MRCP 1 EXPERIENCE

WHAT IS MRCP UK

MRCP is a postgraduate Diploma which is designed to test the skills, knowledge and behaviour of doctors in training. It consists of three exams.

1. MRCP Part 1 written.

2. MRCP Part 2 written.

3. MRCP Part 2 Clinical (PACES).

In this blog, I will only focus on MRCP Part 1.

MRCP PART 1 FORMAT

The exam consists of 200 MCQs in total. There will be two papers with a break of 1.5 - 2 hours between them. Each paper is 3 hours long and contains 100 MCQs. All the details about the exam are available at the official MRCPUK website.

EXAM FEE

MRCP Part 1 takes place all over the world.  The fee is 419 GBP if you are taking it in the UK and 594 GBP if you are taking it outside the UK. 

EXAM DATES AND BOOKING

This exam takes place 3 times a year. January, May and September. The booking window for these attempts open in October, February and June respectively.

PRE-REQUISITES 

The only condition to take the exam is that you must have a 12-month post-graduate experience. So, you can take it any time after completing your housejob.

FEW TIPS

If you are a recent graduate and wish to work in the UK but are stuck in PLAB exams due to COVID situation, this would be the ideal time to start preparing for the January 2021 attempt of MRCP 1. Even if you find a 3-4 months gap at any time before starting to work in the UK, MRCP 1 would be the best idea. Why? Because:

1. We usually forget many important things and principles that we had learnt in medical school because we didn’t integrate those concepts with our medical practice, MRCP 1 provides the best opportunity to revise all basics that are actually used in clinical practice hence giving an added advantage from the very start of professional life. 

2. If you prepare or take MRCP 1 in time, it will benefit you in PLAB1, PLAB2 and even in securing a job in the UK, having said that you shouldn’t delay your PLAB exams for it. 

3. When you come to the UK it takes a considerable amount of time to understand the NHS system and your job feels way more hectic in the beginning as compared to a job at home and you can’t give as much time to your study as you can in your country.

MY PERSONAL EXPERIENCE

One resource if you know 100% gives you more chances to pass the exam rather than 2-3 resources which you know 50-70%. For part 1, the only Q bank that is necessary and the one you can’t afford to skip is Passmedicine. Give it 3-4 reads and you can easily pass the exam. Now the strategy I would recommend to prepare for it is: 

1. Take an online subscription. (Only 40 GBP fee for a 6 months subscription, up to date, helps in better concentration as compared to books for which publishers just change the year on the outer-cover).

2. Make notes from the online subscription. 

3. If you will start making notes on the register it will take months, search ‘Suda notes’ on google chrome, download them and print them. They are word to word copy of 2012 Passmedicine in a better and arranged topic wise manner. Just make the changes on these notes according to updated Passmedicine and your own notes will be ready in a very short time. 

4. Revise them and now you’ll just need to do questions from Q bank and you won’t need to read explanations, imagine how fast you’ll finish Q bank in revisions while reading from Suda notes. 

5. Some seniors also mentioned other Q banks like 'PassTest' and 'OneTest'. If you have time, you can do CVS, CNS, GIT and Endo portion from them. I had no time so I didn’t do it.

6. One extra resource that I came to know at about 11 pm the night before exam day was MRCP official website 200 pattern MCQs. I could only attempt 10-15 and I guess I got 2-3 questions out of those in the real exam. 

7. One last thing regarding the timeline is to find out booking dates for your exam and aim that the day you submit your fees, you should have done at least 80% of your first read. After fees closing date there are usually close to 3 months in which you can complete your preparation in the best manner possible. 

P.S. After graduation all exams are taken with a job so don’t think of quitting your job for any of the exams.

COMMON MISTAKES IN PLAB 2

MY PERSONAL EXPERIENCE OF PLAB 2

In my last post, I explained the basics of PLAB 2 in the simplest way possible. Now I am going into a bit deeper detail, throwing light on common myths and mistakes in PLAB 2 and tips to cope with them. It can be really helpful for the candidates who unfortunately failed their PLAB 2. But if you have not started preparing for PLAB 2, it’s natural that many of you guys won’t be able to apprehend it at the moment. My message to everyone is to go through this section again, once you have taken the PLAB 2 academy course. It will make more sense then.

