Trust Grade Jobs (15 May 2024)

SPEAKER_01 0:00

If you enjoy listening to career conversations, why not become a member of the Royal College of Physicians of Edinburgh? Our membership provides you with access to the RCPE educational portal with live evening medical updates, and you have options to view the symposia both in person or online. If you would like to learn more about this, please go to the Royal College of Physicians of Edinburgh website. My name is Dr. Marilena Gianudi, and I am on the TNMC. And today I'm delighted to be joined by Dr. Big Kandasami, a trust grade doctor currently working in West Yorkshire. Big welcome.

SPEAKER_00 0:56

Hello, thank you for having me.

SPEAKER_01 0:58

Thank you for joining me. So the topic of this podcast is to talk our listeners through options for jobs outside of a training post. And I know that you've had quite a lot of experience in that at different phases of your training. So could you maybe start by I guess introducing yourself and telling our listeners what you've done in between your training posts?

SPEAKER_00 1:23

Yeah, sure. So hi ever. My name is Vic Camposal, I'm one of the trust grade doctors in West Yorkshire, currently working in Bradford. In terms of my art training experience, I went through F1, F2, I was permanent mobile, and then did what's now known as an F3, doing a trust grade job in Bradford Royal Infirmary. Did that for a year and then moved on to IMT, and now I'm doing another trust grade job in between IMT 3 and ST4 at Bradford again.

SPEAKER_01 1:53

Thank you, Vic. So can I ask then, why did you decide to go into an F3 post after your F2? And could you maybe talk us through why you chose to do a trust grade job as opposed to just low-coming?

SPEAKER_00 2:10

I knew I wanted to do an F3 post, I think probably in third or fourth year of uni, to be honest. Quite early, I guess. I think for me, basically I was still kind of searching around to know what I wanted to go to training for. Go straight into training from F2. You kind of apply October, November time mob F2. So by that point, I'd only done my F1 posts, one surgical, one A ⁇ E, and one medical, and a couple of months of my medical job. I didn't think there was enough experience for me to know where I wanted to head. There's loads of options I hadn't done yet, such as GP, Ps, obviously, Giny. Now I know realistically, not everyone's going to be able to try everything before they go into it. But I felt there was a couple more options that I wanted to try before making the decision one way or another. So essentially, I think it was a case of nothing really grabbed me to go to training straight away. But having a bit more time to think about it, a bit more experience in different fields. I felt a bit more confident in the decision I was going to make going forward for the next training step. I think in terms of why trust grade rather than locum, I reflected on myself quite sincerely in terms of locoming is good, it gives you more flexibility. But I think over the course of a year I needed the stability of what the medical rotor would give me. Now, maybe if I ended up locoming, I would have been fine and I would have just pulled my socks up and got to grips with you know having shifts booked in six weeks in advance and you know working hard. Knowing myself, I'm sure I would have worked less effectively than I would be on a medical rotor. I would have probably gained more from it. Off the top of my head, I found that there would probably be a few more advantages by doing a trust grade job in one department for a while. Just in terms of bolstering the CV a little bit as well. So there's a few more opportunities that can come your way, or it's slightly easier to make those opportunities by working in a department a bit more consistently rather than locuming on an ad hoc basis. Things like setting up teaching opportunities or doing audits and projects kind of need a relationship with the department to do that. And going in for ad hoc locums, you may be in one department one day, one department the next, maybe two or three days in the same, fair enough. And a lot of consultants might get to know you because you're working in different departments. But I think having one base department where it's easier to establish things and set things up was quite important for me because my CVA wasn't the strongest at the time. And the opportunity made sense.

SPEAKER_01 4:47

I totally understand that. And I guess if you're taking a year out of training where everything is being pre-decided for you, you want to make some decisions, but equally it's a lot to just say I'm going to locum. I totally take on your point that you weren't 100% sure what you wanted to do, but equally, I guess you must have had a little bit of a hunch that you would have wanted to do something medical, or did you just spend a trust grade job? Did you go between medical and surgical or GP? How did that work?

SPEAKER_00 5:17

So I went purely medical. Well, kind of. I did six months of cardiology to begin with, and then moved on to ICU slash critical care. Then this small issue happened, you may have heard of it called the COVID pandemic.

SPEAKER_01 5:34

Rings a bell, yeah. I think that were.

