FAQs about the MTI (for Trusts)

Frequently Asked Questions for Trusts about the Medical Training Initiative (MTI) scheme

MTI posts and requirements

You may have unfilled training posts in your department and want to utilise these to train International Medical Graduates (IMG) for a maximum of 2 years so that they can take the skills gained within your Trust back home. This is also a good way to diversify your department’s trainees and forge relationships with doctors overseas, once they return to their home country.

You can apply for as many posts as you identify in your department as long as the total number of MTI posts in your department do not exceed 30% of the rota. Please be aware that you will not need to submit an application for each post. If you have more than one post for the same job description, you will only need to submit one application for all the posts.

The main difference is their background and experience. MTI doctors have not previous experience in the UK and therefore may need extra support to adapt to the NHS and the UK. However, both groups are undertaking a training post and MTI doctors and their UK doctors counterparts at the same should enjoy the same benefits and educational opportunities (including annual leave, study leave and salary). Another key difference is that UK trainee salaries will be paid through HEE whilst MTI doctors salaries will be paid by the Trust.

If you are going to apply for the RCoA to consider your application, the posts must in Anaesthesia, Intensive Care Medicine and/or Pain Medicine. If you are interested in setting up an MTI placement for another specialty, you should contact the relevant College. Details of the UK medical royal colleges with MTI schemes can be found on the Academy of Medical Royal College’s website

MTI posts can be at any level of the training programme. When making an application for post approval, you should consider what the training capacity and opportunities exist within your department and use this to design the job description and person specification.

This must be in line with the job they are undertaking. MTI doctors should receive the same remuneration as their UK counterparts.

MTI doctors should enjoy the same amount of annual leave and study leave days (minimum 10 days) as UK trainees. Please bear in mind however that the study leave budget would come from your Trust.

Obtaining MTI post approval from the College

Please complete the MTI Post Application Form and submit it to the College along with a copy of the job description (this must include a) total number of trainee doctors in the department b) the study leave allowance - number of days/year and the budget allocated c) If Relocation package is offered- how much? d) salary).

The College will endeavour to inform you of the outcome of your application within 4 weeks of receiving it.

To be able appoint MTI doctors, the post you are offering must have been approved by the College. However, you may interview candidates whilst waiting to receive the outcome of your post application providing that you inform the candidate that their appointment is dependent on the post receiving approval from the College.

Approval of MTI posts last for 24 months, that means that from the day you receive the approval letter from the College you have 24 months to name and inform the College of doctors that will take the approved posts. It does not mean that doctors must start as soon as approval is granted. Once the post has expired, if you want to continue to appoint doctors for MTI, you will need to re-apply to have the posts approved.

Once your MTI posts have expired you will need to re-apply to have the posts re-approved. Please contact global@rcoa.ac.uk where will advise in what paperwork will be required. 

Please contact global@rcoa.ac.uk where will advise in what paperwork will be required. 

Recruiting and appointing MTI doctors

Once your posts have been approved for MTI you can advertise the posts or ask the College for CVs from potential candidates. We have a bank of CVs from doctors who want to secure an MTI post through our matching scheme.

No, we carry out an initial scan of CVs received by candidates to ensure that they meet the minimum eligibility criteria, (including that they are in possession of the required English test), but this does not mean that the doctors are ready to start. Successful candidates will need to go through the MTI application process.

  • You will be responsible for scrutinising MTI candidates and interview them. Please ensure that you are familiar with the eligibility criteria for the scheme
  • Please read our Interview guidelines available here
  • Inform us of successful candidates so that we can initiate the application process-Please quote your post reference number (which will be provided to you in the post approval letter) when you do that
  • Medical staffing at your hospital will need to complete the Academy of Medical Royal College’s (AoMRC) MTI Application Form

From beginning to end the process can take between 3 and 6 months.

Trust MTI Fee

Yes, as of 1 July 2023 Trusts will need to pay a placement fee of 1,380 per appointed candidate.

Upon selecting a candidate for an approved MTI post, they should be given confirmation of the offer of employment including the salary. We will then need you to contact us and provide their contact details, CV and offer of employment letter.  At that stage, we will carry out an initial check of the doctor’s eligibility for the scheme, and if deemed eligible, revert back to you to request that the payment of £1,380 be made. To make the payment you will need to send a purchase order to finance@rcoa.ac.uk . Our Finance department will then raise an invoice for £1,380. We will be unable to progress with the doctor’s application until confirmation of payment has been received by our Finance department.  