COMMON MYTHS AMONG CANDIDATES

1. “All 3 sections of the station are judged independently.” There are 3 basic sections; data gathering, management and inter-personal (IP) skills. I’ll add another one here “time management”. Contrary to what other people say, I strongly believe that all four of them are highly interconnected and performance in one area will definitely affect your other sections. Just look at this picture: 

The white area in the middle represents your score. In order to succeed, you have to be an all-rounder. If your IP skills are weak, you will never get good marks in data gathering and management no matter how good you are in them. Similarly, if your IP skills are strong but you lack clinical knowledge, you will never get 4/4 in IP skills no matter what. Conversely, if you are good in all three of them but you don’t finish your station in time, there are chances you might still fail. BE AN ALL-ROUNDER!

2. “PLAB 2 is not a test of your knowledge, it’s a test of how you deal with patients” Partially contradict it. If you don’t have proper knowledge, how are you supposed to give proper consultation to the patient? For example, there is a pediatrics station in which a mother comes to you with her baby having tonsillitis. Now, if you don’t remember the ‘indications of tonsillectomy’ I assure you there is a high likelihood that you will never pass that station no matter how good your dealing with patients is. 

3. “If a patient is happy with you at the end of the station, it means you have passed that station and vice versa” Absolutely incorrect. You will only pass if you have completed the task of the station regardless of the patient's attitude. For example, in my exam I got a station in which a lady had attempted a suicide by ingesting dozens of paracetamol pills; my task was to take relevant history, take blood sample (from a mannikin) and then manage the patient. I was sure I was going to fail that station because the lady did not cooperate at all (that was her role) but I passed anyway because I had completed the task. In the same way you can fail a station if you made your patient happy but didn’t complete the required task.

 4. “If a patient does not want to talk, keep silent” There was a funny myth in our academy that once a student went into the station and the patient didn’t want to talk so, he kept silent the whole 8 minutes and when the result came, he had got 12/12 in that station 😛 All I can say is:

Look if a patient is not willing to talk, give him time, say words like “There is no rush, please take your time”, if he is crying, offer tissue, water etc. But you can’t afford to lose more than 1 minute in silence. Proceed with “I know you must be going through a lot, but I need to ask a few questions that might allow me to help you in a better way” and proceed with your task.

5. “You can still pass a station if your history taking was good but you made the wrong diagnosis.” You cannot pass that station, as simple as that. You will definitely get zero in management, 1 or 2 in data gathering (I am saying it because of my personal experience). In PLAB 2, you have to rule out all the differentials by your data gathering and give ONE SINGLE diagnosis to the patient and give him a management plan accordingly.

COMMON MISTAKES IN PLAB 2

1. “Time management” This is undisputedly, the most common cause of failure in the exam. Ask anyone who failed the exam, the most common answer will be, “I gave too much time to history taking and that left me very little time for clinical management.” A senior once said to me, “We Pakistanis have never been taught to take a proper history, so when we finally learn it, we get so excited that we unintentionally give all our time to history taking.” In my exam, there was a station of GCA (giant cell arteritis). Patient had vision loss. I had made my diagnosis in the 2nd minute when I asked her if it hurt when she combed her hair and chewed food and she said yes. But just to look cool in front of the examiner, I asked questions to rule out every single cause of vision loss on earth which took me too long. I had to do fundoscopy as well, which I did. In the end, I didn’t have enough time to talk about management plan. When results came, I had got 2 in history taking, 1 in management and 3 in IP skills. Even though I had taken such a long history, the examiner still gave me just 2/4. Why? Because I asked irrelevant questions and wasted time.

SUGGESTION: Try to finish history within 3-4 minutes. Be precise and concise. Try to start talking about clinical management as early as possible as it will allow your patient to ask more and more questions, hence more chances for you to score better in management and IP skills.  If you haven’t started management and the 6-minute bell rings, just leave everything and move on to management. 

2. “Too much and too little attention to IP skills and clinical knowledge, respectively” When we start our PLAB 2 preparation, the majority of us have good clinical knowledge but very little IP skills because we have never been taught that way. So naturally we start paying too much attention to IP skills and ultimately it destroys the balance between these two and ultimately leads to failure. Many times, our teachers tell us to not stick to notes too much and be natural. I personally am not in accord with this. I believe that we can stick to notes and still be natural as well. It’s all about practice.

