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  • Writer's pictureDeniz Eroglu

Advantages and Disadvantages of General Medicine

I am Dr. Nowrin Jahan Arvy, working as a trust grade doctor in general medicine. It has been 11 months I am working in NHS. As it is my first job, initially it was really stressful but with time now I feel more confident . As a general medicine SHO, I also do day and night on-calls every month as part of my rota. In NHS, almost in all trusts, general medicine posts are rotational. That means you will be rotated in different medicine departments according to trust policy. Today, I will share some pros and cons of working in general medicine as a trust grade, my experience and some suggestions. 🙂


1.Rotation in different Departments:

If your post is rotational in different departments, you would be able to gather knowledge about those specialities. I have worked in care of elderly and Endocrine departments so far. Working Geriatric department helped me to learn details about end of life-care management, DNACPR, some ethical part like power of attorney as well as general approach and management for elderly people. On the other had, while I worked in endocrinology, I have learned more about management of diabetes, different types of insulin and there proper indications.

2.Doing On calls:

Doing on-calls can be bit stressful initially but this is best time to learn and imply your own knowledge. While you will clerk new patient, you will be all your own, so you have to make decision about investigation and treatment plan. However, the positive point is that you can always check Trust Document library in intranet, some apps like BMJ and Up to Date. Always try to make your own patient lists those you have clerked and then check those patient's update on the following day, so that you can see the post take ward round plan from consultant. It would help you to assess your knowledge and management plan. In addition, on-call is the best time to do more case based discussion (CBD) and Mini-clinical Examination (MiniCEX) to improve your portfolio.

Doing on-call as ward cover is also a tremendous way to know about new diagnosis and management plan and also would boost your confident. For example, in my last on-call as 2nd On SHO, I have got a patient with Miller-Dieker Syndrome (Lissencephaly) which is a rare genetical abnormality and I have not heard about it before.

3.Participating Audit / QIP / Research:

While you will rotate in different specialities ,you will get chance to be involved with different quality improvement project (QIP), audit and research activities. In order to do that, you have to be very pro active and have to show that you are highly interested in those activities. Never ever fear that you have not done these things before. I have completed my very first audit on my own and presented it in my hospital but I had no idea about these things before starting it. You have to take your own initiative and then ask help from seniors and consultants.


As a trust grade doctor, you will get an e-portfolio free from your trust (Horus portfolio). You will also get education and clinical supervisor to get advice and to discuss about your career plan. Most of the consultants are very helpful and kind to guide juniors. You have to do your GMC appraisal with your supervisor and also discuss about your progression in developing a good portfolio. However, if you want to apply for IMT, it’s better to buy NHS portfolio from the beginning and to enrich it by adding more clinical activities.

5.Study budget and Study leave:

Certain amount of study budget is allocated for trust grade doctors but the amount varies trust to trust. You can utilise it to buy your NHS portfolio, for ALS and to do other courses. You will also get certain days study leave and you can take those leaves for doing courses and taking preparation for exams.


1.If no rotation :

In some trusts, they don’t allow trust grade in all specialities and you may need to stay in one particular department during your whole contract period. It is also beneficial if you are particularly interested in that speciality but if you want to get knowledge about other specialities, you may have to raise it to your supervisors and rota coordinator.

However, you have always chance to apply for jobs somewhere else if you don’t get you preferred speciality and comfort.

2.No fixed study or teaching time / Clinic time:

Usually in almost all trusts, there is no fixed study or teaching time for trust grade doctors. Therefore ,you won’t get any specific learning hours in your working days. So you have to manage your study time after your duty time to add learning hours in your portfolio and if you want to take preparation for post-graduation exams.

There are lots of clinic in NHS but no clinic is allocated for trust grade SHOs.

Attending clinic helps to enhance knowledge and experience but you can not attend their as a trust grade as per your rota.

Nevertheless, by showing your interest and enthusiasm ,you can kindly ask to attend IMTs teaching and clinics after managing your word jobs.

3.Work load:

NHS is in shortage of staffs in all trusts and trust grade doctors need to handle more ward jobs as trainees go for their allocated teaching and clinics.

As a result, sometimes they cannot leave ward on time which may impact their work-life balance. Still, this is also manageable with time and working experience.

Above all, after PLAB 2, we start with non-training job (trust grade) in NHS, so in the beginning, everything would be more stressful and difficult but, with time being, experience and positive attitude we all can adjust with the system and can progress ourselves.

How TrewLink can help

If you have any questions about building your portfolio, I would be happy to answer them at Find me as an expert and follow my profile – Nowrin Jahan Arvy - to receive regular support and advice.

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