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Orianna2000
02-27-2018, 03:46 AM
My MC is an American woman who's studying medicine in London, modern-day (no earlier than 2014). I've done as much research as I can on this, but I'm running into some confusion. She got there on a student visa, which according to my research, means she had to prove she had enough funds in the bank to pay for all expenses for the next year, at least. (I'm not sure if she needs to have funds for more than one year at a time, the government site I read was unclear.) So, she'll either earn a scholarship or get a student loan (assuming that's allowed on a student visa? Again, it was unclear.) When the story begins, she's a junior doctor, first year.

Questions:



Do you still need a student visa once you're a junior doctor, completing your residency? (I think it's not called a residency in the UK. Still trying to sort that out.) You're a doctor, but minimally. You're getting paid, though, so does it switch to a work visa? Or some other kind of visa?




Does your hospital ID badge say that you're a junior doctor? Does it specify which department you're currently working/studying in?




Does a psychiatric rotation need to be completed at the main teaching hospital? (She's studying at St. Mary's/St. Bart's, assuming I remembered those names right.) Or can she go to an outside facility for that? I wanted it to be an independent psychiatric hospital because there's a hostage situation that would be much more difficult to pull off if it's in a psych ward, rather than a psych hospital.


I will probably think of more questions later. . . . :)

cornflake
02-27-2018, 05:41 AM
My MC is an American woman who's studying medicine in London, modern-day (no earlier than 2014). I've done as much research as I can on this, but I'm running into some confusion. She got there on a student visa, which according to my research, means she had to prove she had enough funds in the bank to pay for all expenses for the next year, at least. (I'm not sure if she needs to have funds for more than one year at a time, the government site I read was unclear.) So, she'll either earn a scholarship or get a student loan (assuming that's allowed on a student visa? Again, it was unclear.) When the story begins, she's a junior doctor, first year.

Questions:



Do you still need a student visa once you're a junior doctor, completing your residency? (I think it's not called a residency in the UK. Still trying to sort that out.) You're a doctor, but minimally. You're getting paid, though, so does it switch to a work visa? Or some other kind of visa?




Does your hospital ID badge say that you're a junior doctor? Does it specify which department you're currently working/studying in?




Does a psychiatric rotation need to be completed at the main teaching hospital? (She's studying at St. Mary's/St. Bart's, assuming I remembered those names right.) Or can she go to an outside facility for that? I wanted it to be an independent psychiatric hospital because there's a hostage situation that would be much more difficult to pull off if it's in a psych ward, rather than a psych hospital.


I will probably think of more questions later. . . . :)

I'm confused by some stuff in the q., and don't know much about UK med school specifically, so some of this may be off, but know some about studying abroad so might be helpful a little?

For London, you need to prove you have the $$ up front for a year of tuition, living expenses, books, your medical fee, etc. I believe there's a specific minimum for living expenses per month. They do a year at a time because that's what the visa is for, you have to re-up.

I'm confused by the junior dr. thing -- has she been through med school in the U.S. and moved to the UK for her residency? That's different, I'd imagine, as she'd be getting paid. If she's in med school first year, she's no kind of doctor at all; she's just a regular student and residency is years off.

Same for the latter q. kind of, do you mean a general med school rotation or do you mean she's studying to be a psychiatrist after med school?

neurotype
02-27-2018, 07:00 AM
Hi there! I was an American student and studied in the UK (not medicine though), so I can help with some of the visa stuff. The visa she would be on is a Tier 4, you can find the actual application for it on the UK Border website.

Americans are meant to have the funds, but they don't need to submit any proof when applying because America is grouped together with other "priority" countries. Every time you re-enter the UK on your visa after home visits, etc. you're supposed to have proof of funds with you, but in four years I was never asked once to show financial evidence. Your application is mainly submission of biometric data (you have to go in and have your fingerprints scanned) which they put on basically what looks like a driver's licence with a chip in. This is your actual visa that they scan at the border crossing, and then they check your fingerprints to make sure it's you.

The rest of the application is mainly just data for the university. You need to get an acceptance from a university (obvs) and they send you a CAS (Certification of Acceptance for Study) letter with an ID number that you use to apply to the visa. The border agent will ask for this CAS when you first use your visa to get into the country.

