Guidance for international medical graduates

If you trained outside the UK, some role titles or phrases in practice questions may be unfamiliar. This page explains them and offers ways to check your interpretation. Use the parts that help; your training route doesn’t determine what you’ll find difficult. The professional expectations and assessment task are the same for all candidates.

You do not need specialist knowledge of UK systems. NHS England states that every PD scenario is reviewed by subject matter experts to ensure it does not depend on knowledge of procedures or policies that apply only in certain localities or are very UK-specific, specifically so that IMGs are not disadvantaged. The setting in a stem only provides context.

The table below offers background to help you picture a scenario. You don’t need to memorise it for the exam.

Answer from the role in the stem

Your previous seniority may be different from the role described. Follow the stated role; the official practice instructions use F2 unless otherwise specified.

Before answering, ask: “What can this doctor safely do, what do they need help with, and what responsibility remains theirs?” Do not interpret seeking assistance as automatically failing to cope, or a senior’s instruction as removing the need to recognise a safety concern.

Understand what each role can do

Titles and arrangements vary locally. Use the role described in the question to decide who can help, rather than memorising an order for escalation.

Term	Function to recognise in a scenario
F1 / FY1	Doctor in the first year of UK Foundation training, with provisional registration; usually more closely supervised than an F2.
F2 / FY2	Doctor in the second year of UK Foundation training.
SHO	Informal term for a junior doctor above F1, such as an F2 or core trainee.
On call / bleep	Covering patients beyond your usual team, often out of hours; “bleep” is the pager or phone used to contact the covering doctor.
Handover	The structured transfer of responsibility for patients and outstanding tasks between shifts or teams.
Registrar	Common term for a more senior doctor, often in specialty training; check the role described rather than infer exact competence from the title.
Consultant	Senior specialist; may be the responsible clinician or part of the relevant escalation route.
Clinical supervisor	Oversees clinical work and development in the relevant placement.
Educational supervisor	Supports educational progress; may suit a recurring training concern.
Nurse in charge	Coordinates nursing work on the ward or shift; may be central to understanding a practical ward problem.
Occupational health	Advises on work-related health, fitness and adjustments; distinct from arranging today’s clinical cover.
PALS	Patient Advice and Liaison Service in England; helps patients with concerns and navigating services. Other UK nations have different arrangements.
Freedom to Speak Up Guardian	An organisational speaking-up support role, particularly in England; local and national arrangements differ.
Rota coordinator	Administrative role that manages shift allocation and swaps; not a clinical escalation route.
Guardian of safe working hours	In England, a role overseeing junior doctors’ working hours and safety concerns about rotas.
Practice manager	Runs the business and staffing of a GP practice; clinical decisions remain with clinicians.
Incident reporting system	A route for recording safety events and supporting learning; the product name varies locally.

Check your assumptions

These questions can help you spot assumptions in your reasoning:

Hierarchy: Would I suppress a clear concern because the person involved is senior? Identify a safe and effective route to help.
Family involvement: Am I assuming the family should receive information or decide? Establish the patient’s wishes and any lawful authority.
Autonomy: Am I treating disagreement with advice as proof of incapacity? Revisit patient decisions.
Teamwork: Am I discounting a concern because it comes from someone in another profession? Examine its content.
Pressure: Am I treating silence or taking on every task as the only acceptable response? Compare the actual effects on care.
Language: Am I interpreting a polite suggestion as a firm arrangement, or “raise a concern” as necessarily making a formal complaint?

These checks can help any candidate, including UK graduates. They don’t describe particular countries or cultures.

Practise the English of the options

Translate each option into a plain action sentence. Preserve its strength and timing: suggest is weaker than arrange; consider is different from do; when convenient is different from immediately. The aim is to understand the action accurately. More forceful wording doesn’t automatically make an answer better.

Build a personal list of unfamiliar phrases. For each, write its meaning, what action it actually commits to, and an example where it would be insufficient. Explain your preferred answer aloud in simple language before reading a rationale.

A practical starting routine

Attempt a small set of official questions without time pressure.
Note what made each question difficult: unfamiliar terminology, an unfamiliar system, a missed fact or comparing the professional duties involved.
Study the relevant source rather than memorising a guessed cultural rule.
Repeat with fresh scenarios, then add timed practice.

The GMC offers Welcome to UK practice, a workshop using ethical scenarios for doctors new to UK practice. Its page gives current eligibility and booking information.