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J R Soc Med. 2006 June; 99(6): 328.
PMCID: PMC1472721

What the PLAB did not teach me

This article highlights the challenges a typical foreign medical graduate experiences when he begins to work in the NHS and the UK.

Much has been written and discussed about the PLAB (Professional and Linguistic Assessment Board) examinations and about the doctors who come to the UK and appear for these exams in hope of getting a training post in the National Health Service. A lot of what has been written only highlights the difficulties these doctors face in getting that elusive first post.

This probably gives a false impression that the struggle ends with the beginning of the first job, but on the contrary this is the start of yet another struggle. One perhaps not as desperate as the preceding one but yet of great significance. What happens after the euphoria of landing your first job subsides and the dust, arising from frantic efforts prior to that, settles?

Like the salmon, which continually swims upstream against great odds, foreign medical graduates have to go through no less than 12 hurdles—e.g., getting a visa, passing exams, getting attachments and, of course, getting a job offer—all in a span of 6 months before being able to work in the NHS.

The first exposure I had to the UK after having landed in Heathrow was tube travel and East Ham. I discovered that, in London, the roads were not paved with gold, that nobody remotely looked or behaved like James Bond, and the bewildered expression I was getting from everyone passing me was because I was smiling at them. On the tube journey to East Ham, I decided to read something while travelling (only because everyone else was doing so). So I made my way to the newsstand and bought a copy of the paper that most people were reading. I hurriedly closed it after seeing page three and was sure I would be asked to leave the train for my act of public indecency. To this day, my colleagues try to convince me that the Sun really is a `newspaper'. I found out that crime exists in the developed world after my mobile phone was stolen only hours after I had landed, and after seeing helicopters circling the sky with searchlights in search of the fighting gangs of East London. Three weeks of intensive cramming in subhuman conditions for the PLAB 2 ensued; and after passing the exam I started my clinical attachment.

Soon after, I was offered my first cuppa, and, to my surprise, discovered that the ingredients were not cooked together but just mixed in hot water. People almost fell out of their chairs when I asked for my customary three spoonfuls of sugar. I had been also fairly confident of my ability to communicate in the Queen's English. However, I discovered, rather embarrassingly, that being `on the game' did not mean that the person was an athlete, that pants are not the same thing as trousers, and your `backside' did not mean behind you! Perhaps the most embarrassing event I can recall is when a pleasant elderly lady on the ward wanted to know my `Christian name' and in a very apologetic tone I confessed to her that I did not have one, as I am a Muslim. I later found out that she only wanted to know my first name!

Thinking wishfully that things would be relatively easy once I started to work, I stumbled across the purple haze of paper work and formalities like getting a National Insurance number, CRB clearance, TV license even though I did not intend to watch the five free channels. And then there were the different taxes—fuel tax, road tax, council tax, and VAT. Coming from India, to me VAT sounded very much like `waat' that means the experience of having something unpleasant inserted in your back passage. It probably holds true in the UK as well.

I also had to come to grips with the British Asian culture in the UK which, although Asian, is still very distinctly British. Indian restaurants served food that could not be found in India, and the young danced to a completely different tune of `bhangra' from that heard in India.

In spite of all this, I and several others like me, have managed to cope. We look back at these difficult times and laugh. Despite the light-hearted way in which I have written this passage, the process of adjustment is not an easy one and is an ongoing process. I choose to use humour in putting my point across because it is a mature defence mechanism and has been shown to reduce psychiatric morbidity in people who use it. So the next time you see a bewildered foreign medical graduate walking around a hospital, spare a thought for the struggle he has had to go through. It is, after all, not everyday that you have a change of country, culture, language, weather and experience a lack of family and friends, unemployment, a new work ethic, and start searching for a post-graduate qualification, a career and a new identity.


Competing interests None.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press