As for student loans, you cannot receive any funds from the UK for study (unless you manage to get a practically non-existent international student scholarship - they do exist, but they don't usually cover more than a few thousand dollars of tuition). You can, however, get the same US DEpartment of Education loans that American students are eligible for. It works the same way, you just use a foreign university code to apply for the loan.

Okay, as for the actual degree/work stuff. Getting a work visa in the UK is really, really difficult right now. They do have a need for medical staff and I believe at least nurses are on the UK's list of priority work visas for people that want to come and work. The work visa is called a Tier 2 in case you want to look it up. As a student she would definitely do rounds basically of all the different types of medicine and I believe you're right that they get paid. I unfortunately have no clue how that works for international students, but I would imagine the course websites may have some insight into that in their international student sections. When the time comes, you apply for the area you would prefer to work in, so if you wanted your MC to be able to travel somewhere else then she could -- but I believe this is after she graduates and would be working for the NHS full-time (which again, not sure how that would work visa-wise!).

As for psychiatric hospitals in themselves, I don't actually recall seeing many of these. Mental health care is incredibly limited in the UK, especially through the NHS. You'd be more likely to find a big NHS facility with a mental health ward rather a singular building entirely devoted to psychiatry.

Sorry I don't more about the medical stuff, but feel free to message me with additional questions. I do know some junior doctors, so I can follow up with them if you have any further queries!

waylander
02-27-2018, 06:00 PM
Yes, the ID badge gives your name, department and position. First year is Junior House Officer
If your MC is doing a Psych rotation then it could be at one of the district hospitals associated with the Med School Hospital e.g. if she is at St Mary's it could be West Middlesex, Ealing or Hillingdon or at a specialist psych hospital like this one https://en.wikipedia.org/wiki/Maudsley_Hospital
I think it unlikely she would be at a private hospital, unless she was moonlighting with a locum agency for extra cash/experience
My s-i-l is a Consultant at St Mary's and I can ask her. PM me if you need more detailed answers.

P.K. Torrens
02-27-2018, 06:10 PM
I’m a doc working in the UK for a year.

Feel free to PM if you need any clarification.

Psych runs are generally done with a mixture of inpatient and outpatient rotations. House officers only work in inpatient facilities. Residents/registrars will rotate through both.

Terminology has changed a lot in the U.K. residency is fine but the positions are:
Intern = house officer
Resident = registrar
Attending = consultant

Now, they have replaced House officer and registrar with FY1 and FY2 for House surgeon/officer years (FY = Foundational Year)

Registers are split into whether or not they are training or rotating through. Etc

Lastly, I would like to add, mental health is grossly underfunded in every corner of the world, apart from a few enlightened countries. Underfunding is, by no means, limited to the NHS.

Orianna2000
02-28-2018, 06:31 PM
I'm confused by the junior dr. thing -- has she been through med school in the U.S. and moved to the UK for her residency? That's different, I'd imagine, as she'd be getting paid. If she's in med school first year, she's no kind of doctor at all; she's just a regular student and residency is years off.
She did her first few years of college in the US, then moved to the UK for medical school. She's now graduated, so she's a junior doctor, but still has to do her residency, which is called something different there, but I don't recall what at the moment. She's granted doctor status, but since she hasn't done any of the additional training, she's a junior doctor.


Same for the latter q. kind of, do you mean a general med school rotation or do you mean she's studying to be a psychiatrist after med school?
It's part of her residency. You have to work in various departments for several months at a time. For example: surgery, psychiatry, obstetrics, pediatrics, etc. The opening scene takes place when a psych patient decides to hold everyone hostage, so it has to be during her psychiatric residency training. She isn't going to be a psychiatrist, it's just a general part of her education.


Hi there! I was an American student and studied in the UK (not medicine though), so I can help with some of the visa stuff. The visa she would be on is a Tier 4, you can find the actual application for it on the UK Border website.
I read a lot of the information on the official government site, as well as university sites. It helped, but some things were confusing.


As for student loans, you cannot receive any funds from the UK for study (unless you manage to get a practically non-existent international student scholarship - they do exist, but they don't usually cover more than a few thousand dollars of tuition). You can, however, get the same US DEpartment of Education loans that American students are eligible for. It works the same way, you just use a foreign university code to apply for the loan.
Interesting. Okay. I probably won't even address how she's paying for her education, since it's not all that relevant to the story and it looks like it could get complicated.


