Some of the best medical students when I was at university were overseas students. They were mainly from China and Malaysia but also from the Middle East, Europe and Africa. These were individuals who had worked harder than me to win their place at med school. No doubt they have all have become good doctors.

Some of them have stayed in the UK, but plenty have returned to their home countries. One or two have found attractive opportunities in the Gulf, Australia and the US. Every one of them that I personally know are doing very well in their careers. A UK MBChB degree goes a long way almost anywhere in the world.

If you’re an overseas student, the chances are that you’ll be a great asset to any UK medical school. Overseas students offer a reliable bank of good exam results and almost never drop out.

So it isn’t surprising that medical schools like overseas students, and would prefer to fill their classes with as many as possible.

As an overseas student you are also likely to pay much more in tuition fees than a home student and this is a further reason why medical schools might be fighting for you to accept a place. You may be aware that universities have a quota to fill with overseas students.

However, as an individual student it may not feel that you are in such demand. In fact it will probably feel like an uphill struggle. More recently there has been increasing interest by overseas candidates and competition for places has increased.

Compared to UK students, overseas students are given very limited guidance about the application process and have poorer interview and presentation skills.

In addition they are competing with ever increasing numbers of students from a vast number of countries, many of whom are good candidates.

Here are the top reasons why you might get rejected as an overseas applicant and what you can do about them.

1. Poor English
Even with the best background education in English, the demands of writing a perfect personal statement or the pressure of performing under interview can make you suddenly look like a complete tourist.
The only solution is to practice speaking under pressure. That means mock interviews wth someone who is prepared to criticise every grammatical and pronounciation error.

2. Poor knowledge about medical training in the UK
I remember interviewing a young girl from Zimbabwe who was an excellent candididate in almost all regards but the panel (including me) reluctantly rejected her. The reason? She lacked awareness about postgraduate exams for GP training and didn’t know about the length of training. The relevant information is widely available. Make sure you’re familiar with it.

3. Sartorial incongruity (!)
Candidates from mainland China are often guilty of this but so are plenty of others. It’s not your fault. You wear the standard formal wear of your city or country which is probably a suit of some description. However one small error in colour, cut or style can make you look like an incongruous loser, or worse still, like you’re using the interview to make some sort of fashion statement.
My advice? Dress like the people you are going to impress, not like they do in the country you’re leaving. Look like you fit in and they are more likely to believe you.
Read the upcoming article on how to dress and be very, very careful.

4. Style failure in your personal statement
I’ve read some personal statements from brilliant students who have lost everything because they couldn’t get the style right. Medical schools expect too much and are not forgiving because they have so many good candidates to choose from. Make sure you read through examples of winning statements and compare yours to see if you have the tone and style right.
One more point here. Are you doing medicine for ‘job security’? Do not put this on your statement! It is commonly seen and seldom liked. See the articles on how to articulate this.
Get someone else to read your statement for you too. Do not rely on your own judgement. Email me for guidance if you really are struggling to find help.

5. Too few places!
The truth is that we receive huge numbers of applicants from overseas. Way more than we can possibly accomodate. Some excellent candidates are therefore rejected where they would possibly have been offered a place had they been a home student.
This is good news for home students of course, but the quotas for overseas students will undoubtedly increase in future years due to funding problems in the higher education sector as a whole. There are big changes just around the corner.

Finally, as an overseas student you probably have many medical schools, possibly in different countries as options.

Remember, if you’re called for an interview, make sure you tell the panel how much you want to study at their medical school. Better yet, if you can tell them you know someone that studied here and liked the course, or you have some connection with the city or some other specific reference point you can add some authenticity to your story and perhaps get some sympathy from the panel.

Interviewer: So, what would you say was your greatest weakness?

Interviewee: I think I interview very badly and fail to convince people of how good I really am.

That’s a real example that resulted in a rejection despite an otherwise reasonable interview performance.

It’s a tricky question to have fired at you in many ways. Firstly, it doesn’t crop up in every interview so it’s often a surprise and hence poorly prepared for by those who try to ‘pre-script’ their answers.

Secondly it can be tricky to come up with an answer that gives the interviewer what they’re looking for without sounding false or harming your chances.

