Information on Oncology for International Medical Graduate (IMG) – ACP Trainees

Dr Waleed Khalifa, THE CHRISTIE NHS FOUNDATION TRUST

Introduction

This section highlights key information for IMGs on working as a doctor in the UK along with key information on medical oncology higher specialist training in the United Kingdom (UK), which is the route enabling doctors to work as consultants with entry onto the specialist register on satisfactory completion of training. Within this section, there will be a focus on international medical graduates who wish to apply to higher specialist training in medical oncology.

Healthcare structure in the UK

The UK has the National Health Service (NHS), providing free healthcare to the nation. Care provision is dependent on clinical needs, regardless of whether patients can fund treatment or not. Each country within the UK is responsible for healthcare provision. The private sector contributes to around 10% of elective patient care. The illustration below highlights the ecosystem care providers which make up the NHS in England, comprising of primary, secondary, tertiary and community healthcare.

Adapted from The healthcare ecosystem – NHS england digital (no date) The healthcare ecosystem. Available at: https://digital.nhs.uk/developer/guides-and-documentation/introduction-to-healthcare-technology/the-healthcare-ecosystem (Accessed: 11 December 2024).

Oncology training in the UK

In the UK, non-haematological solid organ malignancy is managed by medical or clinical oncologists. Education and training of healthcare professionals in the UK is governed by Local Education Training Boards (LETB) in England, and by deaneries in Northern Ireland, Scotland and Wales. Within England, there are 12 areas which cover north, south, east, midlands and London area. Scotland, Wales and Northern Ireland each have their own deaneries. To seek additional information on the various training areas within the UK, (click here).

Medical oncology is a group 2 specialty with training spanning over a 4-year period, whereby trainees rotate every 4 months through different tumour groups to gain clinical exposure through a variety of multi-disciplinary teams. The initial ST3 year is classified as an Oncology Common Stem (OCS) year, allowing medical oncology trainees to gain some knowledge into radiation therapy and treatment planning. Years between ST4-ST6 enable trainees to build on common stem capabilities gained in the initial ST3 year of training. Trainees gain experience in managing patients with localised or advanced stages of cancer with use of systemic anticancer therapies (e.g. chemotherapy, immunotherapy, targeted therapies, hormone therapies) across neoadjuvant, adjuvant and palliative settings. There is active involvement in research clinics, recruitment of patients into clinical trials, along with engagement in multi-disciplinary team meetings. Trainees are expected to complete the medical oncology Speciality Certificate Exam (SCE), which is a 2-paper multiple choice question based assessment taken through the Royal College of Physicians, with further information available through this link (click here). Trainees can take time out of programme to undertake research (PhD or MD) or apply for a fellowship post during training.

Clinical Oncology is also a group 2 specialty training programme, with a training duration of 5 years. Trainees applying to clinical oncology gain exposure and clinical experience in the use of radiotherapy and treatment planning, managing radiotherapy toxicities, along with use of systemic anticancer therapies. Similar to medical oncology, the initial ST3 year is highlighted as an OCS year, allowing trainees to gain common and generic capabilities in practice (CiPs) applicable to oncology. The development of the OCS year allows alignment of medical and clinical oncology as the two specialties continue to work closer in the non-surgical management of patients affected by cancer. Trainees are expected to sit the FRCR examinations, with the first exam assessing knowledge relevant to clinical oncology e.g. physics, pharmacology, biological basis of cancer, radiobiology and medical statistics. The first exam needs to be completed by the end of ST4. The second exam is made up of part A and Part B, encompassing all relevant knowledge related to cancer management, with part A being made up of single best answer (SBA) question & part B focusing on a multi-station style of assessment. Completion of the second exam is required by the end of the ST6 training year. Further guidance is available through the RCR website (Click here). Like medical oncology, trainees can take time out of programme to pursue research or fellowship posts.

The timeline below, highlights the training timescales for foundation training, internal medicine training, followed by higher specialist training in either medical or clinical oncology in the UK, up to the point of attaining the certificate of completion of training (CCT) which enables entry onto the specialist register.