As for psychiatric hospitals in themselves, I don't actually recall seeing many of these. Mental health care is incredibly limited in the UK, especially through the NHS. You'd be more likely to find a big NHS facility with a mental health ward rather a singular building entirely devoted to psychiatry.
When I looked up mental health hospitals in London, there were several. As far as I could tell, they were independent facilities. And by "independent" I mean they were hospitals specifically oriented for psychiatric care, rather than being regular hospitals with a psych ward. I just wasn't sure about whether she could do her psych rotation there, or if it would have to be at the main teaching hospital.


Yes, the ID badge gives your name, department and position. First year is Junior House Officer
If your MC is doing a Psych rotation then it could be at one of the district hospitals associated with the Med School Hospital e.g. if she is at St Mary's it could be West Middlesex, Ealing or Hillingdon or at a specialist psych hospital like this one https://en.wikipedia.org/wiki/Maudsley_Hospital
I think it unlikely she would be at a private hospital, unless she was moonlighting with a locum agency for extra cash/experience
My s-i-l is a Consultant at St Mary's and I can ask her. PM me if you need more detailed answers.
Thanks! This is exactly what I needed to know, regarding the psychiatric rotation. From what I was reading, junior doctors have a very full work schedule, it's something like 56 hours a week, so she wouldn't have time or energy to work elsewhere. (I think this is insane, personally. I don't want a doctor who's exhausted!)



Terminology has changed a lot in the U.K. residency is fine but the positions are:
Intern = house officer
Resident = registrar
Attending = consultant

Now, they have replaced House officer and registrar with FY1 and FY2 for House surgeon/officer years (FY = Foundational Year)
Wow. This is even more confusing than Wikipedia's page on medical training in the UK. Fortunately, this isn't the focus of the story, so I can gloss over some of this. I hope.

I'll definitely PM some of you if I find I need more detailed info for the story. Thanks!

Oh! Quick question that's slightly related. Registrar. Around here, if someone got married, you could check with the registrar or clerk's office to confirm it. (At least, that's the impression I get, as far as the terms involved.) In the UK, would it be called something different? It seems like it's a medical term, so I'm a bit confused. The scene involves someone accusing the MC of being married. She's not, so she tells them to check the registrar.

waylander
02-28-2018, 07:47 PM
Oh! Quick question that's slightly related. Registrar. Around here, if someone got married, you could check with the registrar or clerk's office to confirm it. (At least, that's the impression I get, as far as the terms involved.) In the UK, would it be called something different? It seems like it's a medical term, so I'm a bit confused. The scene involves someone accusing the MC of being married. She's not, so she tells them to check the registrar.

Nope - same word describes the person who registers births, marriages and deaths and the level of medic below consultant - confusing eh?

Junior doctor's workload used to be greater but is now regulated under the EU Working Time directive. There is still some dissension as to whether this is a good thing.

I don't know about junior medics being referred to as FY1 or FY2. I'm currently visiting our local hospital way too often. I'm assigned to a consultant but frequently see her registrar who is on rotation placement.

P.K. Torrens
02-28-2018, 09:54 PM
I’m a fellow (pre-attending/consultant) in the U.K. and I can tell you it’s definitely FY1 and 2. It’s synonymous and the proper term for “House officer.” Although, to patients, most will introduce themselves as a house officer.
Their badge would say, “Foundation Year 1 Doctor” - at least in NHS Scotland.

Residency = Registrar training. Some still call it residency.

56 hours as per the EWTD but in reality most work more.

In the USA, NZ and Australia, a lot are hitting 70 hours easy. In surgical specialties, you hit 80 most weeks as a resident/registrar.

What’s “official” and what’s actually required are two very different things but I could go on about that :-p

Albedo
03-01-2018, 09:00 AM
Just to make things more confusing, the U.K. training system is pretty close to the Australian (ours evolved out of theirs), but we use the American term 'intern' for what's a first year house officer in the U.K. A second year doctor's a Resident Medical Officer, a third a Senior Resident Medical Officer, unless they've started specialist training (in which case they're a registrar).