SUGGESTION: Study your notes by heart. Keep your clinical knowledge updated. If you have enough knowledge, you will naturally feel at home with the given station and naturally in a position to answer patient queries in a better way. Having good IP skills is always a blessing. It does compensate for our lack of clinical knowledge a bit but it really can't compensate for lack of “basic” knowledge. Like I said earlier, if you don’t remember ‘indications of tonsillectomy’ in tonsillitis station, you will probably never pass it no matter how good your IP skills are.

3. “Fast Speech” A very common mistake among Asians, especially Pakistanis. I think we naturally have a fast way of speaking. Sometimes, if a station is long, we automatically start speaking fast so that we can complete the station. It’s a bad habit since we just keep talking and forget to listen to the patient. The examiners over there are very expert, they pick this up and cut our marks for being unprofessional.

SUGGESTION: Speak slowly, of course. While practicing with your colleagues, record yourself and listen to it later. If the station is long, try to be concise and precise instead of rushing through it. Listen to the patient carefully like you mean it. If a patient feels comfortable with you, he will literally help you with the station. For example, there was a TIA station. I finished the station in 7 minutes. The patient then asked, “Doctor, do you think I should drive?” And I said, “Oh, I am glad that you asked that question, I was just coming to that.” (I literally had forgotten that I had to forbid him from driving and tell him to go to DVLA, but he helped me with that himself.)

4. “Overconfidence” Another common reason for failure. Many times, you see people who did great in mocks, fail in the real exam and people who performed awfully in mocks, clear the exam. Doing good in mocks is a great feeling, it gives you good confidence to sit in the upcoming exam, however, there is a very thin line between confidence and over confidence, and if your cross it, it can lead to devastation. On the other hand, people who under perform in mocks can assess their weak areas in a better way and if they take the critical feedback constructively, they can easily turn the tables around in real exam. 

SUGGESTION: Even if you are doing good in mocks, always go to your teachers and inquire them about your feedback. Ask your colleagues as well. Don’t get too chilled, little anxiety is always good for a good performance in the exam.

5. “Bad stations'' Everyone has some favorite stations and some “bad” stations. Sometimes we hate those stations so much that we don’t even bother to get better at them. We are like, “There are more than 350 stations, leaving just a few ones won’t be such a bad idea.” But hey, I swear it is. 😛 There is an obstructive uropathy station, in which you have to take history about BPH, pass Foley catheter and tell management plan to patient. I hated that station to my guts, because unlike in Pakistan, urinary catheterization is a very technical procedure in the UK. It came in my mock and I failed it. Still, I didn’t bother to learn from my mistakes. Ironically, it came in my real exam as well and as soon as I entered the room and saw the apparatus, I knew I was gonna fail that one and I did, miserably. 

SUGGESTION: Like they say, “Keep your friends close and your enemies closer.” Enough said 😀

BOTTOMLINE

PLAB 2 is a very subjective exam. Sometimes it makes no sense because we pass the stations in which we performed miserably and fail the stations which we thought we put our best performance in. Remember, it is a competitive exam. If a station is difficult, it will be difficult for all 71 other candidates and if it’s easy, it will be easy for everyone. In order to pass you have to be “better than the average”. In my exam, the chief examiner spoke to us just before we were entering the hall. He said, “We want just three things from you. Safe doctors. Doctors who listen. Doctors who don’t judge.” And I think that’s the essence.

PLAB 1 STUDY GUIDE

PLAB 1 BASICS AND STUDY GUIDE

PLAB 1 is a written exam made up of 180 multiple choice questions which you must answer within three hours, which makes it essentially 60 seconds for an answer. Each starts with a short scenario followed by a question. You need to choose the right answer out of the five possible answers given.

BOOKING FOR PLAB 1

Before you book a PLAB exam you must have:

1. Primary Medical Qualification - ie MBBS final year result in our case.

2. IELTS/OET results

3. GMC Online account - to book or cancel the exam.

To make a GMC Online account you additionally need to provide:

4. Valid Passport (many applicants don't realize that they need a passport to book PLAB 1 and end up having to struggle to get it made in time)

You will be assigned your GMC reference number once you have completed the setup process. You will be sent an email regarding PLAB exam venue, date, time and instruction that you need to print out and take with you on exam day.