Medical training pathway in the United Kingdom. Adapted from “Curriculum for Medical Oncology training”, implementation August 2021

Cancer alliances

There are 21 cancer alliances across the UK, which allow leaders in clinical and management positions across different NHS trusts, to collaborate and coordinate with health and social care departments in order to enhance and coordinate cancer diagnosis & management through cancer pathways.

Adapted from Cancer Alliances – improving care locally (no date) https://www.england.nhs.uk/. Available at: https://www.england.nhs.uk/cancer/cancer-alliances-improving-care-locally/#map (Accessed: 05 December 2024).

Cancer centres across the UK

Medical & clinical oncologists in the UK work in standalone specialist cancer centres or oncology units within larger or district general hospitals with support from other medical/surgical subspecialties. Specialists are expected to cover duties across a mix of both types of cancer centres. Oncology trainees across both medical and clinical oncology can be placed in a variety of different cancer centres during their higher specialist training.

Some standalone cancer centres will provide services such as proton beam therapy, stereotactic radiosurgery along with access to dedicated oncology services such as an integrated procedures unit, oncology critical care units and active trials teams involved in different study phases with support from institutional research centres nearby. Many will have educational hubs delivering oncology teaching to healthcare professionals within and beyond the standalone cancer centre. Trainees gain exposure in inpatient/outpatient workload with involvement in regional MDT meetings.

Oncology units within hospitals gain support from other medical/surgical specialties within the trust, with a similar involvement in clinical trial recruitment, inpatient and outpatient workload, MDT meeting involvement & organisation of peer-led medical education.

Funding of cancer treatments in the UK

In England, cancer treatments are funded through the Cancer Drug Funds (CDF), which has been in place since July 2016. This allows patients affected by cancer, to have earlier access to newly approved cancer drugs as well as certain access to future treatments. In England, the National Institute for Health and Care Excellence (NICE) governs whether certain drugs can be routinely funded to treat oncology patients. Further information on the CDF in England, along with a comprehensive list of drugs funded by the CDF is available online through this link (click here).

The CDF is not applicable to Wales, Scotland or Northern Ireland, all of which have a different entity responsible for drug funding as follows: –

Scotland funds drugs through the Scottish Medicines Consortium (SMC). Click here to find out more.
Wales has The All Wales Medicines Strategy Group (AWMSG). Click here for further information
Norther Ireland’s funding is managed by the Health and Social Care department & follows NICE CDF recommendations. Click here to find out more

In both England and Wales, the Blueteq system assist health boards in monitoring high-cost drug prescribing and enables oncologists to apply for funding of drugs through the CDF. This system enhances governance and ensures treatments are provided in accordance with health appraisal guidance e.g NICE or AWMSG. Clinicians must complete a Blueteq form prior to treatment which requires recording of certain datasets such as demographics, as well as ensuring patients meet certain eligibility criteria for treatment.

Aspects to consider when applying as an IMG to work in the UK

IMGs will need to have completed a period of internship, for a minimum of 12 months, which is the equivalent to Foundation Year 1 of medial training (FY1) in order to apply for full GMC registration
Completion of the two parts of the Professional and Linguistic Assessments Board exam (PLAB) within a 2-year period is required if an applicant graduated from a medical school outside of the United Kingdom, the European Economic Area (EEA) or Switzerland. From 2024, the PLAB exam will be in compliance with the Medical Licensing Assessment (MLA), which is now a requirement for all medical students studying in the UK. The GMC website has further information on the PLAB exams (click here)
Full GMC registration – IMGs are eligible if they’ve acquired their primary medical qualification from a medical school outside the UK or Switzerland. Applicants will need to have completed the two parts of the Professional and Linguistic Assessments Board exam (PLAB) to apply for full GMC registration. Click on the link attached for further information on full GMC registration for IMG doctors (click here)
Before working in the UK, IMG doctors need 24 months of clinical experience, excluding clinical exposure gained through attachments prior to achieving a primary medical qualification. The 24 month encompass 12 months of internship experience (equivalent of the FY1 year), followed by an additional 12 months post internship
IMG doctors who haven’t completed an internship, will need to apply to the UK Foundation Programme. Further guidance is available through this link (click here)
Those with a 12-month internship, can apply for a standalone FY2 post for 12 months, gain 12 months exposure in an acute specialty in the UK or abroad or both.
Apply for medical indemnity – When working in the UK, there are various clinical schemes which will provide indemnity cover depending on where you work in the UK. In England, this is covered by the Clinical Negligence Scheme for trusts, in Wales through the Welsh Risk Pool Services, in Scotland this is through the Clinical Negligence and Other Risks Indemnity Scheme, while in Northern Ireland individual trusts provide this role and funding is received through the department of health. Further guidance is available through the GMC website (click here). There are several situations whereby indemnity through the clinical schemes do not apply and therefore doctors additional medical indemnity protection can be provided by various different organisations. Here are a few useful links with further information on additional protection through medical defence organisation. (Click here for Indemnity for IMGs), (Click here for further info on professional indemnity), (click here for further info on different types of indemnity).

