Embedding into the ways of working in the NHS: A seamless transition and reflective learning as a clinical observer in general internal medicine

The transition of embedding into the National Health Service (NHS) healthcare system in the UK is accompanied by significant social, cultural and educational challenges. The common educational barriers faced by international medical graduates (IMGs) are usually related to lack of appreciation of the values and structure of the NHS as well as understanding the ethical and medicolegal issues. Clinical observer roles or attachments are an opportunity for doctors who are IMGs to gain direct experience of the NHS system, enhancing their knowledge of the ways of working in the UK, and thereby improving their chances of getting to know the system and potentially assisting with finding employment. The UK will remain reliant on the skills and expertise of IMGs for the foreseeable future; predicted 32 % IMG doctors in 2036 according to the General Medical Council (GMC). They will therefore represent an important part of the NHS workforce, many of whom commence work as locally employed doctors (LEDs) and contribute significantly to the success of NHS services. This article describes the information gathered from clinical observers within one department at an NHS trust in general internal medicine (GIM). We elaborate on how this experience enabled an enhanced awareness of knowing how to go about the routine daily working pattern in the NHS. The recent Royal College of Physicians (RCP) guidance on LEDs and IMGs highlights the importance of educational supervision for this group of doctors within the NHS workforce. Similarly, the GMC has reiterated the need to support the growing number of LEDs in their latest workforce planning report 2024.