And here, only masochists (otherwise known as those who do physician or surgical training) work those kinds of hours. I'll take my cushy GP reg 40 hr week with no overtime for twice the pay, thanks. ;)

P.K. Torrens
03-01-2018, 01:12 PM
*glares at GP 40 hours*

You bastard.

:-p


Just to make things more confusing, the U.K. training system is pretty close to the Australian (ours evolved out of theirs), but we use the American term 'intern' for what's a first year house officer in the U.K. A second year doctor's a Resident Medical Officer, a third a Senior Resident Medical Officer, unless they've started specialist training (in which case they're a registrar).

And here, only masochists (otherwise known as those who do physician or surgical training) work those kinds of hours. I'll take my cushy GP reg 40 hr week with no overtime for twice the pay, thanks. ;)

Tanydwr
03-21-2018, 01:12 AM
Okay, I don't know about the visas, but I actually work with junior doctors, so that's something I can answer!

Firstly, the phrase 'junior doctor' can be applied to anyone below a consultant or Specialty Doctor/Associate Specialist level (the latter are the level below consultants - essentially permanently-employed registrars who have specialised - it's quite common for overseas doctors to come into this grade). However, if you saw anything about the issues over the junior doctor contracts and strikes a couple of years ago, this referred specifically to those doctors at foundation level or on a specialty training track. For this reason, we often refer to this group specifically as trainees.

Others are correct - Foundation Year 1 (also known as FY1 and F1) is your first year out of medical school, and this used to be called house officer. The next year is Foundation Year 2 (FY2/F2) and used to be called Senior House Officer. However, Senior House Officer was also used for numerous other grades of what I personally call 'junior trainees' - i.e. the juniors who have started their specialty training track (Surgery, General Practice, Medicine, etc.) - as well as what are now often referred to as Trust Grades (trust-employed doctors who are not on a specialty training track and therefore not officially classed as 'junior doctors'), which could make it very difficult to identify the level of doctor being talked about, which is why HO and SHO are being phased out. (I mean this strictly - we're actually not allow to use the terms in paperwork any longer, according to Health Education England!)

Strictly speaking, doctors on the first two years of their specialty tracks (i.e. after completing the Foundation Programme) are Core Trainees. Around the third or fourth year of their training programme (depending on the specialty), they would become specialist trainees - which is the old registrar. In practical terms, most people still tend to use the term registrar or reg for these senior trainees.

As to whether a Psych rotation is required at Foundation level, I can confirm that it is not, although it may be offered as one of the tracks. Students can apply for specific tracks on Foundation programmes when assigned to their hospital, and there is some range. At the moment, the only absolute definites tend to be a Medical specialty, a Surgical Specialty, and a GP rotation (in FY2). I can't confirm if they'd be at a separate hospital for the Psych rotation - you might actually be able to find out more info by trying the Postgraduate Medical Education websites for the hospitals in question. Sometimes they'll have information about their foundation courses posted online. I work for a smaller hospital, and our psych-based F1 and F2 are on a ward. Some consultants do have clinics at other hospitals, so if it doesn't require the character being at the hospital on a regular basis, they could be attending an outside clinic with a consultant at a psychiatric facility.

I hope that helps, and if you have any more questions about the admin/education side, please get in touch. It's one thing I can claim to know professionally!

Orianna2000
03-22-2018, 08:08 PM
Tanydwr, thanks! This is so insanely complicated, I think I'll mostly gloss over the technical aspects of what year she's in, what her title is, and all of that. Especially since the terms and details are currently changing for the UK. By the time the story is done, everything might be different!

There's really only two points in the story where her training status might come up. The one I'm most concerned with is when she needs to move from London to Cardiff. I don't know if training tracks are transferable, like, can she move from London to Cardiff without interrupting her training? If not, I'll just say that it's been long enough that she's fully trained and can get a job at the Cardiff hospital as a regular doctor.

Another question. Is there a specific training track for A&E doctors? Or can any doctor/junior doctor work in the A&E? I know here, you can specialize as a trauma surgeon, which would keep you near the ER. Not sure if there's lesser degrees for trauma/emergency care, or if they'll take anyone who's interested.