Applying to medical oncology higher specialist training

Medical oncology applications and interviews are competitive, however both IMG’s and UK graduates have a fair and equal opportunity in the application process.
Further details of applicant qualifications, essential entry criteria and selection criteria specifically for medical oncology are available through the health education website (click here)
The Physician Higher Specialist Training Recruitment website has details on planning specialty training applications in medical oncology, utilised scoring systems, interview dates and available posts across the UK (click here)
The Association for Cancer Physicians (ACP) has additional resources promoting medical oncology for undergraduate students and junior doctors (Click here). A useful medical oncology careers webinar by the ACP, for those interested in applying to medical oncology, is accessible through this link (click here)

References

Anderson M;Pitchforth E;Edwards N;Alderwick H;McGuire A;Mossialos E; (2022) United Kingdom: Health System Review, Health systems in transition. Available at: https://pubmed.ncbi.nlm.nih.gov/35579557/ (Accessed: 11 December 2024).
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Association of cancer phyisicans – Promotion of medical oncology to undergraduates and junior doctors (no date) Association of cancer phyisicans . Available at: https://www.theacp.org.uk/jobs/resources (Accessed: 06 November 2024).
BMJ Careers (2022) A guide to IMG applications for specialty training in the UK, BMJ Careers. Available at: https://www.bmj.com/careers/article/a-guide-to-img-applications-for-specialty-training-in-the-uk (Accessed: 06 November 2024).
Cancer Alliances – improving care locally (no date) https://www.england.nhs.uk/. Available at: https://www.england.nhs.uk/cancer/cancer-alliances-improving-care-locally/#map (Accessed: 05 December 2024).
Cancer drugs fund (CDF) (2024) Cancer Drugs Fund (CDF). Available at: https://www.cancerresearchuk.org/about-cancer/treatment/access-to-treatment/cancer-drugs-fund-cdf#:~:text=start%20the%20treatment.-,Scotland%2C%20Wales%20and%20Northern%20Ireland,with%20a%20GP%20in%20England. (Accessed: 09 December 2024).
CDF methodologies – NDRS (no date) CDF Methodologies. Available at: https://digital.nhs.uk/ndrs/data/data-sets/sact/sact-cdf-methodologies (Accessed: 11 December 2024).
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Curriculum for Medical Oncology Training – MRCP UK (2021) Joint Royal Colleges of Physicians Training Board. Available at: https://www.thefederation.uk/sites/default/files/Medical%20Oncology%202021%20Curriculum%20FINAL.pdf (Accessed: 04 November 2024).
Full registration for international medical graduates – GMC (no date b) General Medical Council . Available at: https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/application-guides/full-registration-for-international-medical-graduates (Accessed: 04 November 2024).
Howe , A. and Koulaouzos, T. (2023) Oncology Cancer Centres in the NHS, BDI . Available at: https://www.bdiresourcing.com/img-media-hub/blog/oncology-cancer-centres-in-the-nhs/#:~:text=Clatterbridge%20Cancer%20Centre%20is%20one,care%2C%20and%20blood%20cancer%20services. (Accessed: 12 December 2024).
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(No date) NHS England. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/person-specifications/person-specifications-2025/medical-oncology-st3-2025 (Accessed: 06 November 2024).
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