Focus
  1. rmacdonald{at}


Rhona MacDonald asks Steve Field, chair of the Modernising Medical Careers delivery board, about what the programme will mean for overseas doctors

Q: Can you explain Modernising Medical Careers (MMC) to doctors just coming into the United Kingdom, and how it is going to affect them?

SF: “The MMC `movement,' if you like, is all about changing education so that it's better for trainees, as it is more focused on their needs, and better for patients. It's all about improving care for patients. We can improve patients' care by recruiting and retaining the best doctors. But we do really need to improve the quality of training and assessment of our doctors whether they are general practitioners or specialists to meet the needs of this new century.

“What it means is that training will be streamlined and will be competency based. Any assessments that happen during training including college exams will be based on those defined competencies. The system hopefully will be less open to any form of prejudice against a particular group, and I really hope that by looking at training and moving to a `run through' system, we won't have any artificial hurdles between basic and specialist training. Rather, it will be about appropriate selection to a programme be it foundation or for specialist or general practice training. While passing through the programme, junior doctors should receive more feedback so that they can optimise their learning and really see where they are going.

“A lot of overseas doctors complain to me about difficulties with selection and particularly getting into basic programmes and then into specialist programmes, and many often say that they get stuck in senior house officer (SHO) posts and can't progress.

“Some of the existing SHO posts are not of good educational quality; we need to deal with that. Some posts are in educationally unapproved trust grade posts [non standard and non-training] and not SHO posts, and I'd say doctors coming from outside are bewildered by what's on offer and therefore open to the suggestion that there is prejudice against them. Some doctors end up in those trust grade posts for years without support, without security, and this is made worse by the fact that there is very poor careers advice and guidance for people who are not UK graduates. Having said that the careers advice for UK graduates is not much better. So the system needs to be improved and be much more trainee centred.

“Doctors coming into this country don't always get the induction into the health service they need, and we might be able to help that through Modernising Medical Careers in the F2 [second foundation year] programmes. We should be able to develop and tailor specific programmes to help them.

“For example, In the West Midlands, we will be able to provide a number of opportunities for a one year long second foundation year, alongside the UK graduates who have been doing the two year programme, which is about the care of acutely ill patients. It will also have educational opportunities to induct them more into the NHS, into NHS management, and the whole ethos of it.”

Q: So overseas doctors couldn't apply for basic specialist training after passing PLAB [the Professional and Linguistic Assessments Board exam]? They'd have to do some form of foundation?

SF: “Well, I think some would elect to apply for the second year of a foundation programme. If they have full registration and the appropriate competencies equivalent to doctors who have been through foundation programmes, then of course they could apply for `run through' specialist or general practice training programmes. But hopefully, even then, we will be able to do much more about induction for overseas doctors and adequately support them.”

Q: But isn't it still going to be open to discrimination. Presumably it's still open competition?

SF: “The work hasn't been done on the issue of entry into specialist programmes yet and of course the standards will be set by the PMETB [Postgraduate Medical Education and Training Board]. But the standards for entry will obviously have to reflect the standards for exit for foundation programmes. The competencies that the Academy of Medical Royal Colleges has produced for F2 can be used. This should remove discrimination because it doesn't matter who you are or where you are from—it's about demonstrable competencies.

Further information

Modernising Medical Careers—

Career Focus theme issue about trust grade doctors— Career focus topic collections on modernising medical careers—

“These competencies will be advertised on the web. So doctors who want to come into the United Kingdom need to know that they are going to be treated fairly and what they need to do to be able to get on the programme. At the moment entry to programmes varies across the country and entry to SHO posts varies even more. What we will do with MMC is push for agreed national standards in partnership with the PMETB who are working with us and will help assure these standards.”

Q: So will this do anything to end the exploitative trust grade posts?

SF: “A number of things have happened already. For example, some trust grade posts have been absorbed into foundation programme pilots across the country. There has also been a scheme running for the last two years where suitable Trust grade posts have been transferred into general practice training programmes in England. The big change, however, will be in 2006, when foundation programmes take off, many more trust grade posts at that level will be absorbed into programmes, so that most posts which currently exist will become educationally approved posts.

“When we start to move towards `run through' programmes, or whatever model comes out working with the colleges, many of the trust grade posts will be absorbed into that system as well. Hopefully we can put more logic into the system.”

Q: So basically, the bottom line is Modernising Medical Careers is a fantastic thing for overseas doctors?

SF: “Yes. I think it is a tremendous opportunity to make the system fairer for overseas doctors and to help them realise their potential.

“I don't think we've respected or valued overseas doctors or their contributions to the NHS. You see a lot of negative press about overseas doctors, but frankly they hold the health service together and many of them work in areas that UK graduates have refused to work in. They haven't had the support that they have needed in the past. Many of them have floundered in the system as trust grades. I do believe there has been a lot of abuse going on, and this is a way of stopping that.”

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