PLANNING TO BOOK PLAB 1

IELTS takes roughly 2 weeks to publish their results and OET tends to take 7-10 days. Overseas closing dates for booking PLAB 1 close usually 1 month before the exam. It is better to book at least 2 months prior to the test date of the PLAB 1 exam date.

EXAM COST

Part 1 of the PLAB test:

£239 from 1 April 2020 (subject to change) which, at the time of writing this article is approximately PKR 49,200.

CANCELLATION FEE

Over 83 days before the exam - No cancellation fee

Between 83 and 57 days before the exam - 50% of the fee paid

Less than 57 days before the exam - 100% of the fee paid

RESULTS

Your results will be available six (6) weeks after you take the exam.

You'll be sent an email to access your results in the 'My Tests' section of GMC Online.

WHAT IF YOU FAIL?

If you fail PLAB 1, you can book to take the exam again provided you still meet all the requirements. You can attempt the exam a maximum of four times. You can not apply for a re-check, however, there seems to be a way to appeal the exam results but that is unheard of anyone actually ever going for it.

EXAM DATES

Unlike previously, when PLAB was held twice a year in overseas centers, Pakistan now has 4 sitting in:

March

June

September

November

They are held twice in Islamabad and twice in Karachi. Available dates can be seen when you book PLAB 1 from your GMC Online account.

SCORING AND PASS RATES

Each correct answer is worth one mark and the total number of correct answers will be your score. They will publish your total score, the score required to pass the exam and the average score for all candidates. They will also tell you the percentage of the questions you answered correctly in each of the three domains.

Pass marks are set after each exam according to the difficulty and how candidates respond to questions. Over the years, it tends to stay in the range of 115-125, but some exams have pass score as high as 134 and as low as 108. Overall, you don't need to worry as it is relative to how candidates perform and only a set percentage of candidates pass. Recent pass rates are as follows:

2015 69%

2016 72%

2017 76%

2018 69%

2019 64%

DIFFICULTY

PLAB 1 is the easier especially when compared to PLAB 2 or even IELTS writing for some people. However, the exam difficulty has been creeping up every sitting. Instead of the one liner questions testing basic recall, they are more focused on paragraph sized scenarios and including a plethora of ethics and medical practice guidelines of the NHS.

Your scores especially two people with exactly the same preparation can vary wildly depending on their background knowledge during MBBS, but again, you only have to pass the exam and I really haven't heard anyone out of my colleagues or friends who failed the exam.

DURATION OF PREPARATION

PLAB 1 can be prepared in less than a month. You might even want to take 3-4 months to prepare depending on how much time you have. Ideally, for someone not working. 1.5 months is enough. For someone even with hectic duties during house-job, it is easily doable in 2 months.

STUDY MATERIALS

DO NOT, I repeat, DO NOT go for the conventional approach of going through a textbook cover to cover. OXFORD HANDBOOK OF CLINICAL MEDICINE is your friend only to look up if you really did not cover a topic in MBBS properly or you need to understand a topic. I never opened it up once though, and as mentioned below, you have better options when you are unsure about a particular topic.

Start with a good question bank. PLABABLE (https://plabable.com) is the gold standard of preparation. You may have heard of Dr. Khalid's 1700 questions, Unity Qbank, Plabzilla 1700, Samson Banks etc. I have seen all of those offline banks and essentially they are all the same. All of them are the modified versions of 1700 questions but PLABABLE is ONLINE. All answers are verified and correct with occasional links to published guidelines. They also update their question bank with themes from latest exams. Having said this, DO NOT waste time on any offline bank as they all are included in plabable and often they have very little explanations and lots of mistakes. . Also, PLABABLE is dirt cheap, 20 GBP for 3 months and 25 GBP for 5 months. You can also take random timed mocks from within their bank for practice. Many new PLAB takers also swear by PLAB1KEYS Online Qbank (https://www.plab1keys.com) They are also constantly updating.

If you have extensive time more than 3 months, you can try PASSMEDICINE PLAB Part 1 Qbank, but I'd suggest that would be overkill, and if it comes to that, you might as well buy MRCP Part 1 Passmedicine Qbank and start attempting it if you have too much time.