Why would they ask such a useless question?

From my own experiences, 95% of answers to this question are non-replies that tell you nothing about the candidate.
The remaining 5% will say something very honest but badly thought out such that it may well raise serious doubts about their suitability for medicine.

International applicants with English as a second or third language often fall short here because, well, they’re often just too honest and fail to spin the weakness into a more complete answer.

However, there are ways of using this question to your advantage and delivering an answer that makes you stand out above the other bores the panel have had to put up with.

Remember though, that there is no consensus on what a good answer to this question is, despite what is being taught lately.

More and more candidates come out with those stock answers telling us on the panel that they’ve all been to one of the generic medical application courses that seem to be a rite of passage these days.

When thinking about how to answer this question, remember that your weakness has to be:

A. Legitimate
B. Doesn’t rule out a medical career

To start with there are too basic approaches one can use.

1. Tell them you’re too much of a hardworker, or a perfectionist, just too nice, or take your work too seriously. In other words try and convince them your weakness is simply a strength that needs to be tamed. (It’s surprising how many 17 year olds can deliver this answer without any sense of irony.)

2. Give a genuine weakness such as, meeting deadlines or public speaking and then talk about how you’ve recognised this weakness and worked to improve it.

Both of these approaches can work if you know what you’re doing. If you get them wrong you can alienate your interviewer or worse still reveal that you are totally unsuited to training for clinical medicine.

With option number 1, if I were interviewing you and you simply said, ‘I work too hard’ I would take that as an invitation to probe further. I have heard of interviewers suggesting that you give another weakness rather than a fake one so be careful.

However, if you’re good at wording things carefully under pressure, you could say that being too much of a perfectionist is common amongst students applying for competitive areas such as medicine and has advantages but you’ve recognised that there is a downside.

For example not meeting deadlines or losing sight of the bigger picture. Furthermore you are aware that in medicine, whilst there is no room for error, one must always keep the whole picture (or patient) in mind whilst focusing on the detail. One cannot really be a perfectionist in the true sense because one is always faced with the psychosocial complexities in any clinical situation and the need to tailor treatment to the whole patient. Perhaps follow this up with an example from your work experience. This is always a good route away from your weaknesses and onto more comfortable ground.

With option number 2 the bulk of your answer will be taken up with examples of how you’ve been working on your weakness. You can work backwards here and try to engineer a ‘weakness’ answer that relates to courses or classes you’ve been taking or some voluntary work you’re doing.

There are some examples below but first some real life examples of what NOT to say:

As nice as they may seem your interviewers will be looking for a good reason to reject your application. Don’t drop your guard and let them kill off your chances of becoming a doctor.

- I expect too much of others (bad attitude, too self regarding)

- I am disorganised (will fail A2 or degree or preclinical course)

- I have chronic fatigue syndrome (or other unsuitable pathology)

- I’m very shy (usually a genuine answer but doesn’t give any room for discussion and might indicate unsuitability to some)

- Chemistry and biology (why?)

Two good examples to work from

“…I realised that I had very little contact with very elderly or mentally ill patients and found communicating with them a challenge during my work experience on the medical ward. Of course this is an integral skill for any doctor and I felt it was an area I needed to work upon. I decided to volunteer at Sunbrookes nursing home once a week and have been doing so for the last year. I have learned alot from the nursing staff and patients as well as their families. I have realised that communication is challenging in some situations and although my confidence and ability have increased significantly I’m aware there is still alot to learn…”

“…So I would say my main weakness is really being too detail orientated at times and perhaps losing sight of the bigger picture. I didn’t pick up on the disadvantages of this trait in a clinical medicine environment until my week at the facial reconstruction unit. My work experience actually opened my eyes to the fact that doctors must often focus away from their area of expertise in order to best treat the whole patient. The plastic surgeon I was shadowing was considering a patient for ear reconstruction. She had suffered a canine attack that had left her with severe physical as well as mental scarring. Although he was convinced he could get an excellent cosmetic result and was keen to add her to his list, he realised that she may not benefit from the surgery until her post-traumatic psychological pathology was treated first. Referral to a psychiatrist was therefore made and surgery was delayed. The surgeon and I had a chat afterwards about the importance of looking at the whole patient and not getting too consumed with the detail of one specific problem, whatever ones speciality…”

Your work experience will certainly have shown you aspects of medical practice that you can tailor into a ‘my main weakness’ answer.

