Journey of an International Psychiatrist to the UK

Medicine is a global profession and doctors from the time recorded history began, have migrated between different parts of the globe bringing with them not only knowledge of different diseases and treatments but also culture and language, enriching their adopted lands as well as building bridges across nations and people. Due to the British Empire reaching across the globe, many countries that were previous dominions and are now part of the Commonwealth, share the legacy of language, culture and the British way of life. So, institutions of learning in many countries across the globe, use English as a language of instruction and inspire a desire to visit Britain in many impressionable young minds. In the last seven decades, the UK National Health Service has been held in high regard as a magic formula for universal health provision. For a doctor or a nurse in many countries, one of the career aspirations usually involves travelling to and working in the UK NHS. Hence, the UK NHS has over 47% of doctors from 200 countries and around a quarter of its 1.3 million employees have qualified overseas. This blog narrates the professional trajectory of a doctor qualifying in a medical school in Malaysia to become a consultant psychiatrist in the United Kingdom. The combination of hard work, diligence and an unwavering will to pursue one’s passion in mental health, has enabled the author to achieve his career objectives.


Multi-cultural Malaysia
Sai is a fourth-generation Malaysian whose ancestors originated in Kerala, India.His upbringing was rich in cultural diversity with a strong emphasis on family values.Sai completed his medical degree at the Manipal University in Malaysia in 2012 and developed a fascination with psychiatry during housemanship (equivalent to Foundation year 1 training in the UK).His inclination towards psychiatry was consolidated during his apprenticeship with Professor Ismail Drahman, 1  2.5 years were spent in Manipal, India.Being multi-lingual, with fluency in English, Malay, Malayalam, Tamil, Sarawakian, and some command of rudimentary Mandarin and Hindi, he found this talent to be helpful in his interactions as a doctor.
The experience of training in a mental health system in Malaysia that closely resembled the UK further strengthened his desire to pursue training in Britain while appreciating the difference in culture and structure of a developing country compared to a developed country.In 2016, he commenced the MRCPsych training programme to attain specialised accreditation in Malaysia, which resembles the training in the UK.In 2017, he undertook a fellowship in Addiction Medicine followed by membership of the Royal College of Psychiatrists having passed the examination in 2018.

Coming to the UK
One of the requirements for working in the UK was the IELTS English examination which Sai considered to be straightforward for him, as a native English speaker.The writing component posed a challenge, which he successfully surmounted by transitioning to the computer-based format and achieving a passing score on his second attempt.This minor setback did not deter him.Initially, he enrolled with a recruitment agency, looking for speciality training roles in NHS hospitals.Although he was successful in interviews, he realised that these NHS speciality training roles were not suitable for him.He decided to opt for the independent mental health sector, which was more aligned with his career choices.

Cultural Integration
Sai really loved Malaysian food -which was a heady fusion of Indian, Malay, and Chinese cuisine.Moving from the hustle and bustle of a busy metropolis in sunny Malaysia to the bucolic countryside of England's West Country was quite the culture shock.While life in Malaysia is hectic, people like to congregate together, while in the UK rural life is more laid back and values individuality.Taunton's old homes and charming countryside were a far cry from the sparkling skyscrapers and neon cityscapes of Malaysia.
The longing for connection with family and friends in Malaysia was somewhat lessened by the easy availability of social media, video-chats and the frequent trips home.The exposure to other cultures and ways of living while growing up in multicultural Malaysia provided the mindset and social skills to communicate well with individuals from all walks of life.At first, the British formality (the fabled stiff upper lip) was somewhat difficult to fathom but as rapport was established it became easier.
In his professional experience, he found that the UK placed a higher value on privacy and attention to detail than in Malaysia.The NHS appeared to be bureaucratic and well-governed because of its need to stay within available resources, but he felt that Malaysia's less formal and flexible approach had its advantages.Having lived in Malaysia, where the work was demanding, strenuous, and often unforgiving, he appreciated the UK's focus on work-life balance.While nothing can compare to the delicious food of Malaysia, he found comfort in the slower pace of life.

Independent Sector
Cygnet Health Care expeditiously sent an invitation for a comprehensive interview, including insightful questions about NHS structures, mental health law, mental capacity acts, and processes.He articulated his objective of attaining specialist registration as a Consultant Psychiatrist and was offered a customised position at Cygnet Taunton as a speciality doctor, which he started in September 2019.
He was supported in his quest for specialist registration by Cygnet Healthcare.In December 2019, he submitted his application for Section 12 permission and initiated the process of collecting documentation from Malaysia to support his Certificate of Eligibility of Specialist registration (CESR) portfolio, which aims to establish the comparability of training to that of the United Kingdom.Cygnet provided complete financial support for the equivalence training programme, which was undertaken in collaboration with the Royal College of Psychiatrists.
His supervisor and mentor at Cygnet dedicated two hours per day, to thoroughly examine and evaluate his clinical competence, reflections, and work-based assessments.In 2020, he was promoted to Associate Specialist and later as acting consultant.He had an honorary contract with the National Health Service (NHS), which provided him with community experience enhancing his understanding of the nature of the mental health system in the UK, particularly within the framework of community mental health.Working closely with a clinical psychologist contributed to the improvement of his therapy abilities, and the involvement of an occupational therapist helped refine his skills in behaviour management strategies for his patients.

Post CESR-CCT
Despite the challenges posed by the pandemic in 2020, the utilisation of telehealth has significantly enhanced his professional capabilities.His dedication was recognised with awards for being a model employee and for 'an act of random kindness'.In 2022, he successfully obtained certification on the specialist register as a Consultant Psychiatrist specialising in general adult psychiatry.He also completed the Postgraduate Diploma in Clinical Psychiatry.
While working as Deputy Medical Director at Cygnet Taunton, he led efforts to enhance the quality of care across all domains and the Learning Disability service at Cygnet Taunton achieved Good or Outstanding ratings during inspections.Following his promotion to Medical Director at Cygnet Kewstoke, he implemented several quality improvement initiatives.His professional growth included a Diploma in Healthcare Leadership and Management, an MBA in Healthcare Management, and a master's degree in clinical psychiatry.He received nominations for Cygnet national honours in the categories of Medical Educator, Consultant and Leader of the Year, and was named Consultant of the Year in 2022.In 2023, he was shortlisted for the Medical Leader of the Year in recognition of his contributions at Cygnet Kewstoke.He became the Deputy Regional Advisor of Southwest at The Royal College of Psychiatry fostering enhanced collaboration between the independent and NHS sectors.

Ingredients for Success
As a foreign medical school graduate in the UK, he understood that respect, flexibility, and being cognizant of local cultural norms was essential.Making new friends and connecting with the local expat communities was essential to his happiness.Sai considered himself to be fortunate to have had the best of both worlds.He believes that International medical graduates who are open to new ideas while maintaining their cultural origins and their healthcare training bring innovative solutions to the NHS and have a promising future.
No matter where one practices medicine, the ability to approach patients with compassion and an open heart is vital which is not much of a difference from Malaysia, and critical for a crosscultural psychiatrist.This narrative illustrates the combined contribution of personal dedication, mentorship, support, and dogged diligence in facilitating the success of an overseas medical practitioner in the UK or for that matter any health system.In pursuing the Certificate of Eligibility for Specialist Registration (CESR), success depends on understanding the stipulated criteria and working with mentors to achieve them.
who had qualified in Geriatric Psychiatry during his training in the United Kingdom several decades ago.Malaysia's medical school has options to complete a twinning program with different countries namely the UK, Ireland, India, Indonesia, and many more-as my