If you need to quickly look up a topic:

https://patient.info/

https://www.nhs.uk/conditions/

If you have to look up a detailed explanation of a topic that you have no background of:

Oxford Handbook of Clinical Medicine / Specialties (latest edition)

https://www.gmc-uk.org/-/media/documents/plab-blueprint_pdf-65021787.pdf

This is the official link from GMC for PLAB 1 topics. They vary the pool every year but just give it a quick glance and click on the Psychiatry and Ethics topics to give you a list of conditions that they expect you to know. As in MBBS, we do not really dwell deep into psychiatry and ethics questions as it makes up only 2-3 questions in our profs.

Mock Tests and Clinchers

To Practice your timing, give PLABALE Mocks, it uses the questions already in the bank.

Offline mocks are outdated and often incorrect, only attempt them with a partner so you can discuss at the end. They can be found in many plab groups. One link I used is this one https://drive.google.com/drive/folders/1CM1OOuisp0eUUqtM1ZBBH6KU6sWjf5D2

Do as many mocks as you need to feel confident and prepared for exam

Use one of these clinchers to give a rapid revision in an hour or two on the last day https://drive.google.com/drive/folders/1-MOIRjEFtrtiT_JHPOUZFTB_OPANgWNh However, I advise you to attempt your question bank and make your own points, one liners and important tables or charts or mnemonics as you go through the questions you get wrong.

Here are some sample questions from GMC https://www.gmc-uk.org/registration-and-licensing/join-the-register/plab/plab-1-guide/sample-questions

Study Partner

This is more useful than many think. I have never in my life studied with a partner, but I started studying with Dr. Rafay since final year MBBS and it changed the whole experience. Study a topic, do a mock, ask each other questions, teach each other what they don't understand. Once you teach something to someone, you never forget ! Use only 1 partner that is of similar temperament. For some people, they like Facebook group commenting and whatsapp groups. Feel free to experiment, but do not despair if people know more than you. focus on your weaknesses only.

My Experience

I prepared twice for PLAB 1, as the first time around it got cancelled in Islamabad center due to political lockdown. We were transferred to the next diet.

First time, I had around 2 months to prepare. I started directly with PLABABLE. Did 50-100 questions a day, half in the mornings, half at night. I was very strong in internal medicine, so I focused more on other specialties, taking one liner notes and important points in a notebook. Made it concise so I could revise in 4-5 hours on the last day. Flag any question you get wrong and any question you got right but do not know the logic to. Read up on NHS guidance or patient.info

Our exam was very DIFFICULT compared to previous years, all of a sudden we had questions in exam that were paragraphs long, 5-6 questions only on warfarin and many questions on ETHICS, MEDICOLEGAL, CONSENT, MISTAKES, and PHARMACOLGY. Focus on those questions and read all links given in ethics and psychiatry sections of plabable. This will also help you later in PLAB-2.

The first time Plabable took 1-1.5 month as I did lazily, then I attempted all the flagged questions and removed the flags from the ones that I remembered, so less flags now. Last 15-20 days, attempted a lot of mocks. The offline mocks were a nuisance as many keys were wrong, we then went for plabable mocks and revision of flagged questions. Last couple of days reviewed my notes.

Then exam got cancelled and the 2nd time around, I took only 20 days to prepare. Plabable flagged questions and specialties I was weak in followed by more mocks and little revision of my notes. By the end I had gone through PLABABLE so many times I could attempt a 3 hour mock in like 50 minutes or so. The exam was difficult but everyone I knew still passed. Never in my life I was short of time in an exam, but I randomly ticked a few answers on the last minute. So I would suggest attempting mocks as much as you can. Tip : fill your bubbles on answer sheet directly. DO NOT waste time and leave the bubbles till the end.

Reach at least a day or two before your test to Islamabad or Karachi, rest adequately, you can only take water in a clear bottle, a snack in a clear pouch, pencil, eraser, sharpener.

Do not forget your ID ( CNIC or passport or driving license), your GMC email photocopy which mentions your gmc number and exam booking confirmation.

