Enhancing Musculoskeletal Radiology Experience in the United Kingdom: A Beginner’s Guide for an Indian Radiologist

Clinical observership

These are best done at larger tertiary care centers or teaching hospitals as they provide comprehensive musculoskeletal radiology services such as polytrauma imaging, bone, and soft tissue sarcoma imaging, rheumatology-related services, musculoskeletal ultrasound and interventions, and imaging-guided spinal interventions. These are institutions, often predominantly involved in research and teaching. Applying for a clinical observership in one such institution needs at least 6 months of careful planning in addition to gathering a range of documents as a part of Standard Visitor Visa.^[2] Furthermore, some teaching institutions may charge a nominal processing fee for observership applications. Unfortunately, observership period under this category could be limited up to 30 days. As these are entirely observership, they may require constant shadowing of a consultant radiologist. Overall, one has to plan visa, travel, and accommodation costs, which may skyrocket UK expenses given a higher cost of living and Indian National Rupee to GBP (British Pound) ratio. These are more useful for the experienced radiologist or any radiologist wanting to relocate to the UK for a short or long term as such observerships will help one acquaint with the NHS and musculoskeletal radiology departments.

Visiting the UK while appearing for final FRCR 2b may serve an ideal opportunity to have a clinical observership or attachment to one of such institutions as it can reduce travel and visa expenditure. One should carefully plan dates and duration of clinical attachment to make these professional development activities cost effective. One should also be prepared for additional accommodation, food, and local transportation expenditure as these are not covered in observerships.

Common wealth medical fellowships

These opportunities get mid carrier academic medical professionals from low- and middle-income countries forming a part of commonwealth, to enhance their clinical skills and professional development. Funded by the UK Department for International Development, these medical fellowships dedicated to science and technology for development and strengthening health systems and capacity. For India, these fellowships involve cut-throat competition from central government-funded institutions’ candidates and an interview at University Grants commission based at New Delhi.^[3]

Bracco fellowships

These fellowships are delivered by the European School of Radiology (ESOR) in partnership with Bracco. Every year, ESOR, in collaboration with Bracco, offers variable numbers of training opportunities in globally recognized institutions all over Europe, including the UK. These fellowships are offered in three categories: Clinical, management, and research. For clinical fellowships, one needs to demonstrate high scientific potential, contact, and get prior approval from a mentor in the institution of choice and satisfy membership criteria. Although training opportunities are funded, one can reimburse expenditure only after completion of fellowship and submission of the final report to the ESOR. These fellowships do not require GMC registration, and they are more akin to observerships. After being successful in acquiring Bracco fellowship, one has to obtain Visa and accommodation and travel expenditures should be taken into account.^[4]

Post-FRCR musculoskeletal radiology fellowship

All such opportunities are advertised on the NHS jobs website^[5] with Leeds, Birmingham, Stanmore, Imperial College London, and Oxford among a few world-renowned institutions offering such opportunities. These opportunities are suitable for Indian radiologists who have already relocated and working in the NHS for sometimes either as a consultant or as an NHS contributor-trust grade or staff and associate specialist grade radiologist. These fellowships are extremely competitive, require UK specific documentation, including but not limited to, clinical audits, teaching, leadership and management experience, and publications, even to qualify for an interview. Once selected, clinical musculoskeletal radiology fellows enter into a 1-year training program. They are expected to contribute to clinical work, including reviewing and reporting radiographs, computed tomography (CT) scans, musculoskeletal magnetic resonance imagings, leading supervised multidisciplinary team meetings, and performing imaging (CT and US) guided interventions. In addition, fellows are provided with extensive teaching opportunities for registrars and allied staff as well as opportunities.

Global fellowship

This is a collaborative initiative among the RCR, Apollo Radiology International and The University Hospitals of Morecambe Bay.^[6] This involves a contractual agreement between the candidate and the employer for a fixed period of 3 years, 60% of general radiology, and the remaining 40% of work involve learning opportunities in the subspecialty of interest. As more and more institutions are offering such schemes, one should be aware that these fellowships typically involve 60% general radiology work and not hard- core supervised training specifically in musculoskeletal radiology. Many of the institutions, keen to join such programs, may not be a dedicated musculoskeletal services center. We recommend a in-depth discussion about the job description, including direct clinical care provision and subspecialty development activities between the candidate and the employer before accepting such roles. Unrealistic high expectation from the candidates may lead to dissatisfaction once relocated. It is the authors’ perspectives that such schemes are ideally suited for the candidate who wants to develop subspecialty interest rather than who already has some subspecialty training either in India or abroad.

Locum consultant radiologist position

This is particularly suitable for candidates aiming to access post-clinical competency test dedicated musculoskeletal radiology fellowships or wishes to relocate to the UK for a long term. Ideally, for the former, one should take such clinical service delivery position in a district general hospital. This will provide one appropriate time to acclimatize to the NHS work pattern and plentiful opportunities to develop academic, quality improvement, and management skills. Such skills serve as a checklist, essential to get dedicated musculoskeletal radiology fellowship, otherwise considered extremely difficult to get into for non-European Economic Area medical graduates. We wish to highlight that one has to complete a Certificate of Eligibility for Specialist Registration to have a substantive consultant radiologist position into the NHS, even after completing a dedicated musculoskeletal radiology fellowship. All such posts are advertised on the NHS jobs website.^[5]

Staff and associate specialist grade positions

GMC registration is the prerequisite for applying for such positions. Radiologists working in these positions usually have lesser clinical decision-making burden compared to consultant radiologists. They typically contribute to direct clinical care with limited access to management and leadership roles as they need not have complete FRCR qualification. These can also be accessed through medical training initiative, allowing international medical graduates to work within the NHS for 2 years on Tier 5 (Temporary Worker) Visa before returning to their home country. Although it may not require FRCR, one has to be successful in PLAB for GMC registration before the RCR can sponsor a candidate’s Visa.^[7]

In conclusion, the UK NHS provide numerous possibilities for professional enhancement in musculoskeletal radiology depending on one’s need and wish. The onus of choice among them remains on the candidates and their will to pursue musculoskeletal radiology as their long-term subspecialty.