If for any reason the MTI doctor withdraws their application, we will offer a refund to you, or use the payment to cover a replacement doctor, depending on what you would prefer.

Supporting MTI doctors during their placement

MTI doctors may need extra support to adapt to the new country and new healthcare system. Some may struggle at first with settling in, particularly because of the cultural differences and communicating with their colleagues and patients (and understanding the local accent) may be difficult for them. The RCoA strongly recommends that the following steps be taken to support new MTI doctors:

  • Organise a comprehensive induction
  • Inform the relevant trust staff that the MTI doctor is new to the NHS and therefore they may ask a lot of questions and will require their colleagues to be patient and speak slowly and clearly
  • Identify a colleague who is happy to be a ‘mentor’ to the trainee
  • Arrange a sufficient period of shadowing
  • Provide essential information often taken for granted such as the NHS and trust management structure
  • Arrange separate IT training sessions
  • Ensure that study leave number of days and funding is equivalent of UK anaesthetists in training
  • Release the MTI doctors from the trust when requested so that they can attend the New to the NHS Meeting held at the College


No, MTI doctors must be supervised and must be assigned an Educational Supervisor who must meet them regularly to provide advice, set objectives and review progress against objectives. They will also complete their assessments.

You will be required to submit a 6-monthly report to the RCoA for each doctors. Failure to do that will result in not having more posts approved for MTI.

While we insist that, in most instances, MTI doctors should be treated the same as their UK anaesthetists in training counterparts, we would be concerned if MTI doctors are asked to cover acute areas in other specialties due to the following

  • Unlike their UK counterparts (UK trainees have a 7-year programme and will have completed a 2-year foundation programme in which they will have been exposed to other acute specialities in the UK), MTI doctors would not have the generic experience of working in UK hospitals in different specialties as they come from different training backgrounds.
  • MTI doctors are in the UK for a very limited time with specific training objectives. For them to be diverted to other acute specialities would dilute the training in anaesthesia/ICM and pain medicine they have come here for.
  • The concept of winter pressures implies reduced staffing in areas such as Emergency Departments and Acute Medical Units. MTI doctors should not work in these areas unless they are fully trained to do so, have had a proper induction and an on-site clinical supervisor. These preconditions are highly unlikely to be met where there are staffing shortages.

Therefore, and given the concerns outlined above, our view is that MTI doctors should in most cases not be asked to cover areas in other specialties. However, if the individual doctor and the education supervisor agree that the post is educationally valuable and training is being maintained, the doctor would be able to undertake other duties.

It is dependent upon the individual ability. The RCoA’s IAC should be used as a framework to measure competence (MTI doctors normally take 6 weeks to receive their IAC). Putting an MTI doctor on on-call will also need the endorsement of the educational supervisor.

Yes, we have an MTI Leadership Group made up of experienced consultants who would be able to provide advice. Please contact them through the Global Partnerships team.

This would depend on the nature of the issue. We would advise that the performance issues are discussed with the MTI doctor in the first instance, and when possible, mechanisms are put in place to support doctors in difficulty. If following these, no improvement has occurred, and deemed necessary, you should speak to your HR department so that they can apply the HR procedures relevant for each case. If you think that your MTI doctor could put in risk a patient, the doctor should not be allowed to practise until the issue is resolved. Remember to keep the RCoA posted on the issues, as our MTI leadership Group may be able to provide you with further advice.

Extending visas for MTI doctors

Complete the Application for a visa extension and return it to the AoMRC (and inform the Global Partnerships team at the RCoA)

No, MTI doctors can be in post for a maximum of 24 months and Tier 5 visas cannot be extended beyond that. The expectation is that on completing their MTI placement, MTI doctors return to their home country to put in practice the skills gained in the NHS.

Appointing MTI doctors from another Trust and paperwork and support for MTI doctors completing their placement

Please complete the Transfer form and send it to the AoMRC (and inform the RCoA).

You will need to let the AoMRC know by completing the End of Placement form. Please also keep the RCoA informed. You will also need to ensure that all the six-monthly reports to cover the entirety of the doctor's placement have been sent to the RCoA so that we can issue them with a Certificate of Completion of MTI.