The advice zone

Got a career or university related problem that needs answering? Can't find the right person to point you in the right direction? Log on to the Advice Zone at www.bmjcareers.com/advicezone to post a question or to see if one of our experts has already solved your problem

As an overseas doctor, how can I show competence in English?

You must show competence in English by getting a satisfactory score in the International English Language Testing System (IELTS). The IELTS test consists of four sections--reading, writing, listening, and speaking, and candidates must achieve minimum scores for each section as well as a minimum overall score.

Jo Constable, Research and information officer, BMA

Because preregistration house officers have provisional registration, can they do locum jobs during their free time?

No rules or laws state that a preregistration house officer cannot do locum jobs. Obviously, you can only locum as a pre-registration house officer, but some agencies prefer it if you have a few months' experience. I do not see any reason why you should not start locum jobs immediately, even if you are a newly employed preregistration house officer, as the work and level of responsibility will surely be the same for a locum as for a substantive member of staff.

If you are already employed, I would advise doing extra on-call shifts at your own hospital for their bank or in-house agency, if they have one, as you will know the senior house officers and specialist registrars that you will be working with and they will know you. This is something I did myself as a junior house officer, and I felt more protected doing this than I would have if I were working for an agency in a strange hospital.

You have to beware of the European Working Times Directive, however; you may only work so many hours in a week and hours worked as a locum count towards this. If you are already working the maximum number of hours allowed by law, therefore, you will be breaking the law by working any more. This does not preclude you from working during your annual leave of course.

Adam Mark Harrison, SHO trauma and orthopaedic surgery, Queen's Medical Centre, Nottingham

Who is eligible for flexible training?

Flexible training is accessible to doctors in training who have a good reason for being unable to work full time. In practice, most flexible trainees are women and men who wish to look after their young children for part of the week, and a small number look after other family members. People who have physical or mental health problems who would like to continue their training but are unable to do so full time are also eligible. These are considered as category 1, or priority applicants.

Category 2 covers a variety of other reasons for wishing to work part time, including religious activities, voluntary work, arts degrees, high level competitive sports, and second careers, such as writing or music.

In most deaneries, category 1 applicants are automatically considered eligible, and acceptance as a flexible trainee will then depend purely on the availability of funds. If funds are short, the deanery may operate a waiting list, whereby a trainee can become flexible when another person leaves the scheme. There is wide variation in terms of category 2 applicants, again usually dependent on the availability of funds.

Anita Houghton, Careers counsellor and coach, London

I am interested in working in South Africa, preferably Cape Town, after completing my preregistration house officer year in August 2005. Could you offer some basic advice as to how to go about organising this?

I assume you want to spend only six months or a year in South Africa. If you are thinking of emigrating, the advice below may not be entirely appropriate.

Firstly, you must do your preregistration house officer year and get registered. Have a chat with seniors and consultants about your plans. Can you get a job arranged to come back to in a year? (It will make your life a lot easier and relaxed in South Africa.)

South Africa is not a common place for people to go to as senior house officers (in terms of training), though it is for voluntary work. You may be aware that some jobs in Australia and New Zealand can count towards membership exams. I do not know of any in South Africa, but you should ask the college of the pathway you hope to follow as they may have an agreement with a hospital there. It would be best if you could work there and get it to count.

Your next consideration is whether you want to work as a senior house officer to be trained (and to get paid) or as a volunteer. There are hundreds of hospitals (a long but not exhaustive list is available at www.medicstravel.co.uk/CountryHospitals/Africa/south_africa.htm). You will have to approach the teaching hospitals directly for paid work (and then have a chat with your college in the United Kingdom to see if they would allow a six month job to count--this must be done prospectively). If you want voluntary work, then just write to any of the smaller hospitals, especially in Kwazulu Natal and remote areas.

You may want to get in touch with their department of health and medical association for more information. Their addresses are Department of Health, Hallmark Building, Proes St, Pretoria 0002 (tel +27 12 312 0000); South African Medical and Dental Council, PO Box 205, Pretoria 0001 (tel +27 12 328 6680; fax 12 328 5120); South African Medical Association, PO Box 74789, Lynnwood Ridge 0040, Castle Walk Office Park, Block F, Nossob Street, Erasmuskloof Ext 3, Pretoria 0153 (tel +27 12 481 2000; fax 12 481 2100; www.samedical.org)

Mark Wilson, A&E/Plastics clinical fellow, Royal London Hospital

I am a medical student and interested in a career in Ophthalmology. How should I work towards my first Ophthalmology job?

As soon as you realise you are serious about eyes you should show you are interested. Approach your local academic department and make an appointment to discuss career opportunities with one of the Ophthalmologists involved with student teaching. Arrange to sit in some extra clinics to get a bit more experience of Ophthalmology and to demonstrate your commitment.

Many medical schools now give medical students the opportunity to undertake a special module towards the end of their training. A bit of extra "voluntary" time doing ophthalmology will look very good on your CV and will also endear you to your local eye department.

During your pre-registration house jobs try and maintain communication with the eye department in your medical school. If you are working in a district general hospital make contact with your local eye department and go and see one of the Consultants there. Once more arrange to sit in on a few clinic sessions or volunteer to undertake some research or audit. Not only will this get your name and face recognised but it will also improve your clinical skills and give you a good foundation of basic knowledge. Express an interest in their next Ophthalmology SHO job and ask them what it would take for you to get it.

Work hard and try and get your Part I MRCOphth as quickly as possible. You may do other jobs before you begin your Ophthalmology or go straight into eyes (see next question). Keep on going and stay focussed on your final goal of getting your first job in Ophthalmology. Best of luck.

Amar Alwitry, specialist registrar in opthalmology, Queen's Medical Centre, Nottingham