What is the MTI scheme?
The Medical Training Initiative (MTI) is a national scheme which provides training placements for International Medical Graduates (IMGs).
It enables a small number of overseas doctors to enter the UK for training placements of up to 24 months, in order to gain experience and knowledge whilst working in the NHS.
IMGs are expected to return to their home country after two years and therefore also contribute to improving the quality of healthcare in their own setting.
Units in the UK hosting MTI placements benefit by learning from their international colleague; sharing experiences and surgical knowledge.
The RCOG provides educational guidance and support, and trainees on the MTI scheme should have access to a local educational supervisor, the RCOG e-portfolio and the same training opportunities as other trainees in the department.
MTI doctors should attend the RCOG induction at the beginning of their placement, as well as receiving local induction.
They are encouraged to complete a shadowing period of at least two weeks, and some may start on the ST2 rota, before moving to ST3 when their competencies are signed off.
You can read more about the MTI scheme on the main RCOG MTI pages and also on the AoMRC website:
Academy of Royal Medical Colleges (AoRMC) links
AoMRC – MTI introduction:
What are the common issues MTIs face?
Most MTI placements are successful, with doctors and hospitals enjoying the mutual benefits of the scheme. It is not uncommon, however, that doctors may experience issues within their placement that need to be addressed.
- Settling into life in the UK – Challenges include practicalities, such as banking or schools for children, culture shock, loneliness, or isolation and homesickness. Acclimatising to a new culture, language, customs, and place of work all at the same time can be difficult and overwhelming.
- Working in the NHS – Understanding the NHS structure, working culture and environment, moving to IT system from paper based systems, team working and role of other professional bodies such as NICE, GMC and RCOG.
- Workplace problems – Bullying and harassment, racism, undermining, unacceptable behaviours in the workplace
- Communication and non-technical skills due to language e.g. understanding accents or cultural differences
- Using the ePortfolio – Understanding how to use the platform to record WPBA, reflective practice, monitoring progress against the MTI Training Matrix
- Pastoral support – Trainees may not know where to seek support if they find themselves in difficulty or how to raise concerns / get support before an issue/situation has escalated.
- Educational support and access to training – Involvement of local Deanery varies e.g. education and training, educational support and annual appraisal e.g. MTI not being released to attend local training and having to cover for NTN trainees, study leave for exams being withheld
More advice, support, and useful contact details for those settling into a new life in the UK, can be found in the RCOG MTI booklet for new starters, and also in the relocation guide produced by the AoRMC.
Other useful resources are included later in this leaflet and listed in the guides above.
What is the role of the buddy?
The buddy scheme for MTI doctors partners each IMG with a UK trainee, at a similar stage in training, ideally working in the same geographical area.
The buddy can help to facilitate the integration of the MTI doctor, particularly during the initial stages of the placement.
This may involve: talking through local procedures and guidelines, help accessing and using the RCOG e-portfolio, guidance on who to approach for help with professional issues or how to tackle any problems that arise.
At a later stage in the placement the buddy can help signpost the MTI doctor to resources for preparing to sit the MRCOG. The resources listed previously may be helpful.
The UK trainee will benefit from an opportunity to increase their understanding and knowledge of international healthcare, and gain experience in mentoring.
Pastoral support and guidance should come primarily from the educational supervisor and college tutor, in the same way as UK trainees, but additional support is available at the RCOG if needed. Sometimes MTI trainees may need guidance on who best to approach for help. The appropriate pathway is:
- Educational supervisor
- College tutor
- Training program director
- Head of school
If this is unsuccessful or not possible:
- RCOG MTI Officer (Mr Sanjay Rao)
- RCOG MTI Regional Champion
Suggested topics for meetings
The NHS in England
The Kings fund has several useful videos to explain how the NHS works. Watch them together and discuss.
How does the NHS in England work:
An alternative guide to the new NHS in England:
See also the NHS choices website:
MTI doctors need to apply for access to e-portfolio but are then encouraged to use it in same way as UK trainees. It may be useful to spend some time explaining each of the different assessments and how to raise these.
- RCOG training resources – how to access and make the most of RCOG training resources including STRATOG, TOGs, e-LFH, how to find tools for preparing for MRCOG exams, courses they may find helpful.
- Discuss other opportunities to learn e.g. research, audit, presenting at events/conferences, teaching locally etc
e-Learning for Health (e-LfH): ‘Induction for International Doctors’. Online modules to introduce UK clinical practice, including ethical, social, legal and professional aspects.
GMC: Good Medical Practice guidance (https://www.gmc-uk.org/guidance/index.asp) and ‘Promoting professionalism: Welcome to UK practice’. Online case studies including confidentiality, teamworking and ethical issues.
Communication skills: How people talk about illness in the UK (http://healthtalk.org/health-professionals ) StratOG teaching on communication skills (https://stratog.rcog.org.uk/tutorials/non-technical-skills)