SPEAKER_00 5:36

Yeah, yeah, yeah, yeah. I think you may have heard of it. Because of that, I moved back from ICD. There was loads of anesthetic trainees, as you could have guessed, you know, coming back from theatres and everything. Moved back onto the medical road to where it was a bit more useful and a bit more needed, which completely made sense. But even in the two months I did on the ICU road, I still learned a lot. But I think I found that out more towards the end of left too, because by then I'd done another surgical job as an SHO, which is different to being an F1 in surgery, and I'd done the GP job at that point as well. And for better or for worse, I figured out those two went for me. But it helped me realize that if the application process worked, that you know you kind of applied towards the end of F2 to start in August or September of the next year. I may have thought twice about going into trading rather than trust great job, but I felt like I needed a little bit of a break as well just from portfolio and stuff. Looking back, those portfolio requirements weren't a lot. But at the time it feels like it's you know a bit of a slog to get through. By the end of that F2 period, I realized okay, yeah, medicine is more for me. IC was obviously something I wanted to rule in or out based on that as well, having not had that much experience with it. Those were the two things I kind of went for.

SPEAKER_01 6:54

And I guess you're highlighting two key things that potentially listeners can take away from that. Number one is if you search for a trist grade job that suits you, you can actually tailor it to the way you want. So a trist grade job for a year after a training post doesn't necessarily have to be with one department, and there is scope to work in different departments, especially after F2. I think that's quite common throughout Scotland and England, and it's just about finding that post. The other thing, I guess, then is the timing of applying for these jobs. So I know it was a few years ago, but when do trust grade jobs open for application? Is it, you know, much later on in the year?

SPEAKER_00 7:40

The answer to the second point, my application is opened around February to start in August. To be honest, I think it was a similar time for my application for this trust grade job as well before specialty training. So it's roughly six months before the post starts. Different trusts might do it differently, but in general, around West Yorkshire, that's what I've kind of heard. So I think after Christmas in January, if you start looking round or asking round, you'll end up with a bit of an idea as to when the jobs on NHS jobs go up. Generally, even if you know the department, the consultant, and you kind of talk to them informally, there will still be an NHS jobs process to go through, and there's a window for applications and everything, as with everything else that you don't want to miss. Generally, it's about six months before, but if you start looking slash thinking about it January time, you'd be sure not to miss anything. Seeing as there's even more people that want to do it now since I did it. Maybe it's even a bit of a longer lag time because departments trust need a bit more time to process things because I think the popularity of it was popular then, but I think it's even more popular now, really.

SPEAKER_01 8:49

So again, I'm just gonna highlight for our listeners then that the big difference between applying for a training post is that you apply via Oriel, but for a trust grade job, you apply via NHS jobs. And in terms of your time during a trust grade job, I know that you mentioned that you use that as you know, a portfolio building exercise. Was that something that is required of you? Do you keep building on the portfolio that you had during your time in training? Or do you have you know a separate portfolio?

SPEAKER_00 9:22

So my portfolio was such in terms of the usual mini-kex or CBDs that you do in the foundation program. I didn't really keep much of it. It was quite informal then. It was meant to be done on paper, and then because of the pandemic and everything, appraisals just kind of got forgotten about, really. I think what they recommend, or what I've certainly seen people do, is you can extend the Horace portfolio from the foundation program for another year if you ask the trust. I think even if you don't work in the trust, it's more ideal if you do. You can ask them to extend it. You can email people at Horace to extend it. So then that's quite an easy way of keeping track of everything because you will need an appraisal at the end of the year. For my portfolio building exercises, it was more kind of doing audits and everything, not so much recording it in the portfolio sense, but presenting it and then keeping my own log and then a folder to bring to interview that kind of thing. Evidence to accompany my application rather than uploading it to Horus or anything like that.

SPEAKER_01 10:24

You're doing a triskree job again now. So have you extended your IMT portfolio, or again are you just keeping it separate?

SPEAKER_00 10:34

Just keeping it separately. There is an option to sort of extend the IMT portfolio as well. However, I achieved all the other competencies for that, so I didn't really see the benefit of extending it. So I'm just keeping a kind of separate log of what I'm doing for the purposes of application, really. It certainly helps if you're more organized and you want it in one place and having it online as a bank where you can upload PCBDs, mini kexas. That's easier. I think it depends on how much you want to do and how much you want to keep a portfolio as well. Some people the benefit of having this year off is not to worry about that kind of thing. Unfortunately, there is a minimum requirement for appraisals and everything. It's certainly not as strenuous as an actual foundation program or, in my case, internal medicine involved earlier.

