By an IMG Consultant Cardiology in the NHS
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So, you want to know if you can break into cardiology subspecialty training in the UK. The answer is – yes, of course, it is possible. After all, if I can do it, so can anyone of you reading this can – but there is a second question that only you can answer: Are you willing to pay the price?
“What price?” I hear you asking. I will come to that.
Imagine you have obtained that passport to subspecialty training – MRCP and you feel that you can conquer the world. You are even invited to an interview for training in cardiology. As you patiently wait outside for the interview panel to call you, you start exchanging pleasantries with the candidates sitting next to you. On your right is a candidate who trained in Oxford, has an intercalated PhD from the same esteemed institution and three publications in journals with high impact factor. Unknown to you, his boss is mates with the head of the interview panel and has told them that he is (quite rightly) an excellent candidate. The candidate on your left trained in Cambridge and she was an accredited echocardiographer for three years before she decided to enrol in a medical degree which she obtained with first class honours. They were trained in the system that is (relatively) new to you and they speak the interview language that you have only just learnt. Hand on heart, tell me this: what is it in your CV that will make you choose yourself if you were on that interview panel?
The price, my friends, is the time and effort that it will take you to make your CV even better than your competitors. This is the time that you will steal from yourself, your spouse and your children (the latter depending on the stage of your life). This may or may not take years – depending on a certain lady smiling at you. But the crucial question is this: do you think a career is worth all this struggle? Trust me that this is a question that you will ask yourself a lot, especially when you are struggling, so give yourself an honest answer before you commit.
I certainly thought it was; after all we spend most of our lives working and what use is work if we are not to enjoy it? My heart was (forgive the pun) set on cardiology. I got a non-training post in Cardiology in a tertiary centre that was two hours commute from home (each way) and after eighteen months of solid tertiary cardiology experience, I appeared at an interview for specialist training thinking that I would get it. The result: failure. My bosses realising that I was not a total dunce, offered me a non-training registrar post which I gratefully grabbed. Another selection interview six months later after tertiary/quaternary centre registrar-level experience: second failure.
The Price Is High
The price was higher than I initially calculated. I worked on a research project, obtained pilot data and a year later got funding for a PhD project. Three years later I had a PhD from Imperial College with decent papers. Guess what I was told by one of the lead interviewers when I sought some ‘informal’ advice on how to get into cardiology after this achievement? “Go and find yourself a non-training post!” At least he was honest. And did I think of taking his advice? No. This was not negotiable, though I did not tell him.
Focus on Person Specifications
I then focused completely on the person specification for specialty entry criteria (here are the latest criteria). By the time I got to my third interview, I had a PhD, publications, and ticked every box on the selection criteria. And when they showed an ECG with pre-excitation: I told them the diagnosis as well as location of the accessory pathway, stratification for sudden death in WPW, management plan and counselling. The rest is now history. The journey, littered with failures, had already become the destination.
Do Not Take Anything for Granted
There are of course IMGs who are more astute and fortunate than me. There are many who have got into cardiology with less suffering but nearly all of them had to prove their intellectual prowess and dedication to the specialty one way or the other. My late teacher, Prof T. A. Shah’s words ring in my ears, “Do not take anything for granted.”
You Will Win by Not Giving Up
You will get into cardiology, or any other competitive subspecialty, if you are willing to pay the price. But only you can decide if the price is right for you. My advice to any IMG considering cardiology would be: Start today, know yourself, be optimistic, believe, read the person specification and work on every part of it, have a structured approach to cardiac history, examination and auscultation, know how to read and critique papers, know the ESC guidelines like the back of your hand, go to local ECG teaching sessions, take time to learn echocardiography and respect those who give their time to teach you without expecting anything in return. And with time excellence will become a habit. You will win by not giving up.
An IMG and a Consultant Cardiologist in the NHS.
About the Author
The author is an IMG who entered ST3 Cardiology in 2011. The author chose to remain anonymous but can be contacted at their email address here.