PLAB 1 is easy, but you need to be prepared as they are slowly increasing the difficulty and time management is crucial. We'll add study materials and experiences of recent test takers if you guys want. Let us know in the comments if you have any questions.

PROS AND CONS OF NHS

PROS OF WORKING IN NHS

1. TRAINING You are always supported clinically till you become a consultant. You always have a clinical and an educational supervisor attached to you who will be around you when you are working in the hospital, hence the burden of responsibility will always lie more on them, rather than you. In order to progress your career within NHS, you will need to get your competencies signed from your supervising consultant at each level and unlike back home, where you can get away with almost anything, it’s not the case in UK, because your supervisor will be held responsible for your work in the future. He will only sign the competencies, if he feels you have gained enough experience and skill and are competent enough for the job. Ultimately it all leads you to become a better clinician in future. Secondly, working in NHS not only makes you a good doctor, but also a better human being (ethically speaking). This becomes evident when you are preparing for cases like ‘Breaking Bad News’ or ‘Managing Angry Patients’ during PLAB 2.

2. EDUCATIONAL SUPPORT The trust provides you a study budget for the exams (even up to 600 GBP per year) to write post graduate exams like MRCP.  They also allow paid study leaves for your exams. They encourage out of training educational programs to widen your educational and teaching experience.

3. ADEQUATE SALARY Junior doctors have an annual salary package of 32,000 to 38,000 GBP. You do the math now. Senior doctors earn around 51,000 to 74,000 GBP and consultants earn around 100,000 GBP

4. EXTRA BANDING 7pm-7am time is called ‘non-social hours.’ So, if you are performing duties during this time period, you will get banding (up to 10-20% compensation) depending on your program and contract.

5. LOCUM MONEY You can earn extra money by doing locum duties. A senior once told me that he doesn’t usually do locums, but whenever he has to plan a visit Pakistan, he does two locum shifts during the weekend and voila, money arranged for the return tickets. (Avg Rate: 40 GBP per hour, you do two 8-hour duties at weekend and get 640 GBP or PKR 130,000) 

6. WORK-LIFE BALANCE Rota is really well balanced, let's say you have worked 3 nights in a row, next 2 days will be rest days. The maximum working limit is 48 hours/week. If you work extra, you’ll be paid extra but even then, there is a limit on that extra work.  You want less work, more party? Join NHS. You want more work, more money? Join NHS.

7. SOCIAL LIFE UK is small. The distance between London and Glasgow which are two extreme ends of UK is just 412 miles which can be covered in 7 hours on car. What I am trying to say is that if you have a car, you can always hang out with your desi friends (residing in different cities) whenever and wherever you want. 

8. EASY TRAVELLING A direct flight from UK to Pakistan only takes 7-8 hours. So, you can always come back in no time, in case of any emergency or in case your mother finds a dulha/dulhan for you. Don’t smile, teri nai hone lagi. 

CONS OF WORKING IN NHS

1. WORKING IN DIFFERENT CITIES This is, in fact, the only negative aspect in my eyes. You have to keep moving from one city to another depending on your job. Let's say for aspiring physicians, you'd shift from non training job to 3 years IMT training then to ST training in your desired specialty and then find another job as a consultant. However, you can keep working in the same city if the deanery over there has abundant vacancies.

2. HIGH LEVEL OF ACCOUNTABILITY This one is not a real con actually but for desi doctors like us, it may be. Let me explain, according to a report from The Guardian, NHS paid around 2.63 billion GBP in negligence claims in 2019. Patients can sue doctors on things which we can’t even imagine in Pakistan. For example, a patient can sue a doctor if he disclosed his diagnosis to his family without taking permission from him first. This is called ETHICS. Sadly, in Pakistan, Medical Ethics is only found in 4th year books of Community Medicine. Another time, a friend of mine told me that a doctor got his GMC registration cancelled because she used parking card of her handicapped sister while parking her car outside a market.

