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by Jon Sturman,

Clinical Director of Critical Care, North Cumbria.

MTI stands for Medical Training Initiative and is one way of allowing overseas doctors access to training in the UK. Applicants should have at least 3 years’ postgraduate clinical training and possess a postgraduate medical qualification – see MTI sections in the RCOA and RCP websites for more information on this. Application is facilitated by the Colleges to help with GMC registration and hospital trusts’ sponsorship on a tier 5 (2 year) visa.

MTI doctors must have an educational supervisor, consultant supervised work at least 3 sessions per week and an annual ARCP like process. They should not form more than 25% of a deanery trainee rota and posts must be approved by the local postgraduate dean and college. Candidates can either approach a trust direct or through the relevant College, in the latter case the College may facilitate a matching process for trust and doctor.

MTI can be mutually beneficial by providing high quality training for overseas doctors to take skills to their health service and also supporting UK trainee numbers. There is a recent move to prioritise certain countries’ applications in recognition of the areas need. The visa process can be a long one and a time of at least 6 months set aside between appointment and an MTI doctor being ready to start UK work. A period of orientation to the UK and NHS should be planned for and unsupervised/on call work delayed until a mutual evaluation of progress and competency made at a departmental level. It is particularly useful to understand what skills or experience the doctor wishes to acquire in the 2 years to benefit on their return home.

Intensive Care is structured and staffed differently around the world and this should be borne in mind both in terms of recruitment and capability to work in a position. Potential candidates may have anaesthetic or physician backgrounds and this should be considered.

Our experience in North Cumbria has been very positive with our trainees integrating well, both with the NHS and their colleagues. They have had exam success, taken part in quality improvement and some have published papers. All have access to study leave mirroring that of speciality trainees. We have recruited both anaesthetic and medical MTIs. All anaesthetic MTIs rotate through the ICU at least once in the 2 years (mirroring that of an ST3-7 trainee) and some with special interest in ICM have had longer ICM modules. Medical MTIs have rotated between ICU, acute and speciality medicine according to their career aims.

In summary, MTI represents an excellent opportunity for experienced doctors from abroad to learn from UK critical care practice.

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Useful links

Royal College of Anaesthetists Webpage 

Royal College of Phycisians Webpage

MTI – A Personal Perspective

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