What are the benefits of clinical attachments?
August 2006
To the doctor
There are a number of advantages to doctors undertaking clinical attachments:
- they gain valuable experience of working in the NHS in primary and/or secondary care settings and insight into the knowledge base required of UK doctors
- they are exposed to UK medical, legal and cultural traditions
- it is often the only way for IMGs (especially refugee doctors) to obtain a UK reference which is extremely beneficial when applying for posts in the UK. Although, given the nature of a clinical attachment, doctors should note that the reference will only relate to a limited range of work.
- exposure within the NHS can help improve self esteem and confidence in relation to clinical skills
- they are able to improve their communication skills and learn colloquial language within the context of the NHS
- they are often granted access to medical libraries and are able to participate in the educational life of hospitals/GP surgeries
- they learn how to work in multi-disciplinary teams in the NHS
Naturally it is not only the doctor who benefits from clinical attachments. The department/general practice to which they are attached gains an additional team member who is keen to undertake as many tasks as they are permitted to do in order to gain experience. It is a good opportunity for Trusts to invest in their potential future medical workforce. In particular, regions and specialties with recruitment problems stand to gain by attracting potential new doctors by offering them clinical attachments.
When should an IMG undertake a clinical attachment and for how long?
Clinical attachments can be useful for different purposes at different stages in a doctor’s progress towards GMC registration and the resumption of their medical career. There is wide consensus that, to gain maximum benefit, attachments should be undertaken after the IMG has passed the International English Language Testing System (IELTS) examination at the level required by the GMC. A number of doctors apply to undertake clinical attachments after passing part one of the Professional and Linguistic Assessment Board (PLAB) test as useful preparation for part two. However, recent practice is showing that doctors gain the most benefit from clinical attachments when they undertake them post-PLAB part two because they focus solely on the attachment. Also, given that they are job-ready, they are able to establish useful contacts whilst they are actively looking for jobs. Specialised clinical attachments, relevant to the field in which the doctor wishes to practise, are certainly best conducted post-PLAB part two.
Whilst not considered in these guidelines, it is worth bearing in mind that doctors not following the PLAB route to limited registration may also benefit from undertaking clinical attachments. For example, those applying for limited registration via the basic specialist training route.
Thinking varies in relation to the duration of a clinical attachment, however, a well structured clinical attachment of two to four months should be sufficient to ensure that the IMG receives a good grounding. This duration would ensure that the consultant or GP is able to provide a comprehensive reference. Indeed, some may even be reluctant to provide references for short attachments. Clinical attachments should last no longer than four months.
For the purposes of these guidelines IMGs encompasses all international medical graduates whatever their reason for wishing to practise medicine in the UK. Some sections may be more relevant to specific groups, for example refugee doctors
How to find a clinical attachment
Unfortunately there is no centralised national or regional application process for clinical attachments. For those doctors with personal contacts in the NHS, these are the best way to start. Doctors without personal contacts are advised to contact their local postgraduate deanery, some of which have contact details of the appropriate individuals within the various hospitals within their area that deal with clinical attachments. The deaneries may also be able to tell you if there are any projects in your local area that arrange clinical attachments. Some Strategic Health Authorities (SHAs) are establishing centralised application systems for those living within their area, so it may also be worth contacting your local SHA. There is useful information about clinical attachments on the ROSE website at: http://www.rose.nhs.uk/site/Registration/Doctors/Clinical attachments/index.html - go there
If, however, you find yourself having to arrange your own clinical attachment it is advisable to contact the medical staffing departments of local hospitals to identify whether they accept individuals for clinical attachments. Unfortunately, some do not. The medical staffing department will then advise about their application process. It can be easier to obtain clinical attachments in district general hospitals rather than the more popular large city based teaching hospitals. For attachments in primary care you will need to apply to individual practices.
When submitting an application for a clinical attachment you will probably be asked for a copy of your curriculum vitae (CV), including your IELTS score and PLAB examination results. You should attach a covering letter with your CV which should include key points relating to your experience and why the Trust should offer you a clinical attachment. Where possible, include details of any work experience in the specialty of the clinical attachment you are applying for, as well as any other evidence showing an interest in that specialty. If possible ask a doctor who is practising in the NHS to look at these for you. Copies of your primary medical qualification (if available), with translation where appropriate, and evidence of your immigration status granting valid permission to be in the UK may also be requested.
Applicants may be asked for references and a copy of a certificate of good standing (CGS). This is usually issued by the medical regulatory body in their country of origin. The latter is required by the GMC in order for a doctor to be registered. In cases where doctors, usually refugee doctors, are unable to obtain a CGS, the GMC will accept a structured character reference by a GMC registered doctor. Further information about CGS is available from the GMC website at:
http://www.gmc-uk.org/doctors/join_the_register/registration/good_character.asp - go there
Immigration provisions for clinical attachments
A special category was incorporated into the immigration rules in March 2005 for doctors wishing to undertake a clinical attachment. These rules were amended on 3 April 2006 and provide that doctors may seek leave to undertake a clinical attachment for up to a maximum of six weeks at a time or six months in total. Further information can be obtained from the Immigration and Nationality Directorate at http://www.ind.homeoffice.gov.uk/lawandpolicy/immigrationrules/part3 - go there