3. HIGH TAXES AT SENIOR LEVEL There is a 25% tax on junior doctor’s pay which can go as high as 40% when you progress to higher levels in career. But even that 40% tax won’t be applied on all of your salary, it will only be triggered if you start earning above a given threshold. Let’s say you make 100 quid a month, you won't be taxed for the first 50 quid, then 25% for the next 30 and 40% on the last 20 quid. So, the higher taxes are not on the whole income, rather they apply to the amount that goes beyond the threshold only

PLAB vs USMLE

PLAB vs USMLE

This is the most featured question put by the juniors to PLAB-oriented seniors, “Bhai PLAB better hai ya USMLE better hai.” The answer is complicated. I personally think it depends on how we define the criteria for being “better”. If it means having the best training in the world, sure, nothing beats USMLE, however, if you want a balanced lifestyle with loads of pounds, put on your royal armor and march onward with your golden horse to Buckingham Palace (Or you could always take a flight😂). Secondly, and more importantly, your personal circumstances matter, so choose wisely. Here is a comprehensive comparison:

VARIABLES	USMLE	PLAB
IELTS/OET	Not required	Required (Clearing IELTS/OET itself is relatively more difficult than passing PLAB1)
LEVEL OF EXAM	Difficult Only 1 attempt Scores matter	Easier  Multiple attempts Scores don’t matter
PREPARATION TIME	Depends largely on your clinical knowledge. 8-14 months for STEP 1  4-6 months for STEP 2 CK 2 months for STEP 2 CS	3-4 weeks for IELTS/OET 2 months for PLAB 1. 2-2.5 months for PLAB 2
WHEN CAN YOU TAKE EXAM	Anytime during/after graduation	Only after graduation
COST IN TOTAL	PKR 25-30 lac	PKR 8-10 lac
PAY AT YOUR FIRST JOB (AFTER TAX DEDUCTION)	Avg 3500 USD/month (PKR 550,000)	Avg 2800-3000 GBP/mo (PKR 600,000) 💷
FIRST JOB	Training job	Most probably non-training job
WORKING HOURS IN JOB	Avg 80 hours/week	40-48 hours/week
LOCUM JOBS	No	Yes (30-50 GBP per hour at junior level)

COMMON MYTHS AMONG KEMCOLIANS

1. UKMLA IS COMING AND IT’S BAD Firstly, nobody knows for sure when it will come into action. GMC has been giving tentative dates for this since 2015. The latest expected time for its arrival is 2023. Secondly, contrary to what medical students might think, I personally believe that it will open new doors for immigrants and further increase their chance for getting into specialty training. See, locals do not take PLAB, only we do. But according to GMC, UKMLA will be necessary for all the graduates, locals as well as immigrants, to obtain their GMC registration. Hence, increased prospects for us.

2. THERE ARE NO JOBS IN UK According to a recent survey, UK has the second lowest doctor-to-patient ratio in Europe, so there are plenty of jobs here. To have a brief idea, just visit www.jobs.nhs.uk.

3. UK TRAINING PATHWAY IS WAY LONGER THAN USA It might be longer but it certainly by no means is “way longer”. In reality, it depends on many factors i.e., what specialty you want to pursue, when you are taking the royal college exams, if you are clearing the exams in first attempt, if you are getting your competencies signed in time, if you are taking any breaks during your training. In most of the cases, it takes around 6-8 years to become a consultant from start of your first non-training job.

4. THERE IS TOO MUCH TAX IN UK There is around 25% tax on junior doctors’ pay. After deduction of this “too much tax” if you are still earning 3000 pounds (aka PKR 600,000) per month in your first non-training job, I don’t think it’s a bad deal by any means (And I am not even including the locum money here). Having said that, the tax structure is UK is built in such a way that the higher you earn, the higher the taxes. So, the wages of consultants in UK seem relatively smaller than those in USA. May be that’s why many consultants come back to Pakistan after completing their training. 

5. THERE IS NO SAVINGS IN UK It depends on where you live and how you live. For example, in London, everything including accommodation, commuting and food is expensive, hence, you’ll be having very little savings. On the other hand, working in small county like Durham will result in plenty of savings. 

SUMMARY

After aforementioned discussion, one might think of UK road as a fairy pathway. Theoretically speaking it is, but the ground reality might feel a bit harsh. For example, following recent trends, after clearing PLAB and getting GMC registration, it’ll take months for you to get your first job in UK. Exceptions, however, are always there. I have also seen people getting jobs within one month of their GMC registration but usually it takes around 5-6 months. (We will discuss it in detail in another post and also put light on the factors which can enable you get the job as early as possible).