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Navigating the NHS as a doctor in a non-training grade in emergency medicine. A thread...
If you cannot tell the difference between a SASG, LED or a CESR
, or youāre hoping to one day go into training but not just yet
, then this thread may, or may not be for you.
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If you cannot tell the difference between a SASG, LED or a CESR
, or youāre hoping to one day go into training but not just yet, then this thread may, or may not be for you./1
Doctors in non-training grades make up about a 1/5 of doctors working in the NHS. They are often:
young UK graduates pre-training, or on a training break
young foreign graduates acquiring competencies pre-training, or
older & established, not seeking to enter training.
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young UK graduates pre-training, or on a training breakyoung foreign graduates acquiring competencies pre-training, orolder & established, not seeking to enter training./2
Despite often being grouped together, non-training grades occupy a variety of roles. These depend on the level of supervision required: complete, close, limited, remote or no supervision.
Take a few moments to consider how much supervision you require.
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Take a few moments to consider how much supervision you require.
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Locally employed doctors (or LEDs) are often less experienced and require more supervision.
Specialty & Associate Specialist Grade doctors (or SASGs) are often more experienced and require less supervision. The term 'middle grade' for SASGs is actively frowned upon
.
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Specialty & Associate Specialist Grade doctors (or SASGs) are often more experienced and require less supervision. The term 'middle grade' for SASGs is actively frowned upon
./4
It is unusual to see an advert for an LED post. These are commonly referred to as trust grade, F3 (4,5,...) & clinical fellow posts.
Folks like @DrLindaDykes & @DrRobgalloway have revolutionised these posts by blending traditional ED roles with research, education, PHEM, etc
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Folks like @DrLindaDykes & @DrRobgalloway have revolutionised these posts by blending traditional ED roles with research, education, PHEM, etc
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LED posts suit younger, pre-training UK graduates & foreign graduates recently joined the NHS.
The former group often seeks to improve their experience;
the latter often use it as a stepping stone into training.
It is worth bearing this in mind when writing job descriptions.
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The former group often seeks to improve their experience;
the latter often use it as a stepping stone into training.
It is worth bearing this in mind when writing job descriptions.
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It is more common to see adverts for specialty doctors. Associate specialist posts are not commonly advertised and tend to be acquired through promotion.
There is broad overlap with LED posts relating to why UK and foreign graduates apply for these roles.
7
There is broad overlap with LED posts relating to why UK and foreign graduates apply for these roles.
7
The main difference is the lower level of supervision SASGs require to practice, compared to LEDs.
Unless a person becomes established in a SASG role, there is always a high likelihood that they are simply passing through. This should be a key consideration in job design.
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Unless a person becomes established in a SASG role, there is always a high likelihood that they are simply passing through. This should be a key consideration in job design.
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The Certificate of Eligibility for Specialist Registration (or CESR), is the route to specialist registration for doctors who have not completed formal training.
Doctors wishing to enter the specialist register in this way has to prove equivalence to their CCT counterparts.
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Doctors wishing to enter the specialist register in this way has to prove equivalence to their CCT counterparts.
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The possibility to obtain a CESR can be built into SASG adverts. This has become fairly popular of late.
It is worth noting that some of the competencies required to obtain the CESR would be difficult to achieve without a rotation to ITU, paediatrics and anaesthetics.
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It is worth noting that some of the competencies required to obtain the CESR would be difficult to achieve without a rotation to ITU, paediatrics and anaesthetics.
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Typically, the CESR route is more preferable for more experienced, established doctors, or those that have taken a scenic route through medicine after graduating.
Typically, the CCT route is more preferable for those going into training after graduating.
Variation exists.
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Typically, the CCT route is more preferable for those going into training after graduating.
Variation exists.
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For employers:
It is worth appreciating that LEDs & SASGs are often just passing through (6 to 24 months)
It is important to understand their needs (seeking experience/ stepping stone to training) and building job plans around that
Ignore CESR at your own peril
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It is worth appreciating that LEDs & SASGs are often just passing through (6 to 24 months)It is important to understand their needs (seeking experience/ stepping stone to training) and building job plans around thatIgnore CESR at your own peril/12
For job hunters:
You can literally throw a dart at the map of the UK and find employment these days
The ED you like is likely in the market (even without an active advert)
Respectfully approach and offer your CV
Research the ED online (CQC, SoMe, etc.)
(cont...)
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You can literally throw a dart at the map of the UK and find employment these daysThe ED you like is likely in the market (even without an active advert)Respectfully approach and offer your CVResearch the ED online (CQC, SoMe, etc.)(cont...)
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For job hunters (...cont)
Always speak to LEDs/ SASGs already working in the ED
Ask about annualisation and self-rostering. These rota features allow you maximum flexibility in planning a rota that suits you.
Express your needs clearly.
/end
Always speak to LEDs/ SASGs already working in the EDAsk about annualisation and self-rostering. These rota features allow you maximum flexibility in planning a rota that suits you.Express your needs clearly./end
My DMs are open
Gosh loads of interest. I realised this was confusing when we started recruiting and folks had no idea how this work.
Thanks for all the DMs too. I'm not ignoring you. Just slowly working my way through them.
Thanks for all the DMs too. I'm not ignoring you. Just slowly working my way through them.