Practice making one up on the spot under the pressure of a mock interview. If you can do that well you can be sure you’ll be fine in other areas of the interview too.

And whatever you do, please don’t become the easy rejection of the morning.

Can I make it in my chosen specialty in the UK with an overseas degree? Doesn’t the NHS just look after its own?

This is a common question i’m getting asked lately. It seems to originate from two groups of people.

There are those that are are already at, or about to start at an overseas medical school and are worried that moving to the UK might not afford them the same career opportunities as it does for local UK graduates.

A second group of individuals are worried that they may not make the cut for medicine this year and are thinking about taking up an expensive place at an overseas medical school. Commonly this might be in the Czech Republic, Romania, the West Indies but also elsewhere.

Let me start by saying something a little controversial.

The NHS has historically discriminated against foreign medical graduates whenever it has found itself in a comfortable enough position to do so.

This situation does not commonly arise and certainly woud be unlikely to apply to all areas.

So to a large extent it depends on what you want to do and the current job situation within the NHS.

To explain this, let me give you a bit of useful background that you should already be aware of.

In the 1960s plenty of consultant and GP posts were taken up by foreign graduates who had been encouraged to the UK and had also done most of their postgraduate training overseas. The UK was desperate for doctors due to a major shortage and there were plenty of them arriving from Indian and Pakistan. These were deemed to be of exemplary quality by none other than Enoch Powell who lead the call for overseas recruitment.

Why?

Well you see, the UK repeatedly gets its medical workforce planning terribly wrong due to perennial political interference. The shortage of the 1960′s happened because of a planned cut in medical school places by the Willink Committee of 1957 along with vast numbers of British doctors emigrating to find better conditions in the US and elsewhere.

By the 1990s however, graduates from India and Pakistan as well as other less well off countries suddenly found it much more difficult to climb the career ladder and find suitable specialist posts.

There were accusations of discrimination from well qualified foreign specialists who found themselves stuck in staff grade posts with no clear route to consultant jobs which often seemed suspiciously reserved for British graduates.

Clearly there were more local graduates in the pool now and the NHS could now afford to pick and flick accordingly.

By 2005 disillusioned foreign doctors in some specialities were already leaving after realising that the path ahead was pretty well blocked for them in the UK. Even UK graduates found that competition in some specialities, particularly surgery had stiffened with tens of applicants per post. Many left for Australia and many abandoned their hopes of ever getting ahead in their first choice specialities.

Of course those who set their goals elsewhere may not have noticed the change and in the world of pathology and psychiatry there was an ongoing recruitment drive that also helped mop up the fall out from more competitive areas.

That’s a long winded way of saying that you can’t trust the system to always help you out paticularly if you’re aiming for something competitive or lucrative in the long run.

For example, who knows whether dermatology will be as competitive as it is today in five or ten years time when you are finally applying for specialist posts. If it is, you may find that a foreign degree is indeed a disadvantage and you will need to show a more bejewelled CV to muscle past the local favorites.

However most applicants to medical school are just happy to get a place and to have a shot at becoming a doctor at the end of the process. If the speciality and the region in which you end up are not critical you probably* should not be worried.

How to ignore the above and rise above the competition
My final advice to anyone with an overseas medical school education and a firm desire to work in a competitive area in the UK would be to start sorting your CV out early.

If you have two original papers in the BMJ and a review article published in the lead speciality journal for your intended area of interest, you stand an excellent chance of getting through. Those are difficult things to get done and will take months and years to accomplish. Consequently they carry great weight and will eat up the competition. The majority of UK graduates at present leave medical school with a CV that may as well be blank when it comes to postgraduate competitiveness.

So, decide what you want to do early, and make contacts in the relevant fields. They will give you research ideas and guidance.

On the other hand if you’re sure you’d be happy as a salaried GP in a small town far away from London, relax, enjoy the sun (yes, SGU Carribean) and work on your golf swing.

And don’t fail finals.

*Unless a policy maker somewhere really screws it up. This is common.