SPEAKER_01 11:23

And during these, you know, two years at Trust Greek jobs, did you have a supervisor that you could report to or discuss any problems that you had or your future plans and get advice?

SPEAKER_00 11:36

The education supervisor for us at the time was the consultant who kind of ran what in Broughtrib was called a Post Foundation Fellow program. And Leeds was called a Junior Clinical Fellow. Same with the kind of educational supervisor that looked through your portfolio every so often if needed. And then a clinical supervisor, there'd be a nominated consultant on each rotation ad. Sometimes nominated, sometimes you kind of have to find it yourself. But I think departments are improving in that aspect now. It's been a few years since the first trust grade job. I think it's really important to have those just in case you do need to speak about things. And I think that's the advice I'd give to people looking for these trust grade jobs, is make sure that you have a nominated supervisor or email around until you can either find a consultant that will happily do it for you, or what should really happen is that the department find one for you. You shouldn't have to go asking around yourself. But if you do end up doing yourself, which is uh unfortunate, I'd rather put the effort in to have one rather than be without one waiting for it to happen. Just in case, you know, anything goes wrong, you need to chat to someone about it, even if it isn't careers advice or anything. I think it's always important to have someone to report back to in case there is any kind of feedback, positive or negative.

SPEAKER_01 12:55

Yeah, I could not agree more. I think we all need that support there. Whether we use it or not, it's good to know that it's there. And at the end of the day, we're still all, if I can use the term junior doctors, and I know there's loads of terms being thrown about about what we are, but doctors of non-consultant grades, you're always going to need advice. That's just part of working at the level that we're working at. In terms of the rotor, then everyone's dreaded consideration. How does it work on a trust grade job with the rotor? Do you literally just fill a rotor gap? Do you have a bit of say as to what you do? Are you doing more long calls, or how does that work?

SPEAKER_00 13:37

So I've only ever worked in a place where you're essentially one of the medical SHOs, whether in my place of work it was the same rotor for F tunes, IMT1s, IMT2s, and anyone in between. So I just filled in one of those gaps. So it was part of the medical SHO brigade. Normal on calls, as with everything else. And I've not really known anywhere that doesn't do that now, really. I think there are a few jobs, if you get them great, but they're very rare now. They were becoming rarer when I applied. But 9-5, Monday to Friday, non-call requirements. Back in the day, there used to be kind of low-come jobs like that as well, in specific departments where you work 9 to 5, Monday to Friday for low-come pay, no on-call requirements, but I think they're like gold us now, to be honest. Most departments are looking for people that can fulfill on-call roles because that's what they need from the department as well. So it is a bit of a quick pro-co situation, something that we're not always used to in terms of coming into medicine. We go into it, okay, we've got this degree, going to work for this one employer, going for this job. This is how it's going to work. We don't really shop around in terms of our careers and things like that until we get maybe towards the end of it. So it's quite interesting to see the different routes people go down. Yeah.

SPEAKER_01 15:08

I guess though that's something that you can potentially just consider interview. People are starting to go, you know, less than full-time. It's not to say that all trust grade jobs come with, you know, a full space on the rotor. As you said, it very much depends on the job, the deanery, and what's needed, really.

SPEAKER_00 15:27

I'm sure there's provenance for people to go less than full-time as well, but I'm not 100% sure on that.

SPEAKER_01 15:34

What do you think has been the best thing about doing your trust greed is?

SPEAKER_00 15:42

It gives you the time, A, to choose which department you want to go into. But you're not rotored on to a certain department where you're not that interested in it. You get the kind of flexibility to choose you may end up not being interested in it, but it gives you a chance to explore what you might be interested in going forward. So in my case, it was cardiology at the time, and also allow me to explore ICU as well. Yes, you're on call, but you're not always there to fulfill a gap. You're not there to just get mini kexes and CBDs signed off for the sake of it. You have time to build a bit of a relationship with the department. If you end up doing audits and things, it's because you figured out a gap, because you've been there for a bit longer, it's not just four months. Uh mine was six months and then varying to that. I think it's essentially the chance to explore what you want to do. At a time where you're an F3, you've done F1 and F2, you're a little bit more confident in yourself. You're not like a consultant or anything like that, obviously, but you know a little bit about what's going on. You kind of know how the hospital works, you know what's expected of you as an SHO. So that bit's all okay. You have the brain space to kind of explore a bit more about oh, is this something that I want to do going forward? Like spending time with the registrars, having chats with the consultant about it. And you can have that variety as well. I didn't do surgery and medicine, I did medicine with ICU, but I know people who have done a bit of surgical, medical, and critical care just to really spread their wing wide but to see what they want. Essentially, you're doing what you want, but also the variety of what you can do. I think that's the best way to put it.

