NHS Scotland Medical Workforce Centre

1. Every Health Board must have a named IMG Lead Consultant, senior SAS doctor or GP to oversee the induction and ongoing support of IMGs (sitting on the Scottish Regions’ IMG Support Network Group). 

2. Health Boards/Hospitals/Primary care settings must develop reliable processes for identifying newly starting IMGs, both in training and locally employed doctor (LED) posts, ideally at least 6 weeks ahead of their start date. 

For resident doctors in training posts

NES should send details of incoming IMGs (ideally highlighting those without prior NHS experience) to their Training Programme Director, the Director of Medical Education in the Health Board in which they are starting. These must be shared with the named IMG Lead for that Health Board. This information should then be forwarded to the Service Lead and Rota Co-ordinator in the department in which they are starting – ideally at least 6 weeks before their start date, with the following requirements.

For LEDs

Health Boards/Hospitals’ HR departments will play a vital role in ensuring the IMG Lead, Service Lead and Rota Co-ordinator in the department in which they are starting are aware there are incoming IMGs with the following requirements.

3. Every new-start IMG must be allocated a named supervisor, trained in supporting IMG needs – ideally from the service/department in which they are working. 

4. Departments must ensure each new-start IMG has protected time to attend IMG-specific induction sessions (local + NES’) as well as standard induction. 

5. Departmental Rota Co-ordinators must not allocate new-start IMGs to solo out-of-hours/on-call rota work during their first 4 weeks to allow for assessment that they have sufficient knowledge of the systems and processes required for them to carry out their duties safely. 

As described in the 'Softer Landing, Safer Care' document, this should be achieved with: 

• A period of shadowing/supernumerary work - likely minimum of 2 weeks (the Softer Landing period).
• Provision of additional support - identified by their supervisor, using the needs assessment framework outlined in the 'Softer Landing, Safer Care' document.
• Explicit agreement between the newly starting IMG and their supervisor that they are capable/feel sufficiently prepared, before being allocated solo out-of-hours/on-call rota work (departments should consider developing their own “rota-readiness” framework/checklist to support this process). 

Note IMGs in GPST posts undertaking their first hospital attachment have been identified as a group that might need closer supervision/support, as have IMGs starting in higher specialty training posts in Medicine in particular (high-demand, high expectation roles that require a deep understanding of local systems/processes).

6. NES and local Directorates of Medical Education must ensure IMG supervisors are adequately trained and supported in their role.

• Promoting inter-cultural competence/cultural humility, raising awareness of the specific needs of IMGs – recommended workshops for IMG Supervisors are run by NES and GMC.
• Promoting attendance at the NES-run Welcoming IMGs New to Scotland (WINS) day, alongside their newly starting IMG.
• Disseminating of the IMG Supervisors’ Guide (developed for SING).
• Training in / standardisation of assessment for the CREST route (for locally employed IMGs), including promotion of the TURAS Professional Portfolio.
• Signposting to additional resources – e.g. NES IMG webpages, NES Facebook group, NES Active Bystander training, Scottish IMG Buddy Scheme, GMC ‘Good Conversations, Fairer Feedback’ workshop. 

7. Continuous improvement through feedback from: 

New-start IMGs

• Those who attend sessions / access resources (immediate + delayed – “what did we not include that we should have?”).
• Those who felt they did not need to attend (“in hindsight, what do you wish you had known when you started?”).
• Those who wanted to attend but did not make it (“what were the barriers to attending?”). 

 Supervisors

• What additional support would they have needed, what went well, what didn't, etc.
• + sharing of learning nationally (via SING).