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This article looks at why the NHS needs international medical graduates (IMGs) and why we need to do better at integrating them into the workforce to maximise their contribution.

The General Medical Council’s Workforce report 2023 emphasises that the current reliance of the NHS on IMGs will continue in the future, despite an expansion of medical school places. The GMC predicts that almost a third of all doctors will be IMGs by 2036. It declares that the ‘integration and retention….must be improved’ and describes as essential that these colleagues are ‘welcomed into supportive teams’.

The way we welcome our international colleagues not only determines the extent to which they can contribute safely to the service, but also how easy it is to recruit and retain them. Our attitude should include a willingness to learn from their previous expertise and their ability to look at our services with fresh eyes.

SAS doctors play a pivotal role within the anaesthetic workforce, and it is imperative for organisations to establish robust support structures to nurture their professional development. Unlocking the full potential of each SAS doctor not only benefits them personally, but also augments the services they provide and ultimately enhances patient care.

SAS doctors are crucial in anaesthesia, necessitating robust support structures for their growth. Unleashing their potential both benefits them personally and enhances patient care. Vital support includes that of an SAS tutor, a trust local negotiating committee representative, and an SAS advocate. The Guidelines for the Provision of Anaesthesia Services (GPAS) define exemplary departments and highlight non-clinical attributes vital for success. Notably, roles like ‘SAS clinical lead’ and ‘SAS mentor’ empower SAS doctors for self-determined career paths.

With the rise of the Black Lives Matter and #MeToo movements in the last few years, media attention has been drawn to the abusive behaviours that have become embedded in our culture. Under the Equality Act 2010, it is against the law in the UK to discriminate against anyone because of nine ‘protected characteristics’. These are race, age, gender reassignment, being married or in a civil partnership, being pregnant or on maternity leave, disability, religion or beliefs, and sex and sexual orientation.

A survey among doctors and medical students highlighted that 76% had experienced racism in the work place at least once in the previous two years.¹ Similarly, 91% of woman doctors in the UK have experienced sexism at work,² and a survey among European surgeons revealed that 20% had considered quitting their job due to discrimination.³ While surgery is a specialty where discrimination and harassment concerns have been well documented, these issues have not been explored widely among anaesthetists.

In addition to the newly elected and co-opted anaesthetists in training on College Council there are a number of other individuals who, through their roles within the College, work directly on behalf of anaesthetists in training.

As your new elected anaesthetist in training (AiT) members of the Bulletin’s editorial board, we would like to welcome you to the AiT edition of the Bulletin. We're very excited to be taking over from Dr Susie Thoms and Dr Soumen Sen, and would like to thank them for their excellent work with both the Bulletin and The Gas Newsletter in recent years.

Looking at the current landscape, we wanted to touch on a few issues that we have recently been discussing within the College’s Anaesthetists in Training Representative Group and its Anaesthetists in Training Committee.

Authors:

• Alessandra Anzante, Employment Lead, RefuAid
• Dr Siân Jaggar, Cardiothoracic Anaesthestist, Royal Brompton Hospital
• Maria Burke, RCoA Global Partnerships Manager

World events have seen record numbers forcibly displaced from their homes – currently estimated at 103 million people.¹ According to the Refugee Council, in the 3^rd Quarter of 2022, 24,511 applications for asylum were made,² an increase of 58.1% on the previous quarter. Government statistics tell us that in 2022 74,751 asylum applications were made (relating to 89,398 people).³

A study by Deloitte in 2017 surveying Syrian refugees in Europe⁴ found that 38% of respondents were university educated, but that despite this 82% were unemployed. It highlighted language as being one of the biggest barriers to re-entering employment, despite 63% of those surveyed wanting to continue their careers in the professions for which they had trained in their home countries. In the case of anaesthetics (and medicine as a whole), there are significant challenges for them in entering UK practice.

We would like to use this Bulletin article to focus on setting up a Personal Development Plan (PDP), some guidance on what should and should not get included, and to address a query about using your PDP in the Lifelong Learning Platform. In providing this advice we are making reference to the Mythbusters¹ guidance which has been produced by the Academy of Medical Royal Colleges.

The goals within the PDP should be taken from your appraisal, and should meet your needs and the context within which you work. It is recommended that goals are developed with your appraiser using SMART (Specific, Measurable, Achievable, Relevant and Timely) objectives, and it often helps to work out how you can demonstrate that a change planned as one of your goals has made a difference, by considering its impact on patients.

I have recently been offered a role as a specialist anaesthetist. This is the final stage of my career pathway. To most, becoming a consultant is the final stage. To those not on the trainee pathway, the goal is to become a specialist.

The introduction of the specialist grade in April 2021 has finally given SAS doctors a new genuine career progression opportunity. This contract allows experienced anaesthetists to have a role that recognises the value we bring to our departments. Although this is a very new role, many trusts have created specialist anaesthetist posts that offer a fair and balanced job plan.

I will have started in my new role by the time of publication of this article. The agreed job plan is very different to the role that I currently have. I will be working on a variety of elective, urgent and emergency lists in a range of specialties in a major trauma centre. My employers have been very understanding about my family situation, and have agreed to keep my days fixed and close together so that time away from home is minimised.

As I sit down to write this article, I am very much aware that today is the anniversary of the death of my mother. A strong-minded, intelligent and, above all, proud woman, her greatest fear as she became increasingly physically frail was a loss of dignity, something she had witnessed in the slow demise of her own mother.

From middle age onwards, she wrote me detailed letters describing what she would and would not tolerate as she got older, and instructing me, the only doctor in the family, to do everything possible to help her to die peacefully when the intolerable became manifest. Sadly, the law forbade such measures and, despite receiving excellent care in her failing years, she suffered much of the indignity that she most feared before passing.