SPEAKER_01 17:22

I guess it's that breathing space and doing things because you want to, not because it's a tick-box exercise. And not that we should ever treat the portfolio as that, but sometimes when you're fed up, ARCP is coming around and you think, oh, I haven't got this signed off, I haven't got this signed off. It's just extra pressure when you're already under stress because of the nature of the work.

SPEAKER_00 17:42

Yeah, I think sometimes getting towards ARCP, you do a couple of reflections and mini kexes on cases that you may not have learnt that much from because you've seen it before, but you need to get it signed off. I found myself discussing cases that were more interesting in general, even if it wasn't interesting for the senior addressing to me, because I hadn't seen it before. A little bit more depth about the specialty, not just the width of it.

SPEAKER_01 18:07

I think that's really important. If you could turn back the time, would you still choose to do trust great job?

SPEAKER_00 18:15

So I I'd have picked a different year to do it, I think.

SPEAKER_01 18:19

I mean, we'd have all have picked a different year to be working in the hospital than when COVID hit.

SPEAKER_00 18:24

So originally my plan for that year was to do six of cardio, four of ICU, and then two months of unpaid leave that I could take at any time. So I was actually gonna go traveling for those last two months. So if I could have that time, I'd be okay because I was gonna go away in Japan or Australia or something and have some fun. If I just had to work full-time and not have that kind of time off, I would still do a trust grade job. I don't think I would look ad hoc. However, I think I'd try and get either two months or three months where I could go away.

SPEAKER_01 18:55

So building the flexibility. Yeah, yeah, yeah, yeah.

SPEAKER_00 18:58

So a bit of flexibility. I don't know if I would go abroad and work. I'd have to think about that one, yeah. Yeah.

SPEAKER_01 19:06

And you know, if anyone is considering going abroad to work, we do have another podcast episode on working in Australia under our career conversations, which I will link to this episode's footnotes. You mentioned an appraisal process with your trust grade year. Is that organized for you? And if so, is it similar to an ARCP? Or is that something that you need to organize and is different to an ARCP?

SPEAKER_00 19:37

So I think the principle is similar to an ARCP. It's revalidation. They want to make sure that you've been keeping up to date with things in terms of training. Uh it could be in the form of attending conferences, training, courses, or in terms of reflections and things. Whether you need to organize it or not is variable. Each trust will have a revalidation officer, which you'll have to find on the internet as to who that is. And then you can email them and they will essentially go through the local process of how to go about things. I'm sure there's a specific form to fill in and send off. You'll have to find someone to do that appraisal for you. So at our level, it would be a consultant that we've worked with kind of on and off through the uh, probably not your supervisor, but someone that's worked with you. Some trusts, if they're quite experienced at the trust grade jobs now, they might build into the fact that this is your supervisor and this is the person who's going to appraise you at the end of the year. It may be that you have to do it yourself. It very much depends on the way the job is set up. The main thing is finding out who your revalidation officer is. I'm going to just send them an email and say what exactly is it that you need from me.

SPEAKER_01 20:53

Perfect. Thank you. I feel like we ended on a bit of a more serious note there. I think I will summarize what you've said and correct me if I'm wrong. That you've chosen to do two trisk great jobs as time for you know breathing and thinking as to what you want to do, building up your portfolio. You've done that whilst working on a router, but there can be some flexibility on that. You can keep a portfolio if you want to. And again, it's probably advised, but it's not as much pressure to do so as when you're in training. And you will still have to go through a revalidation process, but perhaps if I could say this not as strenuous as an ARCP trading. And you enjoyed it, and if you could, you would show it again. I feel like that's us ending on a high. Thank you so much for joining me today. Thank you everyone for listening. I hope it's been useful. Please feel free to listen to any of our other episodes. We've got lots of episodes on different medical specialties under our career conversations podcasts, and we've got loads of clinical episodes managing patients under clinical conversations. Thank you so much for listening. We wish to recommend our Demystifying PACES podcast series on career conversations. As some of you may know, in late 2023, MRCP UK updated the PACES exam format, so we developed this new series to support PACES candidates. Episodes cover exam organization, calibration, every PACE station including key changes and candidate perspectives.